Psychiatry (Q)

psychiatrIC

SITUATION I

Mrs. C, a 48-year-old Hispanic woman is seen by you after receiving a call from her son. According to her son, since his father's death 7 months ago, his mother can’t sleep, always agitated, stays at home and has lost interest in her usual activities. He tried to encourage his mother but ineffective. During her initial visit, you noticed that her hair is unkempt and is poorly dressed. Her speech is not spontaneous and she is not able to find the right words to say. During your interview, the patient states, "My husband talks to me in his visits, but his words make no sense to me. I don't understand what he wants me to do." She was diagnosed for paranoid schizophrenia.see answer

Question 1:

Identify 3 positive symptoms that the patient have?

1. ____________________________________________________________________________________________________________________________.

2. ____________________________________________________________________________________________________________________________.

3. ____________________________________________________________________________________________________________________________.

Question 2:

Identify 3 negative symptoms that the patient have?

1. ____________________________________________________________________________________________________________________________.

2. ____________________________________________________________________________________________________________________________.

3. ____________________________________________________________________________________________________________________________.

SITUATION II

Ms. B is a 29-year-old patient who had a history of child abuse and maltreatment. Her father suffered from alcoholism and the neighborhood where she grew up is a low-income community. She is active in their church and member of a choir. She lives with her cat, goes to college and is involved in their after-school activities (Music Club). She is also a volunteer in Shield of Athena (support group for abuse women). Ms. B has been taking imipramine (Topranil), 125 mg by mouth daily for her depression one week from now. She reports that she wants to stop taking the medication because she still feel a little depressed.see answer

Question 1:

What is your best response to Ms. B?

1. ____________________________________________________________________________________________________________________________.

Question 2:

Identify three key features of risk factors that Ms. B have?

1. ____________________________________________________________________________________________________________________________.

2. ____________________________________________________________________________________________________________________________.

3. ____________________________________________________________________________________________________________________________.

Question 3:

Identify three key features of protective factors that Ms. B have?

1. ____________________________________________________________________________________________________________________________.

2. ____________________________________________________________________________________________________________________________.

3. ____________________________________________________________________________________________________________________________.

SITUATION III

A 45-year-old patient with chronic schizophrenia who takes haloperidol (Haldol) 1 mg PO daily is admitted to the psychiatric unit today. You're the charge nurse and you're working with an experienced LPN. Your nursing assessment to the patient reveals rigidity, fever, hypertension, tachycardia, altered consciousness, and diaphoresis.see answer

Question 1:

An experienced LPN asked you if she can give the patient's regular haloperidol (Haldol) 1 mg PO daily as prescribed?

Yes or no?

Justify: _______________________________________________________________________________________________________________________.

Question 2:

Identify two nursing interventions you will do according to the scenario?

1. ____________________________________________________________________________________________________________________________.

2. ____________________________________________________________________________________________________________________________.

SITUATION IV

A delusional male patient Mr. Zach approaches you, stating, "I am the Easter bunny," and insisting that you refer to him as such. The belief appears to be fixed and unchanging.see answer

Question 1:

What nursing interventions should you implement when working with this patient?

1. ____________________________________________________________________________________________________________________________.

2. ____________________________________________________________________________________________________________________________.

SITUATION V

You're a nurse in a psychiatric unit who is monitoring a patient who appears to be hallucinating. Paranoid content is noted in the patient speech and agitated behavior. The patient is gesturing at a figure on the television.see answer

Question 1:

What nursing interventions are appropriate when taking care of this patient?

1. ____________________________________________________________________________________________________________________________.

2. ____________________________________________________________________________________________________________________________.

3. ____________________________________________________________________________________________________________________________.

SITUATION VI

A patient with schizophrenia is taking the atypical anti-psychotic medication clozapine (Clozaril).see answer

Question 1:

What signs and symptoms indicate the presence of adverse effects associated with this medication?

1. ____________________________________________________________________________________________________________________________.

2. ____________________________________________________________________________________________________________________________.

Question 2:

Throughout the course of the patient's treatment, what should you monitor at least weekly?

SITUATION VII

A physician prescribes lithium to a patient diagnosed with bipolar disorder. You would like to provide appropriate education for the patient on this drug.see answer

Question 1:

What topics should you cover when teaching this patient about lithium?

1. ____________________________________________________________________________________________________________________________.

2. ____________________________________________________________________________________________________________________________.

Question 2:

You explained to the patient that approximately how many days may pass before he/she notes a change in his mood?

1. ____________________________________________________________________________________________________________________________.

SITUATION VIII

The nurse is caring for a patient with schizophrenia who experiences auditory hallucinations. The patient appears to be listening to someone who isn't visible. He gestures, shouts angrily, and stops shouting in mid-sentence.see answer

Question 1:

How will you response appropriately for this patient?

1. ____________________________________________________________________________________________________________________________.

SITUATION IX

A patient with paranoid schizophrenia repeatedly uses profanity during an activity therapy session.see answer

Question 1:

What response would be appropriate?

1. ____________________________________________________________________________________________________________________________.

SITUATION X

A patient has a diagnosis of borderline personality disorder. She has become very attached to one of the nurses who has been caring for her. She remarks that the other nurses are mean and don't care about her.see answer

Question 1:

What intervention would be most appropriate for the nursing staff to implement?

1. ____________________________________________________________________________________________________________________________.

SITUATION XI

Mrs. B, a 32-year-old woman who is diagnosed with major depression is treated with Elavil (amitriptyline) for one-and-a-half month. After a period of unsuccessful treatment with Elavil (amitriptyline), her physician switched to Parnate (tranylcypromine). The patient expresses that she ate aged cheese this morning.see answer

Question 1:

What is your concern according to Mrs. B’s statement?

1. ____________________________________________________________________________________________________________________________.

Two weeks after taking her new medication, she has become very outgoing, cheerful, and talkative.

Question 2:

What do you suspect of Mrs. B’s behavior?

1. ____________________________________________________________________________________________________________________________.

Justify: _______________________________________________________________________________________________________________________.

SITUATION XII

You are caring for a patient with bulimia nervosa. Strict management of the patient’s dietary intake is necessary.see answer

Question 1:

What intervention is most important to ensure the patient will meet dietary intake?

1. ____________________________________________________________________________________________________________________________.

SITUATION XIII

A patient admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital.see answer

Question 1:

What action should you take initially?

1. ____________________________________________________________________________________________________________________________.

SITUATION XIV

A suspicious patient states, "I know you nurses are spraying my food with poison as you take it out of the cart." Serving foods in sealed packages is unrealistic in your unit since the foods does not arrive this way, additionally, when sealing of the packages was done before to this patient it had further reinforce the patient's delusion.see answer

Question 1:

What is your appropriate intervention?

1. ____________________________________________________________________________________________________________________________.

Parents ask you how they should reply when their child, diagnosed with paranoid schizophrenia, tells them that voices command him to harm others.

Question 2:

What is your appropriate nursing reply?

1. ____________________________________________________________________________________________________________________________.

SITUATION XV

The nurse is caring for a client who is experiencing disturbed thought processes as a result of paranoia.see answer

Question 1:

In formulating nursing interventions with the members of the health care team, what is the best instruction should the nurse provide to the staff with this type of patient?

1. ____________________________________________________________________________________________________________________________.

SITUATION XVI

A patient with paranoid schizophrenia refuses food. He states the voices are telling him the food is contaminated and will change him from a male to a female.see answer

Question 1:

A therapeutic response for the nurse would be what?

1. ____________________________________________________________________________________________________________________________.

SITUATION XVII

During a conversation with your male patient, he suddenly jumps up, begins pacing, and wrings her hands.see answer

Question 1:

What will you do next?

1. ____________________________________________________________________________________________________________________________.

See answers