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The medical records of a patient diagnosed with schizophrenia state that the patient has cognitive dysfunction. From this statement, the nurse can expect to see evidence of:
- A. anxiety, fear, and agitation.
- B. aggression, anger, hostility, or violence.
- C. blunted or flat affect or inappropriate affective responses.
- D. impaired memory and attention as well as formal thought disorder.
Correct Answer: D
Rationale: The correct answer is D because cognitive dysfunction in schizophrenia typically involves impaired memory, attention, and formal thought disorder. This is due to the underlying neurobiological and neurocognitive deficits associated with the disorder. Choices A, B, and C are incorrect because they primarily align with emotional and affective symptoms commonly seen in schizophrenia, not specifically cognitive dysfunction. Symptoms such as anxiety, fear, agitation, aggression, anger, hostility, violence, blunted affect, or inappropriate affective responses are more related to the emotional and behavioral aspects of schizophrenia, rather than cognitive deficits.
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A short-term goal for a patient with Alzheimer disease is:
- A. Improved functioning in the least restrictive environment
- B. improved problem solving in activities of daily living
- C. increased self-esteem and improved self-concept
- D. regained sensory perception and cognitive function
Correct Answer: A
Rationale: Promoting function in a safe, least restrictive setting is realistic and achievable given Alzheimer's progressive nature.
Which behavior would the nurse expect to observe in a person who commits psychic rape?
- A. The perpetrator gives money to the patient after the rape.
- B. The perpetrator seduces the patient by providing wine, flowers, and music.
- C. The perpetrator threatens the patient to submit or else be severely beaten.
- D. The perpetrator mentions always including violent bondage in sexual activities.
Correct Answer: D
Rationale: The correct answer is D because mentioning violent bondage in sexual activities indicates a pattern of behavior associated with psychic rape, where the perpetrator exerts control and inflicts harm on the victim. This choice aligns with the power dynamics and manipulation typically seen in cases of psychic rape.
A: Giving money after the rape does not necessarily indicate psychic rape and is more characteristic of bribery or transactional behavior.
B: Seduction with wine, flowers, and music may indicate manipulation but does not specifically relate to the psychological violation inherent in psychic rape.
C: Threatening the patient with violence is a form of physical coercion rather than psychic rape, which involves psychological manipulation and violation.
After a rape victim visited a rape crisis counselor weekly for 8 weeks, which finding best demonstrates that reorganization was successful?
- A. Absence of signs or symptoms of posttraumatic stress disorder
- B. Presence of mild somatic reactions
- C. Moderate doubts about self-worth
- D. Occasional episodic nightmares
Correct Answer: A
Rationale: The correct answer is A because the absence of signs or symptoms of posttraumatic stress disorder indicates successful reorganization after therapy. This demonstrates that the victim has effectively processed and coped with the trauma. Choice B indicates lingering somatic reactions, C suggests ongoing self-esteem issues, and D implies unresolved trauma manifesting in nightmares, all of which do not reflect successful reorganization.
A male patient diagnosed with paranoid schizophrenia typically relates effectively with female staff but angrily tells the male nurse, 'You act like a homosexual. None of the men trust you or want to be around you.' The nurse, who is heterosexual, is perplexed by the patient's statements and discusses the event with his mentor. Which explanation most likely underlies the patient's behavior?
- A. The patient was unleashing unconscious, hostile feelings toward the nurse.
- B. The patient feared the nurse would reject him, so he coped by rejecting the nurse first.
- C. It was the patient's way of distancing himself from potential emotional intimacy.
- D. The patient was coping with homosexual urges by projecting them onto the nurse.
Correct Answer: D
Rationale: The correct answer is D because the patient's accusation of the nurse being homosexual and implying that other men do not trust him or want to be around him suggests projection of the patient's own homosexual urges onto the nurse. This defense mechanism of projection helps the patient avoid acknowledging and dealing with his own uncomfortable feelings by attributing them to someone else.
Option A is incorrect because the patient's behavior is more about projecting feelings onto the nurse rather than unconscious hostility. Option B is incorrect as it focuses on the patient's fear of rejection rather than projecting his own feelings onto the nurse. Option C is incorrect as it does not address the specific dynamic of projecting homosexual urges onto the nurse.
The nurse at the clinic is interviewing a patient who offers a number of vague somatic complaints that might not ordinarily prompt a visit to a caregiver: fatigue, back pain, headaches, and sleep disturbance. The patient seems tense, and after having spoken of the symptoms, seems reluctant to provide more information and is in a hurry to leave. The nurse can best serve the patient by:
- A. Asking if the patient has ever had psychiatric counseling.
- B. Completing a structured abuse assessment protocol.
- C. Exploring the possibility of patient social isolation.
- D. Asking the patient to disrobe to check for signs of abuse.
Correct Answer: B
Rationale: The correct answer is B: Completing a structured abuse assessment protocol. Given the patient's vague complaints, tension, reluctance to provide more information, and hurry to leave, these could be signs of potential abuse. Completing a structured abuse assessment protocol allows the nurse to systematically assess for any signs of abuse, which could be contributing to the patient's somatic complaints. This approach is necessary to ensure the patient's safety and well-being.
Incorrect choices:
A: Asking if the patient has ever had psychiatric counseling - This choice does not directly address the potential abuse concerns indicated by the patient's behavior.
C: Exploring the possibility of patient social isolation - While social isolation could be a contributing factor, the urgency to leave and reluctance to provide information are more indicative of potential abuse.
D: Asking the patient to disrobe to check for signs of abuse - This choice is invasive and inappropriate without first completing a structured abuse assessment protocol to determine if abuse is likely.