A nurse is caring for a client who has experienced a stroke and exhibits parkinsonian effects. The client's cognition fluctuates. Which of the following types of dementia should the nurse expect the client to have?

Correct Answer: B

Rationale: In this scenario, the nurse should expect the client to have Lewy body disease. This is because individuals who have experienced a stroke and exhibit parkinsonian effects with fluctuating cognition often present with Lewy body dementia. Lewy body dementia is characterized by the presence of abnormal protein deposits in the brain, known as Lewy bodies, which can lead to symptoms such as cognitive fluctuations, visual hallucinations, and movement issues similar to Parkinson's disease. The other options can be ruled out for the following reasons: A) Frontotemporal lobar degeneration: This type of dementia is associated with changes in behavior, personality, and language, rather than the parkinsonian effects and fluctuating cognition described in the case. C) Prion disease: Prion diseases are rare neurodegenerative disorders that progress rapidly and do not typically present with the specific symptoms mentioned. D) HIV infection: While HIV can affect the brain and lead to cognitive issues, it is not typically associated with parkinsonian effects or fluctuating cognition in the same way Lewy body disease is. Educationally, understanding the specific manifestations and characteristics of different types of dementia is crucial for healthcare providers to provide appropriate care and support to individuals with these conditions. Recognizing the unique features of Lewy body dementia in this case can help the nurse tailor their interventions and support strategies to meet the client's specific needs effectively.

Correct Answer: C

Rationale: In the context of behavioral nursing, the correct answer is option C) The patient who throws a heavy plate at a waiter at the direction of command hallucinations. This individual's behavior poses an immediate threat to others, indicating a need for emergency intervention and possible involuntary hospitalization for their safety and the safety of those around them. Option A) The patient who resumes using heroin while still taking methadone, although concerning, does not necessarily warrant emergency or involuntary hospitalization unless there is an immediate risk of harm to self or others due to the drug use. Option B) The patient who reports hearing angels playing harps during thunderstorms may be experiencing auditory hallucinations, which can be distressing and indicative of mental illness, but unless there is a clear indication of imminent danger, emergency hospitalization may not be required. Option D) The patient who does not show up for an outpatient appointment with the mental health nurse may indicate non-compliance or difficulties engaging in treatment, but it does not necessarily warrant emergency hospitalization unless there are other concerning factors present. In a clinical setting, it is crucial for healthcare providers to assess the level of risk posed by a patient's behaviors or symptoms to determine the appropriate course of action, which may include emergency intervention or involuntary hospitalization to ensure the safety and well-being of the individual and others. This question highlights the importance of recognizing when immediate intervention is necessary in cases where there is a clear and present danger associated with a patient's mental health condition.

Correct Answer: A

Rationale: The correct answer is A) Make observations on neutral topics. This approach is the most effective because it allows the nurse to engage the patient in a non-threatening manner, providing opportunities for the patient to participate in the conversation at their comfort level. By making observations on neutral topics, the nurse can show nonjudgmental acceptance and support, which is crucial in building rapport with a patient diagnosed with major depressive disorder. Option B) Ask the patient direct questions may be seen as intrusive and overwhelming for a patient who is not engaging voluntarily. This approach may increase the patient's feelings of discomfort and may lead to further withdrawal. Option C) Phrasing questions to require 'yes' or 'no' answers limits the patient's ability to express themselves and may not foster a sense of open communication or trust. Option D) Frequently reassuring the patient to reduce guilt feelings may not address the underlying issues contributing to the patient's depressive symptoms. While reassurance can be helpful in certain situations, it may not be the most effective approach in this scenario. In an educational context, it is important for nurses to understand the principles of therapeutic communication when interacting with patients with mental health disorders. Building trust, showing empathy, and using open-ended questions or neutral observations can help create a safe and supportive environment for patients to express themselves and engage in meaningful interactions.

Correct Answer: B

Rationale: In this scenario, the best response for the nurse is option B: "It sounds like you're feeling very frightened and distrustful right now." This response demonstrates therapeutic communication by acknowledging and reflecting the patient's feelings without dismissing or contradicting them. It shows empathy and validates the patient's experience, which can help build trust and rapport. Option A is incorrect because it denies the patient's feelings and reality, which can increase the patient's distress and worsen the therapeutic relationship. Option C is inappropriate as it places undue pressure on the patient to trust others, which may not be feasible or therapeutic at that moment. Option D, while acknowledging the patient's feelings, fails to reflect back the emotions expressed by the patient, missing an opportunity for empathetic connection. Educationally, this question highlights the importance of using therapeutic communication techniques in psychiatric nursing. Validating the patient's feelings, even if they are based on delusions, is crucial for building trust and rapport in the nurse-patient relationship. By understanding and acknowledging the patient's emotions, nurses can create a supportive environment for individuals with schizophrenia to feel heard and understood.

Correct Answer: C

Rationale: In caring for a patient on lithium for a mood disorder, monitoring for side effects is crucial. The correct answer is C) Polyuria, polydipsia, and fine hand tremors. Lithium is known to cause nephrogenic diabetes insipidus, leading to increased urination (polyuria) and thirst (polydipsia). Fine hand tremors are also common with lithium use. Option A) Tremors, nausea, and weight gain are more commonly associated with antipsychotic medications, not lithium used for mood disorders. Option B) Blurred vision, dizziness, and hyperactivity are not typical side effects of lithium. These symptoms may be seen with other medications or conditions, but not specifically with lithium. Option D) Fatigue, drowsiness, and headache are not primary side effects of lithium. While fatigue and drowsiness can occur, they are less common compared to the symptoms listed in option C. Educationally, understanding the side effects of psychiatric medications is essential for nurses to provide safe and effective care. Recognizing the specific side effects of lithium helps in early detection and management, ensuring optimal patient outcomes.