The nurse is evaluating several clients with a diagnosis of schizophrenia. Which client will be assessed as having the worst potential outcomes?
An adolescent client with alogia, anhedonia, and a flat or blunted affect.
A client who has a first cousin with bipolar I disorder.
A client with an exacerbation of hallucinations and delusions 2 years after diagnosis.
An older adult client with an onset of positive symptoms at age 35.
The Correct Answer is A
Choice A reason: This client presents with negative symptoms of schizophrenia, which are often associated with a poorer prognosis. Negative symptoms like alogia and anhedonia indicate a diminished emotional response and lack of motivation, which can severely impact the client's ability to function and respond to treatment.
Choice B reason: Having a first cousin with bipolar I disorder may suggest a genetic predisposition to mood disorders but does not directly influence the prognosis of a client already diagnosed with schizophrenia.
Choice C reason: While an exacerbation of hallucinations and delusions indicates a worsening of symptoms, it is the positive symptoms of schizophrenia that are often more responsive to treatment. Therefore, this client may not necessarily have the worst outcomes.
Choice D reason: An older adult with a late onset of schizophrenia typically has a better prognosis than those with an earlier onset. Late-onset schizophrenia is often less severe and may respond better to treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The correct answer is: "Tell me what is concerning you."
Choice A reason:
Asking "Did your husband say something to upset you?" may seem accusatory and could lead the spouse to feel defensive. It does not open a dialogue for the spouse to express their concerns freely and can be perceived as leading the conversation in a negative direction.
Choice B reason:
"Tell me what is concerning you." is an open-ended statement that invites the spouse to share their feelings and concerns. It demonstrates empathy and active listening, which are key components of therapeutic communication. This response encourages the spouse to elaborate on their feelings and fosters a supportive environment.
Choice C reason:
Saying "Your husband is making really good progress!" is reassuring, but it does not address the spouse's current emotional state or concerns. It may come across as dismissive of the spouse's feelings and does not encourage further discussion about their worries.
Choice D reason:
Asking "Did something bad happen to your husband?" can increase anxiety and assumes a negative event has occurred. It is not a therapeutic response because it does not provide comfort or support to the spouse in a stressful situation.
Correct Answer is B
Explanation
Choice A reason: Gastric lavage is typically not the first-line treatment for lithium toxicity due to the risk of aspiration and potential complications. It is usually reserved for cases where the ingestion was recent and massive.
Choice B reason: When a client presents with an extremely elevated lithium level, it is crucial to hold further doses to prevent exacerbation of toxicity. The nurse should monitor for early signs of toxicity, which include gastrointestinal symptoms like nausea, vomiting, diarrhea, and neurological symptoms such as tremors, confusion, and ataxia. The normal therapeutic range for lithium is 0.6 to 1.2 mmol/L, and levels above 1.5 mmol/L are considered toxic.
Choice C reason: While it is important to review the medication record, the immediate concern with an extremely elevated lithium level is addressing the toxicity. Checking the medication record can be part of the assessment process but is not the priority action.
Choice D reason: Administering the morning dose of lithium could worsen the client's condition by increasing the lithium level further, which is already extremely elevated. This could lead to severe toxicity or even fatal consequences.
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