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When a patient with schizophrenia is taking haloperidol, what is a priority assessment for the nurse?
- A. Assessing for signs of tardive dyskinesia
- B. Monitoring for signs of neuroleptic malignant syndrome
- C. Checking for signs of depression
- D. Monitoring for changes in appetite
Correct Answer: B
Rationale: The correct answer is B: Monitoring for signs of neuroleptic malignant syndrome. This is because neuroleptic malignant syndrome is a potentially life-threatening side effect of haloperidol, characterized by fever, muscle rigidity, altered mental status, and autonomic dysfunction. It requires immediate medical intervention. Assessing for tardive dyskinesia (A) is important but not as urgent as monitoring for neuroleptic malignant syndrome. Checking for signs of depression (C) is relevant but not a priority when the patient is at risk of a serious adverse reaction. Monitoring changes in appetite (D) is less critical than assessing for neuroleptic malignant syndrome, as it is a common side effect that does not pose an immediate threat to the patient's life.
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When developing a care plan for a patient with borderline personality disorder, which intervention should be included to address self-harm behaviors?
- A. Encouraging the patient to keep a journal of their thoughts and feelings.
- B. Setting clear and consistent boundaries with the patient.
- C. Providing the patient with coping skills to manage their emotions.
- D. Developing a safety plan with the patient.
Correct Answer: D
Rationale: The correct answer is D, developing a safety plan with the patient. This intervention is crucial for addressing self-harm behaviors in patients with borderline personality disorder. A safety plan helps the patient identify triggers, warning signs, coping strategies, and support networks to prevent self-harm. It also outlines specific steps to take in a crisis situation. This intervention is more direct and practical compared to the other options.
A: Keeping a journal may be helpful for self-reflection but may not provide immediate strategies to prevent self-harm.
B: Setting boundaries is important but may not directly address self-harm behaviors.
C: Providing coping skills is beneficial, but a safety plan is more specific and tailored to managing self-harm risks.
In summary, developing a safety plan is the most effective intervention for addressing self-harm behaviors in patients with borderline personality disorder.
Which therapeutic communication technique is being used when the nurse says, 'Tell me more about what you are feeling right now'?
- A. Restating
- B. Clarification
- C. Reflection
- D. Exploration
Correct Answer: D
Rationale: The correct answer is D: Exploration. This therapeutic communication technique encourages the patient to expand on their feelings, promoting exploration of thoughts and emotions. By asking the patient to elaborate on their feelings, the nurse facilitates deeper understanding. Restating (A) involves repeating the patient's words back to them. Clarification (B) is seeking to understand the patient's meaning. Reflection (C) involves mirroring the patient's emotions. In this scenario, the nurse is prompting the patient to delve further into their emotions, making exploration the most appropriate technique.
A patient with panic disorder is prescribed alprazolam. Which instruction is most important for the nurse to include in the teaching plan?
- A. Avoid driving until you know how the medication affects you.
- B. Take the medication with food to avoid stomach upset.
- C. Take the medication at bedtime to help with sleep.
- D. Increase the dose if you do not feel better in a few days.
Correct Answer: A
Rationale: The correct answer is A: Avoid driving until you know how the medication affects you. This is crucial because alprazolam can cause drowsiness and impair cognitive function. It is important to prioritize safety and prevent accidents. Choice B is incorrect as alprazolam does not necessarily need to be taken with food. Choice C is incorrect as alprazolam is typically taken during the day due to its sedative effects. Choice D is incorrect as increasing the dose without medical guidance can lead to overdose and adverse effects.
A patient with obsessive-compulsive disorder (OCD) spends hours washing their hands. Which nursing intervention is most appropriate?
- A. Encouraging the patient to stop washing their hands
- B. Allowing the patient to wash hands at specified times
- C. Ignoring the patient's behavior
- D. Setting strict limits on the time allowed for hand washing
Correct Answer: B
Rationale: The correct answer is B: Allowing the patient to wash hands at specified times. This option acknowledges the patient's need for hand washing while also setting boundaries. By allowing the patient to wash hands at specified times, the nurse can help establish a routine and gradually reduce the excessive hand washing behavior. Encouraging the patient to stop washing hands (A) may increase anxiety and resistance. Ignoring the behavior (C) can reinforce it. Setting strict limits (D) may cause distress and worsen the OCD symptoms. Option B strikes a balance between addressing the patient's needs and promoting healthier behaviors.
A healthcare professional is assessing a patient with bipolar disorder. Which finding suggests the patient is experiencing a manic episode?
- A. Decreased need for sleep
- B. Feelings of worthlessness
- C. Increased need for sleep
- D. Avoidance of social interactions
Correct Answer: A
Rationale: The correct answer is A: Decreased need for sleep. During a manic episode in bipolar disorder, individuals often experience decreased need for sleep. This is a key symptom of mania, as it is characterized by high energy levels, impulsivity, and decreased need for rest. In contrast, option B (feelings of worthlessness) is more reflective of symptoms seen in depressive episodes, not manic episodes. Option C (increased need for sleep) is also not indicative of mania, as mania is associated with decreased sleep. Option D (avoidance of social interactions) may occur in some cases, but it is not a defining feature of mania.