A homeless individual with severe mental illness, anosognosia, ...

[K@]

A homeless individual with severe mental illness, anosognosia, and a history of persistent treatment nonadherence is persuaded to come to the day program at the community mental health center.
 
  Which intervention should be the team's initial priority? a. Educate him about the importance of treatment adherence.
  b. Help him obtain employment in a local sheltered workshop.
  c. Interact regularly and supportively without trying to change him.
  d. Teach appropriate health maintenance and prevention practices.

Question 2

A nurse can anticipate anticholinergic side effects are likely when a patient takes:
 
  a. lithium (Lithobid).
  b. buspirone (BuSpar).
  c. risperidone (Risperdal).
  d. fluphenazine (Prolixin).

[Kingjoffery]

Answer to Question 1

C
Given his history of treatment nonadherence and the difficulty that exists in achieving all other goals until he is psychiatrically stabilized and adherent, getting the patient to accept and adhere to treatment is the fundamental goal to address, and the intervention here that is most likely to help meet that goal at this stage is developing a trusting relationship with him. Interacting regularly, supportively, and without demands is likely to build the necessary trust and relationships that will be the foundation for all other interventions later on. No data here suggest the patient is in crisis, so it is possible to proceed slowly and build this foundation of trust.

Answer to Question 2

D
Fluphenazine, a conventional antipsychotic, exerts muscarinic blockade, resulting in dry mouth, blurred vision, constipation, and urinary retention. Lithium therapy is more often associated with fluid-balance problems, including polydipsia, polyuria, and edema. Risperidone therapy is more often associated with movement disorders, orthostatic hypotension, and sedation. Buspirone is associated with anxiety reduction without major side effects.

[K@]

TY

[Kingjoffery]

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