Age Specific Care Competency

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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 because it demonstrates empathy and validates the patient's feelings without agreeing with the delusion. By acknowledging the patient's fear, the nurse can establish trust and rapport, which are crucial in therapeutic communication. This response shows understanding and compassion, helping to de-escalate the situation and provide a supportive environment for the patient.

Choice A is incorrect as it denies the patient's belief and may lead to increased agitation. Choice B is incorrect as it challenges the patient's delusion, which can worsen the situation and lead to further confrontation. Choice D is incorrect as it dismisses the patient's feelings and may cause the patient to become defensive or feel misunderstood.

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In most anxiety disorders, the person's distress is

  • A. focused on a specific situation
  • B. related to ordinary life stresses
  • C. greatly out of proportion to the situation
  • D. based on a physical cause
Correct Answer: C

Rationale: Anxiety disorders feature exaggerated distress disproportionate to the trigger, unlike normal stress.

Which of the following may occur in Expressive Language Disorder?

  • A. Limited amount of speech
  • B. Difficulty learning new words
  • C. Difficulty finding the right word
  • D. All of the above
Correct Answer: D

Rationale: Expressive Language Disorder: A specific learning disability in which scores on tests of expressive language development are substantially below those for chronological age, intelligence, and educational level.

A newly admitted patient diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment. He states that he saw two doctors talking in the hall and knows they were plotting to kill him. When charting, how should the nurse identify this behavior?

  • A. Idea of reference
  • B. Delusion of infidelity
  • C. Auditory hallucination
  • D. Echolalia
Correct Answer: A

Rationale: The correct answer is A: Idea of reference. This term refers to the belief that neutral events are directed at oneself. In this case, the patient's interpretation of doctors talking as a plot against him signifies a misinterpretation of reality. Delusion of infidelity (B) involves belief in a partner's unfaithfulness, which is not applicable here. Auditory hallucination (C) involves hearing voices, not relevant to this scenario. Echolalia (D) is the repetition of words spoken by others, not demonstrated in the patient's behavior. Thus, A is the most appropriate identification for this behavior.

The nurse has been working with a patient diagnosed with schizophrenia who experiences auditory hallucinations. The patient relates, 'When I first heard the voices they said nice things about me. Lately, they've changed and they say bad things.' What information has the least impact on therapeutic patient care at this point in the hospitalization?

  • A. Do you trust me to help you with the voices?'
  • B. Are the voices commanding you to do something?'
  • C. How often during 24 hours do you hear the voices?'
  • D. Do you hear the voices if you're busy in noisy environment?'
Correct Answer: A

Rationale: Correct Answer: A

Rationale:
A: Asking about trust in the nurse is not immediately relevant as the patient's primary concern is the change in voice content. Building trust is important but addressing the content of hallucinations takes priority.
B: This is relevant as commanding voices could pose a safety risk.
C: Monitoring frequency helps assess severity and response to treatment.
D: Understanding triggers for hallucinations is important for managing symptoms.

A community mental health nurse receives a new client for his caseload. The diagnosis of the client is residual schizophrenia. Documentation states that the client has a number of negative symptoms. Which symptom would the nurse expect to assess in the client?

  • A. Bizarre, somatic delusions
  • B. Disorganized speech pattern
  • C. Catatonic posturing
  • D. Emotional blunting
Correct Answer: D

Rationale: The correct answer is D: Emotional blunting. In residual schizophrenia, negative symptoms are prominent, including emotional blunting which refers to a reduced ability to express emotions. This is commonly seen in clients with residual schizophrenia.

Explanation of why other choices are incorrect:
A: Bizarre, somatic delusions are characteristic of paranoid schizophrenia, not residual schizophrenia.
B: Disorganized speech pattern is a symptom of disorganized schizophrenia, not residual schizophrenia.
C: Catatonic posturing is associated with catatonic schizophrenia, not residual schizophrenia.

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