Population Based Health Care

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When a patient diagnosed with paranoid schizophrenia was discharged from the unit 6 months ago, the plan was for him to take chlorpromazine (Thorazine), a conventional (first generation) antipsychotic medication, 300 mg po daily. He tells the nurse he stopped taking his pills after a few months because they made him feel like a 'zombie.' What other common side effects should the nurse determine if the patient experienced?

  • A. Sweating, nausea, and weight gain
  • B. Sedation, tremor, and muscle stiffness
  • C. Headache, watery eyes, and runny nose
  • D. Mild fever, sore throat, and skin rash
Correct Answer: B

Rationale: The correct answer is B: Sedation, tremor, and muscle stiffness. These side effects are commonly associated with conventional antipsychotic medications like chlorpromazine. Sedation is a common side effect that can make the patient feel drowsy or sluggish. Tremors are involuntary muscle movements that can affect the hands, arms, or legs. Muscle stiffness can cause rigidity and difficulty moving smoothly. These side effects are known to impact the quality of life and may contribute to the patient feeling like a 'zombie.'

Choices A, C, and D are incorrect because they do not align with the common side effects of conventional antipsychotic medications. Sweating, nausea, and weight gain (Choice A) are not typical side effects of chlorpromazine. Headache, watery eyes, and runny nose (Choice C) are more commonly associated with allergies or cold symptoms rather than antipsychotic medications. Mild fever, sore throat, and skin rash (Choice D)

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Health Services for disabilities in children and youth:

  • A. Are provided by HPB and the Child Development Programmes only
  • B. Are inclusive and equitable
  • C. Are well-integrated with social services
  • D. Ought to include caregiver support and be familycentred
Correct Answer: D

Rationale: Health services should be family-centered and include caregiver support, reflecting best practices in disability care.

A patient diagnosed with schizophrenia tells the community mental health nurse, 'I threw away my pills because they interfere with Gods voice.' The nurse identifies the etiology of the patients ineffective management of the medication regime as:

  • A. inadequate discharge planning
  • B. poor therapeutic alliance with clinicians
  • C. dislike of antipsychotic medication side effects
  • D. impaired reasoning secondary to the schizophrenia
Correct Answer: D

Rationale: The patients ineffective management of the medication regime is most closely related to impaired reasoning. The patient believes in being an exalted personage who hears Gods voice, rather than an individual with a serious mental disorder who needs medication to control symptoms. Data do not suggest any of the other factors often related to medication nonadherence.

One bed is available on the eating disorders unit. Which patient should be admitted? The patient whose assessment findings show the weight dropped from:

  • A. 150 to 102 pounds over a 4-month period.
  • B. 120 to 90 pounds over a 3-month period.
  • C. 130 to 100 pounds over a 2-month period.
  • D. None of the above.
Correct Answer: A

Rationale: The correct answer is A because the patient has experienced a significant weight drop from 150 to 102 pounds over a 4-month period. This represents a loss of 48 pounds over a relatively longer period, indicating a more severe and prolonged issue with weight loss. The other choices show weight drops of 30 pounds over 3 months (B) and 30 pounds over 2 months (C), which are also concerning but not as severe or long-lasting as the situation described in choice A. Choice D is incorrect as at least one patient should be admitted based on the information provided.

A nurse is working with a perpetrator of family violence who has a long history of violent rages when frustrated, with periods of remorse after each outburst. The nurse is most likely to establish the nursing diagnosis of:

  • A. Risk for injury related to victim reprisal.
  • B. Risk for other-directed violence related to stress.
  • C. Ineffective coping related to poor anger management.
  • D. Caregiver role strain related to feelings of being overwhelmed.
Correct Answer: C

Rationale: The correct answer is C: Ineffective coping related to poor anger management. This nursing diagnosis is appropriate because it addresses the perpetrator's inability to manage their anger effectively, leading to violent outbursts. The perpetrator's history of violent rages and subsequent remorse suggest a pattern of maladaptive coping mechanisms. This diagnosis focuses on the underlying issue of poor anger management, which is essential to address in order to prevent future acts of violence.

Choices A, B, and D are incorrect:
A: Risk for injury related to victim reprisal - This choice places the focus on potential harm to the victim as a result of retaliation, which is not the primary issue in this scenario.
B: Risk for other-directed violence related to stress - While stress may contribute to the perpetrator's behavior, the primary issue lies in their poor anger management rather than just stress.
D: Caregiver role strain related to feelings of being overwhelmed - This choice is not appropriate as it does not address the core issue of poor

Prior to discharge, the nurse plans to teach the client and family about relapse. Which items will the nurse include in the teaching?

  • A. Recognition of warning signs of relapse
  • B. Notify the nurse of warning signs present for more than one month
  • C. Lower medication dosage to manage emerging side effects
  • D. Use street drugs judiciously and only in small amounts
Correct Answer: A

Rationale: The correct answer is A because recognizing warning signs of relapse is crucial for early intervention. By identifying these signs, the client and family can seek help promptly, preventing a full relapse. Choice B is incorrect as waiting for signs to persist for more than one month delays intervention. Choice C is incorrect as altering medication dosage without medical advice can be dangerous. Choice D is incorrect as using street drugs is never a safe or appropriate way to manage relapse.

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