Which patient meets the criteria for hospice services?

A 74-year-old newly diagnosed with chronic obstructive pulmonary disease (COPD) and life expectancy of 2 years.

A 16-year-old with type 1 diabetes, multiple infections, and substance abuse.

A 36-year-old diagnosed with multiple sclerosis complicated by major depressive disorder and pain associated with muscle spasms.

A 54-year-old diagnosed with glioblastoma and life expectancy of 8 to 10 weeks.

Answer and Explanation

The Correct Answer is D

Choice A reason: Hospice requires a prognosis of 6 months or less. COPD with a 2-year life expectancy does not meet this, as the chronic disease allows longer-term management, not immediate palliative care for end-stage illness.

Choice B reason: Type 1 diabetes and substance abuse are not terminal conditions meeting hospice criteria (6 months or less prognosis). These require chronic management, not end-of-life care, as they lack imminent mortality despite complications.

Choice C reason: Multiple sclerosis with depression and pain is chronic, not terminal within 6 months, excluding hospice eligibility. Symptom management, not end-of-life care, is appropriate, as the prognosis does not indicate imminent death.

Choice D reason: Glioblastoma with an 8-10 week prognosis meets hospice criteria (6 months or less). Rapid tumor progression causes neurological decline, requiring palliative care to manage symptoms and support end-of-life needs, aligning with hospice goals.

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Correct Answer is A

Explanation

Choice A reason: Citalopram, an SSRI, increases serotonin levels, requiring 4-6 weeks to upregulate serotonin receptors and modulate prefrontal-amygdala circuits for mood improvement. Explaining this delay addresses patient expectations, reducing frustration and enhancing adherence by clarifying the neurochemical timeline of antidepressant action.

Choice B reason: Increasing the dose after 4 days is premature, as SSRIs like citalopram require weeks to alter serotonin signaling and neural plasticity. Premature dose escalation risks side effects like serotonin syndrome without addressing the expected therapeutic lag, making it an inappropriate intervention.

Choice C reason: Assessing for improvement after 4 days is unlikely to yield significant findings, as citalopram’s serotonin modulation takes weeks to impact mood via prefrontal cortex changes. This approach may reinforce the patient’s frustration without addressing the neurochemical basis of the delayed response.

Choice D reason: Reassuring effectiveness without explaining the delay is misleading. Citalopram’s action on serotonin pathways requires time for receptor upregulation and neural circuit adaptation. This vague reassurance does not educate the patient on the neurochemical timeline, potentially reducing trust and adherence.

A. A 25-year-old woman who is not experiencing symptoms of delusions and hallucinations. B. A 20-year-old man who is exhibiting a decrease in his ability to concentrate and function in daily activities. C. A 30-year-old man who is experiencing an exacerbation of symptoms after stopping his antipsychotic. D. A 28-year-old woman who is exhibiting bizarre and disruptive behavior.

Correct Answer is B

Explanation

Choice A reason: Absence of symptoms does not indicate the prodromal phase of schizophrenia, which involves subtle cognitive and functional declines driven by early dopamine dysregulation in the prefrontal cortex. This woman shows no signs of prodromal neural changes, making this choice incorrect.

Choice B reason: The prodromal phase of schizophrenia includes decreased concentration and functioning, reflecting early dopamine and glutamate dysregulation in the prefrontal cortex and hippocampus. These subtle neurocognitive changes precede overt psychosis, accurately describing the 20-year-old’s symptoms as prodromal.

Choice C reason: Exacerbation after stopping antipsychotics indicates active schizophrenia, not the prodromal phase. Dopamine receptor hypersensitivity from medication withdrawal causes symptom relapse, not the subtle, pre-psychotic cognitive decline characteristic of the prodromal period, making this incorrect.

Choice D reason: Bizarre and disruptive behavior indicates active schizophrenia, not the prodromal phase. Overt psychosis reflects advanced mesolimbic dopamine hyperactivity, unlike the prodromal period’s subtle cognitive and functional impairments driven by early prefrontal and hippocampal changes.

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Which patient meets the criteria for hospice services?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient diagnosed with major depressive disorder began taking citalopram (Celexa) 4 days ago. The patient now says, "This medicine isn't working." The nurse's best intervention would be to:

Correct Answer is A

Explanation

Which client best exhibits the characteristics that are typical of the prodromal period of schizophrenia?

Correct Answer is B

Explanation

A patient presenting with delusions of persecution about being poisoned has refused all meals for 3 days. Which intervention will most likely be acceptable to the patient?

After being told that his family will not be attending visitation, a 70-year-old patient turns over a table in a crowded common area. Which action takes priority?

A troubled adolescent pulled out a gun in a school cafeteria, fatally shot three people, and injured many others. Hundreds of parents come to the school after hearing news reports. After police arrest the shooter, which action should occur next?

Which patient meets the criteria for hospice services?

During lunch, a patient cuts herself with a plastic eating utensil. The patient refuses redirection and continues to attempt to cut herself. The patient is safely secured in a restraint chair. What is the next priority action for the nurse?

A nurse is working with a client who has frequent angry outbursts when he becomes frustrated. Which statement by the nurse is a true statement about anger?

A client is suspected to have dissociative identity disorder. Which characteristic does the nurse identify that the disturbed personal identity is most likely related to?

As part of the stress response, the HPA axis is stimulated. Which structures make up this system?