CHEAP BUY ! ! !
NCLEX E-Book with FREE Saunders and KAPLAN ($4)
Situation: H., age 40, is brought to the hospital by his wife, who states that for the past week her husband has refused all meals and accused her of trying to poison him. She claims that before this drastic change in behavior, he became withdrawn, forgetful, and inattentive and had frequent mood swings. During the initial interview, H. appears suspicious. His speech, which is only partly comprehensible, reveals that his thoughts are controlled by delusions of possession by the devil. He claims that the devil told him that people around him are trying to destroy him and that he should trust no one. The physician diagnoses paranoid schizophrenia and admits the patient to the psychiatric unit.
33. Schizophrenia is best described as a disorder characterized by:
a) disturbed relationships related to an inability to communicate and think clearly
b) severe mood swings and periods of low to high activity
c) multiple personalities, one of which is more destructive than the others
d) auditory and visual hallucinations
34. The nursing assessment of H. should include careful observation of his:
a) thinking, perceiving, and decision-making skills
b) verbal and nonverbal communication processes
c) affect and behavior
d) psychomotor activity
35. The patient's thought content can be evaluated on the basis of which assessment area?
a) presence or absence of delusions
b) unbiased information from the parent's psychiatric history
c) degree of orientation to person, place and time
d) ability to think abstractly
36. Nursing care for psychotic patient must be based on valid psychiatric and nursing theories. The nurse's interpersonal communication with the patient ans specific nursing interventions must be:
a) flexible enough for the nurse to adjust the nursing care plan as the situation warrants
b) clearly identified, with boundaries and specifically defined roles
c) warm and nonthreatening
d) centered on clearly defined limits and expression of empathy
37. After 2 days on the unit, H. continues to refuse to eat any hospital meals. He has been observed drinking soda and juices bought from a vending machine in the hospital lobby. Which approach is best at this time?
a) have staff members eat meals with H., encouraging him to eat and demonstrating that the food is not poisoned
b) set firm limits with H., restricting his access to vending machine items until he begins to eat at least part of his meals
c) express concern to H. about his refusal to eat but allow him to control what and when he eats while continuing to observe and monitor him
d) ignore H.'s refusal to eat and recognize that he will eat when he is hungry
38. Although H. refuses to eat, he continues to take his medication. Considering his suspicious behavior and delusions, what is the best way to administer his medication?
a) administer all medications parenterally to ensure adequate dosage
b) administer medication only in liquid form to eliminate the possibility of the patient not swallowing his tablets
c) administer a combination of liquid and tablets to ensure that the patient is getting at least some medication
d) administer the medication in the same form each time
39. The nurse observes H. pacing in his room. He is alone but talking in an angry tone. When asked what he was experiencing, he replies, " The devil is yelling in my ear. He says people here want to hurt me." The nurse's best response is:
a) can you tell me more about what the devil is saying to you?
b) how do you feel when the devil says such things to you?
c) I don't hear any voice, H. are you afraid right now?
d) H., the devil cannot talk to you
40. H. has been hearing voices for many years. An approach that has proven effective is for the hallucinating patient to:
a) practice saying "Go away" or "Stop" when he hears voices
b) take an as-needed dose of his psychotropic medication whenever he hears voices
c) sing loudly to drown out voices and to distract himself
d) go to his room until the voices go away
41. H. requests that his room be changed. He states that his roommate is homosexual and has been making advances to him. He wants to be in a private room. How should the nurse reply?
a) remind H. that he is in a hospital and not a hotel and tell him that patients are assigned to rooms on the basis of need
b) tell H. that his request will be discussed that morning and if a room is available he will be moved
c) inform H. that his roommate is not homosexual and that he should get to know him better
d) ask H. if he physically attracted to his roommate
42. Physical activity is an important part of the schizophrenic patient's treatment plan. Assuming H. is capable of the following activities, which one is most appropriate for him?
a) taking a daily brisk walk with a staff member
b) playing a basketball game
c) participating in touch football
d) shooting basketballs with another patient and a staff member
43. Plans are being made for H.'s discharge. His wife expresses concern over whether her husband will continue to take his prescribed medication. The nurse should inform her that:
a) her concern is valid but H. is an adult and has the right to make his own decisions
b) she can easily mix the medication in H.'s food if he stops taking it
c) H. can be given a long-acting medication that is administered every 1 to 4 weeks
d) H. knows that he must take his medication as prescribed to avoid future hospitalizations.
ANSWERS AND RATIONALE
33) A
- Rationale: Schizophrenia can best be described as one of a group of psychotic reactions characterized by disturbances in an individual's relationship with people and an inability to communicate and think clearly. Schizophrenic thoughts, feelings, and behavior are commonly evidenced by withdrawal, fluctuating moods, disordered thinking, and regressive tendencies. Severe mood swings and periods of low to high activity are typical of bipolar disorder. Multiple personality, which is sometimes confused with schizophrenia, is a dissociative personality disorder, not a psychotic illness. many schizophrenic patients have auditory, not visual, hallucinations. Visual hallucinations are more common in organic or toxic disorders.
34) A
- Rationale: the nursing assessment of a psychotic patient requires careful inquiry about and observation of his thinking, perceiving, symbolizing, and decision-making skills and abilities. Assessment of such a patient typically reveals alterations in thought content and process, perception, affect, and psychomotor behavior, changes in personality, coping, and sense of self, lack of self-motivation, presence of psychosocial stressors, and degeneration of adaptive functioning. Although assessing the patient's communication processes, affect, behavior, and psychomotor activity would reveal important information about the patient's condition, the nurse should concentrate on determining whether the patient is hallucinating by assessing his thought processes and decision-making ability.
35) A
- Rationale: because delusions constitute the major disturbance in thought content, the nurse should base her assessment on their presence or absence. Although patients may report delusions spontaneously, specific questioning usually is required. Clues suggesting the presence of delusions are evasiveness, suspicion, and other indications of sensitivity to interview questions. The nurse cannot effectively evaluate the patient's thought content from his history. A patient can be oriented to person, place, and time yet still have delusions. Abstract thinking, the ability to infer beyond the literal and concrete meaning of words, reflects the patient's type of thinking, not its content.
36) A
- Rationale: a flexible care plan is needed for any patient who behaves in a suspicious, withdrawn, or regressed way or who has thought disorder. Because such a patient communicates at different levels and is in control of himself at various times, the nurse must be able to adjust the nursing care as the situation warrants. The nurse's role should be clear, however, the boundaries or limits of her role should be flexible enough to meet patient needs. Because a schizophrenic patient fears closeness and affection, a warm approach may be too threatening at this time. Expressing empathy is important, but centering interventions on clearly defined limits is impossible because the patient's situation can change without warning.
37) C
- Rationale: the nurse must avoid a power struggle with H. about his eating habits to prevent any further escalation of paranoia. The patient should be allowed to eat what he chooses as long as no coexisting medical problem, such as diabetes or a compromised fluid and electrolyte status, is present. However, the nurse should monitor the patient's physical status closely. As H. begins to trust the environment and those in it and his psychotic symptoms subside with medication, he will begin to eat. H.'s delusions about food poisoning probably will not be corrected by having staf members eat with him or by setting firm limits. Theses activities may heighten his suspicion and augment his paranoid behavior. The nurse should not ignore H.'s behavior or assume that he will eat eventually, doing so could place the patient at risk for dehydration and malnutrition.
38) D
- Rationale: paranoid patients are hypersensitive to changes in routines and established patients. Consistency on the part of the nurse and other staff members fosters trust and security. Medication should be administered in the same form each time -- for example, the same number of tablets with the same type of juice. Parenteral routes are generally used only when the patient refuses oral medication or is extremely agitated. Liquid psychotropic agents can be distasteful but may be ordered if the nurse suspects that the patient is not swallowing his tablets. The nurse should not give the patient a combination of liquid and tablets because it may confuse him.
39) C
- Rationale: when dealing with hallucinating patient, the nurse should assess the patient's needs and reflect reality by telling him that she does not hear or share his perception. Because hallucinations are generally projections of the patient's own unconscious thoughts and feelings, the nurse should not deny the patient's experience. However, asking about the voices in a way that implies the nurse agrees with their reality is nontherapeutic. Telling H. that the devil cannot talk to him is confrontational and judgmental.
40) A
- Rationale: researchers have found that the most patients can learn to control bothersome hallucinations by telling the voices to go away or stop. Since H. has been hearing voices for many years, this approach would be appropriate for him. Taking an as-needed dose of psychotic medication whenever he hears voices may lead to overmedication and put him at risk for adverse effects, such as extrapyramidal symptoms. Because it is unlikely that H. will become totally free of the voices, he must learn to deal with the hallucinations without relying on medication. Although distraction is helpful, singing loudly may upset other patients and will be socially unacceptable after the patient is discharged. Hallucinations are most bothersome when it is quiet and the patient is alone, so going to his room would increase rather than decrease the hallucinations.
41) B
- Rationale: telling H. that his request for a room change will be discussed with other team members is an honest and factual response. Paranoid patients are commonly disturbed by doubts about gender identity, which is expressed as beliefs that others think they are homosexual or that others are making homosexual advances to them. A change of room would be appropriate if possible. Responding by telling the patient that he is not in a hotel would be inappropriate and only serve to alienate him from the staff. Attempting to dissuade the patient from his beliefs by telling him that his roommate is not homosexual or confronting him about his possible attraction to his roommate would further increase his anxiety.
42) A
- Rationale: the patient should encouraged to participate in noncompetitive and nonthreatening physical activity. A brisk walk with a staff member best meets H.'s activity needs at this time. Activities such as basketball and touch football should be avoided because they require the patient to have physical contact with others, particularly other men. Since H. has already expressed some homosexual concerns, these activities would be threatening to him.
43) C
- Rationale: medications such as fluphenazine decanoate (Prolixin Decanoate), fluphenazine enanthate (Prolixin enanthate), and haloperidol decanoate (haldol decanoate) are long-acting psychotropic drugs that are given by depot injection every 1 to 4 weeks. These agents are especially useful for noncompliant patients because they are not given daily and their effect can be monitored when the patient receives his injection at the outpatient clinic. This arrangement also puts less stress on family members by alleviating the burden of having to monitor the patient's compliance with the medication regimen. A patient has the right to refuse medication, but this issue is not the focus of discussion at this time. Medication should never be hidden in food or drink to trick the patient into taking it. Besides destroying the patient's trust, it places the patient at risk for overmedication or undemedication because the amount administered is difficult to determine. Assuming that the patient knows he must take his medication as prescribed to avoid future hospitalizations is unrealistic; many schizophrenic patients are noncompliant and require close monitoring by family members.
Related Topics:
Posts
