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An outpatient diagnosed with schizophrenia attends programming at a community mental health center. The patient says, I threw away the pills because they keep me from hearing God. Which response by the nurse would most likely to benefit this patient?
- A. You need your medicine. Your schizophrenia will get worse without it.
- B. Do you want to be hospitalized again? You must take your medication.
- C. I would like you to come to the medication education group every Thursday.
- D. I noticed that when you take the medicine, you have been able to hold a job you wanted.
Correct Answer: D
Rationale: Connecting medication to the patient's goal (job) (D) motivates adherence despite desirable hallucinations. Exhortations (A, B) ignore insight issues, and education (C) assumes a knowledge deficit, not the core problem.
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A male patient diagnosed with paranoid schizophrenia typically relates effectively with female staff but angrily tells the male nurse, 'You act like a homosexual. None of the men trust you or want to be around you.' The nurse, who is heterosexual, is perplexed by the patient's statements and discusses the event with his mentor. Which explanation most likely underlies the patient's behavior?
- A. The patient was unleashing unconscious, hostile feelings toward the nurse.
- B. The patient feared the nurse would reject him, so he coped by rejecting the nurse first.
- C. It was the patient's way of distancing himself from potential emotional intimacy.
- D. The patient was coping with homosexual urges by projecting them onto the nurse.
Correct Answer: D
Rationale: The correct answer is D because the patient's accusation of the nurse being homosexual and implying that other men do not trust him or want to be around him suggests projection of the patient's own homosexual urges onto the nurse. This defense mechanism of projection helps the patient avoid acknowledging and dealing with his own uncomfortable feelings by attributing them to someone else.
Option A is incorrect because the patient's behavior is more about projecting feelings onto the nurse rather than unconscious hostility. Option B is incorrect as it focuses on the patient's fear of rejection rather than projecting his own feelings onto the nurse. Option C is incorrect as it does not address the specific dynamic of projecting homosexual urges onto the nurse.
CT scans of the brains of some young schizophrenics show than normal
- A. wider ventricles
- B. smaller fissures
- C. smaller ventricles
- D. fewer fissures
Correct Answer: A
Rationale: Enlarged ventricles in schizophrenics suggest brain abnormalities linked to the disorder.
After a rape victim visited a rape crisis counselor weekly for 8 weeks, which finding best demonstrates that reorganization was successful?
- A. Absence of signs or symptoms of posttraumatic stress disorder
- B. Presence of mild somatic reactions
- C. Moderate doubts about self-worth
- D. Occasional episodic nightmares
Correct Answer: A
Rationale: The correct answer is A because the absence of signs or symptoms of posttraumatic stress disorder indicates successful reorganization after therapy. This demonstrates that the victim has effectively processed and coped with the trauma. Choice B indicates lingering somatic reactions, C suggests ongoing self-esteem issues, and D implies unresolved trauma manifesting in nightmares, all of which do not reflect successful reorganization.
A physically frail elderly patient with mild cognitive impairments needs services of a facility that can provide supervision and safety as well as recreation and social interaction. The family cares for this patient during the evening and night. Which type of facility should the nurse suggest to meet this patients needs?
- A. Adult day care program
- B. Skilled nursing facility
- C. Partial hospitalization
- D. Group home
Correct Answer: A
Rationale: A day care program provides recreation and social interaction as well as supervision in a safe environment. Nursing, medical, and rehabilitative care are usually not provided. Skilled nursing facilities go beyond meeting recreational and social needs by providing medical interventions and nursing and rehabilitation services on a 24-hour basis. Partial hospitalization provides acute psychiatric hospital programs. A group home is inappropriate and would not meet the patients needs.
When a patient with a personality disorder uses manipulation as a way of getting needs met, the staff agree to use limit setting as an intervention. How does limit setting work to reduce manipulation?
- A. Limit setting indulges the patient's desire for attention from staff.
- B. It gives the patient a different concern on which to focus his anger.
- C. External controls provide security while internal controls are developing.
- D. When staff limit the patient's behavior, he is no longer anxious about it.
Correct Answer: C
Rationale: Correct Answer: C
Rationale:
1. External controls, like limit setting, provide structure and predictability for the patient.
2. This security allows the patient to gradually develop internal controls to manage their behavior.
3. By relying on external limits, the patient's need for manipulation decreases over time.
4. This approach fosters growth and autonomy in the patient, reducing the reliance on manipulative behaviors.
Summary:
A: Incorrect. Limit setting does not indulge attention-seeking behaviors; it establishes boundaries.
B: Incorrect. Limit setting does not redirect anger; it focuses on promoting internal control.
D: Incorrect. Limit setting does not solely address anxiety; it aims to foster self-regulation.