A patient with schizophrenia, aged 60 years, spent 5 years in a ...

[mydiamond]

A patient with schizophrenia, aged 60 years, spent 5 years in a state hospital before being discharged to a community residence.
 
  The patient requires persistent direction to accomplish daily activities of living, has difficulty determining what to do with his time, and is resistant to behaving independently, expecting others to provide meals or wash his clothes. The nurse assesses this passive behavior as being the probable result of: a. dependency caused by institutionalizatio n.
  b. cognitive deterioration from schizophrenia.
  c. brain damage from recreational drug use.
  d. side effects of neuroleptic medications.

Question 2

A patient, aged 42 years, seeks crisis intervention. She tells the nurse, I cannot take it anymore It has to stop. Last year my husband had an affair, and we do not communicate anymore.
 
  Three months ago I found a lump in my breast that the doctor is watching closely, and yesterday my 20-year-old daughter told me she is quitting college and moving to another state with her boyfriend.. Which comment or concern should be the priority for further assessment? a. What support persons and coping skills the woman has to draw upon
  b. The status of the marriage and whether the husband is involved in the affair
  c. How the patient feels about the possibility of having a mastectomy
  d. What the patient has in mind when she says she cannot take it anymore

[TheDev123]

Answer to Question 1

A
Institutions such as state hospitals or corrections facilities tend to impede independent functioning; daily activities, for example, are planned and directed by staff, meals are provided by others and only at set times, and so forth. Over time, patients became dependent on the institution and its staff to meet their needs and adapt to being cared for rather than caring for themselves. When these patients were discharged into the community, many continued to demonstrate passive behaviors despite efforts to promote renewed independent activity. Cognitive dysfunction and neuroleptic side effects can make planning and carrying out activities more difficult, but the pattern here is more suggestive of adjustment to institutional care and difficulty readjusting to independence instead. The scenario does not suggest recreational drug use.

Answer to Question 2

D
During crisis intervention, the priority concern is patient safety, so it is most important to assess whether the patient is a risk of self-harm (or other-directed violence). Assessing coping skills and resources, assessing her response to the possible breast cancer and her daughter's plans, and the current status of her marriage would all be assessed subsequent to establishing her safety.