Population Based Health Care

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The wife of a patient with schizophrenia is worried about her 17-year-old daughter and asks the nurse what symptoms mark the prodromal stage of schizophrenia. The nurse should respond by listing behaviors such as:

  • A. withdrawal, poor concentration, phobic or obsessive behavior, oddities of speech.
  • B. auditory hallucinations, ideas of reference, thought insertion, and broadcasting.
  • C. stereotyped behavior, echopraxia, echolalia, waxy flexibility, thought-blocking.
  • D. looseness of associations, concrete thinking, echolalia, paranoid delusions.
Correct Answer: A

Rationale: The correct answer is A because the symptoms listed: withdrawal, poor concentration, phobic or obsessive behavior, and oddities of speech are characteristic of the prodromal stage of schizophrenia. During this phase, individuals may start to exhibit subtle changes in behavior and thinking, which may signal the onset of the disorder.

Choice B includes symptoms of active psychosis, such as auditory hallucinations and delusions, which are not typically seen in the prodromal stage. Choice C describes symptoms of catatonia, which are not specific to the prodromal phase. Choice D includes symptoms of acute psychosis, such as paranoid delusions, which are not typically present during the prodromal stage.

In summary, the correct answer is A because it accurately reflects the early, subtle symptoms that may precede the full onset of schizophrenia, while the other choices describe symptoms that are more indicative of later stages of the disorder.

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Which of the following personality disorders describes a person who has an extremely unstable self image, is moody, and does not develop stable relationships?

  • A. borderline
  • B. histrionic
  • C. narcissistic
  • D. schizoid
Correct Answer: A

Rationale: Borderline personality disorder involves unstable self-image, mood swings, and relationship difficulties.

The population of Boston today is compared to its population after World War

  • A. The same
  • B. Slightly higher
  • C. Considerably higher
  • D. Less
Correct Answer: C

Rationale: Boston's population has grown considerably since post-World War II due to urban development and economic opportunities.

A patient with many positive symptoms of schizophrenia, whose behavior is disorganized and who is highly anxious, tells the nurse in the psychiatric emergency department, 'You have got to help me. I do not know what is going on. I think someone is trying to wipe me out. I have to get a gun.' The patient, a college student, lives alone and has no family or support system in the immediate area. He has not left his room in 2 weeks, has not eaten in several days, and is unkempt. Of the available treatment settings, the nurse should recommend:

  • A. admission to an unlocked residential crisis unit.
  • B. inpatient hospitalization on a locked unit.
  • C. attending a day treatment program for 4 weeks.
  • D. admission to a partial hospital program.
Correct Answer: B

Rationale: The correct answer is B: inpatient hospitalization on a locked unit. This option is the most appropriate because the patient is presenting with severe symptoms of schizophrenia, including paranoia, disorganized behavior, and potential harm to self or others by mentioning getting a gun. In this case, the patient requires a higher level of care and safety, which can only be provided in an inpatient hospital setting on a locked unit. Admission to an unlocked residential crisis unit (Choice A) may not provide the necessary level of supervision and security. Attending a day treatment program for 4 weeks (Choice C) may not be intensive enough to address the patient's current crisis. Admission to a partial hospital program (Choice D) also may not provide the required level of supervision and structure for a patient with such acute symptoms.

A friend brings a teenager to the emergency department. The friend found the patient unconscious in a bedroom at a party. Semen is observed on the patient's underclothes. Priority actions by the nurse should focus on:

  • A. Preserving rape evidence.
  • B. Maintaining the patient's airway.
  • C. Obtaining a description of the rape.
  • D. Determining what drugs were ingested.
Correct Answer: B

Rationale: The correct answer is B: Maintaining the patient's airway. This is the priority action because the patient is unconscious and airway patency is crucial for survival. Preserving rape evidence (A) can be important, but the patient's immediate health takes precedence. Obtaining a description of the rape (C) can wait until the patient's condition stabilizes. Determining what drugs were ingested (D) is important but secondary to ensuring the patient can breathe.

A patient referred to the eating disorders clinic lost 35 pounds over 3 months. To assess eating patterns, the nurse should ask:

  • A. Do you often feel fat?
  • B. Who plans the family meals?
  • C. What do you eat in a typical day?
  • D. What do you think about your present weight?
Correct Answer: C

Rationale: Rationale:
C is correct because it directly addresses the assessment of eating patterns by inquiring about the patient's actual food intake. This question provides valuable information on the quantity and quality of food consumed, aiding in diagnosing and treating eating disorders.
Other choices are incorrect:
A is focused on body image and self-perception, not eating patterns.
B is about family dynamics, not the patient's individual eating habits.
D pertains to body weight perception, not the specifics of the patient's diet.

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