Author Question: Which patient with schizophrenia would be expected to have the lowest score in global assessment of ... (Read 57 times)

audie · **on:** Jul 19, 2018

Which patient with schizophrenia would be expected to have the lowest score in global assessment of functioning?

a. 39 years old; paranoid ideation since age 35 years
b. 32 years old; diagnosed as catatonic at age 24 years; stable for 3 years
c. 19 years old; diagnosed with undifferentiated schizophrenia at age 17
d. 40 years old; disorganized schizophrenia since age 18; frequent relapses

Question 2

A community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia. The patient lives at home with a supportive family. Select the nurse's best plan.

a. Visit daily for 4 days, then visit every other day for 1 week; stay with the patient for 20 minutes; accept silence; state when the nurse will return.
b. Arrange to spend 1 hour each day with the patient; focus on asking questions about what the patient is thinking or experiencing; avoid silences.
c. Visit twice daily; sit beside the patient with a hand on the patient's arm; leave if the patient does not respond within 10 minutes.
d. Visit every other day; remind the patient of the nurse's identity; encourage the patient to talk while the nurse works on reports.

LVPMS · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

ANS: D
Disorganized schizophrenia represents the most regressed and socially impaired of all the schizophrenias. The 40-year-old patient who has had disorganized schizophrenia since 18 years of age could logically be expected to have the lowest global assessment of functioning. In addition, the patient has been ill for a number of years and has had frequent relapses. The 39-year-old patient who has had paranoid ideation since 35 years of age could be expected to have the highest score, because paranoid schizophrenia of short duration may be less impairing than other types. The patient who was diagnosed as catatonic at the age of 24 years has been stable for more than 3 years, suggesting a higher functional ability. The 19-year-old patient who was diagnosed with undifferentiated schizophrenia at 17 years of age has been ill for only 2 years, and disability in undifferentiated schizophrenia remains fairly stable over time.

Answer to Question 2

ANS: A
Severe constraints on the community mental health nurse's time will probably not allow more time than what is mentioned in the correct option, yet important principles can be used. A severely withdrawn patient should be met at the patient's own level, with silence accepted. Short periods of contact are helpful to minimize both the patient's and the nurse's anxiety. Predictability in returning as stated will help build trust. An hour may be too long to sustain a home visit with a withdrawn patient, especially if the nurse persists in leveling a barrage of questions at the patient. Twice-daily visits are probably not possible, and leaving after 10 minutes would be premature. Touch may be threatening. Working on reports suggests the nurse is not interested in the patient.