Nokea
If you met an individual who appeared to be very charming at first, but later you discovered that he or she manipulated people, caused others hurt without a second thought, and could not be depended upon, you might suspect him of being
- A. dependent
- B. narcissistic
- C. paranoid
- D. antisocial
Correct Answer: D
Rationale: Antisocial personality disorder features charm, manipulation, and lack of remorse, fitting this description perfectly.
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A patient with schizophrenia is admitted to the psychiatric unit in an acutely disturbed, violent state. He is given several doses of haloperidol (Haldol) and becomes calm and approachable. During rounds the nurse notices the patient has his head rotated to one side in a stiffly fixed position. His lower jaw is thrust forward and he appears severely anxious. The patient has _____, and the nurse should _____.
- A. A dystonic reaction"¦administer PRN IM benztropine (Cogentin)
- B. Tardive dyskinesia"¦seek a change in the drug or its dosage
- C. Waxy flexibility"¦continue treatment with antipsychotic drugs
- D. Akathisia"¦administer PRN diphenhydramine (Benadryl) PO
Correct Answer: A
Rationale: The correct answer is A: A dystonic reaction"¦administer PRN IM benztropine (Cogentin). This patient is exhibiting symptoms of acute dystonia, a extrapyramidal side effect of haloperidol. Dystonic reactions are characterized by sustained muscle contractions causing abnormal postures. Benztropine is an anticholinergic medication that helps alleviate these symptoms by blocking the neurotransmitter acetylcholine. Administering benztropine is the appropriate treatment for acute dystonia.
Summary of other choices:
B: Tardive dyskinesia"¦seek a change in the drug or its dosage - Tardive dyskinesia is a side effect that occurs after long-term antipsychotic use, not acutely like in this case.
C: Waxy flexibility"¦continue treatment with antipsychotic drugs - Waxy flexibility is a symptom of catatonia, not a side effect of antipsychotic medications
When a patient with paranoid schizophrenia has a recurrence of positive symptoms after stopping his antipsychotic medication because of its postural hypotension (orthostasis) side effect, he is readmitted to the mental health unit. What measure should the nurse suggest to help the patient address this side effect?
- A. Ask the doctor to prescribe an anticholinergic drug like trihexyphenidyl (Artane).
- B. Chew sugarless gum or use sugarless hard candy to moisten your mouth.
- C. Increase the amount of sleep you get, and try to take frequent rest breaks.
- D. Wear elastic support hose, drink adequate fluids, and change position slowly.
Correct Answer: D
Rationale: The correct answer is D because wearing elastic support hose, drinking adequate fluids, and changing positions slowly can help prevent postural hypotension associated with antipsychotic medications. Elastic support hose can improve blood circulation and prevent blood pooling in the legs. Adequate fluid intake can help maintain blood volume and blood pressure. Changing positions slowly can prevent sudden drops in blood pressure upon standing.
Choice A (anticholinergic drug) is incorrect as it may worsen symptoms of schizophrenia. Choice B (sugarless gum or candy) is unrelated to postural hypotension. Choice C (increasing sleep and rest breaks) may help with fatigue but does not address postural hypotension directly.
The psychiatric-mental health nurse knows that the patient's spouse clearly understands the adverse effects of lithium carbonate (Eskalith), when they say:
- A. I should call the doctor if my spouse shakes badly'
- B. I should make sure my spouse drinks as much water as possible'
- C. My spouse must remain on a salt-free diet'
- D. When the lithium level is 1.6mEq\L, my spouse can go back to work'
Correct Answer: A
Rationale: Tremors are a common lithium side effect requiring medical attention; other options reflect misunderstanding (e.g., salt-free diet increases toxicity risk, 1.6mEq\L is toxic).
An advance directive gives legally binding direction for health care interventions when a patient
- A. has a new diagnosis of cancer.
- B. is diagnosed with Parkinson's disease.
- C. is unable to make decisions for self because of illness.
- D. diagnosed with amyotrophic lateral sclerosis is unable to speak.
Correct Answer: C
Rationale: The correct answer is C because an advance directive is a legal document that specifies a person's wishes for healthcare decisions if they are unable to make decisions for themselves due to illness. This ensures their preferences are followed. Choices A and B are specific diagnoses and do not address decision-making capacity. Choice D focuses on the inability to speak, which is just one aspect of decision-making ability, but not comprehensive enough for an advance directive.
Stuttering is a disturbance in the normal fluency and time patterning of speech that is inappropriate for the individual's age. It involves which of the following?
- A. Frequent repetitions or prolongations of sounds
- B. Pauses within words
- C. Filled or unfilled pauses in speech
- D. All of the above
Correct Answer: D
Rationale: Stuttering: A disturbance in the normal fluency and time patterning of speech that includes frequent repetitions, prolongations, and pauses.