NR 322 Reasoning Scenario Details Schizophrenia Module Report

12 August 2024

Individual Name:Julie Hicks Nicholas

Institution: Chamberlain University Columbus

Program Type:BSN

Malia Roach

Chamberlain University Columbus

BSN

Standard Use Time and Score

Date/Time: 8/2/2017 9:33:45 PM Time Use: 8 minutes Score: Strong

Module Report:

Real Life RN Mental Health 2.0

Schizophrenia

Reasoning Scenario Details

Schizophrenia - Module Usage on 8/2/2017 9:33:45 PM

Report Created on: 8/2/2017 09:41 PM EDT

Body Function

  • Cognition and Sensation: 100%

NCLEX RN Categories:

  • Psychosocial Integrity RN 2010: 100%
  • Pharmacological and Parenteral Therapies RN 2010: 100%
  • Management of Care RN 2013: 100%
  • Psychosocial Integrity RN 2013: 100%
  • Pharmacological and Parenteral Therapies RN 2013: 100%
  • Reduction of Risk Potential RN 2013: 100%

QSEN Categories:

  • Safety: 100%
  • Patient-Centered Care: 100%
  • Evidence-Based Practice: 100%
  • Quality Improvement: 100%

Decision Log:

Scenario: Daniel’s mother calls the urgent care hotline.

  • Question: Daniel’s mother explains to Nurse Kathy the events that have just taken place. Which of the following is the appropriate response by Nurse Kathy?
  • Selected Option: “I’m going to contact an ambulance to bring your son into the emergency room.”
  • Rationale: The client’s current behavior poses a safety risk and requires immediate intervention. Arranging ambulance transport provides the most immediate care and safety for both the client and his mother.

Scenario: Nurse Kathy responds to Daniel’s refusal for admission.

  • Question: Nurse Kathy is talking with Daniel and his mother. Which of the following is an appropriate response by Nurse Kathy to Daniel’s refusal of admission?
  • Selected Option: “Ms. Morris, because of Daniel’s current needs, you can agree to a temporary admission for diagnosis and treatment.”
  • Rationale: Due to the client’s acute symptoms, the provider is legally permitted to initiate a temporary admission for up to 15 days, with informed consent from the client’s mother.

Scenario: Nurse Kathy gives a report for Daniel’s admission.

  • Question: Nurse Kathy is preparing to give a report to Nurse Amber. Use the SBAR format to identify the findings Kathy should include when giving the report.
  • Selected Option:
    • Situation: Daniel Morris, a 17-year-old male, was brought to the emergency department by his mother. He exhibited auditory hallucinations at home, appeared anxious, paced the exam room, and spoke incomprehensibly. His vital signs were stable, urine toxicology was negative, and his blood glucose was 90 mg/dL. Due to the acute nature of his symptoms, Dr. Khan recommended admission.
    • Background: Approximately one year ago, Daniel’s father lost his job and subsequently committed suicide seven months ago. Since then, Daniel’s mother reports that he has become withdrawn and obsessed with basketball. His grades have dropped, and he began taking fluoxetine (Prozac) six months ago. This evening, Daniel became visibly upset, angry, and was heard having auditory hallucinations.
    • Assessment: Daniel appears visibly anxious, with incomprehensible speech, and is pacing around the room.
    • Recommendations: Dr. Khan has written a behavioral plan, which will be implemented as soon as possible.

Scenario: Daniel becomes agitated during his room admission.

  • Question: Which of the following interventions by Nurse Amber is appropriate when Daniel remains agitated?
  • Selected Option: Administer haloperidol (Haldol).
  • Rationale: The nurse should first employ the least restrictive intervention, such as administering haloperidol to reduce agitation and anxiety before considering more restrictive measures.

Scenario: Daniel remains agitated after receiving haloperidol.

  • Question: What action should Nurse Amber take if Daniel remains agitated after receiving haloperidol?
  • Selected Option: Place the client in physical restraints until he calms down.
  • Rationale: Since administering haloperidol was ineffective and Daniel continues to pose an immediate risk of harm, applying physical restraints is appropriate.

Scenario: Daniel is placed in restraints due to aggressive behavior.

  • Question: What is the appropriate intervention for Nurse Amber to take while Daniel is in restraints?
  • Selected Option: Observe Daniel directly while restraints are in place.
  • Rationale: Direct observation is necessary to ensure the client’s safety due to his increased agitation.

Scenario: Nurse Amber identifies symptoms of schizophrenia.

  • Question: Which findings are positive symptoms of schizophrenia? (Select all that apply.)
  • Selected Options: Disorganized speech, auditory hallucinations, acute paranoia.
  • Rationale: These are positive symptoms, as they are abnormal features present in schizophrenia.

Scenario: Nurse Mike cares for Daniel during his initial treatment with risperidone (Risperdal).

  • Question: What intervention should Nurse Mike include during the initial treatment?
  • Selected Option: Monitor orthostatic blood pressure every 4 hours.
  • Rationale: It is essential to monitor for orthostatic hypotension during initial risperidone treatment due to the associated risk.

Scenario: Nurse Mike provides education to Daniel’s mother.

  • Question: What should Nurse Mike say about the risk of schizophrenia in Daniel’s twin brother?
  • Selected Option: “Having an identical twin with schizophrenia significantly increases the risk of developing the disorder.”
  • Rationale: Research indicates that an identical twin has about a 50% risk of developing schizophrenia if the other twin has it.

Scenario: Nurse Mike provides discharge teaching.

  • Question: What should be included in the relapse prevention plan for Daniel?
  • Selected Option: “Daniel should participate in group therapy to decrease the risk of relapse.”
  • Rationale: Group therapy can help Daniel better understand the disease, learn coping strategies, and develop a support system, all of which can reduce the risk of relapse.

Scenario: Daniel is in the emergency department, upset and hostile.

  • Question: How many mL of lorazepam (Ativan) should Nurse Kathy administer when the prescribed dose is 1 mg and available dose is 2 mg/mL?
  • Selected Option: 0.5 mL.
  • Rationale: With 2 mg/mL available, 0.5 mL is the appropriate volume to administer for a 1 mg dose.

Scenario: Nurse Kathy responds to Daniel’s delusion.

  • Question: What is an appropriate response when Daniel claims to be a professional basketball player?
  • Selected Option: “Tell me more about basketball and what is important to you about the sport.”
  • Rationale: This therapeutic communication technique helps build rapport and provides insight into the client’s delusion.

Scenario: Nurse Kathy gathers assessment data on Daniel’s acute crisis.

  • Question: Which audio clip displays the speech alteration known as neologisms?
  • Selected Option: “It’s very schmoo of yem.”
  • Rationale: Neologisms are words that are made up and have no meaning to others, which is demonstrated in the selected audio clip.

Scenario: Nurse Nicole discusses risperidone (Risperdal) with Daniel.

  • Question: What should Nurse Nicole mention about the risk for extrapyramidal side effects (EPSs)?
  • Selected Option: “Risperidone has a low risk for EPSs but can cause weight gain.”
  • Rationale: While risperidone has a low risk for EPSs, clients should be aware of the potential for weight gain as a side effect.

Scenario: Nurse Nicole completes the Abnormal Involuntary Movement Scale (AIMS) assessment.

  • Question: Which action is appropriate during the AIMS examination?
  • Selected Option: Shine a penlight in the client’s mouth to observe the tongue at rest.
  • Rationale: Observing the tongue at rest for abnormal movements is part of the AIMS assessment.

Scenario: Nurse Nicole documents Daniel’s weight on a growth chart.

  • Question: Where should Daniel’s weight be documented on the growth chart?
  • Selected Option: Where age 18 and 75 kg meet.
  • Rationale: The nurse should document the weight where the horizontal line for age intersects with the vertical line for weight on the growth chart.

Individual Report – Score Explanation and Interpretation

Reasoning Scenario Information:

  • Reasoning Scenario Information provides the date, time, and duration of use, along with the score earned for each attempt. A Reasoning Scenario Performance score of Strong, Satisfactory, or Needs Improvement is provided for each attempt. This information is also provided for the Optimal Decision Mode if it has been enabled.

Reasoning Scenario Performance Scores:

  • Strong: Exhibits optimal reasoning that results in positive outcomes in the care of clients and resolution of problems.
  • Satisfactory: Exhibits reasoning that results in mildly helpful or neutral outcomes in the care of clients and resolution of problems.
  • Needs Improvement: Exhibits reasoning that results in harmful or detrimental outcomes in the care of clients and resolution of problems.

NCLEX® Client Need Categories:

  • Management of Care: Providing integrated, cost‐effective care to clients by coordinating, supervising, and/or collaborating with members of the multi‐disciplinary health care team.
  • Safety and Infection Control: Incorporating preventative safety measures in the provision of client care that provides for the health and well‐being of clients, significant others, and members of the health care team.
  • Health Promotion and Maintenance: Providing and directing nursing care that encourages prevention and early detection of illness, as well as the promotion of health.
  • Psychosocial Integrity: Promoting mental, emotional, and social well‐being of clients and significant others through the provision of nursing care.
  • Basic Care and Comfort: Promoting comfort while helping clients perform activities of daily living.
  • Pharmacological and Parenteral Therapies: Providing and directing administration of medication, including parenteral therapy.
  • Reduction of Risk Potential: Providing nursing care that decreases the risk of clients developing health‐related complications.
  • Physiological Adaptation: Providing and directing nursing care for clients experiencing physical illness.

Quality and Safety Education for Nurses (QSEN) Competencies:

  • Safety: The minimization of risk factors that could cause injury or harm while promoting quality care and maintaining a secure environment for clients, self, and others.
  • Patient‐Centered Care: The provision of caring and compassionate, culturally sensitive care that is based on a client’s physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values.
  • Evidence-Based Practice: The use of current knowledge from research and other credible sources, upon which clinical judgment and client care are based.
  • Informatics: The use of information technology as a communication and information gathering tool that supports clinical decision making and scientifically based nursing practice.
  • Quality Improvement: Care-related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet the needs of clients.
  • Teamwork and Collaboration: The delivery of client care in partnership with multidisciplinary members of the health care team, to achieve continuity of care and positive client outcomes.

Body Function Categories:

  • Cardiac Output and Tissue Perfusion: The anatomical structures (heart, blood vessels, and blood) and body functions that support adequate cardiac output and perfusion of body tissues.
  • Cognition and Sensation: The anatomical structures (brain, central and peripheral nervous systems, eyes, and ears) and body functions that support perception, interpretation, and response to internal and external stimuli.
  • Excretion: The anatomical structures (kidney, ureters, and bladder) and body functions that support filtration and excretion of liquid wastes, regulate fluid and electrolyte and acid‐base balance.
  • Immunity: The anatomic structures (spleen, thymus, bone marrow, and lymphatic system) and body functions related to inflammation, immunity, and cell growth.
  • Ingestion, Digestion, Absorption, and Elimination: The anatomical structures (mouth, esophagus, stomach, gall bladder, liver, small and large bowel, and rectum) and body functions that support ingestion, digestion, and absorption of food and elimination of solid wastes from the body.
  • Integument: The anatomical structures (skin, hair, and nails) and body functions related to protecting the inner organs from the external environment and injury.
  • Mobility: The anatomical structures (bones, joints, and muscles) and body functions that support the body and provide its movement.
  • Oxygenation: The anatomical structures (nose, pharynx, larynx, trachea, and lungs) and body functions that support adequate oxygenation of tissues and removal of carbon dioxide.
  • Regulation and Metabolism: The anatomical structures (pituitary, thyroid, parathyroid, pancreas, and adrenal glands) and body functions that regulate the body’s internal environment.
  • Reproduction: The anatomical structures (breasts, ovaries, fallopian tubes, uterus, vagina, vulva, testicles, prostate, scrotum, and penis) and body functions that support reproductive functions.

Decision Log:

  • Information related to each question answered in a scenario attempt is listed in the report. A brief description of the scenario, question, selected option, and rationale for that option is provided for each question answered. The words “Optimal Decision” appear next to the question when the most optimal option was selected.
  • The rationale for each selected option may be used to guide remediation. A variety of learning resources may be used in the review process, including related ATI Review Modules.