Nokea
schizophrenia usually involves delusions of persecution and grandeur
- A. Catatonic
- B. Disorganized
- C. Paranoid
- D. Undifferentiated
Correct Answer: C
Rationale: Paranoid schizophrenia is marked by prominent delusions of persecution or grandeur.
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The client tells the nurse, 'I thought my psychiatrist was the best doctor in the world. I thought he understood me completely. Now, I hate him! He doesn't understand me at all. He's just dumping me to go on a 2-week vacation.' The nurse assesses the client's description of feelings about the physician as evidence of the use of:
- A. Splitting
- B. Projective identification
- C. Isolation of affect
- D. Dissociation
Correct Answer: A
Rationale: The correct answer is A: Splitting. Splitting is a defense mechanism where a person sees things in extremes of either all good or all bad. In this scenario, the client initially idealizes the psychiatrist as the best doctor, then suddenly devalues and hates him for taking a vacation, indicating a shift from all good to all bad. This extreme change in perception is characteristic of splitting.
B: Projective identification involves projecting one's own feelings onto another person and then identifying with those projected feelings. This choice does not fit the scenario as the client is not projecting their feelings onto the psychiatrist.
C: Isolation of affect refers to the separation of feelings from ideas and events. The client's strong emotions towards the psychiatrist do not demonstrate a lack of emotional expression or detachment from feelings.
D: Dissociation is a defense mechanism where thoughts, feelings, and experiences are separated from conscious awareness. The client's reaction does not suggest a disconnection from reality or consciousness.
For those family members who desire to care at home for loved ones who have been given a diagnosis of Alzheimer's disease, it is important for the nurse to ensure that the family is aware of which caregiver skills and responsibilities will be necessary. What is one of the responsibilities of the caregiver during the middle stage of the disease?
- A. Helping the loved one with memory and communication problems
- B. Providing a stable, routine environment
- C. Providing complete assistance with physical care
- D. Adapting to the changing personality and behavior of the loved one
Correct Answer: D
Rationale: The correct answer is D: Adapting to the changing personality and behavior of the loved one. During the middle stage of Alzheimer's disease, individuals may experience significant changes in personality and behavior. Caregivers need to adapt to these changes by being patient, understanding, and flexible. This responsibility is crucial for maintaining a positive and supportive relationship with the loved one.
A: Helping the loved one with memory and communication problems is important, but it is more relevant in the early stages of the disease when these issues are more prominent.
B: Providing a stable, routine environment is essential throughout all stages of Alzheimer's disease, not just the middle stage.
C: Providing complete assistance with physical care may become necessary in the later stages of the disease when the individual's physical abilities decline significantly.
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 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 characterized by acute onset, fluctuating course, altered level of consciousness, and cognitive impairment. In this case, the patient's alternating sensorium and agitation suggest an acute confusional state, which is typical of delirium. Delirium is often caused by underlying medical conditions, medications, or substance abuse.
Summary of other choices:
B: Dementia is a chronic, progressive cognitive decline that does not typically present with acute onset and fluctuating symptoms like delirium.
C: Sundown syndrome refers to worsening of symptoms in the evening and is often seen in patients with dementia, not in this acute and fluctuating presentation.
D: Early-onset Alzheimer's disease is a form of dementia that typically has a more insidious onset and does not present with acute fluctuations in cognition like delirium.
A parent who is very concerned about a 3-year-old son says, 'He likes to play with girls' toys. Do you think he is homosexual or mentally ill?' Which response by the nurse most professionally describes the current understanding of gender identity?
- A. A child's interest in the activities of the opposite gender is not unusual or related to sexuality. Most children do not carry cross-gender interests into adulthood.
- B. It's difficult to say for sure because the research is incomplete so far, but chances are that he will grow up to be a normal adult.
- C. The research is incomplete, but many boys play with girls' toys and turn out normal as adults.
- D. I am sure that whatever happens, he will be a loving son, and you will be a proud parent.
Correct Answer: A
Rationale: The correct answer is A because it accurately reflects the current understanding of gender identity. Children's interests in activities typically associated with the opposite gender are not unusual and are not indicative of sexual orientation or mental illness. Most children who exhibit cross-gender interests do not carry these into adulthood. This response emphasizes the normalcy of such behavior and provides reassurance to the parent.
Choice B is incorrect because it implies uncertainty based on incomplete research, which goes against the established understanding that cross-gender interests in childhood are common and not predictive of future outcomes.
Choice C is incorrect because it focuses on incomplete research and uses the term "normal as adults," which can perpetuate stigmas surrounding gender expression.
Choice D is incorrect because it does not address the parent's concerns about the child's behavior and does not provide accurate information about gender identity development.
A common form of mental disorder afflicting 10-20\% of the population is
- A. schizophrenia
- B. senile dementia
- C. depression
- D. delusional disorder
Correct Answer: C
Rationale: Depression affects 10-20\% of people at some point, making it far more common than schizophrenia or delusional disorders.