A patient with schizophrenia has received typical (first-generation) antipsychotics for a year. His hallucinations are less intrusive, but he remains apathetic, has poverty of thought, cannot work, and is socially isolated. To address these symptoms, the nurse might consult the prescribing health care provider to suggest a change to:

Correct Answer: B

Rationale: The correct answer is B: olanzapine (Zyprexa). Olanzapine is an atypical (second-generation) antipsychotic that is known to be effective in treating negative symptoms of schizophrenia, such as apathy, poverty of thought, and social withdrawal. These symptoms are often resistant to typical antipsychotics like haloperidol (A) and chlorpromazine (D), which are more effective for positive symptoms like hallucinations. Diphenhydramine (C) is an antihistamine and not used to treat schizophrenia symptoms. In summary, olanzapine is the best choice to address the specific symptoms described in the scenario.

Correct Answer: D

Rationale: The correct answer is D because cognitive dysfunction in schizophrenia typically involves impaired memory, attention, and formal thought disorder. This is due to the underlying neurobiological and neurocognitive deficits associated with the disorder. Choices A, B, and C are incorrect because they primarily align with emotional and affective symptoms commonly seen in schizophrenia, not specifically cognitive dysfunction. Symptoms such as anxiety, fear, agitation, aggression, anger, hostility, violence, blunted affect, or inappropriate affective responses are more related to the emotional and behavioral aspects of schizophrenia, rather than cognitive deficits.

Correct Answer: D

Rationale: The correct answer is D because early identification of signs of impending relapse and coping strategies are crucial in preventing relapses in schizophrenia. By recognizing early warning signs, the patient can receive timely intervention and support to prevent further deterioration. This proactive approach enables healthcare providers to adjust treatment plans and provide necessary resources, ultimately reducing the likelihood of rehospitalization. Choice A is incorrect because developing tolerance for cognitive symptoms may be beneficial but not a priority in preventing relapses. Choice B is incorrect as family support is important but solely relying on family for structure may not address all factors contributing to relapse. Choice C is incorrect as working on self-concept may be helpful but not directly related to preventing relapses.

Correct Answer: C

Rationale: Concrete thinking refers to interpreting things in a literal or factual way without grasping the underlying meaning. In this question, the client's interpretation of the proverb demonstrates a lack of understanding of the metaphorical meaning behind it. By focusing on the literal aspect of the stone not turning green, the client displays concrete thinking. Mutism, flight of ideas, and loose association are unrelated to the client's interpretation of the proverb, making them incorrect choices.

Correct Answer: D

Rationale: The correct answer is D because mentioning violent bondage in sexual activities indicates a pattern of behavior associated with psychic rape, where the perpetrator exerts control and inflicts harm on the victim. This choice aligns with the power dynamics and manipulation typically seen in cases of psychic rape. A: Giving money after the rape does not necessarily indicate psychic rape and is more characteristic of bribery or transactional behavior. B: Seduction with wine, flowers, and music may indicate manipulation but does not specifically relate to the psychological violation inherent in psychic rape. C: Threatening the patient with violence is a form of physical coercion rather than psychic rape, which involves psychological manipulation and violation.