Author Question: A patient with paranoid schizophrenia tells the nurse, The FBI is listening through fluorescent ... (Read 37 times)

tnt_battle · **on:** Jul 19, 2018

A patient with paranoid schizophrenia tells the nurse, The FBI is listening through fluorescent lights in this room. Be careful what you say. Which response by the nurse would be most therapeutic?

a. Let's talk about something other than the FBI.
b. It sounds like you're concerned about your privacy.
c. The FBI is prohibited from operating in health care facilities.
d. You have lost touch with reality, which is a symptom of your illness.

Question 2

A 72-year-old widow has just returned home after 2 weeks in the hospital after a fall. She lives alone and is visited weekly by her son. She takes digoxin, hydrochlorothiazide, and an antihypertensive drug.

She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety. When the visiting nurse stopped by 2 days after discharge, he found the woman confused and disoriented, with an unsteady gait. The patient asks him who the small people are who have been living in her house. The patient had not evidenced any of these symptoms at the time of discharge. Vital signs were unremarkable except for bradycardia. The nurse correctly deduces that the most likely cause for the changes seen in the patient is: a. delirium.
b. dementia.
c. amnestic syndrome.
d. drug toxicity.

heyhey123 · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

B
It is important not to challenge the patient's beliefs, even if they are unrealistic. Challenging undermines the patient's trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patient's message conveys. Other distracters use reflection or are nontherapeutic (changing the subject, false reassurance). One distracter presents reality but in an uncompassionate way.

Answer to Question 2

D
Drug toxicity can cause a number of mental status changes, particularly in an elderly or medically fragile person. Digoxin toxicity can cause a delirium-like presentation that includes hallucinations (e.g., the small people the patient asked about in this case), and excess valium ingestion can cause central nervous system depression and confusion. In addition to memory disturbances and disorientation, delirium is characterized by an abrupt onset of fluctuating levels of awareness, clouded and/or fluctuating consciousness, and perceptual disturbances, which are not evident in this case. Dementia has a gradual onset, contrary to the acute nature of this patient's symptoms. Amnestic disorder involves memory impairment without other cognitive problems.