Age Specific Populations

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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 (Ability).
Correct Answer: D

Rationale: The correct answer is D: aripiprazole (Ability). Aripiprazole is a second-generation antipsychotic that is less likely to cause weight gain and metabolic side effects compared to other antipsychotics like clozapine (A), olanzapine (C), and haloperidol (B). Given that the patient is overweight and has hypertension, aripiprazole would be a better choice to minimize the risk of exacerbating these conditions. Additionally, aripiprazole has a lower risk of sedation, which can be beneficial for a patient with apathy and anhedonia, allowing for improved social functioning. Aripiprazole's unique mechanism of action as a partial dopamine agonist can also be advantageous for managing auditory hallucinations in schizophrenia. Therefore, aripiprazole is the most suitable choice for this patient based on their clinical presentation and comorbidities.

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When planning nursing care for a client with a dependent personality disorder, the nurse recognizes which of the following as characteristic behavior for someone with this disorder? The client:

  • A. Perceives his or her behavior to be embarrassing
  • B. Believes he or she cannot function without help of others
  • C. Exaggerates the potential dangers of ordinary situations
  • D. Demands excessive attention from others
Correct Answer: B

Rationale: The correct answer is B because individuals with dependent personality disorder typically believe they cannot function without the help of others. This is a key characteristic of the disorder as they rely heavily on others for decision-making and day-to-day tasks. This behavior stems from an intense fear of separation and abandonment.

Choice A (perceiving behavior as embarrassing) is incorrect as it is more aligned with social anxiety disorder rather than dependent personality disorder. Choice C (exaggerating dangers) is incorrect as it is more characteristic of individuals with anxiety disorders. Choice D (demanding excessive attention) is incorrect as it is more typical of individuals with histrionic personality disorder.

A patient admitted to the eating disorders unit has yellow skin, the extremities are cold, and the heart rate is 42 bpm. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient is quiet during the assessment, saying only, 'I will not eat until I lose enough weight to look thin.' Select the best initial nursing diagnosis.

  • A. Anxiety related to fear of weight gain.
  • B. Disturbed body image related to weight loss.
  • C. Ineffective coping related to lack of conflict resolution skills.
  • D. None of the above.
Correct Answer: D

Rationale: Rationale for Correct Answer (D): None of the above is the best initial nursing diagnosis because the patient's symptoms suggest a severe medical condition rather than psychological issues. The yellow skin, cold extremities, low heart rate, extreme low weight, and refusal to eat indicate severe malnutrition and possible organ failure. Therefore, the priority is to address the patient's immediate medical needs, such as restoring electrolyte balance and preventing further complications. Psychological assessments and diagnoses can follow once the patient's physical health is stabilized.

Summary of Other Choices:
A: Anxiety related to fear of weight gain - This choice focuses on psychological factors, but the patient's symptoms indicate severe physical malnutrition rather than anxiety.
B: Disturbed body image related to weight loss - While body image issues may be present, the patient's critical medical condition takes precedence over psychological concerns.
C: Ineffective coping related to lack of conflict resolution skills - This choice does not address the urgency of the patient's physical symptoms and is not the most

A psychosis arising from an advanced stage of syphilis, in which the disease attacks brain cells, is called

  • A. Korsakoff's syndrome
  • B. delirium tremens
  • C. schizotypical psychosis
  • D. general paresis
Correct Answer: D

Rationale: General paresis results from neurosyphilis, causing psychotic symptoms due to brain damage.

When a patient with paranoid schizophrenia has a recurrence of positive symptoms after stopping his antipsychotic medication because of its postural hypotension (orthostasis) side effect, he is readmitted to the mental health unit. What measure should the nurse suggest to help the patient address this side effect?

  • A. Ask the doctor to prescribe an anticholinergic drug like trihexyphenidyl (Artane).
  • B. Chew sugarless gum or use sugarless hard candy to moisten your mouth.
  • C. Increase the amount of sleep you get, and try to take frequent rest breaks.
  • D. Wear elastic support hose, drink adequate fluids, and change position slowly.
Correct Answer: D

Rationale: The correct answer is D because orthostatic hypotension is a common side effect of antipsychotic medications. Elastic support hose can help improve venous return, adequate fluids can prevent dehydration which worsens hypotension, and changing position slowly can prevent sudden drops in blood pressure. This measure directly addresses the side effect.

A: Anticholinergic drugs can worsen orthostatic hypotension.
B: Chewing gum or using candy does not address the physiological issue of orthostatic hypotension.
C: Increasing sleep and rest breaks may help overall well-being but does not directly address orthostatic hypotension.

After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This patient now requires persistent direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of:

  • A. side effects of antipsychotic medications.
  • B. dependency caused by institutionalization.
  • C. cognitive deterioration from schizophrenia.
  • D. stress associated with acclimation to the community.
Correct Answer: B

Rationale: Institutions impede independent functioning, fostering dependency (B) over time as daily activities are directed by staff. Antipsychotic side effects (A) and cognitive issues (C) may contribute, but the scenario suggests institutional adaptation. Stress (D) is less likely the primary cause.

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