Nokea
A psychiatric technician asks the nurse to explain the difference between schizotypal personality disorder and schizophrenia. The information that should serve as the basis for the nurse's response is the fact that with schizotypal personality disorder:
- A. There is greater personality disorganization than in schizophrenia
- B. There may be misinterpretation of events but not psychosis
- C. The client will be sicker and require longer hospitalization
- D. The client will be more outgoing, actively seeking interactions with others
Correct Answer: B
Rationale: The correct answer is B: There may be misinterpretation of events but not psychosis. In schizotypal personality disorder, individuals may have odd beliefs, behaviors, and experiences, leading to misinterpretation of events, but they do not typically experience full-blown psychosis as seen in schizophrenia. This is a key distinction between the two disorders. Choice A is incorrect because schizophrenia is characterized by more severe disorganization of thoughts and behaviors. Choice C is incorrect as individuals with schizotypal personality disorder typically do not require long hospitalizations compared to those with schizophrenia. Choice D is incorrect as individuals with schizotypal personality disorder tend to be more socially isolated and have difficulty forming close relationships.
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What is the first intervention a nurse should take when assessing a patient with suspected anorexia nervosa?
- A. Begin refeeding to restore nutritional status.
- B. Measure vital signs to assess the extent of malnutrition.
- C. Start a counseling session to discuss the patient's thoughts on eating.
- D. Involve the family in discussions about treatment plans.
Correct Answer: B
Rationale: The correct answer is B. The first intervention a nurse should take when assessing a patient with suspected anorexia nervosa is to measure vital signs to assess the extent of malnutrition. This is crucial to determine the patient's current physiological status and to identify any immediate risks such as dehydration, electrolyte imbalances, or cardiac complications. By measuring vital signs, the nurse can quickly assess the severity of malnutrition and determine the urgency of intervention. Refeeding (choice A) should not be initiated abruptly due to the risk of refeeding syndrome. Starting a counseling session (choice C) may be important but is not the initial priority. Involving the family (choice D) can be beneficial but is not the first step in assessing and managing a patient with anorexia nervosa.
Multiple personality or dissociative identity disorder often begins
- A. as a result of combat exhaustion
- B. in adulthood as a response to unremitting phobias
- C. as a consequence of post-traumatic stress disorders
- D. in childhood as a result of unbearable experiences
Correct Answer: D
Rationale: Dissociative identity disorder typically originates in childhood from severe trauma, such as abuse, leading to identity fragmentation.
A client with a borderline personality disorder tells the nurse, 'My doctor tells me there's something wrong with the hard wiring of my brain, and that's why I'm so impulsive and get so many mood swings. He said he's going to prescribe some medication.' Being aware of current practice guidelines, the nurse will prepare a teaching plan for:
- A. Lithium
- B. Fluoxetine
- C. Lorazepam
- D. Haloperidol
Correct Answer: B
Rationale: The correct answer is B: Fluoxetine. Borderline personality disorder (BPD) is primarily treated with psychotherapy, but in some cases, medication is used to manage symptoms like impulsivity and mood swings. Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is commonly used to address mood instability and impulsivity in BPD. SSRIs help regulate serotonin levels in the brain, which can improve mood stability and decrease impulsive behaviors. Lithium (choice A) is used for bipolar disorder, not BPD. Lorazepam (choice C) is a benzodiazepine used for anxiety and not typically recommended for BPD. Haloperidol (choice D) is an antipsychotic used for conditions like schizophrenia and not typically indicated for BPD.
When a patient diagnosed with paranoid schizophrenia was discharged from the unit 6 months ago, the plan was for him to take chlorpromazine (Thorazine), a conventional (first generation) antipsychotic medication, 300 mg po daily. He tells the nurse he stopped taking his pills after a few months because they made him feel like a 'zombie.' What other common side effects should the nurse determine if the patient experienced?
- A. Sweating, nausea, and weight gain
- B. Sedation, tremor, and muscle stiffness
- C. Headache, watery eyes, and runny nose
- D. Mild fever, sore throat, and skin rash
Correct Answer: B
Rationale: The correct answer is B: Sedation, tremor, and muscle stiffness. These side effects are commonly associated with conventional antipsychotic medications like chlorpromazine. Sedation is a common side effect that can make the patient feel drowsy or sluggish. Tremors are involuntary muscle movements that can affect the hands, arms, or legs. Muscle stiffness can cause rigidity and difficulty moving smoothly. These side effects are known to impact the quality of life and may contribute to the patient feeling like a 'zombie.'
Choices A, C, and D are incorrect because they do not align with the common side effects of conventional antipsychotic medications. Sweating, nausea, and weight gain (Choice A) are not typical side effects of chlorpromazine. Headache, watery eyes, and runny nose (Choice C) are more commonly associated with allergies or cold symptoms rather than antipsychotic medications. Mild fever, sore throat, and skin rash (Choice D)
An 83-year-old man becomes lost while driving. He pulls into a driveway to turn around and cannot figure out how to put his car in reverse, so he drives into the yard, makes a circle, and drives back out of the driveway. He is stopped by police, who take him to the emergency department. The physician diagnoses him with Alzheimer's disease and refers him to the neurology clinic for follow-up. Given this diagnosis, which behaviors should the clinic nurse anticipate?
- A. Does not know today's date.
- B. Unable to shower without help.
- C. Denial of mental impairment.
- D. None of the above.
Correct Answer: A
Rationale: The correct answer is A: Does not know today's date. This behavior is commonly associated with Alzheimer's disease due to memory impairment. The inability to recall the current date is a key symptom of cognitive decline. In this case, the man's difficulty with reversing his car and getting lost are indicative of cognitive impairment.
Choice B, Unable to shower without help, is a functional impairment and not specific to Alzheimer's disease. Choice C, Denial of mental impairment, may occur in some individuals with Alzheimer's but is not a consistent behavior. Choice D, None of the above, is incorrect as memory deficits, such as not knowing the date, are commonly seen in Alzheimer's disease.