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In planning aftercare for a client with schizophrenia and whose insurance benefits have been exhausted, the nurse who is concerned about overcoming negative symptoms will make provisions for the client to have stimulation, structure, socialization, and support. Which option would best incorporate these factors?
- A. Day hospitalization
- B. Attending a psychosocial club
- C. Living with his elderly mother
- D. Spending free time in the mall
Correct Answer: B
Rationale: The correct answer is B, attending a psychosocial club. This option best incorporates the factors of stimulation, structure, socialization, and support. Psychosocial clubs offer a structured environment with various activities to stimulate the client's mind and prevent social isolation. It provides opportunities for socialization and peer support, which are crucial for individuals with schizophrenia. Day hospitalization may offer structure but lacks the socialization aspect. Living with his elderly mother may provide support but not necessarily the stimulation and structure needed. Spending free time in the mall does not provide the structured environment, socialization, or support necessary for aftercare in schizophrenia.
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An individual brought by ambulance to the emergency room is accompanied by a roommate. The patient fights against the restraints and shouts incoherently. The roommate reports that the patient was weak and confused on awakening this morning and about 3 hours ago began "rambling and talking crazy."Â A nurse notes that the patient's skin is flushed and dry. The priority nursing action is to:
- A. take the patient's vital signs.
- B. start intravenous fluids.
- C. administer a sedative.
- D. perform a mental status examination.
Correct Answer: A
Rationale: The correct answer is A: take the patient's vital signs. This is the priority action because the patient is exhibiting signs of potential medical emergency, such as altered mental status, flushed and dry skin, and confusion. Vital signs can provide crucial information about the patient's condition and help determine the urgency of the situation. Starting intravenous fluids (B) may be necessary but should be based on the assessment of vital signs first. Administering a sedative (C) is not appropriate without knowing the underlying cause of the symptoms. Performing a mental status examination (D) is important but not the priority in this situation where the patient's physical condition needs immediate attention.
Which nursing diagnosis is likely to apply to an individual diagnosed with a serious mental illness who is homeless?
- A. Insomnia
- B. Substance abuse
- C. Chronic low self-esteem
- D. Impaired environmental interpretation syndrome
Correct Answer: C
Rationale: Many individuals with serious mental illness do not live with their families and become homeless. Life on the street or in a shelter has a negative influence on the individuals self-esteem, making this nursing diagnosis one that should be considered. Substance abuse is not an approved NANDA-International diagnosis. Insomnia may be noted in some patients but is not a universal problem. Impaired environmental interpretation syndrome refers to persistent disorientation, which is not seen in a majority of the homeless.
A person suffering from hypoactive sexual desire disorder has:
- A. Too little interest in sex
- B. Too much interest in sex
- C. An obsessive need to expose their genitals in public
- D. A desire to witness suffering in other people
Correct Answer: A
Rationale: Hypoactive sexual desire disorder is defined by a persistent lack of sexual interest or desire.
The physician and advanced practice nurse are considering which antipsychotic medication to prescribe for a patient with schizophrenia who demonstrates auditory hallucinations, apathy, anhedonia, and poor social functioning. The patient is overweight and has hypertension. Bearing these facts in mind, the drug the nurse should advocate would be:
- A. clozapine (Clozaril).
- B. haloperidol (Haldol).
- C. olanzapine (Zyprexa).
- D. aripiprazole (Abilify).
Correct Answer: D
Rationale: The correct answer is D: aripiprazole (Abilify). Aripiprazole is a second-generation antipsychotic that is less likely to cause weight gain and metabolic side effects compared to other antipsychotics. This is important since the patient is already overweight and has hypertension. Aripiprazole also has a lower risk of causing sedation, which can be beneficial for addressing apathy and anhedonia without worsening social functioning.
A: Clozapine is effective for treatment-resistant schizophrenia but is associated with significant weight gain and metabolic side effects.
B: Haloperidol is a first-generation antipsychotic with a high risk of extrapyramidal side effects and is not ideal for a patient with hypertension.
C: Olanzapine is known for causing significant weight gain and metabolic effects, making it a less suitable choice for an overweight patient with hypertension.
A woman tells the nurse that her husband abuses her most often when he is intoxicated, just as his father had beaten him and his mother. The woman is aware of the location of a safe house and has considered leaving home with her two children, but she cites being brought up to believe 'you keep quiet and stay together, no matter what happens.' She states the husband is always apologetic and remorseful after an incident. What evidence exists that the husband is at risk of becoming a perpetrator of physical abuse? He:
- A. is unable to make lasting behavioral changes.
- B. was an abused child.
- C. is without a job.
- D. experiences remorse.
Correct Answer: B
Rationale: The correct answer is B because the husband's history of being abused as a child increases his risk of becoming a perpetrator of physical abuse. Research shows that individuals who have been abused are more likely to perpetrate abuse themselves. This is due to a cycle of violence where behaviors learned in childhood are repeated in adulthood. In this case, the husband's abusive behavior towards his wife mirrors his own upbringing where his father abused his mother. This pattern suggests that the husband may continue the cycle of abuse.
Choice A (is unable to make lasting behavioral changes) is incorrect because it does not directly correlate with the risk of becoming a perpetrator of physical abuse. Choice C (is without a job) is also incorrect as employment status does not necessarily indicate a propensity for abuse. Choice D (experiences remorse) is incorrect as feeling remorse after abusive incidents does not negate the risk of becoming a perpetrator of physical abuse.