anSWer: Calmly engage the 39-year-old male patient in a therapeutic conversation.
First, ask the patient if he feels safe. although he is safe on the unit, the patient needs to perceive that he is safe; otherwise the patient will react as if he is being threatened, which can lead to violent behavior as the patient defends himself. next, focus the con- versation on the patient’s behavior. say, “i noticed you looking out the window. Do you want to talk about something?” this open-ended question gives the patient the opportunity to express his concerns and explain his behavior. Keep in mind that the behavior of a patient diagnosed with schizophrenia disorder may seem inappropriate to others but is appropriate to the misinterpretation of a situation.
QueStion 3. the patient tells you that the sun is giving him instructions on what to do today while on the unit. his hands are like an antenna. When he stares at the sun, he is receiving instructions. When he squints his eyes, he is sending a reply to the sun. how do you respond?
anSWer: the objective is to acknowledge the delusion and to bring the patient back to reality. tell the patient that you understand that the patient believes he is communicating with the sun. also help return the patient to reality by telling the patient that you don’t believe the sun is giving him instructions because the sun cannot give instructions. help the patient remember recent times when the patient made his own decisions on the unit and that those decisions were positive ones without the aid of the sun.
resistant to movement. What should the nurse suspect?
a. the patient may have a medical condition or adverse drug reaction.
B. the patient has catatonic schizophrenia disorder.
C. the patient has some form of schizophrenia.
D. the patient is faking an illness so the patient will be admitted to the hospital.
the patient is homeless.
3. a family member mentioned that his sister barricades herself in her house and calls the police every time the mail carrier drops off mail. She has been diag- nosed with schizophrenia; however, the family member doesn’t understand her behavior. What is the best response?
a. the mail carrier scares her.
B. she is experiencing hallucinations.
C. she is experiencing delusions.
D. she is misinterpreting reality and behaving as if her perception of reality is real.
4. Your neighbor has a son who was diagnosed with schizophrenia several years ago. You ask your neighbor how his son is doing. Your neighbor says that he is doing fine. he exhibits no more violent behavior. he gets up, eats, and watches television quietly all day. how should you respond?
a. the medication seems to be working well.
B. you should tell your son’s practitioner about his behavior.
C. television is a good way to occupy his time.
D. Medication takes several months to have an effect on behavior.
5. the brother of a patient reports that the patient’s medication stopped working and he has returned to walking the streets late at night chasing trucks out of his neighborhood. the patient lives alone in subsidized housing. You are asked what other medications can be prescribed to the patient. What is the best response?
a. Maybe it is time for your brother to live with you.
B. is your brother taking his medication?
C. ask the practitioner for alternative medications.
D. you should take your brother to the emergency room and have his medications adjusted.
6. new parents raise concerns that their son will develop schizophrenia disorder because the husband’s mother had been diagnosed with paranoid schizophre- nia disorder for most of her adult life. What is the best response?
a. there is no known cause of paranoid schizophrenia disorder; however, there is a genetic predisposition to developing the disorder if a close relative has been diagnosed with paranoid schizophrenia disorder.
B. there is a genetic predisposition; however, a predisposition does not mean that your son will develop paranoid schizophrenia disorder.
C. there is little chance that he will develop paranoid schizophrenia disorder.
D. Watch for symptoms of paranoid schizophrenia disorder when he reaches 16 years of age.
7. a new patient diagnosed with paranoid schizophrenia disorder arrives on your unit. how should you react?
a. Perform the admission assessment immediately and show the patient to her room.
B. Welcome the patient while standing behind the nurse’s station and engage in an informal conversation with the patient.
C. Welcome the patient while standing behind the nurse’s station and avoid any conversation with the patient.
D. take the patient by the hand and lead her into the examination room.
8. a patient walks in and out of other patients’ rooms looking for his dog Mike. You notice a stain on the front of his pants. he is not wearing shoes or sockets. he tries to open all the closed doors on the unit. What is your first intervention?
a. Call security to report an attempted elopement.
B. Prevent the patient from self-injuring behavior.
C. sternly direct the patient back into his room.
D. sternly direct the patient back into his room and help the patient wash his body and put on clean clothes.
9. a father of a 42-year-old man who has been diagnosed with undifferentiated schizophrenia disorder for many years tries to control his son’s bizarre behavior by yelling at him and limiting his movements within the house. Which recom- mendation is best to give the father?
a. Create a calm supportive environment at home. stress and emotional family environments tend to increase signs and symptoms of undifferentiated schizo- phrenia disorder.
B. send your son to a group home where he will experience a less stressful home environment.
C. avoid limiting your son’s movement because this is a violation of the americans with Disabilities act.
D. ask your son’s practitioner to increase his medication.
10. a mother of a 21-year-old man tells you her son has undiagnosed schizophre- nia. She reports that he appears normal and then suddenly takes on the char- acteristics of an 8-year-old boy called Billy Bob. at other times, he appears to be a British rock star called reggie. and then suddenly he is back to being himself.
What is the best response?
a. he has undifferentiated schizophrenia disorder. you should have your son as- sessed by a psychiatrist as soon as possible.
B. he has undifferentiated schizophrenia disorder. take your son to the emer- gency room immediately.
termine if he has dissociative identity disorder.
D. your son is probably pretending to be those personalities.
cOrrect ansWers anD ratiOnaLes
1. B. antipsychotic medication is not prescribed because the medication may increase the catatonic symptoms, which is why the practitioner has not ordered the medication for the patient. Rationale: the nurse has the responsibility to edu- cate the family about medication.
2. a. the patient may have a medical condition or adverse drug reaction. Rationale:
the patient is showing signs of catatonic schizophrenia; however, catatonic schizo- phrenia is rare. the same signs can be caused by a medical disorder or adverse reaction to medication.
3. D. she is misinterpreting reality and behaving as if her perception of reality is real.
4. B. you should tell your son’s practitioner about his behavior. Rationale: the neigh- bor is describing negative symptoms of schizophrenia. the neighbor’s son should be reevaluated by the practitioner. the patient may be in the residual phase of schizophrenia.
5. B. is your brother taking his medication? Rationale: a common problem is that patients diagnosed with schizophrenia disorder are noncompliant with medica- tion treatment especially if they are not monitored daily. signs and symptoms of schizophrenia can return.
6. B. there is a genetic predisposition; however, a predisposition does not mean that your son will develop paranoid schizophrenia disorder. Rationale: the first signs and symptoms of schizophrenia disorder occur as early as 16 years of age; how- ever, this is not the best response to tell new parents.
7. B. Welcome the patient while standing behind the nurse’s station and engage in an informal conversation with the patient. Rationale: the goal is to develop trust.
standing behind the nurse’s station acknowledges the patient’s personal space.
an informal conversation facilitates developing trust.
8. B. Prevent the patient from self-injuring behavior. Rationale: safety is the first goal.
9. a. Create a calm supportive environment at home. stress and emotional family environments tend to increase signs and symptoms of undifferentiated schizo- phrenia disorder. Rationale: sending his son to a group home will likely increase stress because his son will be in unfamiliar surroundings.
10. C. you should have your son assessed by a psychiatrist as soon as possible to determine if he has dissociative identity disorder. a common myth is that schizo- phrenia disorder is exhibited as multiple personalities.
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