Nokea
The school nurse has been alerted to the fact that an 8-year-old boy routinely playacts as a police officer, 'locking up' other children on the playground to the point where the children get scared. The nurse recognizes that this behavior is most likely an indication of:
- A. The need to dominate others
- B. Inventing traumatic events
- C. A need to develop close relationships
- D. A potential symptom of traumatization
Correct Answer: D
Rationale: When an 8-year-old boy engages in playacting as a police officer that instills fear in other children, it can be indicative of a potential symptom of traumatization. This behavior may reflect the child's attempt to process or express experiences of trauma, leading to a manifestation of such distress in his play interactions with others.
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Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania, the psychiatric nurse practitioner recommends:
- A. Clonazepam (Klonopin)
- B. Fluoxetine (Prozac)
- C. Electroconvulsive therapy (ECT)
- D. Lurasidone (Latuda)
Correct Answer: D
Rationale: Lurasidone (Latuda) is an atypical antipsychotic medication commonly used in the treatment of bipolar disorder. It can help manage symptoms of mania by stabilizing mood and reducing the intensity of manic episodes. Given Ted's history of bipolar I disorder and the need to address his manic symptoms, Lurasidone (Latuda) is a suitable recommendation by the psychiatric nurse practitioner to aid in managing Ted's condition effectively.
After Natasha's husband passed away two months ago, she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement?
- A. Depression often begins after a major loss. Losing dad was a major loss.
- B. Bereavement and depression are the same problem.
- C. Mourning is pathological and not normal behavior.
- D. Antidepressant medications will not help this type of depression.
Correct Answer: A
Rationale: It is common for major depressive disorder to be triggered by significant life events, such as the sudden loss of a loved one. Therefore, Nadia's statement that 'Depression often begins after a major loss' is correct. Bereavement and major depressive disorder are related but distinct conditions, and while mourning can be intense, it is generally considered a normal response to loss. Antidepressant medications can be beneficial in treating depression, including cases triggered by a significant loss.
Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his "nice" mom, that he loves school, and gets above-average grades. The strongest explanation for this response is:
- A. Temperament
- B. Genetic factors
- C. Resilience
- D. Paradoxical effects of neglect
Correct Answer: C
Rationale: Resilience is the ability to adapt well despite adversity, which is demonstrated by Christopher's positive relationships and school performance. Despite the challenging situation of being removed from his parents' home, Christopher's ability to form a positive bond with the neighbor, enjoy school, and excel academically showcases his resilience in coping with the circumstances.
What assessment findings would indicate lithium toxicity in a patient hospitalized for an acute manic episode?
- A. Shortness of breath, gastrointestinal distress, chronic cough
- B. Ataxia, severe hypotension, large volume of dilute urine
- C. Gastrointestinal distress, thirst, nystagmus
- D. Electroencephalographic changes, chest pain, dizziness
Correct Answer: B
Rationale: In a patient suspected of lithium toxicity, the presence of ataxia, severe hypotension, and a large volume of dilute urine are key assessment findings. Ataxia is a sign of central nervous system involvement, severe hypotension indicates cardiovascular effects, and a large volume of dilute urine suggests renal impairment, all of which are commonly seen in severe lithium toxicity. Options A, C, and D do not align with typical signs of lithium toxicity.
What principle should guide a nurse's fear about 'saying the wrong thing' to a patient in nurse-patient communication?
- A. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.
- B. The patient is more interested in talking to you than listening to what you have to say and is not likely to be offended.
- C. Considering the patient's history, there is little chance that the comment will do any actual harm.
- D. Most people with a mental illness have, by necessity, developed a high tolerance for forgiveness.
Correct Answer: A
Rationale: Effective nurse-patient communication is guided by the principle that patients value sincere and respectful interactions. A nurse's well-meaning approach that conveys acceptance, respect, and concern helps establish trust and rapport with patients, even if the nurse is apprehensive about making mistakes. It is essential for the nurse to focus on genuine intent and respect for the patient's situation rather than being consumed by the fear of saying something wrong.