Age Specific Considerations in Patient Care

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A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, 'They're all plotting to destroy me. Isn't that true?' Which would be the most appropriate response?

  • A. No, that is not true. People here are trying to help you if you will let them.'
  • B. Let's think about it: what reason would people have to want to destroy you?'
  • C. Thinking that people want to destroy you must be very frightening.'
  • D. That doesn't make sense; staff are health care workers, not murderers.'
Correct Answer: C

Rationale: The correct answer is C: Thinking that people want to destroy you must be very frightening.
Rationale:
1. Acknowledges the patient's feelings: By stating that thinking people want to destroy him is frightening, the nurse shows empathy and validates his experience.
2. Validates the patient's emotions: This response does not directly agree or disagree but acknowledges the emotions behind the patient's statement.
3. Builds rapport: By showing understanding and empathy, the nurse can establish trust and rapport with the patient, leading to better communication and therapeutic relationship.

Summary of other options:
A: This response denies the patient's feelings and could potentially escalate the situation by invalidating his experiences.
B: This response may come off as confrontational and does not address the patient's underlying fears.
D: This response is dismissive and does not address the patient's emotional distress, potentially leading to further agitation.

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A person diagnosed with a serious mental illness (SMI) living in the community was punched, pushed to the ground, and robbed of 7 during the day on a public street. Which statements about violence and serious mental illness in general are accurate? Select one tha does not apply.

  • A. Persons with SMI are more likely to be violent
  • B. SMI persons experience higher rates of sexual assault and victimization than others
  • C. Impaired judgment and social skills can provoke hostile or assaultive behavior
  • D. Lower incomes force SMI persons to live in high-crime areas, increasing risk
Correct Answer: A

Rationale: Mentally ill persons are more likely to be victims of crime than perpetrators of criminal acts. They are often victims of criminal behavior, including sexual crimes, at a higher rate than others. When a mentally ill person commits a crime, it is usually nonviolent. Mental illnesses interfere with employment and are associated with poverty, limiting SMI persons to living in inexpensive areas that also tend to be higher-crime areas. SMI persons may inadvertently provoke others because of poor judgment or socially inappropriate behavior, or they may be victimized because they are perceived as passive, less likely to resist, and less likely to be believed as witnesses.

The nurse wants to enroll a patient with poor social skills in a training program for patients diagnosed with schizophrenia. Which description accurately describes social skills training?

  • A. Patients learn to improve their attention and concentration
  • B. Group leaders provide support without challenging patients to change
  • C. Complex interpersonal skills are taught by breaking them into simpler behaviors
  • D. Patients learn social skills by practicing them in a supported employment setting
Correct Answer: C

Rationale: In social skills training, complex interpersonal skills are taught by breaking them down into component behaviors that are covered in a stepwise fashion. Social skills training is not based in employment settings, although such skills can be addressed as part of supported employment services. The other distracters are less relevant to social skills training.

A severely withdrawn patient diagnosed with schizophrenia will spend time in the dayroom but will not speak to staff or to other patients. The most therapeutic nursing intervention in response to this behavior would be to:

  • A. seat the patient with a group of patients who are talking to each other.
  • B. ignore the silence and talk about superficial topics such as the weather.
  • C. point out that the patient makes others uncomfortable by refusing to speak.
  • D. plan time for staff members to sit with the patient even though the patient does not talk with them.
Correct Answer: D

Rationale: The correct answer is D because it focuses on building a therapeutic relationship with the patient without placing pressure on them to speak. By planning time for staff members to sit with the patient, even if the patient does not talk, it allows for nonverbal communication and presence to convey support and care. This approach respects the patient's boundaries and allows them to engage at their own pace, fostering trust and a sense of safety.

Choice A is incorrect as it may overwhelm the patient by placing them in a social situation they are not ready for. Choice B is incorrect as discussing superficial topics does not address the patient's underlying issues. Choice C is incorrect as it may make the patient feel judged or pressured to speak, further isolating them.

A patient with acute mania approaches the nurse, waves a newspaper, and says, "I want the phone right now. I need to call this store while their sale is going on. I need ten dresses and four pairs of shoes." Select the nurse's best intervention.

  • A. Suggest the patient ask a friend do the shopping and bring purchases to the unit.
  • B. Invite the patient to sit with the nurse and look at new fashion magazines.
  • C. Tell the patient phone use is not allowed until self-control is improved.
  • D. Ask whether the patient has enough money to pay for the purchases.
Correct Answer: C

Rationale: The correct answer is C because the patient's behavior is impulsive and reflects poor judgment, which are common symptoms of acute mania. By telling the patient that phone use is not allowed until self-control is improved, the nurse is setting a boundary to prevent further impulsive actions. This intervention prioritizes safety and helps maintain a therapeutic environment.

A: This option does not address the immediate need to manage the patient's impulsive behavior and may put the friend in a potentially risky situation.
B: Inviting the patient to look at fashion magazines does not address the impulsivity and may even reinforce the behavior.
D: Asking about the patient's financial situation is not the most appropriate intervention at this time.

A group of teenagers are discussing their individual problems associated with having an eating disorder. Which findings would the nurse attribute to purging?

  • A. Excessive facial hair
  • B. Elevated blood pressure
  • C. Polyuria
  • D. Dental enamel erosion
Correct Answer: C

Rationale: Rationale for Correct Answer (C - Polyuria):
1. Purging involves self-induced vomiting or misuse of laxatives/diuretics.
2. Vomiting can lead to electrolyte imbalances, causing increased urine production (polyuria).
3. Polyuria is a common sign of purging behaviors due to electrolyte disturbances.

Summary of Incorrect Choices:
A: Excessive facial hair - Not directly related to purging behavior.
B: Elevated blood pressure - Could be related to stress or other factors, not specific to purging.
D: Dental enamel erosion - More likely associated with frequent vomiting (purging) rather than polyuria.

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