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When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:
- A. Medications provided are ineffective.
- B. Nurses are trying to control their minds.
- C. The medications will make them sick.
- D. They are not actually ill.
Correct Answer: D
Rationale: The correct answer is D: They are not actually ill. Anosognosia is a symptom of schizophrenia where patients lack awareness of their illness. This leads them to deny their condition and refuse treatment. Choice A is incorrect as it assumes patients are aware of the medication's effectiveness. Choice B is incorrect as it introduces a paranoid belief not related to anosognosia. Choice C is incorrect as it focuses on physical side effects, not denial of illness.
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To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply.
- A. Alcohol use disorder
- B. Major depressive disorder
- C. Stomach cancer
- D. Polydipsia
Correct Answer: A
Rationale: The correct answer is A: Alcohol use disorder. Patients with schizophrenia are at higher risk for co-occurring substance use disorders, including alcohol use disorder. Assessing for alcohol use is crucial as it can worsen symptoms and interfere with treatment. Major depressive disorder (B) is a common comorbidity but is not specific to schizophrenia. Stomach cancer (C) is not directly associated with schizophrenia. Polydipsia (D), excessive thirst, can be seen in schizophrenia due to medication side effects but is not a primary associated condition.
Gilbert, age 19, is described by his parents as a 'moody child' with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:
- A. Favorable with medication
- B. In the relapse stage
- C. Improvable with psychosocial interventions
- D. To have a less positive outcome
Correct Answer: D
Rationale: The correct answer is D: To have a less positive outcome. Gilbert's symptoms of odd behavior, academic decline, social withdrawal, inability to perform household chores, and obsession with locks are indicative of schizophrenia, a severe and chronic mental disorder. Onset at a young age and slow progression are associated with a poorer prognosis. Medication can help manage symptoms but may not completely alleviate them. Psychosocial interventions may offer some support but are unlikely to significantly alter the course of the illness. The relapse stage implies some improvement followed by worsening, which is not described in Gilbert's case. Therefore, option D is the most appropriate as it reflects the challenging nature of schizophrenia in young individuals like Gilbert.
The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.
- A. Is the patient expressing suicidal thoughts?
- B. Does the patient have intact judgment and insight into his situation?
- C. Does the patient have experiences with either community or inpatient mental healthcare facilities?
- D. Does the patient require a therapeutic environment to support the management of psychotic symptoms?
Correct Answer: C
Rationale: The correct answer is C: Does the patient have experiences with either community or inpatient mental healthcare facilities? This question is crucial in determining the most appropriate setting for the patient's treatment. If the patient has prior experience with either setting, it can help the mental health team understand which environment may be more beneficial for the patient's current needs. If the patient has had positive experiences in a community outpatient setting, they may be more likely to benefit from that environment. On the other hand, if the patient has had previous success in an inpatient setting, that may be a more appropriate option. This question helps the team tailor the treatment plan to the patient's individual needs based on their past experiences.
Choices A, B, and D are incorrect as they do not directly address the patient's past experiences with different treatment settings, which is the most relevant factor in determining the appropriate treatment setting for the patient.
Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:
- A. I was so mad I wanted to hit my mother.
- B. I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named Todd.
- C. I forgot that you told me to breathe when I become angry.
- D. I scream as loud as I can when the train goes by the house.
Correct Answer: B
Rationale: The correct answer is B because it demonstrates cognitive restructuring in cognitive-behavioral therapy. The patient challenges their negative thought ("everyone hates me") with evidence to the contrary ("most people like me and I have a friend named Todd"). This shows progress in changing maladaptive thought patterns.
Choice A indicates potential aggression, choice C suggests poor retention of coping strategies, and choice D implies a maladaptive coping mechanism. Overall, B is the correct choice as it aligns with the goals of cognitive-behavioral therapy to challenge and reframe negative thoughts.
The RN on the evening shift receives report that a client is scheduled for electroconvulsive treatment (ECT) in the morning. Which intervention should the RN implement the evening before the scheduled ECT?
- A. Hold all bedtime medications.
- B. Keep the client NPO after mid-night.
- C. Implement elopement precautions.
- D. Give the client an enema at bedtime.
Correct Answer: B
Rationale: The correct answer is B: Keep the client NPO after midnight. This is important to prevent aspiration during ECT, as anesthesia is often used and the client must have an empty stomach. Holding all bedtime medications (choice A) is not necessary unless specified by the healthcare provider. Implementing elopement precautions (choice C) is not relevant to ECT procedure. Giving the client an enema at bedtime (choice D) is unnecessary and not indicated for ECT preparation.