Nokea
During occupational therapy a young patient diagnosed with schizophrenia sits staring at a piece of paper. Which response is most therapeutic at this time?
- A. If you prefer to sit and stare for a time, it is acceptable for you to leave.'
- B. You seem immobilized by anxiety. Is there anything I can do to help?'
- C. Are you having trouble deciding where you want to glue that piece?'
- D. Rub the glue stick on the back of the paper.'
Correct Answer: D
Rationale: The correct answer is D because it provides a clear and simple directive that guides the patient on what to do next, promoting engagement in the therapeutic activity. By instructing the patient to rub the glue stick on the back of the paper, it helps redirect their focus and encourages participation in the task.
Choice A is incorrect as it allows the patient to disengage from the activity, which does not promote therapeutic progress. Choice B assumes the patient is anxious without evidence and may not address the core issue. Choice C is incorrect as it may not be relevant to the patient's current state and may further confuse or frustrate them.
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A 25-year-old individual was brought by ambulance to the emergency room. The patient's sensorium alternates between clouded and clear, and the patient becomes agitated both physically and verbally when approached. The patient's roommate states that the patient "was fine after getting up this morning but started talking crazy about 3 hours ago."Â The patient's cognitive impairment is most consistent with:
- A. delirium.
- B. dementia.
- C. sundown syndrome.
- D. early-onset Alzheimer disease.
Correct Answer: A
Rationale: The correct answer is A: delirium. Delirium is an acute change in mental status characterized by fluctuating levels of consciousness, inattention, disorganized thinking, and altered perception. In this case, the patient's clouded and clear sensorium, agitation, and recent onset of symptoms are indicative of delirium.
Choice B: dementia, is incorrect because dementia is a chronic, progressive decline in cognitive function that does not typically present with acute changes in mental status.
Choice C: sundown syndrome, is incorrect as it refers to a pattern of worsening confusion or agitation in the late afternoon or evening, not necessarily characterized by acute onset and fluctuating levels of consciousness.
Choice D: early-onset Alzheimer disease, is incorrect because Alzheimer's disease is a specific type of dementia that does not typically present with the acute and fluctuating symptoms described in the scenario.
While the nurse at the personality disorders clinic is interviewing a patient, the patient constantly scans the environment and frequently interrupts to ask what the nurse means by certain words or phrases. The nurse notes that the patient is very sensitive to the nurse's nonverbal behavior. His responses are often argumentative, sarcastic, and hostile. He suggests that he is being hospitalized 'so they can exploit me.' The patient's behaviors are most consistent with the clinical picture of:
- A. paranoid personality disorder.
- B. histrionic personality disorder.
- C. avoidant personality disorder.
- D. narcissistic personality disorder.
Correct Answer: A
Rationale: The correct answer is A: paranoid personality disorder. The patient's behaviors align with the diagnostic criteria for paranoid personality disorder, characterized by suspicion, distrust, sensitivity to criticism, and interpreting benign interactions as threatening. The patient's constant scanning of the environment, interrupting to clarify meanings, being sensitive to nonverbal cues, and displaying argumentative and hostile responses are all indicative of paranoid traits. Additionally, the belief that hospitalization is for exploitation is consistent with paranoid beliefs.
Choices B, C, and D can be ruled out:
B: Histrionic personality disorder is characterized by attention-seeking behavior, emotional instability, and dramatic expression. The patient's behaviors are not suggestive of seeking attention or being overly dramatic.
C: Avoidant personality disorder is marked by social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. The patient's behaviors are more indicative of suspiciousness rather than avoidance.
D: Narcissistic personality disorder involves grandiosity, need for admiration, and lack of
A client who is diagnosed with schizoid personality disorder is isolative, does not speak to her peers, and sits through the community meeting without speaking. Her mother describes her as shy and having few friends. Which would be an appropriate nursing diagnosis for this client?
- A. Anxiety related to a new environment as evidenced by isolation and not talking with peers
- B. Impaired social interaction related to unfamiliar environment as evidenced by isolation and not talking with peers
- C. Ineffective coping related to new environment as evidenced by isolation and minimal interaction with others
- D. Disturbed thought processes related to a new environment as evidenced by isolation and minimal interactions with others
Correct Answer: B
Rationale: The correct answer is B: Impaired social interaction related to unfamiliar environment as evidenced by isolation and not talking with peers. This is the most appropriate nursing diagnosis for the client because it accurately reflects the client's behavior of isolation and lack of communication with peers, which are indicative of impaired social interaction.
Rationale:
1. Impaired social interaction is a key characteristic of schizoid personality disorder, as individuals with this disorder tend to be socially isolated and have difficulty forming relationships.
2. The client's behavior of not speaking to peers and sitting through meetings without interaction supports the diagnosis of impaired social interaction.
3. The description of the client by her mother as shy and having few friends further supports the diagnosis of impaired social interaction.
Summary:
A: Anxiety related to a new environment is incorrect because the client's behavior is more indicative of impaired social interaction rather than anxiety.
C: Ineffective coping related to new environment is incorrect as there is no evidence to suggest that the client is using maladaptive coping
An acutely psychotic individual diagnosed with schizophreniaform disorder at admission is immediately placed on daily doses of risperidone. A hospitalization of 8 days' duration has been authorized by the HMO. By what hospital day would the nurse expect to note that client was demonstrating beginning trust in the nurse and reduction in hallucinations and delusions?
- A. Day of admission
- B. Day 3 of hospitalization
- C. Day 5 of hospitalization
- D. Day 7 of hospitalization
Correct Answer: B
Rationale: The correct answer is B: Day 3 of hospitalization. Typically, antipsychotic medications like risperidone take a few days to start showing noticeable effects in reducing hallucinations and delusions. By day 3, the medication would have had enough time to begin its therapeutic effect. Building trust with a psychotic patient also takes time, so by day 3, the patient may start showing signs of trust in the nurse. Day of admission (Choice A) is too early for the medication to take effect. Day 5 (Choice C) and Day 7 (Choice D) are too late as the medication usually shows noticeable improvement within the first few days.
A 15-year-old boy presents with fatigue to the clinic. He reports that he is unable to wake up in the mornings and is missing a lot of school. On further questioning he reveals that he has some thoughts of suicide, but requests that the information be withheld from his parent who is in the waiting room. On examination he is noted to be obese with acanthosis. The next best step is to ensure his safety is:
- A. Refer to peds medicine for workup of obesity
- B. Breach confidentiality to inform his parent about the adolescents suicidal thoughts
- C. Refer to school for counselling
- D. Reassurance and diet and exercise advice
Correct Answer: B
Rationale: Suicidal thoughts indicate a safety risk, justifying breaching confidentiality to involve parents and ensure immediate intervention, per ethical and clinical guidelines.