Nokea
The nurse is explaining to the family of a patient diagnosed with schizophrenia that the disorder is considered to have neurobiological origins. When the patient's mother asks, 'What part of the brain is dysfunctional?' the nurse should reply, 'Research has implicated the:
- A. medulla and cortex.'
- B. cerebellum and cerebrum.'
- C. hypothalamus and medulla.'
- D. prefrontal and limbic cortices.'
Correct Answer: D
Rationale: The correct answer is D: prefrontal and limbic cortices. The prefrontal cortex is involved in decision-making, problem-solving, and social behavior, functions that are often impaired in schizophrenia. The limbic cortex is responsible for emotions and memory, both of which are affected in schizophrenia. Research has shown abnormalities in these brain regions in individuals with schizophrenia, supporting the neurobiological origins of the disorder. Choices A, B, and C are incorrect as they do not specifically address the brain regions known to be involved in schizophrenia.
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A client with antisocial personality disorder yells, 'Shut up about that, or I'll punch you in the nose!' and shakes his fist at another client in a group meeting after the client speaks negatively of illicit drug use. The nurse quickly determines that the client is at risk to act violently against others as evidenced by his aggressive behavior, verbal threats, and a history of impulsivity. Which is the best approach for the nurse to use?
- A. Seclude the client to protect the other clients and staff.
- B. Put the client in restraints to protect the milieu.
- C. Explore alternate ways to handle frustrating topics in the group.
- D. Tell the client to leave the group until he can behave appropriately.
Correct Answer: C
Rationale: The correct answer is C: Explore alternate ways to handle frustrating topics in the group. This approach focuses on addressing the underlying issue of the client's aggressive behavior by finding healthier ways to manage emotions and conflicts. It promotes therapeutic communication and helps the client develop coping strategies.
Secluding the client (choice A) may escalate the situation and reinforce negative behavior. Putting the client in restraints (choice B) is a physical intervention that should only be used as a last resort for safety reasons. Telling the client to leave the group (choice D) may not address the root cause of the behavior and could lead to further isolation and resentment. Ultimately, exploring alternate ways to handle frustrating topics is the most therapeutic and effective approach in this scenario.
According to family systems theory, removing the 'identified patient' from the environment most likely causes the:
- A. patient to decompensate, due to the loss of their support system
- B. patient to significantly improve, often with minimal or no additional therapy
- C. remaining family members to decompensate, as evidenced by new dysfunctional behavior
- D. remaining family members to lose motivation and withdraw from therapy
Correct Answer: C
Rationale: Family systems theory posits that removing the 'patient' shifts dysfunction to other members, revealing underlying systemic issues.
When teaching a patient with binge-purge bulimia, the nurse should give priority to information about:
- A. Self-monitoring of daily food and fluid intake.
- B. Establishing the desired daily weight gain.
- C. Symptoms of hypokalemia.
- D. Self-esteem maintenance
Correct Answer: C
Rationale: The correct answer is C: Symptoms of hypokalemia. This is the priority because individuals with binge-purge bulimia often have electrolyte imbalances, including hypokalemia, which can lead to serious cardiac complications. Educating the patient on recognizing symptoms of hypokalemia, such as weakness, fatigue, and irregular heartbeats, is crucial for early intervention.
A: Self-monitoring of daily food and fluid intake is important but not the priority when dealing with potential life-threatening complications like hypokalemia.
B: Establishing the desired daily weight gain is not appropriate for individuals with binge-purge bulimia as the focus should be on addressing the underlying psychological issues rather than weight gain.
D: Self-esteem maintenance is important in the long term but does not take precedence over addressing immediate health risks such as hypokalemia.
The intervention of highest priority for a client with stage 3 Alzheimer's disease is to:
- A. Provide a stimulating environment
- B. Maintain hydration and nutrition
- C. Set limits on behavioral disinhibition
- D. Promote self-care activities
Correct Answer: B
Rationale: The correct answer is B because maintaining hydration and nutrition is crucial for the client's overall well-being and health in stage 3 Alzheimer's. Dehydration and malnutrition can lead to serious complications. Providing a stimulating environment (choice A) may be beneficial but not the highest priority. Setting limits on behavioral disinhibition (choice C) may be challenging due to the progression of the disease. Promoting self-care activities (choice D) may not be feasible as the client's cognitive abilities decline. Maintaining hydration and nutrition is essential for the client's survival and quality of life.
To plan effective interventions, the nurse should understand that the underlying reason a patient with paranoid personality disorder is so critical of others probably lies in the patient's:
- A. need to control all aspects of the world around him.
- B. use of intellectualization to protect against anxiety.
- C. inflexible view of the environment and the people in it.
- D. projection of blame for his own shortcomings onto others.
Correct Answer: D
Rationale: The correct answer is D because paranoid personality disorder is characterized by distrust and suspicion of others, leading individuals to project their own negative traits onto others (projection). This defense mechanism helps them avoid accepting their own shortcomings. Option A is incorrect because the focus is on control, not blame. Option B is incorrect as intellectualization is a defense mechanism that involves avoiding emotions by focusing on rational aspects. Option C is incorrect as it refers to rigidity and not projection of blame. In summary, projection of blame onto others is the underlying reason for the critical behavior in paranoid personality disorder.