ATI RN
Age Specific Nursing Care Questions
Question 1 of 5
A patient with bipolar disorder, mania, relapsed after discontinuing lithium. The health care provider prescribes lithium 600 mg BID and olanzapine (Zyprexa) 10 mg BID. What is the rationale for addition of olanzapine to the lithium regime? It will:
Correct Answer: B
Rationale: The correct answer is B: Bring hyperactivity under rapid control. Rationale: 1. Olanzapine is an atypical antipsychotic known for its rapid onset of action in controlling manic symptoms, including hyperactivity. 2. Lithium alone may take time to reach therapeutic levels and show efficacy, while olanzapine can provide more immediate relief. 3. Combining olanzapine with lithium can address acute manic symptoms effectively and quickly. 4. Choice A is incorrect because olanzapine does not specifically minimize lithium's side effects. 5. Choice C is incorrect as olanzapine does not directly potentiate lithium's antimanic action. 6. Choice D is incorrect because olanzapine is typically used for acute symptom management rather than long-term control.
Question 2 of 5
A client displays disorganized thinking, difficult-to-follow speech, and silly, inappropriate affect. The client isolates himself from other clients and staff, ignores unit activities, and often seems to be listening and responding to unseen stimuli. This client's behavior most closely conforms to the characteristic behavior of:
Correct Answer: D
Rationale: The correct answer is D: Disorganized schizophrenia. The client's symptoms of disorganized thinking, difficult-to-follow speech, inappropriate affect, social withdrawal, and hallucinations (responding to unseen stimuli) align with the diagnostic criteria for Disorganized Schizophrenia. This subtype is characterized by disorganized behavior, speech, and affect, as well as social withdrawal and hallucinations. A: Residual schizophrenia does not involve active psychotic symptoms like hallucinations or delusions, which are present in the client's behavior described. B: Schizoaffective disorder combines symptoms of schizophrenia and mood disorders, and the client's symptoms do not strongly suggest a mood disorder component. C: Paranoid schizophrenia typically involves prominent delusions and auditory hallucinations, which are not emphasized in the client's behavior described.
Question 3 of 5
The nurse is administering haloperidol (Haldol) to a client experiencing delusions and hallucinations associated with schizophrenia. The nurse can expect symptom abatement as a result of the drug's action to:
Correct Answer: B
Rationale: The correct answer is B because haloperidol is a typical antipsychotic that works by blocking dopamine receptors in the brain. By blocking these receptors, haloperidol reduces the effects of excess dopamine, which is known to contribute to symptoms of schizophrenia such as delusions and hallucinations. This action helps alleviate the positive symptoms of schizophrenia. Choice A is incorrect because haloperidol does not reduce the number of brain cells that crave dopamine; it acts on the receptors themselves. Choice C is incorrect because enhancing dopamine receptors would lead to an increase in the effects of dopamine, worsening symptoms. Choice D is incorrect because haloperidol does not cause increased cellular production of dopamine; it blocks dopamine receptors instead.
Question 4 of 5
A client with schizophrenia tells the nurse as they sit in the day room, 'I hear voices telling me bad things.' The most therapeutic response the nurse can make is:
Correct Answer: B
Rationale: The correct answer is B because it demonstrates empathy and validation of the client's experience. By acknowledging the client's reality of hearing voices and emphasizing that the nurse does not hear them, the nurse establishes trust and rapport. This response shows active listening and validates the client's feelings without judgment. Incorrect responses: A: Asking the client to describe the voices may increase distress and is not as supportive as acknowledging their experience. C: Dismissing the voices as not real can invalidate the client's experience and may lead to mistrust. D: Suggesting a change of location does not address the client's immediate concerns and may not be therapeutic in this situation.
Question 5 of 5
Police bring a 63-year-old woman to the emergency room, reporting that her behavior is disorganized and disruptive, that her speech makes little sense, and that she does not seem able to take care of herself. The woman has had elective surgeries at the hospital previously and was seen in the ER last week after a fall; records show no history of similar symptoms or mental illness. The ER physician speaks with the patient but does not examine her medically, diagnoses her with schizophrenia, and orders admission to the inpatient psychiatric unit. Which response by the nurse would be most appropriate?
Correct Answer: C
Rationale: The correct answer is C because it promotes a thorough and systematic approach to the patient's care. First, it challenges the premature diagnosis of schizophrenia without a medical examination. Second, it highlights the importance of considering medical causes for the symptoms presented by the patient. This is crucial as the patient's age and lack of prior history of mental illness suggest that a medical work-up is necessary to rule out underlying medical conditions that could be causing her symptoms. This approach ensures a comprehensive evaluation and appropriate treatment tailored to the patient's specific needs. Choices A, B, and D are incorrect because they do not address the fundamental issue of exploring potential medical causes for the patient's symptoms before jumping to a psychiatric diagnosis or treatment. A, B, and D focus on seeking additional psychiatric opinions, consulting for medication initiation, and evaluating vital signs, respectively, which do not address the need for a thorough medical evaluation in this case.