Nokea
The treatment team believes medication will help a patient diagnosed with adult attention-deficit/hyperactivity disorder (ADHD). Which class of medications does the nurse expect will be prescribed?
- A. Benzodiazepines
- B. Stimulants
- C. Antipsychotics
- D. Anxiolytics
Correct Answer: B
Rationale: Stimulants, such as methylphenidate and amphetamines, provide the basis for treatment of both adult and childhood ADHD. They are the most commonly used medications; therefore, the nurse could expect the health care provider to prescribe a drug in this class. None of the other drugs listed as options have proved useful in the treatment of ADHD.
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A 37 year old is involuntarily committed to outpatient treatment after sexually molesting a 12-year-old child. The patient says, 'That girl looked like she was 19 years old.' Which defense mechanism is this patient using?
- A. Denial
- B. Identification
- C. Displacement
- D. Rationalization
Correct Answer: D
Rationale: Rationalization is used to justify upsetting behaviors by creating reasons that would allow the individual to believe that the behaviors were warranted or appropriate. The patient is rationalizing molestation of a minor. Denial is used to avoid dealing with the problems and responsibilities related to one's behaviors. Identification is incorporating the image of an emulated person and then acting, thinking, and feeling like that person. Displacement is the discharge of pent-up feelings onto something or someone else in the environment that is less threatening than the original source of the feelings.
For patients diagnosed with severe and persistent mental illness, what is the major advantage of case management?
- A. Modification of traditional psychotherapy
- B. Efficient access and use of resources
- C. Focus on social skills training and self-esteem building
- D. Bringing groups of patients together to discuss common problems
Correct Answer: B
Rationale: The case manager not only provides entrance into the system of care, but he or she also coordinates the multiple referrals that so often confuse the patient who is severely and persistently mentally ill and the patient's family. Case management promotes the efficient use of services. The other options are lesser advantages or may be irrelevant.
A homeless patient diagnosed with severe and persistent mental illness became suspicious and delusional. The patient was given depot antipsychotic medication and housing was arranged at a local shelter. After 2 weeks, which statement by the patient indicates significant improvement?
- A. I am feeling safe and comfortable here. Nobody bothers me.'
- B. They will not let me drink. They have many rules in the shelter.'
- C. Those guys are always watching me. I think someone stole my shoes.'
- D. That shot made my arm sore. I'm not going to take any more of them.'
Correct Answer: A
Rationale: Evaluation of a patient's progress is made based on patient satisfaction with the new health status and the health care team's estimation of improvement. For a formerly delusional patient to admit to feeling comfortable and free of being 'bothered' by others denotes an improvement in the patient's condition. The other options suggest that the patient is in danger of relapse.
A patient diagnosed with severe and persistent mental illness who recently moved to a homeless shelter says, 'My life is out of control. I'm like a leaf at the mercy of the wind.' The nurse formulates the diagnosis Powerlessness. Outcomes will focus on which goal?
- A. Instilling hope
- B. Controlling anxiety
- C. Planning social activities
- D. Developing personal autonomy
Correct Answer: D
Rationale: Powerlessness is associated with feeling unable to control events in one's life. It is often associated with low self-esteem. The goal is to increase one's sense of autonomy. The scenario does not indicate hopelessness or anxiety. Socialization is not the primary need.
A patient diagnosed with severe and persistent mental illness lives in a homeless shelter. The priority nursing diagnosis for this patient is Powerlessness. Which intervention should be included in the plan of care?
- A. Encourage mutual goal setting.
- B. Verbally communicate empathy.
- C. Reinforce participation in activities.
- D. Demonstrate an accepting attitude.
Correct Answer: A
Rationale: Mutual goal setting is an intervention designed to promote feelings of personal autonomy and dispel feelings of powerlessness. Although it might be easier and faster for the nurse to establish a plan and outcomes, this action contributes to the patient's sense of powerlessness. Involving the patient in decision making empowers the patient and reduces feelings of powerlessness.