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The nursing diagnosis most likely to be used for a person who has a diagnosis of schizophrenia, paranoid type, is:
- A. social isolation related to impaired ability to trust.
- B. impaired mobility related to fear of losing control of hostile impulses.
- C. fear of being alone related to lack of confidence in significant others.
- D. impaired memory related to poor information processing associated with brain deficits.
Correct Answer: A
Rationale: Step-by-step rationale for choice A:
1. Schizophrenia, paranoid type, involves mistrust and suspicion.
2. Impaired ability to trust can lead to social isolation.
3. "Impaired ability to trust" directly relates to social isolation.
4. Therefore, "social isolation related to impaired ability to trust" is the most likely nursing diagnosis.
Summary of other choices:
- B: Not directly related to mistrust in paranoid schizophrenia.
- C: Lack of confidence in significant others is not a defining characteristic of paranoid schizophrenia.
- D: Impaired memory is not a primary feature of paranoid schizophrenia.
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- A. Late-onset schizophrenia
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Correct Answer: B
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- A. At bedtime, to coincide with rising cortisol levels
- B. Only on school days to improve performance
- C. On an empty stomach
- D. With breakfast and lunch
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A nurse is working with a patient diagnosed with bulimia nervosa. Which of the following would indicate the need for further education?
- A. I know that purging is harmful to my health, but I continue to do it.
- B. I feel better after purging, but I realize it is not a long-term solution.
- C. I can control my eating and purging behaviors without help from others.
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Correct Answer: C
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In planning aftercare for a client with schizophrenia and whose insurance benefits have been exhausted, the nurse who is concerned about overcoming negative symptoms will make provisions for the client to have stimulation, structure, socialization, and support. Which option would best incorporate these factors?
- A. Day hospitalization
- B. Attending a psychosocial club
- C. Living with his elderly mother
- D. Spending free time in the mall
Correct Answer: B
Rationale: The correct answer is B, attending a psychosocial club. This option best incorporates the factors of stimulation, structure, socialization, and support. Psychosocial clubs offer a structured environment with various activities to stimulate the client's mind and prevent social isolation. It provides opportunities for socialization and peer support, which are crucial for individuals with schizophrenia. Day hospitalization may offer structure but lacks the socialization aspect. Living with his elderly mother may provide support but not necessarily the stimulation and structure needed. Spending free time in the mall does not provide the structured environment, socialization, or support necessary for aftercare in schizophrenia.