Kaplan and Sadocks Synopsis of Psychiatry Questions

Correct Answer: D

Rationale: The correct answer is D because it acknowledges the patient's discomfort without making assumptions or judgments. By recognizing the difficulty the patient is facing and offering to discuss it when they are ready, the nurse shows empathy and respect for the patient's feelings. Choice A is incorrect because it assumes the family is a problem for the patient. Choice B is incorrect because it focuses on expressing negative feelings rather than addressing the patient's current discomfort. Choice C is incorrect because it deflects the conversation to the physician without addressing the patient's immediate needs.

Correct Answer: C

Rationale: The correct answer is C: An increase in the brain chemical dopamine explains the presence of delusions and hallucinations. In paranoid schizophrenia, there is an overactivity of dopamine receptors in the brain, leading to an excess of dopamine. This excess dopamine is associated with symptoms like delusions and hallucinations. Therefore, an increase in dopamine levels is directly linked to these specific symptoms in individuals with paranoid schizophrenia. Explanation for why the other choices are incorrect: A: Breakdown of dopamine producing LSD does not directly relate to the symptoms of paranoid schizophrenia. B: Decreased amounts of dopamine do not explain the presence of delusions and hallucinations in paranoid schizophrenia; it is the increase in dopamine that is associated with these symptoms. D: An increase in dopamine is more closely related to delusions and hallucinations rather than lack of motivation and disordered affect in paranoid schizophrenia.

Correct Answer: C

Rationale: Rationale: 1. Educating the patient and family is crucial as it helps alleviate anxiety and ensures informed consent. 2. Monitoring vital signs (A) should be done before, during, and after the procedure, not necessarily in a specific order. 3. Medication administration (B) should be based on physician's orders but is not the initial step. 4. Checking a signed consent (D) is important but typically done before proceeding with any procedure, not necessarily in a specific order.

Correct Answer: D

Rationale: The correct answer is D because focusing on the feelings suggested by the delusion can help the patient process and manage their emotions underlying the delusion. By addressing the emotions, the nurse can help the patient gain insight into the delusion and reduce its intensity. Confronting the delusion (A) may lead to resistance and reinforcement. Refuting the delusion with logic (B) may further alienate the patient. Exploring reasons for the delusion (C) may not directly address the emotional component.

Correct Answer: B

Rationale: The correct answer is B: Adult day care program. This option best meets the needs of the patient as it provides supervision, safety, recreation, and social interaction during the day while allowing the family to care for the patient during the evening and night. Adult day care programs offer a structured environment with trained staff to ensure the patient's safety and provide activities to stimulate cognitive function. Explanation of other choices: A: Skilled nursing facility - Not ideal as the patient does not require 24-hour nursing care. C: Partial hospitalization - Typically for individuals needing intensive mental health services, not suitable for this patient's needs. D: Group home - Usually for individuals who need more permanent residential care, not appropriate for the patient's situation.