Age Specific Care

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A worker is characterized by her co-workers as 'painfully shy' and lacking in self-confidence. Her co-workers say she stays in her cubicle all day, never coming out for breaks or lunch. One day after falling on the ice in the parking lot, she goes to the nurse's office, where she apologizes for falling and mentions that she hopes the company will not fire her for being so clumsy. With which diagnosis is this presentation most consistent?

  • A. Avoidant
  • B. Dependent
  • C. Histrionic
  • D. Paranoid
Correct Answer: A

Rationale: The correct answer is A: Avoidant. This diagnosis is consistent because the worker exhibits characteristics of extreme shyness, lack of self-confidence, social avoidance, and fear of rejection or criticism. By apologizing excessively for a simple accident and expressing worry about being fired for it, the worker's behavior aligns with the avoidance of social situations and excessive concern about negative evaluation typical of Avoidant Personality Disorder.

Choice B: Dependent, does not fit as the worker is not displaying excessive need for others to take responsibility for major areas of her life.
Choice C: Histrionic, is not a match as this disorder is characterized by attention-seeking behavior, which is not evident in the worker's presentation.
Choice D: Paranoid, is not the correct diagnosis as the worker does not display distrust or suspiciousness towards others.

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Police bring a 63-year-old woman to the emergency room, reporting that her behavior is disorganized and disruptive, that her speech makes little sense, and that she does not seem able to take care of herself. The woman has had elective surgeries at the hospital previously and was seen in the ER last week after a fall; records show no history of similar symptoms or mental illness. The ER physician speaks with the patient but does not examine her medically, diagnoses her with schizophrenia, and orders admission to the inpatient psychiatric unit. Which response by the nurse would be most appropriate?

  • A. Ask another physician with more of an interest in psychiatry to also take a look at this patient, explaining that you just want to be as thorough as possible.
  • B. Suggest that a psychiatric consult be requested before admitting the patient to a psychiatric unit, to validate the diagnosis and speed the initiation of medication.
  • C. Remind the physician that schizophrenia usually develops earlier in life, that such presentations may be caused by medical problems, and suggest a medical work-up.
  • D. Note that the patient's blood pressure and respirations were elevated when she arrived, and suggest that they be evaluated before admitting the patient to the psychiatric unit.
Correct Answer: C

Rationale: The correct answer is C because it demonstrates critical thinking and patient advocacy. By reminding the physician that schizophrenia typically develops earlier in life and suggesting a medical work-up, the nurse is advocating for a comprehensive approach to ruling out potential medical causes for the patient's symptoms before jumping to a psychiatric diagnosis. This approach aligns with best practices in patient care and ensures that all possible underlying causes are considered and addressed appropriately.

Choice A is incorrect because it does not address the need for a medical work-up to rule out physical causes of the symptoms. Choice B is incorrect as it focuses on validating the diagnosis and initiating medication rather than investigating potential medical issues. Choice D is incorrect as it only addresses the patient's vital signs, overlooking the need for a thorough medical evaluation.

The nurse knows that stimulant medication for ADHD should be administered:

  • A. At bedtime, to coincide with rising cortisol levels
  • B. Only on school days to improve performance
  • C. On an empty stomach
  • D. With breakfast and lunch
Correct Answer: D

Rationale: Because these medications can contribute to insomnia, it is best to administer them earlier in the day with food. These are generally taken daily unless the doctor orders a drug holiday.

Which instruction has priority when teaching a patient taking clozapine (Clozaril)?

  • A. Avoid unprotected sex.
  • B. Report sore throat and fever immediately.
  • C. Reduce foods high in polyunsaturated fats.
  • D. Use over-the-counter preparations for rashes.
Correct Answer: B

Rationale: The correct answer is B: Report sore throat and fever immediately. This is because clozapine can cause a serious condition called agranulocytosis, which is characterized by a dangerously low white blood cell count. Sore throat and fever can be early signs of this condition, so it is crucial to report them immediately to prevent serious complications.

Avoiding unprotected sex (choice A) is important for overall health but is not directly related to clozapine use. Reducing foods high in polyunsaturated fats (choice C) is not a priority as it does not impact the safety or effectiveness of clozapine. Using over-the-counter preparations for rashes (choice D) is not advised as rashes can be a side effect of clozapine, and professional medical advice should be sought.

Which nursing action should occur first regarding a patient who has a problem of sexual dysfunction or sexual disorder? The nurse should

  • A. develop an understanding of human sexual response.
  • B. assess the patient's sexual functioning and needs.
  • C. acquire knowledge of the patient's sexual roles.
  • D. clarify own personal values about sexuality.
Correct Answer: D

Rationale: The correct answer is D because clarifying the nurse's own personal values about sexuality is crucial before addressing a patient's sexual dysfunction. By understanding personal biases or judgments, the nurse can provide unbiased care. Assessing the patient's needs (B) should follow, as it directly addresses the patient's concerns. Developing an understanding of human sexual response (A) is important, but not as urgent as addressing personal values. Acquiring knowledge of the patient's sexual roles (C) is less relevant and should come after understanding the patient's needs.

In the elderly, administering medication is a great concern for the nurse since these patients are more prone to side effects. The primary cause of this is:

  • A. Altered circulation and renal function
  • B. Accelerated gastrointestinal system
  • C. Enlarged Lymph nodes
  • D. Musculoskeletal system weakness
Correct Answer: A

Rationale: The elderly are more likely to have side effects when there is altered metabolism through the kidneys and liver as well as altered circulatory function (A), unlike the other options (B, C, D) which are less relevant.

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