A child of seven, Michael is brought in for an evaluation. His grandmother, who is raising the child, states, “Mikey is a sweet boy, but he is not very smart. He has never been good at school, even though he likes to go. He still has trouble with his numbers and letters. I have had him up to the school for tutoring, but he just doesn’t seem as smart as Allie or Karrie. Allie is five and she can write her name and knows so much more than Mikey. Karrie is three and can sing the numbers and the letter. I am worried about him.” Michael’s teachers indicate that he has academic difficulty. Michael is a short and slightly overweight child who has problems with reasoning, problem solving, and academic tasks. His progress in mathematics, reading, writing, and understanding time and money issues is limited. He lags behind his peers in all academic skills, reading slowly and poorly and having difficulty with arithmetic calculations. Although generally a gentle child he becomes aggressive and strikes out when he is teased or frustrated by tasks that he cannot accomplish. Accepted by most of the class, a few peers sometimes pick on the child. Michael has delayed mental and social development. He has some friends in his neighborhood and at school and is friendly and sweet, but some of his friends take advantage of him. Early in the year, an older boy coerced him into giving him sweets and his lunch money until another child informed the teacher. The boy is eager to make friends and is unaware that some “friends” will take advantage of him. He is becoming more self-sufficient; he keeps clean if his grandmother mother assists him. She still checks his teeth brushing, bathing and toileting. He sometimes has accidents if he is too focused on a task and needs help cleaning himself. It was a struggle to get him there, but he has learned many important self-care behaviors. At school he is monitored by his teacher. He has learned to do simple chores, taking out the garbage, putting water in the dog’s bowl, even walking the dog with supervision and takes pride in his accomplishments. Michael needs assistance in many areas of life but tries hard to learn skills and be independent. You diagnose what?

Nathan, 33, has had a varying course of issues since late adolescence. He had difficulty in school because of his tendency to engage in risky behaviors, fighting, and his short temper. Although gifted in linguistic and mathematical intelligence, his mood issues created problems with teachers and peers. He had one hospitalization as a child, 7, when he insisted that his grandfather, who had died recently, was talking to him. He was an athlete and channeled some of his excess energy into team sports until an injury sidelined him in his junior year. Nathan has a history of drug and alcohol use disorder from that period. As an adult, he completed undergraduate studies and a master’s degree after recovering from his alcohol and drug use problems. He was diagnosed with depression by an internist and given an Zoloft for the condition. After having taken the medication for several months, his girlfriend brought him to the ER disturbed by his behavior. Betsy states, “I have been with Nate for several years and gotten used to his periods of depression, but this is something new. That is not to say that he is easy to deal with, but this is different. In the past two weeks he has slept less than 3 hour a night. He is not a good sleeper, but 2 or 3 hours a night! Then he was so up and energetic. He had lots of energy, too much, was elated, not happy but almost high. Then he started redoing our basement. He went to Lowes and spent a ton of money on flooring, paint, wood to redo the basement. Nate wanted to redo the whole house. He would start on one part of his projects and go to something else. It upset me to watch him tear stuff out and not fix it. As it went on, he became irritable if I did not do everything he said when he said it. He was hard to take, demanding. The thing is he is just not that way. Nat is sweet and kind. He started to scare me because it just wasn’t like him. Not violent, no, just like I had to stop whatever I was doing and do what he wanted. He kept getting worse and after more than a week he started talking to someone who was not there. That was what brought me here. Another thing he never did, no taking to the wall.” Early in hospitalization the patient was medicated with 5 mg. of Haldol, 2 mg. of Ativan im to calm his agitation and combative behaviors. After awakening from his stupor, he asked where he was and what has happened. He was begun on 250 mg Depakote twice daily and 2 mg. daily of Risperdal for symptom relief. Initial drug screens indicated no illicit medications in the patient’s bloodwork. He is kept in the psychiatric facility for another week and a half during which he has begun to oversleep, reject food, and appear moderately depressed. You diagnose what?  

To differentiate the levels of severity of the conditions in the Schizophrenia Spectrum Category use which of the following instruments?  

Which statement by the client newly prescribed tamsulosin indicates teaching has been effective?

Case Study: Questions 48-50 Mrs. Smith, a 57-year-old scheduled to have a kidney biopsy to determine the cause of her frequent episodes of hematuria.  She has had numerous other diagnostic studies done that remain inconclusive.  She is very concerned of the biopsy risks and is fearful of the results. Question 48: Which of the following will the nurse prioritize as part of Mrs. Smith’s pre-operative checklist?

The client has been prescribed kayexalate 15mg TID.  What is a priority nursing intervention prior to administration?

The client with Chronic Kidney Disease was admitted for shortness of breath, fatigue, and a respiratory rate = 30 breaths/min.  An ABG was ordered and the results are: pH 7.30m CO2 34, HCO3 19.  The nurse would interpret the ABG as? _______

The nurse is providing care for the client post-motor-vehicle accident with a suspected renal injury.  Which order should the nurse anticipate being ordered?

The nurse is assessing the client admitted with renal calculi.  Which of the following admission data should the nurse prioritize?  Select all that apply.

The nurse is caring for the client who is scheduled for a renal CT scan with contrast later in the shift.  Which of the following actions should the nurse anticipate completing? Select all that apply.