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When an individual with multiple cognitive disabilities has extraordinary proficiency in one isolated skill, this is known as?
- A. Rainman syndrome
- B. Asperger ability
- C. Intellectual isolation
- D. Savant syndrome
Correct Answer: D
Rationale: Savant Syndrome: Extraordinary proficiency in one isolated skill in individuals with multiple cognitive disabilities, often linked to autism.
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The highest priority for assessment by nurses caring for older adults who self-administer medications is
- A. use of multiple drugs with anticholinergic effects.
- B. overuse of medications for erectile dysfunction.
- C. missed doses of medications for arthritis.
- D. trading medications with acquaintances.
Correct Answer: A
Rationale: The correct answer is A: use of multiple drugs with anticholinergic effects. This is the highest priority because anticholinergic medications are commonly prescribed to older adults and can lead to serious adverse effects such as confusion, memory issues, and falls. Nurses must assess for these effects to prevent harm.
Choice B (overuse of medications for erectile dysfunction) is not as high a priority as anticholinergic effects, as it is not as common and typically has less immediate serious consequences for older adults.
Choice C (missed doses of medications for arthritis) is important but not as critical as assessing for anticholinergic effects, as missed doses can generally be managed through education and adherence support.
Choice D (trading medications with acquaintances) is a serious concern but is not as high a priority as assessing for anticholinergic effects, as the immediate risks associated with anticholinergic medications are more severe.
A patient reports, 'My brain is tapped. The government has implanted a device in my head.' What outcome would the nurse identify as being appropriate for the patient to achieve within 1 week of admission?
- A. Taking antipsychotic medication as prescribed without objection
- B. Giving coherent data to support beliefs that the brain is 'tapped'
- C. Interpreting reality correctly by stating no 'brain tap' has been implanted
- D. Reporting feeling less anxious about having the government listening to interior thoughts
Correct Answer: C
Rationale: The correct answer is C because it reflects the goal of promoting reality testing and challenging the patient's delusional beliefs. By helping the patient interpret reality correctly and recognize that the implanted device is not real, the nurse can support the patient in overcoming their delusions and improving their mental health.
Choice A is incorrect as simply taking medication does not address the underlying delusional belief. Choice B is incorrect as it validates and reinforces the patient's delusion, which is not therapeutic. Choice D is incorrect as it does not address the core issue of the patient's delusional belief and may not lead to long-term improvement in mental health.
The physician's admission note mentions that a patient has sundown syndrome. The nurse can expect that the patient will:
- A. exhibit chronic fatigue.
- B. evidence extreme lethargy at night.
- C. manifest confusion and agitation at night.
- D. be more alert between 6 PM and 11 PM.
Correct Answer: C
Rationale: The correct answer is C: manifest confusion and agitation at night. Sundown syndrome refers to a pattern of behavior where individuals with dementia experience increased confusion, agitation, or restlessness in the late afternoon or evening. This is due to disruptions in the person's internal body clock. It is important for the nurse to anticipate and manage these symptoms during the evening shift.
Choice A: Chronic fatigue is not a typical symptom of sundowning.
Choice B: Extreme lethargy at night is not a common feature of sundown syndrome.
Choice D: Being more alert between 6 PM and 11 PM is not characteristic of sundowning, as individuals with this syndrome typically experience worsening symptoms during these hours.
The nurse is explaining to the family of a patient diagnosed with schizophrenia that the disorder is considered to have neurobiological origins. When the patient's mother asks, 'What part of the brain is dysfunctional?' the nurse should reply, 'Research has implicated the:
- A. medulla and cortex.'
- B. cerebellum and cerebrum.'
- C. hypothalamus and medulla.'
- D. prefrontal and limbic cortices.'
Correct Answer: D
Rationale: The correct answer is D: prefrontal and limbic cortices. The prefrontal cortex is involved in decision-making, problem-solving, and social behavior, functions that are often impaired in schizophrenia. The limbic cortex is responsible for emotions and memory, both of which are affected in schizophrenia. Research has shown abnormalities in these brain regions in individuals with schizophrenia, supporting the neurobiological origins of the disorder. Choices A, B, and C are incorrect as they do not specifically address the brain regions known to be involved in schizophrenia.
A 75-year-old patient comes to the clinic reporting frequent headaches. As the nurse begins the interaction, which action is most important?
- A. Complete a neurological assessment
- B. Determine whether the patient can hear as the nurse speaks
- C. Suggest that the patient lie down in a darkened room for a few minutes
- D. Administer medication to relieve the patient's pain before continuing the assessment
Correct Answer: B
Rationale: Before proceeding with any further assessment, the nurse should assess the patients ability to hear questions. Impaired hearing could lead to inaccurate answers.