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A patient with schizophrenia who admits to auditory hallucinations anxiously tells the nurse, 'The voice is telling me to do things.' Which of the following responses should the nurse make next?
- A. Do you recognize the voice you hear?'
- B. How long has this been happening?'
- C. Does what the voice tells you to do frighten you?'
- D. What is the voice telling you to do?'
Correct Answer: D
Rationale: The correct answer is D: "What is the voice telling you to do?" This response helps the nurse assess the content and potential danger of the hallucinations, guiding further interventions. Option A focuses on recognition, which is less urgent. Option B addresses duration, not immediate safety. Option C inquires about fear but does not directly address the hallucination's content. By asking what the voice commands, the nurse gains crucial insight for risk assessment and safety planning.
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A researcher seeking an organic basis for schizophrenia would be well-advised to investigate the role of
- A. amphetamines and amphetamine receptors
- B. adrenaline and noradrenaline
- C. histamine and antihistamine
- D. dopamine and dopamine receptors
Correct Answer: D
Rationale: Dopamine dysregulation, particularly via receptors, is a primary organic focus in schizophrenia research.
A patient being treated for major depression is the CEO of her own business. She has shown significant improvement and is about to be discharged after completing a course of 15 electroconvulsive therapy sessions. She will continue on SSRI medications. The patient has been counseled not to make a major business decision for a month. The rationale for this is that:
- A. SSRIs may cause confusion in susceptible persons.
- B. ECT often causes temporary memory impairment.
- C. Lingering depression makes the patient incompetent.
- D. The patient needs months to readjust to work pressures.
Correct Answer: B
Rationale: The correct answer is B: ECT often causes temporary memory impairment. This is because electroconvulsive therapy (ECT) is known to have side effects, including temporary memory loss and confusion. As the patient has just completed a course of 15 ECT sessions, it is important to allow time for the effects of ECT to subside before making major decisions, especially in a high-pressure role like being a CEO. Choices A and C are incorrect as SSRIs do not typically cause confusion and lingering depression alone does not necessarily make a patient incompetent. Choice D is incorrect as there is no indication that the patient needs months to readjust to work pressures; the primary concern here is the potential memory impairment from ECT.
A nurse assesses four patients between the ages of 70 and 80. Which patient has the highest risk for alcohol abuse? The patient who:
- A. consumes 1 glass of wine nightly with dinner
- B. began drinking alcohol daily after retirement and says, 'A few drinks keep my mind off my arthritis.'
- C. drank socially throughout adult life and continues this pattern, saying 'Ive earned the right to do as I please.'
- D. abused alcohol between the ages of 25 and 40 but now abstains and occasionally attends Alcoholics Anonymous (AA)
Correct Answer: B
Rationale: Alcohol abuse and dependence can develop at any age, and the geriatric population is particularly at risk. Losses, such as retirement, widowhood, and loneliness, are often related. The distracters describe patients with a lower risk for alcohol abuse.
Which goal has priority for a patient with anorexia nervosa undergoing nutritional stabilization?
- A. Schedules meals appropriately
- B. Eats 100% of each meal served
- C. Selects food items from a menu
- D. Prepares food under supervision
Correct Answer: B
Rationale: The correct answer is B because ensuring the patient eats 100% of each meal served is crucial for nutritional rehabilitation in anorexia nervosa. This goal helps the patient meet their caloric needs and address malnutrition. It is essential to monitor and support the patient in consuming all the food provided to promote weight restoration and overall health. The other options are less critical: A focuses on timing rather than full intake, C involves choice rather than completion, and D emphasizes supervision but not necessarily full consumption.
The family of a patient with schizophrenia who has been stable for a year reports to the community mental health nurse that the patient reports feeling tense and having difficulty concentrating. He sleeps only 3 to 4 hours nightly and has begun to talk about creatures called 'volmers' hiding in the warehouse where he works and undoing his work each night. This information most likely suggests:
- A. medication nonadherence.
- B. a need for psychoeducation.
- C. the chronic nature of his illness.
- D. relapse of his schizophrenia.
Correct Answer: D
Rationale: The correct answer is D: relapse of his schizophrenia. The patient's symptoms of feeling tense, difficulty concentrating, poor sleep, and delusional beliefs about creatures at work indicate a worsening of his psychotic symptoms. This suggests a relapse of schizophrenia, a chronic mental illness characterized by periods of stability and exacerbation of symptoms. The patient's previous stability for a year makes medication nonadherence less likely. While psychoeducation may be beneficial, the patient's current symptoms require more immediate intervention for relapse management. The information provided does not directly indicate the chronic nature of his illness, but rather an acute exacerbation. Therefore, D is the most appropriate choice based on the presented symptoms and clinical understanding of schizophrenia.