Nursing Elites

1. Gilbert, age 19, is described by his parents as a moody child with an onset of odd behavior 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 scenario describes Gilbert as having an early and slow onset of schizophrenia, which typically indicates a less positive prognosis. Individuals with such presentations may experience more severe symptoms and difficulties in functioning, leading to a poorer long-term outcome. In Gilbert's case, his challenges with completing tasks, social withdrawal, and fixation on security measures suggest a more challenging prognosis. Early detection and intervention are crucial in managing schizophrenia, but the described symptoms and onset pattern are concerning for a less favorable outcome.

2. A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?

• A. Obsessive-compulsive disorder
• B. Generalized anxiety disorder
• C. Persistent depressive disorder
• D. Substance use disorder

Correct answer: D

Rationale: The correct answer is D, Substance use disorder. Ramelteon is preferred for patients with substance use disorder because it lacks abuse potential. This makes it a safer choice for individuals with a history of substance misuse. Choosing a medication with a lower risk of abuse in this population is crucial to prevent potential misuse or dependence issues.

3. A client with schizophrenia is prescribed risperidone. Which statement by the client indicates a need for further teaching?

• A. I can stop taking this medication once I feel better.
• B. I need to avoid drinking alcohol while taking this medication.
• C. I should take this medication with food to avoid stomach upset.
• D. This medication may cause weight gain.

Correct answer: A

Rationale: The correct answer is A. Risperidone should be taken consistently as prescribed and should not be stopped abruptly. It is essential to educate the client that discontinuing the medication without medical advice can lead to a worsening of symptoms or potential relapse. Choices B, C, and D demonstrate understanding of important considerations when taking risperidone, such as avoiding alcohol, taking it with food to reduce stomach upset, and being aware of the potential side effect of weight gain. Choice A suggests a misconception that the medication can be discontinued once the client feels better, which is incorrect and requires further clarification to ensure treatment adherence and effectiveness.

4. Which statement about the concept of psychoses is most accurate?

• A. Individuals experiencing psychoses are aware that their behaviors are maladaptive.
• B. Individuals experiencing psychoses experience little distress.
• C. Individuals experiencing psychoses are aware of experiencing psychological problems.
• D. Individuals experiencing psychoses are based in reality.

Correct answer: B

Rationale: The most accurate statement about psychoses is that individuals experiencing it often exhibit limited distress because they are not fully aware of their altered perception of reality. They may not recognize that their behaviors are maladaptive or acknowledge the presence of psychological issues. Choice A is incorrect because individuals with psychoses may not be aware that their behaviors are maladaptive. Choice C is incorrect because individuals with psychoses may not have insight into their psychological problems. Choice D is incorrect because individuals with psychoses often struggle to differentiate between reality and their altered perceptions.

5. When interviewing a distressed client who was fired after 15 years of loyal employment, which of the following questions would best assist the nurse in determining the client's appraisal of the situation? Select the one that does not apply.

• A. What coping resources have you used previously in stressful situations?
• B. Have you ever faced a similar stressful situation before?
• C. Who do you think is to blame for this situation?
• D. What do you believe led to your termination from your job?

Correct answer: C

Rationale: In this scenario, it is crucial for the nurse to help the client assess their coping mechanisms and perspective on the situation. Questions A and B focus on exploring the client's coping resources and past experiences to guide them towards effective stress management. Asking who is to blame (choice C) is not conducive to evaluating coping abilities; instead, it might elicit a blame-focused response, which can impede progress. Choice D, inquiring about the reason for being fired, is a nontherapeutic approach that does not promote a constructive appraisal of the situation.

Similar Questions