Age Specific Care

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The physician and advanced practice nurse are considering which antipsychotic medication to prescribe for a patient with schizophrenia who demonstrates auditory hallucinations, apathy, anhedonia, and poor social functioning. The patient is overweight and has hypertension. Bearing these facts in mind, the drug the nurse should advocate would be:

  • A. clozapine (Clozaril).
  • B. haloperidol (Haldol).
  • C. olanzapine (Zyprexa).
  • D. aripiprazole (Abilify).
Correct Answer: D

Rationale: The correct answer is D: aripiprazole (Abilify). Aripiprazole is a second-generation antipsychotic that is less likely to cause weight gain and metabolic side effects compared to other antipsychotics. This is important since the patient is already overweight and has hypertension. Aripiprazole also has a lower risk of causing sedation, which can be beneficial for addressing apathy and anhedonia without worsening social functioning.

A: Clozapine is effective for treatment-resistant schizophrenia but is associated with significant weight gain and metabolic side effects.
B: Haloperidol is a first-generation antipsychotic with a high risk of extrapyramidal side effects and is not ideal for a patient with hypertension.
C: Olanzapine is known for causing significant weight gain and metabolic effects, making it a less suitable choice for an overweight patient with hypertension.

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A patient remanded by the court after his wife had him jailed for battery told the judge how sorry he was and suggested he needed psychiatric help. His history reveals acting-out behaviors as an adolescent and several adult arrests. The nurse interviews him about his relationship with his wife. Which statement by the patient is most consistent with a diagnosis of antisocial personality disorder?

  • A. I've done some stupid things in my life, but I've learned a lesson.'
  • B. I'm feeling terrible about the way my behavior has hurt my family.'
  • C. I have a quick temper, but I can usually keep it under control.'
  • D. I hit her because she nags at me. She deserves it when I beat her up.'
Correct Answer: D

Rationale: The correct answer is D. This statement reflects a lack of remorse, empathy, and justification for violent behavior, which are key characteristics of antisocial personality disorder. The patient blames his wife for his violent actions and shows a sense of entitlement.

A: This statement shows acknowledgment of mistakes and a willingness to learn from them, which is not consistent with antisocial personality disorder.
B: Expressing feeling terrible about hurting family members demonstrates some level of empathy and remorse, which is not typical of individuals with antisocial personality disorder.
C: Acknowledging a quick temper but being able to control it does not align with the impulsivity and lack of control often seen in individuals with antisocial personality disorder.

The nursing diagnosis Rape-trauma syndrome is established for a rape victim in the emergency department. Select the most important outcome to achieve before discharging the patient!

  • A. The patient will describe feelings of safety and relaxation.
  • B. The memory of the rape will be less vivid and less frightening.
  • C. Physical symptoms of pain and discomfort are no longer present.
  • D. The patient will agree to keep a follow-up appointment with a rape victim advocate.
Correct Answer: D

Rationale: The correct answer is D. Establishing a follow-up appointment with a rape victim advocate is crucial for ongoing support and recovery. It ensures the patient has access to necessary resources and assistance in coping with the trauma. Choice A focuses on emotional well-being but doesn't address long-term support. Choice B addresses memory but doesn't ensure ongoing care. Choice C only addresses physical symptoms, neglecting the emotional and psychological impact of the trauma. Thus, choice D is the most important outcome to achieve before discharging the patient to promote comprehensive care and support.

Drugs that treat individuals with schizophrenia interrupt neurotransmitter pathways in the brain, producing an effect throughout the entire nervous system that is:

  • A. Calming
  • B. Numbing
  • C. Satisfying
  • D. Stimulating
Correct Answer: A

Rationale: The correct answer is A: Calming. Drugs used to treat schizophrenia often target neurotransmitter pathways to reduce symptoms like hallucinations and delusions. By regulating neurotransmitters like dopamine, these drugs help calm the individual's brain activity, leading to a reduction in psychotic symptoms. Choices B, C, and D are incorrect because drugs for schizophrenia are not intended to numb, satisfy, or stimulate the nervous system; rather, they aim to restore balance and alleviate distressing symptoms.

Which of the following is a common complication of anorexia nervosa?

  • A. Hypertension and hyperglycemia.
  • B. Cardiovascular instability and electrolyte imbalances.
  • C. Insulin resistance and excessive weight gain.
  • D. Severe dehydration and frequent urination.
Correct Answer: B

Rationale: The correct answer is B: Cardiovascular instability and electrolyte imbalances. Anorexia nervosa can lead to severe malnutrition, causing cardiovascular issues like low heart rate and blood pressure. Electrolyte imbalances occur due to inadequate nutrient intake. Hypertension and hyperglycemia (choice A) are not common in anorexia. Insulin resistance and weight gain (choice C) are more associated with conditions like obesity. Severe dehydration and frequent urination (choice D) are not typical manifestations of anorexia.

Which information would be important to incorporate when teaching about medications for dementia in a caregiver's support group? Select all that apply.

  • A. Antipsychotic medications have been shown to be the most useful category of drugs in reducing behavioral problems in dementias.
  • B. Most currently available medications slow the progress of the disease in 20% to 50% of patients but usually do not significantly improve functioning.
  • C. None of the currently available medications for dementias provide a cure.
  • D. None of the above.
Correct Answer: B

Rationale: The correct answer is B because it accurately conveys important information about medications for dementia to caregivers. It emphasizes that most medications do not significantly improve functioning but may slow disease progression in a subset of patients. This is crucial for setting realistic expectations.

Choice A is incorrect because antipsychotic medications are not the most useful category of drugs for reducing behavioral problems in dementia; they are associated with serious side effects and should be used cautiously.

Choice C is incorrect because it is essential for caregivers to understand that medications do not cure dementia; managing symptoms and slowing progression are the primary goals.

Choice D is incorrect as the correct answer is B, which provides valuable information for caregivers to understand the limitations and benefits of medications for dementia.

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