Nokea
The onset of schizophrenia most commonly occurs during the decade of age in the:
- A. Teens
- B. 20s
- C. 30s
- D. 40s
Correct Answer: B
Rationale: The correct answer is B (20s) because research shows that the peak onset of schizophrenia is typically during late adolescence to early adulthood, which aligns with the age range of the 20s. During this period, the brain undergoes significant developmental changes, making individuals more vulnerable to developing schizophrenia. Choices A (Teens), C (30s), and D (40s) are incorrect because while schizophrenia can develop at any age, the majority of cases emerge during the 20s. Schizophrenia rarely starts in the teenage years (A), and onset in the 30s (C) or 40s (D) is less common compared to the 20s.
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Which statement by a patient with borderline personality disorder best indicates the treatment plan is helping?
- A. I think you are the best nurse on the unit.'
- B. I hate my doctor. He never gives me what I ask for.'
- C. I feel empty and want to cut myself, so I called you.'
- D. I'm never going to get high on drugs again.'
Correct Answer: C
Rationale: The correct answer is C. This statement indicates progress because the patient is demonstrating insight into their emotions, seeking help, and utilizing a coping strategy by reaching out for support instead of engaging in self-harm. Choice A does not provide information about progress in treatment. Choice B reflects a negative attitude towards the doctor. Choice D does not offer any insight into the patient's emotional state or progress in managing their behaviors.
A client with dementia is unable to name ordinary objects. Instead, he describes them (e.g., 'the thing you cut meat with'). The nurse should assess this as:
- A. Aphasia.
- B. Paraphasia.
- C. Apraxia.
- D. None of the above.
Correct Answer: B
Rationale: The correct answer is B: Paraphasia. Paraphasia is a language disturbance characterized by the substitution of one word for another, leading to incorrect or nonsensical speech. In the case of the client with dementia unable to name ordinary objects but describing them, such as 'the thing you cut meat with,' this behavior aligns with paraphasia. Aphasia (choice A) refers to a complete loss or impairment of language function, which is not the case here. Apraxia (choice C) involves the inability to perform purposeful movements, not language deficits. Therefore, the client's behavior is best assessed as paraphasia due to the characteristic word substitutions and descriptions given.
A nurse would attempt to reduce nighttime agitation for a patient with either delirium or dementia by:
- A. giving warm milk as a snack at bedtime.
- B. keeping a soft light on in the patient's room.
- C. placing a large-faced lighted alarm clock opposite the bed.
- D. hanging family pictures near enough to the bed to be easily seen.
Correct Answer: B
Rationale: The correct answer is B: keeping a soft light on in the patient's room. This helps to reduce nighttime agitation by providing a soothing environment without complete darkness, which can cause confusion and disorientation in patients with delirium or dementia. Warm milk (A) may not address the underlying cause of agitation. A large-faced lighted alarm clock (C) may be distracting and increase confusion. Family pictures (D) may not directly impact nighttime agitation and could potentially overstimulate the patient.
A client who received chlorpromazine (Thorazine) for 15 years to treat schizophrenia developed tardive dyskinesia as evidenced by tongue thrusting and chewing motions. The physician discontinued the chlorpromazine and prescribed Seroquel (quetiapine). As a result of this change, the nurse should carefully monitor for:
- A. Development of pseudoparkinsonism
- B. Development of dystonic reactions
- C. Improvement in tardive dyskinesia
- D. Worsening of anticholinergic symptoms
Correct Answer: C
Rationale: The correct answer is C: Improvement in tardive dyskinesia. Tardive dyskinesia is a side effect of long-term antipsychotic use, like chlorpromazine. Quetiapine (Seroquel) is an atypical antipsychotic with a lower risk of causing tardive dyskinesia. By discontinuing chlorpromazine and switching to quetiapine, there is a higher likelihood of improvement or resolution of tardive dyskinesia symptoms. Options A and B are incorrect as they are related to other movement disorders caused by antipsychotics. Option D is incorrect as anticholinergic symptoms are not directly related to tardive dyskinesia improvement with the medication switch.
A patient whose boyfriend raped her during an argument tells the nurse, 'It's no use reporting it. No one will ever believe me, because everyone knows I've been sexually intimate with him many times before.' Which response by the nurse would have the greatest therapeutic value initially?
- A. You will need to talk to someone. Do you have a best friend to talk to?'
- B. It's not your fault. He needs to get help controlling his anger.'
- C. The police need to be aware that your boyfriend is willing to act this way when he's angry.'
- D. If you said 'no,' your boyfriend needs to respect your wishes. He needs help so this will never happen again.'
Correct Answer: D
Rationale: Rationale for Correct Answer D:
1. Acknowledges the patient's agency and emphasizes consent.
2. Validates the patient's experience and emphasizes boundaries.
3. Encourages the patient to prioritize her safety and well-being.
4. Addresses the need for intervention and prevention of future harm.
Summary:
A: Does not address the issue of consent or the need for intervention.
B: Shifts focus from perpetrator to victim, potentially placing blame.
C: Focuses on legal action without addressing the patient's emotional needs.
D: Empowers the patient, emphasizes consent, and prioritizes safety and prevention.