Disorders which are characterised by serious abnormalities in the developmental process, fall under the heading of pervasive developmental disorders (PDD) and are usually associated with impairment in several areas of development. From early infancy, some children will exhibit a spectrum of developmental impairments and delays that include which of the following?
- A. Social and emotional disturbances
- B. Intellectual disabilities
- C. Language and communication deficits
- D. All of the above
Correct Answer: D
Rationale: Pervasive Developmental Disorders (PDDs): Characterized by serious developmental abnormalities affecting social, intellectual, and communication skills.
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A client displays disorganized thinking, difficult-to-follow speech, and silly, inappropriate affect. The client isolates himself from other clients and staff, ignores unit activities, and often seems to be listening and responding to unseen stimuli. This client's behavior most closely conforms to the characteristic behavior of:
- A. Residual schizophrenia
- B. Schizoaffective disorder
- C. Paranoid schizophrenia
- D. Disorganized schizophrenia
Correct Answer: D
Rationale: The correct answer is D: Disorganized schizophrenia. The client's symptoms of disorganized thinking, difficult-to-follow speech, inappropriate affect, social withdrawal, and hallucinations (responding to unseen stimuli) align with the diagnostic criteria for Disorganized Schizophrenia. This subtype is characterized by disorganized behavior, speech, and affect, as well as social withdrawal and hallucinations.
A: Residual schizophrenia does not involve active psychotic symptoms like hallucinations or delusions, which are present in the client's behavior described.
B: Schizoaffective disorder combines symptoms of schizophrenia and mood disorders, and the client's symptoms do not strongly suggest a mood disorder component.
C: Paranoid schizophrenia typically involves prominent delusions and auditory hallucinations, which are not emphasized in the client's behavior described.
The risk for developing the condition is about 50% only if both parents were carriers of the gene that predisposes the condition to their offspring.
- A. The risk is 25% if only one parent is a carrier.
- B. The risk is 50% if both parents are carriers.
- C. The risk is 75% if both parents are carriers.
- D. None of the above.
Correct Answer: B
Rationale: The correct answer is B. If both parents are carriers of a gene that predisposes a condition, each parent contributes one copy of the gene, resulting in a 50% chance that the offspring will inherit the gene from both parents, leading to a 50% risk of developing the condition. Choice A is incorrect because if only one parent is a carrier, the offspring has a 25% chance of inheriting the gene. Choice C is incorrect as the risk is not 75% when both parents are carriers, but rather 50%. Choice D is also incorrect as the risk is indeed 50% when both parents are carriers.
A nurse plans an educational program for staff of a home health agency specializing in care of the elderly. Which topic is the highest priority to include?
- A. Pain assessment techniques for older adults
- B. Psychosocial stimulation for those who live alone
- C. Preparation of psychiatric advance directives in the elderly
- D. Ways to manage disinhibition in elderly persons with dementia
Correct Answer: A
Rationale: The topic of greatest immediacy is the assessment of pain in older adults. Unmanaged pain can precipitate other problems, such as substance abuse and depression. Elderly patients are less likely to be accurately diagnosed and adequately treated for pain. The distracters are unrelated or of lesser importance.
A patient is currently in an abusive relationship with the father of her only child and tells a nurse that her partner 'is really sorry for hitting me and wants to come back and be part of the family again.' The nurse should provide which intervention?
- A. Share with the patient that abusers seldom voluntarily stop abusing.
- B. Identify groups that focus on treatment for individuals who are abusive.
- C. Tell the patient to continue the relationship, but focus on how to minimize the abuse.
- D. Tell the patient's partner that any continued abuse will be reported to the police.
Correct Answer: B
Rationale: The correct answer is B: Identify groups that focus on treatment for individuals who are abusive. This intervention is appropriate because it addresses the root cause of the abusive behavior, which is the partner's abusive tendencies. By connecting the abuser to groups that specialize in treating abusive behavior, there is a chance for change and rehabilitation.
A: Sharing with the patient that abusers seldom voluntarily stop abusing may not be helpful as it does not provide a proactive solution to address the abusive behavior.
C: Telling the patient to continue the relationship and focus on minimizing the abuse is dangerous as it normalizes and enables the abusive behavior, putting the patient at further risk.
D: Threatening the patient's partner with reporting to the police may escalate the situation and put the patient at higher risk of harm. It does not address the underlying issue of the partner's abusive behavior.
The client has been taking lithium and fluoxetine (Prozac) for almost a week. During today's assessment, the nurse notes a temperature of 39°C, muscle rigidity, and confusion. The client's signs and symptoms suggest:
- A. Dystonic reactions
- B. Bradykinesic side effects
- C. Extrapyramidal side effects
- D. Neuroleptic malignant syndrome
Correct Answer: D
Rationale: The correct answer is D: Neuroleptic malignant syndrome (NMS). This is indicated by the client's elevated temperature, muscle rigidity, and confusion, which are classic symptoms of NMS. NMS is a serious, potentially life-threatening condition associated with the use of antipsychotic medications like lithium and fluoxetine. The onset of NMS is often rapid and can lead to severe complications if not treated promptly. Dystonic reactions (choice A) involve sudden and involuntary muscle contractions, which are not consistent with the client's symptoms. Bradykinesic side effects (choice B) refer to slowed movements, which are not present in this case. Extrapyramidal side effects (choice C) typically include symptoms like tremors, stiffness, and restlessness, but do not encompass the combination of symptoms seen in NMS.