The physician and advanced practice nurse are considering which antipsychotic medication to prescribe for a patient with schizophrenia who demonstrates auditory hallucinations, apathy, anhedonia, and poor social functioning. The patient is overweight and has hypertension. Bearing these facts in mind, the drug the nurse should advocate would be:

Correct Answer: D

Rationale: The correct answer is D: aripiprazole (Abilify). Aripiprazole is a second-generation antipsychotic that is less likely to cause weight gain and metabolic side effects compared to other antipsychotics. This is important since the patient is already overweight and has hypertension. Aripiprazole also has a lower risk of causing sedation, which can be beneficial for addressing apathy and anhedonia without worsening social functioning. A: Clozapine is effective for treatment-resistant schizophrenia but is associated with significant weight gain and metabolic side effects. B: Haloperidol is a first-generation antipsychotic with a high risk of extrapyramidal side effects and is not ideal for a patient with hypertension. C: Olanzapine is known for causing significant weight gain and metabolic effects, making it a less suitable choice for an overweight patient with hypertension.

Correct Answer: C

Rationale: The correct answer is C: loose associations. This speech pattern is characteristic of loose associations seen in schizophrenia, where thoughts are disorganized and lack logical connections. The patient's statements lack coherence and jump from one topic to another without a clear link. Hyperverbosity (A) refers to excessive speech without a clear point, which is not evident in this scenario. Circumstantiality (B) involves excessive detail before reaching the main point, which is not present here. Expressing delusions (D) would involve holding false beliefs, which are not explicitly stated in the patient's speech.

Correct Answer: A

Rationale: The correct answer is A: Calming. Drugs used to treat schizophrenia often target neurotransmitter pathways to reduce symptoms like hallucinations and delusions. By regulating neurotransmitters like dopamine, these drugs help calm the individual's brain activity, leading to a reduction in psychotic symptoms. Choices B, C, and D are incorrect because drugs for schizophrenia are not intended to numb, satisfy, or stimulate the nervous system; rather, they aim to restore balance and alleviate distressing symptoms.

Correct Answer: B

Rationale: The correct answer is B: "How does your spouse's behavior make you feel?" This question focuses on the patient's emotions, allowing them to express their feelings and validating their experiences. It shows empathy and encourages the patient to explore and understand their own emotional responses to the situation. Choice A focuses on addressing the behavior directly without acknowledging the patient's emotions. Choice C asks for more examples of controlling behavior, which may feel judgmental. Choice D suggests that the spouse's behavior is justified, which can further invalidate the patient's feelings. Overall, choice B is the most therapeutic as it promotes emotional exploration and support.

Correct Answer: C

Rationale: The correct answer is C because it reflects an imbalance of power within the family dynamic. The statement indicates an acceptance of blame and a submissive attitude, suggesting a power dynamic where one person feels the need to please and appease the other. This behavior can indicate an abuse of power by the dominant individual, leading to a controlling and potentially manipulative relationship. In contrast, the other choices do not clearly demonstrate an abuse of power. Choice A shows anger management issues but does not necessarily indicate a power dynamic. Choice B focuses on a disagreement over parenting responsibilities rather than a power struggle. Choice D highlights financial disagreements but does not explicitly show an abuse of power. Therefore, Choice C is the most indicative of power abuse in a family situation.