Once the doctor has explained Grace's condition as post-op Delirium, as well as the probable outcome to Grace's family, which of the following statements by the family would indicate understanding of what to expect with regard to the nature and course of Grace's illness?
"I understand that Grace has had a general anesthetic and many pain medications and that her confusion will probably dissipate once she is more medically stable"
"Grace will likely improve within 4 to 6 months, once antidepressant medication is initiated"
"Grace will require intensive psychotherapy to recover and develop more appropriate coping mechanisms"
"Grace will probably slowly deteriorate until she no longer recognizes us and can no longer care for herself because of her cognitive decline"
The Correct Answer is A
Reasoning:
Choice A reason: Delirium is characterized by an acute, fluctuating disturbance in attention and cognition, often triggered by underlying medical conditions, medications, or metabolic imbalances. Identifying that the confusion is secondary to anesthesia and pain medication, and expecting resolution upon medical stabilization, demonstrates a correct understanding of its transient nature.
Choice B reason: This statement incorrectly identifies delirium as a depressive disorder requiring antidepressants. Delirium is a neurocognitive syndrome, not a mood disorder. Furthermore, the timeline of 4 to 6 months is more characteristic of recovery from a major depressive episode rather than the acute resolution expected in delirium.
Choice C reason: Psychotherapy is used to treat psychiatric conditions like personality disorders or depression by addressing emotional and behavioral patterns. It is not an appropriate or effective treatment for delirium, which is a physiological brain dysfunction requiring the identification and reversal of the primary underlying medical cause.
Choice D reason: This statement describes the progressive, irreversible course of dementia (such as Alzheimer's disease) rather than delirium. Delirium is acute and usually reversible, whereas the "slow deterioration" mentioned here characterizes a chronic neurodegenerative process that is distinct from the post-operative cognitive changes Grace is experiencing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Reasoning:
Choice A reason: Extra-large windows with street views provide excessive environmental stimuli, which can exacerbate the distractibility and psychomotor agitation characteristic of acute mania. Manic patients require a calm, controlled environment to reduce sensory overload and help decrease the intensity of their heightened internal arousal and racing thoughts.
Choice B reason: Milieu management for acute mania focuses on low-stimulus environments. Neutral colors like beige or soft grey and a lack of complex patterns or busy accessories help minimize external triggers. This physical environment supports the pharmacological goals of reducing dopamine-driven hyperactivity and allows the patient’s nervous system to rest.
Choice C reason: Bright colors and busy prints are highly stimulating and can increase the agitation and "flight of ideas" experienced by a manic patient. Such decor can lead to further behavioral dysregulation, as the patient’s brain is already struggling to filter out non-essential sensory information in a state of hyper-arousal.
Choice D reason: While deep colors are less "bright," they can still be visually heavy or stimulating depending on the saturation. In psychiatric design, the goal is "neutrality" rather than "intensity." Heavy upholstery can also pose a safety risk if the patient becomes physically aggressive or destructive during a manic peak.
Correct Answer is C
Explanation
Reasoning:
Choice A reason: This statement is an overt expression of future-oriented thinking and a desire for social reintegration. Asking to work on a resume indicates that the patient is planning for life after discharge, which is generally a positive prognostic sign and the opposite of a covert suicidal warning.
Choice B reason: While a sudden, unexplained improvement in mood can sometimes be a red flag (indicating the patient has made a decision to end their life), "feeling so much better" is a common goal of treatment. Without further context, it is considered a general status update rather than a covert statement.
Choice C reason: This is a classic "covert" or indirect statement of suicidal intent. It implies a definitive end to the patient's perceived burden on others without explicitly mentioning death. Such statements often suggest that the patient has formulated a plan and believes their internal or external "problems" are about to cease.
Choice D reason: "I wish I were dead" is an "overt" or direct statement of suicidal ideation. The question specifically asks for "covert" statements, which are hidden, veiled, or indirect. While this statement is extremely concerning and requires immediate intervention, it is classified as direct communication of intent, not indirect.
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