Population Specific Care

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The physician prescribes haloperidol (Haldol), a first-generation antipsychotic drug, for a patient with schizophrenia who displays delusions, hallucinations, apathy, and social isolation. Which symptoms should most be monitored to evaluate the expected improvement from this medication?

  • A. Talking to himself, belief that others will harm him
  • B. Flat affect, avoidance of social activities, poor hygiene
  • C. Loss of interest in recreational activities, alogia
  • D. Impaired eye contact, needs help to complete tasks
Correct Answer: A

Rationale: The correct answer is A because the symptoms of delusions and hallucinations are key indicators of improvement in schizophrenia with antipsychotic treatment. These symptoms directly relate to the patient's perception of reality and are core features of the disorder. Monitoring these symptoms provides objective evidence of the medication's effectiveness in addressing the patient's psychotic symptoms.

Choices B, C, and D are incorrect because they mainly indicate negative symptoms of schizophrenia, such as flat affect, social withdrawal, and cognitive deficits. While monitoring these symptoms is important for assessing overall functioning and quality of life, they are not the primary target of improvement with antipsychotic medications. Symptoms like delusions and hallucinations are considered primary targets for evaluating the efficacy of antipsychotic treatment in schizophrenia.

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The Omnibus Budget Reconciliation Act (OBRA) provides standards of care for which of the following:

  • A. Very young
  • B. Older adults
  • C. Those who have certain intellectual communication difficulties
  • D. Those without medical insurance
Correct Answer: B

Rationale: OBRA provides regulations for proper assessment of the elderly (B); for this reason, registered nurses have to provide the initial physical assessment.

The wife of a client newly diagnosed with paranoid schizophrenia asks the nurse, 'My husband was well adjusted until a month ago, and then, after a lot of work stress, he got sick. What can I expect? Will he be this sick for the rest of his life?' What information can the nurse provide about prognosis?

  • A. This disorder responds well to treatment and, with follow-up, may not recur.'
  • B. All types of schizophrenia are chronic relapsing disorders.'
  • C. Outcomes are poor related to client prehospital disorganization.'
  • D. The usual outcome is that only partial remission is achieved.'
Correct Answer: A

Rationale: Step 1: Paranoid schizophrenia is a subtype that tends to have a better prognosis compared to other types.
Step 2: The statement that the disorder responds well to treatment and may not recur aligns with the typical course of paranoid schizophrenia.
Step 3: With proper medication and therapy, individuals with paranoid schizophrenia can experience significant improvement and have periods of stability.
Step 4: Recurrence of symptoms is less likely compared to other types of schizophrenia.
Step 5: Therefore, choice A is correct as it provides accurate information about the prognosis of paranoid schizophrenia.
Summary: Choice B is incorrect because not all types of schizophrenia are chronic relapsing disorders. Choice C is incorrect as outcomes are not solely determined by prehospital disorganization. Choice D is incorrect as partial remission is not the usual outcome for paranoid schizophrenia.

A 14-year-old client on the eating disorders unit refuses to eat her meals and says to the nurse on the unit, 'You can't make me eat! There is nothing wrong with me.' The nurse will assess this as use of which defense mechanism?

  • A. Repression.
  • B. Rationalization.
  • C. Sublimation.
  • D. Denial.
Correct Answer: D

Rationale: The correct answer is D: Denial. Denial is a defense mechanism where an individual refuses to acknowledge reality to avoid discomfort. In this scenario, the client is denying the seriousness of their situation by refusing to eat and claiming there is nothing wrong. Repression (A) involves unconsciously blocking out unpleasant thoughts or feelings. Rationalization (B) is creating logical explanations to justify behavior. Sublimation (C) is redirecting negative impulses into positive behaviors. In this case, denial is the most fitting defense mechanism as the client is refusing to accept the reality of their eating disorder.

Which of the following is the most important initial intervention for a patient with bulimia nervosa?

  • A. Provide a structured mealtime environment with supervision.
  • B. Encourage the patient to participate in support groups immediately.
  • C. Administer antianxiety medications as prescribed.
  • D. Assess the patient's family dynamics and home environment.
Correct Answer: A

Rationale: The correct answer is A: Provide a structured mealtime environment with supervision. This is the most important initial intervention for a patient with bulimia nervosa because it addresses the immediate health concern of disordered eating behavior. By providing a structured mealtime environment with supervision, the patient can establish regular eating patterns, learn healthier eating habits, and reduce the risk of purging behaviors. This intervention also helps in restoring proper nutrition and addressing any underlying issues related to food and eating.

Choice B is incorrect because support groups may be beneficial but are not the most critical initial intervention. Choice C is incorrect as antianxiety medications do not directly address the disordered eating behavior. Choice D is also incorrect as assessing family dynamics and home environment is important but not as crucial as addressing the immediate eating disorder symptoms.

An adult patient tells the case manager, 'I dont have bipolar disorder anymore, so I dont need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now Im bored and dont have any friends.' Where should the nurse refer the patient? Select one tha does not apply.

  • A. Psychoeducational classes
  • B. Vocational rehabilitation
  • C. Social skills training
  • D. A homeless shelter
Correct Answer: D

Rationale: The patient does not understand the illness and need for adherence to the medication regimen. Psychoeducation for the patient (and family) can address this lack of knowledge. The patient, who considers himself friendless, could also profit from social skills training to improve the quality of interpersonal relationships. Many patients with serious mental illness have such poor communication skills that others are uncomfortable interacting with them. Interactional skills can be effectively taught by breaking the skill down into smaller verbal and nonverbal components. Work gives meaning and purpose to life, so vocational rehabilitation can assist with this aspect of care. The nurse case manager will function in the role of crisis stabilizer, so no related referral is needed. The patient presently has a home and does not require a homeless shelter.

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