Age Specific Nursing Care

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Police bring a 63-year-old woman to the emergency room, reporting that her behavior is disorganized and disruptive, that her speech makes little sense, and that she does not seem able to take care of herself. The woman has had elective surgeries at the hospital previously and was seen in the ER last week after a fall; records show no history of similar symptoms or mental illness. The ER physician speaks with the patient but does not examine her medically, diagnoses her with schizophrenia, and orders admission to the inpatient psychiatric unit. Which response by the nurse would be most appropriate?

  • A. Ask another physician with more of an interest in psychiatry to also take a look at this patient, explaining that you just want to be as thorough as possible.
  • B. Suggest that a psychiatric consult be requested before admitting the patient to a psychiatric unit, to validate the diagnosis and speed the initiation of medication.
  • C. Remind the physician that schizophrenia usually develops earlier in life, that such presentations may be caused by medical problems, and suggest a medical work-up.
  • D. Note that the patient's blood pressure and respirations were elevated when she arrived, and suggest that they be evaluated before admitting the patient to the psychiatric unit.
Correct Answer: C

Rationale: The correct answer is C because it promotes a thorough and systematic approach to the patient's care. First, it challenges the premature diagnosis of schizophrenia without a medical examination. Second, it highlights the importance of considering medical causes for the symptoms presented by the patient. This is crucial as the patient's age and lack of prior history of mental illness suggest that a medical work-up is necessary to rule out underlying medical conditions that could be causing her symptoms. This approach ensures a comprehensive evaluation and appropriate treatment tailored to the patient's specific needs.

Choices A, B, and D are incorrect because they do not address the fundamental issue of exploring potential medical causes for the patient's symptoms before jumping to a psychiatric diagnosis or treatment. A, B, and D focus on seeking additional psychiatric opinions, consulting for medication initiation, and evaluating vital signs, respectively, which do not address the need for a thorough medical evaluation in this case.

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A patient diagnosed with schizophrenia has had multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply as the patient transitions from hospital to community?

  • A. Administer a second-generation antipsychotic to help negative symptoms.
  • B. Use a quick-dissolving medication formulation to reduce checking.
  • C. Prescribe a long-acting intramuscular antipsychotic medication.
  • D. Involve the patient in decisions about which medication is best.
Correct Answer: D

Rationale: Involving the patient in medication decisions (D) builds trust and alliance, key to adherence. Other options (A, B, C) are useful but secondary to establishing this foundation.

A nurse finds a patient with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Select the nurse's best comment.

  • A. It bothers me to see you exercising.
  • B. You and I will have to sit down and discuss this problem.
  • C. Let's discuss the relationship between exercise and weight loss and how that affects your body.
  • D. According to our agreement, exercising is not permitted until you have gained a specific amount of weight.
Correct Answer: D

Rationale: The correct answer is D because it directly addresses the behavior in relation to the agreed-upon plan and sets clear boundaries. By stating that exercising is not permitted until the patient has gained a specific amount of weight, the nurse reinforces the importance of following the treatment plan to ensure the patient's health and well-being.

A: This response does not address the behavior in a constructive manner and may come across as judgmental.
B: While discussing the problem is important, it does not provide clear guidance on addressing the immediate issue of exercising before reaching the weight goal.
C: While discussing the relationship between exercise and weight loss can be helpful, it does not provide a clear directive on what action should be taken in this specific situation.

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.

A 91-year-old female client with dementia is being seen by the home health nurse. Both she and her husband, who is 92 years old, were very active until her dementia became debilitating. Since that time, the client does not recognize her husband or children, forgets how to eat and dress, and wanders about the house day and night. Her husband wants to keep her at home to care for her, but the nurse notices that he is increasingly tired with each visit. What is the nurse's priority intervention for the nursing diagnosis of caregiver role strain?

  • A. Discuss strategies to coordinate care and other responsibilities
  • B. Encourage involvement in support groups
  • C. Identify resources to include financial, legal, and respite care
  • D. Stress the importance of self-nurturing
Correct Answer: A

Rationale: The correct answer is A: Discuss strategies to coordinate care and other responsibilities. The priority intervention for caregiver role strain is to help the husband effectively manage caring for his wife with dementia. By discussing strategies to coordinate care and other responsibilities, the nurse can assist the husband in creating a plan to ensure the client's needs are met while also addressing his own well-being. This intervention will help alleviate the husband's increasing tiredness and provide support in managing the caregiving responsibilities.

Summary of other choices:
B: Encourage involvement in support groups - While support groups can be beneficial, the immediate priority is to address the husband's caregiving responsibilities.
C: Identify resources to include financial, legal, and respite care - While important, these resources may not directly address the husband's current strain in caring for his wife.
D: Stress the importance of self-nurturing - While self-care is important, the immediate focus should be on assisting the husband in managing his caregiving responsibilities.

A client with schizophrenia tells the nurse as they sit in the day room, 'I hear voices telling me bad things.' The most therapeutic response the nurse can make is:

  • A. Tell me what the voices are saying.'
  • B. I understand you hear these so-called voices, but I hear only the people in the room talking.'
  • C. The voices are not real. They're only your imagination.'
  • D. Do you think the voices would go away if we went into your room to talk?'
Correct Answer: B

Rationale: The correct answer is B because it demonstrates empathy and validation of the client's experience. By acknowledging the client's reality of hearing voices and emphasizing that the nurse does not hear them, the nurse establishes trust and rapport. This response shows active listening and validates the client's feelings without judgment.

Incorrect responses:
A: Asking the client to describe the voices may increase distress and is not as supportive as acknowledging their experience.
C: Dismissing the voices as not real can invalidate the client's experience and may lead to mistrust.
D: Suggesting a change of location does not address the client's immediate concerns and may not be therapeutic in this situation.

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