Just wanting to pick your brains for a sec..

[AllieRat]

Working on a take home open book psych quiz.. having problems with two questions mostly because I cannot find any reference in our text.

1. The physician mentions that R's dementia may be due to Alzheimer's disease or multiple infarcts. For the physician to make a differential diagnosis using the lease expensive test, the nurse might expect to have to prepare R for a

CT scan

MRI scan

SPECT scan

PET or SPECT scan

The group of us that got together were leaning towards CT or MRI but couldn't decide which would give a better differential view and or the costs involved.

2. A psychiatric nurse worked with a client throughout the client 6-week short term outpatient psychiatric treatment and is guiding the client to formulate followup independent self care plans. The nurse gently teases the client about a momentary lapse into an old maladaptive behavior. The client responds by smiling and saying " You're right I'm so much better now. The old me would have stormed out and cursed if you had said that the first day we met" The client's response indicates that the nurse's primary purpose in this use of humor with the client succeeded because it promotes the client's:

insight and control of symptoms

acceptance of a lifelong problem

conscious use of defense mechanisms

awareness of the need for longterm treatment

Again the group was split on this one. The majority went for insight and control of symptoms while others though conscious use of defense mechanisms was more likely.

If anyone has some insight into these questions.. gotta love those critical thinking psych questions. :)

[augigi, CNS]

1. I'd say CT scan - this will allow differential diagnosis since it would show up any cerebral infarcts. The question does not ask which would give a "better differential view".

2. I'd go with "insight and control of symptoms" - but I'm not a professional psych nurse, so don't quote me on that!

[nurse4theplanet, RN]

I agree.

1. CT...of course it will show any infarcts but, also, isn't there hallmark anatomical changes that occur with Alzheimers??? I don't know...I also believe CT is less expensive than MRI...I'd love to know for sure though...

2. Definitely insight (etc.)...The client acknowledges the maladaptive behavoir (insight) as well as the progress that she has achieved by possessing the ability to control the behavoir. No defense mechanisms are being used.

[charebec65]

I'd say a CT too to r/o infarcts. PET is the only one I've heard of that can show Alzheimers but it's apparently horrendously expensive.

I agree with the others iwth the insight.....

[locolorenzo22, BSN, RN]

CT is the less expensive of the two, and coming from someone who worked in a psych home setting, the insight and control is definitly a better answer. Mainly because it's not using defense mechanisms because if the client was, then there would be no insight/description of the issue by the client.

[Daytonite, BSN, RN]

for question #1, i would say the mri. http://www.fpnotebook.com/neu17.htm - according to family practice notebook, the mri would be preferred over the ct scan in diagnosing dementia.

for question #2, i would say the client's response indicates insight and control of symptoms. the patient's actual statement is self-analytical in nature. it makes no mention of a lifelong problem or of longterm treatment.

[1Tulip]

Dementia workup should rule out one of the most (only?) curable causes of dementia and that is normal pressure hydrocephalus (NPH). A non-contrast CT scan will do this. It will also show multiple (old) lacunar infarcts. The MRI (much more expensive) will show subtle things like lymphomas and multiple sclerosis and PML... way down the list of things that might cause dementia.

I haven't got a clue about the second question, but either the first or second options seemed OK to me. (But psych was not ever my strong suit.)

[AllieRat]

Yup just got home from the quiz.. correct answers were

CT scan

and

Insight.

Thanks for letting me pick your brains :)