Age Specific Nursing Care

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The family of a patient with schizophrenia who has been stable for a year reports to the community mental health nurse that the patient reports feeling tense and having difficulty concentrating. He sleeps only 3 to 4 hours nightly and has begun to talk about creatures called 'volmers' hiding in the warehouse where he works and undoing his work each night. This information most likely suggests:

  • A. medication nonadherence.
  • B. a need for psychoeducation.
  • C. the chronic nature of his illness.
  • D. relapse of his schizophrenia.
Correct Answer: D

Rationale: The correct answer is D: relapse of his schizophrenia. The patient is displaying symptoms such as feeling tense, difficulty concentrating, disturbed sleep, and delusional thoughts about creatures hiding in his workplace. These symptoms indicate a return of psychotic features characteristic of schizophrenia, suggesting a relapse. This is supported by the patient's history of schizophrenia and the sudden onset of symptoms after a period of stability. Medication nonadherence (choice A) could be a possible cause, but the patient's symptoms are more indicative of a relapse. While psychoeducation (choice B) is important, the patient's current symptoms require immediate attention for relapse management. The chronic nature of his illness (choice C) is a general characteristic of schizophrenia and does not explain the current symptoms.

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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 nurse is planning care for a patient with anorexia nervosa. What is the priority intervention?

  • A. Encourage the patient to verbalize concerns about body image.
  • B. Monitor the patient's weight and nutritional intake closely.
  • C. Provide education on healthy eating and exercise.
  • D. Offer emotional support to the patient regarding self-esteem.
Correct Answer: B

Rationale: The correct answer is B. Monitoring the patient's weight and nutritional intake closely is the priority intervention for a patient with anorexia nervosa as it directly addresses the immediate health risks associated with the disorder, such as malnutrition and weight loss. By closely monitoring these parameters, healthcare providers can assess the patient's progress and make necessary adjustments to prevent further complications.

Choice A is incorrect because while addressing body image concerns is important in the long term, it is not the priority intervention when the patient's physical health is at risk.

Choice C is incorrect as providing education on healthy eating and exercise may not be effective if the patient is not yet in a stable physical condition to absorb and apply the information.

Choice D is incorrect as offering emotional support is valuable, but it is not the priority intervention in this case where the patient's physical health needs immediate attention.

An infant develops jaundice 6 hours after birth. Which one of the following is the most likely diagnosis?

  • A. Haemolytic disease of the newborn.
  • B. Umbilical sepsis.
  • C. Physiological jaundice.
  • D. Atresia of the bile ducts.
Correct Answer: A

Rationale: Jaundice within 24 hours of birth is pathological, often due to haemolytic disease of the newborn (A), such as Rh incompatibility causing rapid red cell breakdown. Physiological jaundice (C) typically appears after 24 hours, while umbilical sepsis (B), bile duct atresia (D), and neonatal hepatitis (E) are less likely to cause such early onset.

A patient receiving risperidone (Risperdal) reports severe muscle stiffness midmorning. During lunch he has difficulty swallowing food and speaking, and when vital signs are taken 30 minutes later, he is noted to be stuporous and diaphoretic, with a temperature of 38.8° C, pulse of 110 beats/min, and blood pressure of 150/90 mm Hg. The nurse should suspect _____ and should _____.

  • A. Neuroleptic malignant syndrome"¦place him in a cooling blanket and transfer to ICU
  • B. Anticholinergic toxicity"¦check vital signs and prepare to use a cooling blanket stat
  • C. Relapse of his psychosis"¦administer PRN antipsychotic drugs and notify his physician
  • D. Agranulocytosis"¦hold his antipsychotic and draw blood for a complete blood count
Correct Answer: A

Rationale: The correct answer is A: Neuroleptic malignant syndrome. The patient is exhibiting symptoms consistent with NMS, a rare but serious side effect of antipsychotic medications like risperidone. The severe muscle stiffness, difficulty swallowing, altered mental status, diaphoresis, elevated temperature, and vital sign changes are classic signs of NMS. Treatment includes immediate cooling to lower the body temperature and transfer to the intensive care unit for close monitoring and supportive care.

Choice B: Anticholinergic toxicity does not fit the patient's presentation as there are no specific signs of anticholinergic toxicity such as dry mucous membranes, dilated pupils, or tachycardia.

Choice C: Relapse of psychosis is unlikely to present with the same constellation of symptoms, including altered mental status, fever, and vital sign changes.

Choice D: Agranulocytosis is characterized by a severe drop in white blood cells, leading to increased risk of infection, but it does

What would be an expected outcome for a patient with anorexia nervosa undergoing treatment?

  • A. The patient will stabilize weight at a normal level.
  • B. The patient will participate in group therapy regularly.
  • C. The patient will express satisfaction with their body image.
  • D. The patient will regain full cognitive function and independence.
Correct Answer: A

Rationale: The correct answer is A. In Anorexia Nervosa treatment, the primary goal is weight restoration to a healthy level. This is crucial for physical health and recovery. Stabilizing weight at a normal level is a key indicator of treatment success. Choices B, C, and D are incorrect as they do not address the core issue of weight restoration, which is essential in treating Anorexia Nervosa. Group therapy, body image satisfaction, and cognitive function are important aspects of treatment but not the primary outcome measure for patients with anorexia nervosa.

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