Population Specific Care

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When a patient with paranoid schizophrenia has a recurrence of positive symptoms after stopping his antipsychotic medication because of its postural hypotension (orthostasis) side effect, he is readmitted to the mental health unit. What measure should the nurse suggest to help the patient address this side effect?

  • A. Ask the doctor to prescribe an anticholinergic drug like trihexyphenidyl (Artane).
  • B. Chew sugarless gum or use sugarless hard candy to moisten your mouth.
  • C. Increase the amount of sleep you get, and try to take frequent rest breaks.
  • D. Wear elastic support hose, drink adequate fluids, and change position slowly.
Correct Answer: D

Rationale: The correct answer is D because wearing elastic support hose, drinking adequate fluids, and changing positions slowly can help prevent postural hypotension associated with antipsychotic medications. Elastic support hose can improve blood circulation and prevent blood pooling in the legs. Adequate fluid intake can help maintain blood volume and blood pressure. Changing positions slowly can prevent sudden drops in blood pressure upon standing.

Choice A (anticholinergic drug) is incorrect as it may worsen symptoms of schizophrenia. Choice B (sugarless gum or candy) is unrelated to postural hypotension. Choice C (increasing sleep and rest breaks) may help with fatigue but does not address postural hypotension directly.

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A 5-year-old presents with a history of urgency of micturition, occasional enuresis, and a slight, non-offensive vaginal discharge for 3 months. She has had no vaginal bleeding. Examination reveals some reddening of the labia majora. Which one of the following is the most likely diagnosis?

  • A. Trichomonal infection.
  • B. Gonorrhoea.
  • C. Cystitis.
  • D. Non-specific vulvo-vaginitis.
Correct Answer: D

Rationale: Non-specific vulvo-vaginitis (E) is common in young girls due to hygiene or irritation, causing these symptoms. Trichomonas (A) and gonorrhoea (B) are rare without sexual history, cystitis (C) lacks vaginal signs, and foreign body (D) typically causes bleeding or foul discharge.

Appropriate teaching for a patient with bulimia nervosa who binges and purges is:

  • A. Not to skip meals or restrict food.
  • B. To eat a small meal after purging.
  • C. To eat a large breakfast but no lunch.
  • D. None of the above.
Correct Answer: A

Rationale: Step-by-step rationale:
1. A: Not skipping meals or restricting food promotes regular eating patterns, helps stabilize blood sugar levels, and reduces the urge to binge.
2. B: Eating a small meal after purging could reinforce the binge-purge cycle and is not a healthy approach.
3. C: Eating a large breakfast but skipping lunch can lead to imbalanced eating habits and is not recommended for treating bulimia nervosa.
4. D: None of the above options provide a comprehensive and effective approach to managing bulimia nervosa symptoms.

A 32-year-old client with an admitting diagnosis of catatonic schizophrenia has been mute and motionless for 2 days. The priority nursing diagnosis is:

  • A. Risk for deficient fluid volume
  • B. Impaired physical mobility
  • C. Impaired social interaction
  • D. Ineffective coping
Correct Answer: A

Rationale: The correct answer is A: Risk for deficient fluid volume. The priority nursing diagnosis in this case is to address the client's physical needs to ensure their safety and well-being. The client's mutism and immobility put them at risk for dehydration and malnutrition. By prioritizing the risk for deficient fluid volume, the nurse can address the immediate physiological needs of the client.

Choice B: Impaired physical mobility is incorrect because while the client is motionless, the immediate concern is addressing the risk of dehydration.

Choice C: Impaired social interaction is incorrect as addressing social interaction is not the priority when the client's physical needs are not being met.

Choice D: Ineffective coping is incorrect because the client's presentation is indicative of a more urgent physical need for hydration and nutrition.

An appropriate short-term goal for a withdrawn, isolated patient diagnosed with schizophrenia is:

  • A. The patient will participate in all therapeutic activities.'
  • B. The patient will define major barriers to communication.'
  • C. The patient will talk about feelings of withdrawal in group.'
  • D. The patient will consistently interact with an assigned nurse.'
Correct Answer: D

Rationale: Step 1: Interacting with an assigned nurse helps build a therapeutic relationship, essential for engaging withdrawn patients.
Step 2: Consistent interaction promotes trust and communication, aiding in the patient's socialization.
Step 3: This goal is specific, measurable, achievable, relevant, and time-bound, aligning with the SMART criteria.
Summary:
A: Participation in all activities may overwhelm the patient.
B: Defining barriers to communication is too advanced for someone withdrawn.
C: Talking about feelings in a group setting may be too challenging for a withdrawn patient.

A rape victim tells the emergency room nurse, 'I feel so dirty. Help me take a shower before anything else.' The nurse should:

  • A. Arrange for the patient to shower.
  • B. Explain that bathing would destroy evidence.
  • C. Suggest the patient wait until after the examination.
  • D. None of the above.
Correct Answer: B

Rationale: The correct answer is B: Explain that bathing would destroy evidence. This is the best choice because preserving evidence is crucial in cases of sexual assault. Bathing could wash away vital evidence needed for investigation and prosecution. It is important to prioritize the victim's physical and emotional well-being, but preserving evidence for forensic examination takes precedence. Choices A, C, and D are incorrect because arranging for the patient to shower, suggesting waiting, or choosing none of the above would risk compromising the evidence needed for justice.

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