Chapter 17 & 18

The nurse is caring for a client who has been diagnosed with persistent depressive disorder. The nurse expects the client to manifest which symptoms? Select all that apply. A. The symptoms have been present for between 6 months and 1 year. B. The symptoms fluctuate from mild to severe. C. Altered sleep patterns D. Periods of increased energy followed by fatigue E. Altered eating patterns

B. The symptoms fluctuate from mild to severe. C. Altered sleep patterns E. Altered eating patterns

A business traveler has just arrived in Japan from the United States. During a meeting with the customer the traveler begins to experience yawning and stretching with an inability to stay focused on the meeting. The traveler also has some eye irritation and has developed a headache. Based on these clinical manifestations, what diagnosis would most likely be causing these symptoms? A. Advanced sleep phase syndrome B. Delayed sleep phase syndrome C. Free-running sleep disorder D. Time zone change syndrome

D. Time zone change syndrome

A client with a diagnosis of insomnia is surprised when the physician explains that the brain is still highly active during normal sleep. Which statement best captures the character of brain activity during sleep? A. "Fewer neurons in your brain are firing when you're asleep, but they're more synchronized than when you're awake." B. "While you're obviously less aware of stimuli when you're asleep, your brain is actually more active when you're asleep than when you're awake." C. "There are four types of brain activity, and actually all of them occur at different stages of sleep." D. "Your brain alternates between periods of activity and periods of inactivity when you're asleep, and these correspond to your eye movement."

A. "Fewer neurons in your brain are firing when you're asleep, but they're more synchronized than when you're awake."

A 70-year-old woman is brought to the emergency department by her daughter who noticed her mother has been experiencing intermittent confusion, uncoordinated movements and visual disturbances over the past several months. What should the nurse ask to best determine the cause of these symptoms? Select all that apply. A. "What medications is your mother currently taking?" B. "Does your mother drink alcohol?" C. "Does your mother have a history of internal bleeding?" D. "Is your mother facing significant stressors right now?" E. "Is your mother lonely?"

A. "What medications is your mother currently taking?" B. "Does your mother drink alcohol?"

A client asks what to expect when undergoing a sleep study. Which instructions is most accurate for the nurse to relay to this client? Select all that apply. A. "You will have an electrode near your eye to record eye movements." B. "They will place a catheter into your veins to give you medication if need be." C. "A urinary catheter will be placed in your bladder so you will not have to get out of bed to void." D. "You will have electrodes placed on your leg muscles to record movement while sleeping." E. "You will have electrodes placed on your scalp to record brain activity while sleeping."

A. "You will have an electrode near your eye to record eye movements." D. "You will have electrodes placed on your leg muscles to record movement while sleeping." E. "You will have electrodes placed on your scalp to record brain activity while sleeping."

A psychiatrist is providing care for a 68-year-old female whose anxiety disorder is significantly decreasing her quality of life. The nurse knows that the client will likely benefit from which pharmacologic therapies listed below? A. A drug that influences gamma-aminobutyric acid (GABA) levels B. An MAO inhibitor to increase the concentration of serotonin and norepinephrine C. An antipsychotic medication that blocks dopamine receptors D. A calcium channel blocking agent.

A. A drug that influences gamma-aminobutyric acid (GABA) levels

When explaining an upcoming test, a polysomnography, the nurse should include which education points related to equipment the client will have placed on his or her body? Select all that apply. A. An ECG with lots of chest leads will monitor heart rate and rhythm. B. A pulse oximeter placed on a finger is used to determine arterial oxygen saturation. C. An EOG will be placed on the skin near the eye to record eye movements. D. An EMG patch will be placed under the chin to record muscle movement. E. An actigraph device will be placed on the wrists and ankles to measure body motion.

A. An ECG with lots of chest leads will monitor heart rate and rhythm. B. A pulse oximeter placed on a finger is used to determine arterial oxygen saturation. C. An EOG will be placed on the skin near the eye to record eye movements. D. An EMG patch will be placed under the chin to record muscle movement. E. An actigraph device will be placed on the wrists and ankles to measure body motion.

The nurse is caring for a client who is experiencing hallucinations and delusions during an acute phase of schizophrenia. What class of medication should the nurse anticipate the health care provider will prescribe? A. An antipsychotic such as risperidone B. A benzodiazepine such as lorazepam C. A cholinesterase inhibitor such as donepezil D. An opioid receptor antagonist such as naltrexone

A. An antipsychotic such as risperidone

A 5-year-old child has starting sitting up in bed displaying signs of extreme anxiety. In the morning, when the parents ask the child about this, he has no recollection. What should the nurse convey to the parents if this happens again? A. Assist the child in settling down without awakening him or her after an episode. B. Watch closely to see if the child has any twitching or thrashing about. C. Bring the child back to the clinic if this keeps happening so we can prescribe some sleep medicine. D. Shake the child to wake him or her up and then comfort the child and put back in bed.

A. Assist the child in settling down without awakening him or her after an episode.

The parents of a 15-year-old boy are frustrated at his persistent inability to fall asleep at a reasonable hour at night, as well as they extreme difficulty that they have rousing him in the morning. While sleepy after waking, the son claims not to feel drowsy after lunch or in the evening. What is the most likely classification of the boy's sleep disorder? A. Delayed sleep phase syndrome (DSPS). B. Non-24-hour sleep-wake syndrome C. Advanced sleep phase syndrome (ASPS) D. Chronic insomnia

A. Delayed sleep phase syndrome (DSPS).

A 50-year-old woman has experienced devastating consequences in her family and work life as a result of her longstanding alcohol addiction. Her levels and pathways of which neurotransmitter are likely to differ from an individual's without addiction? A. Dopamine B. Acetylcholine C. Serotonin D. Norepinephrine

A. Dopamine

A client has been diagnosed with an anxiety disorder and has been started on a selective serotonin reuptake inhibitor (SSRI) and a benzodiazepine (BZD). What teaching is most important for the nurse to provide? A. Due to their addictive properties, it is important you only take the BZD for a short period of time. B. SSRIs are used for depression, not anxiety. You should clarify with your health care provider. C. These medications should not be taken at the same time of day due to serious interactions. D. For your safety, it is important that you take the BZD at bedtime as it causes extreme drowsiness.

A. Due to their addictive properties, it is important you only take the BZD for a short period of time.

A clinical nurse specialist is asked to assess a client who has returned to the emergency department for the fourth time this year with a suspected myocardial infarction. All tests have consistently been negative and it is believed the origin of the symptoms are psychological; the client has been given antianxiety medication. What information should the nurse gather to best determine a possible cause for the client's symptoms? A. History of childhood trauma B. Cardiovascular health parameters C. Current rating on an anxiety scale D. History of substance use

A. History of childhood trauma

Which describes the most likely course of Wernicke-Korsakoff syndrome? A. If the symptoms are correctly diagnosed, most of the effects of the syndrome can be reversed through better nutrition and supplemental thiamine. B. The syndrome is uniformly fatal, with death most often occurring within a few months of onset. C. The syndrome has no treatment, but drugs may be used to treat its associated dyskinesias and behavioral disturbances. D. The course of the syndrome is relentless, and most affected persons will die of infection within 2 to 10 years.

A. If the symptoms are correctly diagnosed, most of the effects of the syndrome can be reversed through better nutrition and supplemental thiamine.

The educator at a personal care home is teaching the staff about the importance of improving sleep quality for the residents of the home. What consequences of poor sleep in the older adult should the educator include? Select all that apply. A. Increased risk for falls B. Increased incidence of electrolyte imbalances C. Exacerbation of dementia D. Acceleration of cardiac disease E. Increased daytime alertness and activity

A. Increased risk for falls. C. Exacerbation of dementia D. Acceleration of cardiac disease

Which clinical manifestations would the nurse assess in the client with bipolar disorder who is experiencing mania? Select all that apply. A. Labile mood B. Highly distractible C. Inflated self-esteem D. Despondent when asked questions E. Excessive sleepiness

A. Labile mood B. Highly distractible C. Inflated self-esteem

A 20-year-old college student presents to the campus medical clinic because of unshakable despondency in recent months and is diagnosed with depression. What treatments should the nurse expect to be prescribed? A. Medication that inhibits the reuptake of serotonin in his pre-synaptic space. B. Drugs that inhibit the accumulation of cyclic adenosine monophosphatase (cAMP). C. Benzodiazepines such as clonazepam that modulate his GABA receptors. D. Cholinesterase inhibitors that potentiate the action of available acetylcholine.

A. Medication that inhibits the reuptake of serotonin in his pre-synaptic space.

The nurse is educating the new mom about the sleep patterns of a newborn. Which statement should she include in her education? A. Newborns usually sleep ~16-20 hours/day. B. Newborns generally sleep 6-8 hours at a time and then are awake for 2-4 hours. C. Don't worry about them sleeping too long; they will wake up when they are hungry. D. Most newborns will have their days and nights mixed up.

A. Newborns usually sleep ~16-20 hours/day.

The nurse is caring for an 80-year-old client who has developed delirium during the shift. What focused assessments should the nurse conduct in an attempt to determine a cause for the delirium? Select all that apply. A. Recent medication changes B. Heart rate C. Urinary output D. Last bowel movement E. Dietary intake

A. Recent medication changes C. Urinary output D. Last bowel movement

The family member of a client with bipolar disorder reports the client is in a manic phase. What instructions should the health care provider give the family member to watch for, because it can lead to harm? A. The client may self-medicate with alcohol or recreational drugs. B. The client will eventuallly slow down and take a nap. C. The client may become quiet and stare off in space. D. The client will begin to hallucinate and may become belligerent against the family.

A. The client may self-medicate with alcohol or recreational drugs.

Nurses regularly rotate between day shift hours and overnight work hours. Following an overnight shift, nurses frequently exhibit which manifestation? Select all that apply. A. Unable to sleep for long period of time during the day B. Falling asleep while sitting in front of a computer charting during the night C. Finding it difficult to sleep when having a night off D. Heightened alertness and reflexes on drive home after work E. Increase hunger and thirst in the middle of the night

A. Unable to sleep for long period of time during the day B. Falling asleep while sitting in front of a computer charting during the night C. Finding it difficult to sleep when having a night off

As the frontal lobe deteriorates with Huntington disease, for which manifestations should the nurse educate the family to watch? Select all that apply. A. slowing of cognitive function B. hostility C. flaccid muscle tone D. droopy eyelids E. impulsiveness

A. slowing of cognitive function B. hostility E. impulsiveness

The mother of an 18-year-old female has sought the advice of the nurse practitioner regarding her child's substance use. The mother states, "She has been very moody since becoming a teenager but she was so happy recently and making big plans." What should the nurse ask the mother next? A. "Do you know what type of substances your daughter uses?" B. "Is there a history of bipolar disorder in your family?" C. "Is your daughter interested in attending a support group?" D. "Were there any complications when you were pregnant with her?"

B. "Is there a history of bipolar disorder in your family?"

While working for a neurologist who is assessing a client experiencing restless legs syndrome (RLS), the nurse should be prepared to answer the question about why the client needs to have iron level drawn? The nurse response should include: A. "Many of the drugs we give for RLS can cause drastic decreases in your iron level." B. "Many clients with RLS also have an iron-deficiency anemia as well." C. "You just look a little pale and so we want to make sure you have normal blood levels." D. "People with low iron levels do not have enough oxygen circulating to their legs."

B. "Many clients with RLS also have an iron-deficiency anemia as well."

A health care provider specializes in treating conditions classified as parasomnias. Which client should the nurse refer to this provider? A. A 5-year-old who wets the bed at night B. A 25-year-old who sleepwalks C. A 50-year-old with restless legs syndrome (RLS) D. A 68-year-old with chronic insomnia

B. A 25-year-old who sleepwalks

Which observation of a client in a sleep lab would indicate to clinicians that the client is in REM sleep? A. Rolling eye movements are observed and the client has moderate muscle activity. B. Client's motor movements are suppressed and muscle tone is flaccid. C. Delta waves are evident on client's EEG and heart and respiration rates are slowed. D. Client has a low level of cerebral activity and EEG indicates low voltage and mixed frequencies.

B. Client's motor movements are suppressed and muscle tone is flaccid.

Which characteristics are expected during stage 2 non-REM sleep? Select all that apply. A. It occurs at the onset of sleep and last ~7 minutes. B. During this stage theta waves are primarily seen on EEG. C. Known as deep sleep where heart rate and BP are decreased. D. Has interruptions of spindle activity, which helps with integration of new memories. E. Muscles of the body are relaxed.

B. During this stage theta waves are primarily seen on EEG. D. Has interruptions of spindle activity, which helps with integration of new memories.

A 70-year-old client has just been diagnosed with a major depressive episode. For what other condition should the nurse assess? A. Metabolic syndrome B. Neurocognitive disorder C. Psychotic disorder D. Wernicke-Korsakoff syndrome

B. Neurocognitive disorder

A 44-year-old female has been diagnosed with major depression. Which neuroimaging finding is most congruent with the woman's diagnosis? A. Decreased brain activity in the pons and brain stem B. Reduced activity and gray matter volume in the prefrontal cortex C. Atrophy and decreased blood flow in the amygdala D. Enlargement of the lateral and third ventricles and reduction in frontal and temporal volumes

B. Reduced activity and gray matter volume in the prefrontal cortex

Which statement on the final diagnostic report regarding a computerized tomography (CT) of the head with contrast would lead health care providers to diagnose a client with Alzheimer disease? A. Large area of ischemia noted in temporal lobe B. Too numerous to count beta-amyloid (βA) deposits noted C. 90% obstruction in posterior cerebral artery D. Mural thrombus of vertebrobasilar arteries

B. Too numerous to count beta-amyloid (βA) deposits noted

A nurse is counseling a group of clients who range from 65 to 75 years of age about healthy sleep habits. What characteristics of sleep patterns in this population should the nurse include? Select all that apply. People in this population: A. need more sleep than people in their 20s. B. have more interrupted sleep and nighttime arousal. C. require about 2 hours of sleep in the day due to poor nighttime sleep. D. are more likely to have sleep disrupted by nighttime noises. E. live with more chronic illnesses that can affect sleep.

B. have more interrupted sleep and nighttime arousal. D. are more likely to have sleep disrupted by nighttime noises. E. live with more chronic illnesses that can affect sleep.

An adult client who was sexually abused as a child has been displaying some stress. The client seems to complain of increasing medical problems when under more stress. The nurse would classify this as an example of: A. vitamin deficiency. B. the stress-diathesis theory. C. Mendelian research. D. parental disassociation.

B. the stress-diathesis theory.

A 57-year-old client has presented to a clinic exasperated by the effect that restless legs syndrome is having on sleep. The clinician has performed client teaching prior to choosing a treatment plan. Which response by the client demonstrates a sound understanding of the condition? A. "Increasing my calcium intake is something simple that might help." B. "Transcutaneous electrical nerve stimulation might be a treatment that can help me avoid needing drugs for this." C. "This could be something that I'm simply prone to genetically." D. "I'll try to get more exercise, since there aren't really any effective medications for restless legs syndrome."

C. "This could be something that I'm simply prone to genetically."

Parents of a 16-year-old male who has been behaving in increasingly bizarre ways in recent months are distraught that he has been diagnosed with schizophrenia. Which of the mother's statements about her son's diagnosis demonstrates an accurate understanding of the disease? A. "It's disturbing to know that what I did when I was pregnant and the way we raised him contributed to this." B. "We are somewhat relieved that psychotherapy and a supportive environment will resolve most of the positive and negative symptoms." C. "This makes us even more worried about his younger brother and whether he might develop schizophrenia." D. "We're committed to lovingly but firmly convincing him that his delusions aren't based in reality."

C. "This makes us even more worried about his younger brother and whether he might develop schizophrenia."

Which individual would be expected to have the highest risk of developing sleep apnea? A. A woman with restless legs syndrome and chronic obstructive pulmonary disease (COPD) B. A male client with a diagnosis of unstable angina and peripheral arterial disease C. A man with poorly controlled diabetes and hypertension D. A female with chronic insomnia and atrial fibrillation that is treated with warfarin

C. A man with poorly controlled diabetes and hypertension

Which statement about over-the-counter (OTC) melatonin is accurate? A. It has received the FDA approval for effectiveness as a sleep aid. B. Long-term studies of melatonin conclude that it is not addictive. C. It produces phase-shifting changes in the circadian rhythm. D. Under strict clinical testing, potency and purity of melatonin has been shown to be consistent.

C. It produces phase-shifting changes in the circadian rhythm.

Which statement best captures the current understanding of the etiology of mental illness? A. The role of "nurture," experiences, and relationships has been largely disproven. B. Mental illness can be attributed to organic brain changes and pathophysiologic processes. C. Mental illness exists from the interplay of biologic factors and psychosocial influences. D. Current understanding of mental illness has shown that both biologic psychiatry and psychosocial psychiatry are incorrect.

C. Mental illness exists from the interplay of biologic factors and psychosocial influences.

Which motor disorder of sleep can be life threatening? A. Narcolepsy B. Periodic limb movement disorder C. Obstructive apnea D. Restless legs syndrome

C. Obstructive apnea

A 17-year-old female is suspected of having narcolepsy. Which aspect of her medical history and sleep analysis would contribute to a confirmation of the diagnosis? Select all that apply. A. She repeatedly moves her large toe, ankle, and knee during sleep. B. She complains of a powerful urge to move her legs when in bed at night. C. She has frequently awakened unable to move or speak. D. She believes that she experiences auditory hallucinations when she awakens. E. Her sleep latency is normally around 1 hour.

C. She has frequently awakened unable to move or speak. D. She believes that she experiences auditory hallucinations when she awakens.

Which statement most accurately characterizes an aspect of the neurobiology of sleep? A. The hypothalamus stimulates the anterior and posterior pituitary to modulate sleeping-waking cycles. B. The pituitary releases melatonin at predictable points in the circadian rhythm in order to facilitate sleep. C. The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep-wake cycle. D. Input from the retinas is interpreted by the cerebellum and contributes to maintenance of the circadian rhythm.

C. The reticular formation, thalamus, and cerebral cortex interact to integrate the sleep-wake cycle.

A geriatrician and social worker are facilitating a family meeting for the children and wife of a 79-year-old man who has been diagnosed with Alzheimer disease. What goal of treatment will the clinicians most likely prioritize in their interactions with the family? A. Modest reversal of brain plaque formation and improved symptomatology through cholinesterase inhibitors B. Surgical treatment of the underlying ischemic changes that underlie the manifestations of the man's disease C. The use of medications such as donepezil and rivastigmine to slow the progression of the disease D. Cognitive and behavioral therapy to counteract the agitation, depression and suspiciousness associated with Alzheimer disease

C. The use of medications such as donepezil and rivastigmine to slow the progression of the disease

A group of nurses rotate between day shift and night shift hours. Following a very busy, traumatic 12-hour shift, which nurse should be given a ride home for personal safety? A. nurse who is hyperactive following frequent caffeine intake B. nurse who is not going to sleep when arriving home to organize the child's birthday party C. nurse who has been nodding off while charting and just seems sluggish D. nurse who decides to go for a walk outside prior to driving home

C. nurse who has been nodding off while charting and just seems sluggish

A woman has a long-running compulsion to repeatedly check if the doors of her home are locked, and has received a diagnosis of obsessive-compulsive disorder (OCD). Her husband is at a loss to understand her irrational behavior and has sought help from a therapist himself to deal with the effect that the wife's OCD is having on their daily lives. Which of the husband's statements would require correction? A. "It's a relief to know that this can be changed if she continues with therapy and the medications she's been prescribed." B. "It's odd that someone like her and someone who's depressed might both respond positively to the same drugs." C. "I thought that this was something exceedingly rare but I'm actually a bit relieved to learn that others have this disorder as well." D. "I'm glad that this is something that's a result of life stressors and is not associated with any dysfunction in her brain."

D. "I'm glad that this is something that's a result of life stressors and is not associated with any dysfunction in her brain."

A 77-year-old client is concerned because the client's spouse has occasionally been found sleepwalking in the last several weeks. What is the health care provider's most appropriate response to this client's concerns? A. "This is not an uncommon event that often accompanies older age." B. "I'll likely prescribe a benzodiazepine for this when I next see your husband." C. "This is understandably upsetting for you, but as long as the environment is safe it's likely not significant." D. "There may be something else going on with your husband such as delirium or a problem with his medications."

D. "There may be something else going on with your husband such as delirium or a problem with his medications."

Which of the following is a negative symptom of schizophrenia? A. Hallucinations B. Incoherence C. Word salad D. Affective flattening

D. Affective flattening

An adult client is experiencing chronic insomnia related to a recent divorce and child custody proceedings. The client is requesting a renewable prescription for "sleeping pills." The nurse knows that which intervention will provide the most beneficial treatment for this client? A. Sedatives and hypnotic drugs will not provide safe relief of the client's health problem. B. The client is suffering from primary insomnia. C. Melatonin supplements will be the safest and most effective long-term pharmacologic treatment. D. Behavioral therapies and education regarding sleep hygiene will provide assistance for the client.

D. Behavioral therapies and education regarding sleep hygiene will provide assistance for the client.

The nurse knows that which observation of a client during a sleep study would be most likely considered a pathological finding? A. The client experiences periods of apnea of 5 to 15 seconds in duration. B. The client's intrinsic clock involves a sleep-wake cycle that is consistently 2 hours longer than the actual length of a day. C. A client's PCO2 level is increased and the PO2 level decreased during deep sleep. D. The client spends the majority of the sleeping hours in deep REM sleep.

D. The client spends the majority of the sleeping hours in deep REM sleep.

After surviving an ischemic stroke, a 79-year-old male has demonstrated significant changes in his emotional behavior, with his family noting that he now experiences wide mood swings with exaggerated responses of empathy, anger, and sadness to situations. His care team would most likely attribute these responses to ischemic changes in which brain structure? A. The man's occipital lobe B. The client's temporal lobe in general and Wernicke area in particular C. The man's parietal lobe D. The components of the client's limbic system

D. The components of the client's limbic system

Which client at the community mental health clinic should the nurse refer for immediate inpatient hospitalization? A. client who is displaying a posture in an odd fixed position B. client who is performing repetitive, idiosnycratic movements C. client who has a tendency to speak very little D. client who is hearing voices telling him or her to kill one's parents

D. client who is hearing voices telling him or her to kill one's parents

A nurse is exploring treatment options with a client living with sleep apnea. The nurse should inform the client that the most common reason for treatment refusal with continuous positive airway pressure (CPAP) is because: A. surgical options exist that are permanent so clients usually choose this over CPAP. B. using CPAP has not been shown to help with the negative effects of sleep apnea and is for comfort only. C. most clients learn how to manage sleep apnea with oral devices, making CPAP unnecessary. D. many clients find the treatment too uncomfortable and are unable or unwilling to use it regularly.

D. many clients find the treatment too uncomfortable and are unable or unwilling to use it regularly.