#1 Analyze the question
Rephrase the question in your own words
“I have four patients with schizophrenia, a condition that makes it difficult to differentiate reality from delusions. I am planning their care. For which of those clients would long-acting, injectable antipsychotic medications be the best fit?”
Tip: Ask yourself: Which piece of knowledge is the question trying to test for? This question aims at the test-taker needing to know the rationale behind choosing long-acting, injectable antipsychotics, and matching this up with the client that fits that rationale best.
What is schizophrenia?
Schizophrenia is a spectrum of chronic thought disorders characterized by a serious lack of organized thoughts and insight. The literal definition of the word schizophrenia is “fragmented mind.” Affected persons experience hallucinations, delusions, and various impairments in psychosocial functioning.
How can antipsychotics be administered?
Routes of administration for antipsychotic medications:
- Oral (disintegrating tablets)
- Intramuscular (long-acting injectables)
- Intranasal
- Buccal
- Sublingual
- Transdermal
- Rectal
- Via inhalation
Note that not all medications can be administered via all routes.
What are the advantages of long-acting injectable antipsychotics?
Long-acting, injectable antipsychotic medications…
- …reduce non-adherence to the treatment plan.
- …reduce the likelihood of overdoses.
- …reduce the frequency of relapses.
#2 Eliminate the answer options you think are incorrect
A. A client who often travels
If a client often travels, not having to take medication that often would probably be helpful. For now, don’t eliminate this one.
B. A client without health insurance
There are lots of programs, so this is a complicated one – let’s not eliminate it and move on.
C. A client without access to transportation
This one can be immediately eliminated. Injectable medications are given in a physician’s office, so a client with transportation issues would not be a good rationale to choose injectables.
D. A client who frequently loses their medications
Giving a long-acting injectable to a client who frequently loses medications sounds helpful, so don’t eliminate in this first pass either.
#3 Look at the ones you did not eliminate and choose your answer
In the first pass for the answer options, only one of the answer choices was immediately and clearly eliminated. That’s okay: This method can sometimes already leave you with a single correct answer; if not, we move onto the next step.
Look at the remaining answer choices and really understand how you would justify each one as the correct answer:
- A. A client who often travels: This person might have a hard time scheduling regular appointments for medication administration. At the same time, the fact that they travel a lot does not mean they are unable to adhere to their medication plan on their own. It might be convenient for the person to go on a trip and not worry about medication for a while, but that is not a very strong rationale for choosing a medication, compared to patient safety.
- B. A client without health insurance: Issues with funding can be addressed with social workers to try and get coverage for the best medication option for a client, regardless of the method of administration. So, there is no clear direct reason why this is easier for injectable medications.
- D. A client who frequently loses medications: This client is unlikely to take their medication with the consistency that is necessary with antipsychotics. This can pose great risks with a condition as serious as schizophrenia. This client is therefore a great candidate for long-acting injectables, ensuring adherence to the medication regimen.
An important reason why long-acting, injectable medications might be a good choice for a patient is that it takes the responsibility of taking the medication away from the client. The patient comes into the office with an appointment, and the medication is administered there.
While you could probably come up with rationales that justify each of the three answers above as an answer, answer D (the client who frequently loses medications) would have the strongest, clearest benefit of the main thing that is unique about injectable antipsychotics: They are administered in fixed appointments in the office, so the control does not lie with the client who is unable to stay on top of it, and we ensure that the patient receives the treatment they need. D is the correct answer.
#4 Recap: what if several questions seem right in a multiple-choice question?
It can be easy to talk yourself into multiple different answers when several of them seem plausible. The best way to tackle questions that ask for one correct answer but have several plausible choices is to be systematic when looking at the different choices. Make sure you’re clear on what the question is aiming at.
What you can learn from this sample question:
- Injectable antipsychotics are a healthcare-assisted method of administration (client needs to come in), and are typically administered on a 4 week schedule.
- The main reason to choose injectable antipsychotics is for people who are not consistent in taking their medication (takes responsibility away from them)
- Even in a question that asks for one correct answer, the others don’t necessarily need to be plain wrong and can be rationalized. Focus on which answer choice best reflects the underlying learning – “We want to choose this type of medication for people who can’t follow their medication plan reliably by themselves”.
