Chapter 48: Care of Patients with Thought and Personality Disorders |DeWit: Medical- Surgical Nursing: Concepts & Practice, 3rd Edition

MULTIPLE CHOICE 1. Approximately what percentage of the U.S. population is affected with schizophrenia? a. 1 % b. 2 % c. 3 % d. 4 % ANS: A Schizophrenia is the most common thought disorder. It is estimated that 1.1% of the general population is affected with schizophrenia, and in the United States this represents 2.4 million Americans. PTS:1 DIF: Cognitive Level: Comprehension REF: 1109 OBJ:1 (theory) TOP: Schizophrenia: Incidence KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance 2. The nurse explains that depression is thought to be the result of a deficit of which neurotransmitter? a. Norepinephrine b. Serotonin c. Acetylcholine d. Dopamine ANS: B Serotonin is a neurotransmitter of the central nervous system. It is important in sleep, pain perception, and emotional states. Lack of serotonin can lead to depression. Norepinephrine and acetylcholine are neurotransmitters of the autonomic nervous system. Norepinephrine plays an important role in the fight-or-flight reaction (constriction of the blood vessels, dilation of the pupils, increased heart rate, increased awareness, and vigilance). Acetylcholine causes decreased heart rate and force of contraction and plays a role in the sleep-wake cycle. Dopamine is located mostly in the brainstem. It is thought to play a role in controlling complex movements, motivation, and cognition. PTS:1 DIF: Cognitive Level: Comprehension REF: 1110 OBJ:3 (theory) TOP: Depression: Etiology KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. Which statement causes the nurse to document a schizophrenic patient’s delusion of persecution? a. “Did you know that I own this hospital and pay all these people to work for me?” b. “My doctor talked to all the other patients, but not to me. He doesn’t want me to get well.” c. “The president’s speech tonight is going to give me a coded message.” d. “I am going to wait in front of the hospital this morning for my limousine to pick me up and take me to my private jet.” ANS: B Delusions can be either grandiose or persecutory. An individual who believes he owns the hospital or is planning to be picked up by a limousine or has a private jet is having delusions of grandeur. Individuals with delusions of persecution believe that they are being persecuted by agencies, by other people, or by supernatural beings. The patient who believes the president’s speech is coded is having an idea of reference. PTS:1 DIF: Cognitive Level: Application REF: 1110 OBJ:3 (theory) TOP: Delusions: Persecution KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity 4. The paranoid schizophrenic patient states that his whole family has conspired to have him put in the hospital and that the medical staff are part of the conspiracy. Which is the nurse’s most therapeutic response? a. “I promise that I want to help you.” b. “You know your family is concerned about you.” c. “I’m sorry you feel that way. I’ll be around if you want to talk about your feelings.” d. “The doctors are trying to help you feel better. They have your best interest in mind.” ANS: C Arguing with the paranoid patient, or defending self or others, reinforces the paranoia. Passively offering self to the patient to approach you rather than the other way around is helpful to the nurse–patient relationship. PTS: 1 DIF: Cognitive Level: Application REF: 1117, Nursing Care Plan 48-1 OBJ: 3 (theory) TOP: Paranoia: Intervention KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity 5. The delusional patient has become agitated and angry. The patient reports that the cook put tacks in his cereal. He is spacing back and forth in the crowded dining room and cursing the cook. How should the nurse respond? a. Keep distance from the patient and ask, “Can we go to the dayroom and talk?” b. Touch the patient’s arm and say, “Calm down. I’m sure we can straighten this out.” c. Call experienced CNAs to restrain the patient. d. Stand calmly and say, “This behavior is unacceptable. Sit down and eat, Carl.” ANS: A Allowing the angry patient space is important. Encourage the patient to find a quieter place. Acknowledge the anger and demonstrate willingness to help. The agitated patient should not be touched without permission. Restraints are a last resort and will increase the patient’s anger and feelings of persecution. PTS: 1 DIF: Cognitive Level: Application REF: 1120, Box 48-2 OBJ: 2 (clinical) TOP: Agitation and Anger: Intervention KEY: Nursing Process Step:Implementation MSC: NCLEX: Psychosocial Integrity 6. The manipulative patient approaches the nurse and says, “I know it’s too early to give me my pain medication, but you are the only one who seems to care. Could you give me my pain medication now?” Which response is best? a. “The charge nurse is very stringent about scheduled medications. She would be very angry with me if I gave you the medication now.” b. “I know how it is when you are in pain. I’ll give you your medication early.” c. “Your medication is due in 2 hours. I will be glad to give it to you on schedule.” d. “It makes me feel good to know you are appreciative of our care. Here is your medication.”