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Which medication will the nurse expect to administer as a first-line treatment to the patient with bulimia nervosa? 1. Fluoxetine (Prozac) 2. Methylphenidate (Ritalin) 3. Fluphenazine (Prolixin) 4. Diphenhydramine (Benedryl)
Answer: 1 Explanation: 1. Fluoxetine (Prozac), an SSRI, is effective for patients with bulimia when given at the higher dose of 50 to 60 mg per day. Diphenhydramine (Benedryl),methylphenidate (Ritalin), and fluphenazine (Prolixin) are not first-line medications for patients with bulimia nervosa.
The nurse caring for a malnourished patient with anorexia nervosa in the hospital knows to watch for which potentially fatal condition? 1. MAOI toxicity 2. Vitamin deficiency 3. Refeeding syndrome 4. SSRI-induced suicidality
Answer: 3 Explanation: 3. Refeeding syndrome is a potentially fatal condition that occurs when severely malnourished patients begin eating again for weight restoration. Refeeding syndrome can cause fluid and electrolyte disorders and neurological, pulmonary, cardiac, neuromuscular, and hematologic complications. It is important for
) The nurse taking care of a patient with an eating disorder that knows which are goals of treatment? Select all that apply. 1. Prevent relapse 2. Treat physical complications 3. Correct maladaptive thoughts 4. Restore the patient to ideal weight 5. Monitor and restrict family interactions
Answer: 1, 2, 3
) Which initial nursing interventions are appropriate the patient with anorexia nervosa? Select all that apply. 1. Encouraging the patient to listen to her favorite music. 2. Talking to the patient about a favorite pastime. 3. Asking the patient to limit the number of sodas she is drinking. 4. Helping the patient confront the issue that causes stress about eating. 5. Leaving the patient alone to think when the patient is feeling overwhelmed
Answer: 1, 2, 3
The nurse knows that, which meal plan is best when refeeding adolescents with eating disorders during the first two weeks of inpatient hospitalization? 1. Meals with 30% fat, 5% carbohydrates, and 65% protein 2. Meals with 30% fat, 15% protein, and 55% carbohydrates 3. Meals with 35% fat, 20% protein, and 55% carbohydrates 4. Meals with 20% fat, 30% protein, and 50% carbohydrates
Answer: 1 Explanation: 1. A 2010 retrospective study (Whitelaw, Gilbertson, Lam, & Sawyer) suggests that aggressively refeeding adolescents during the first two weeks of inpatient hospitalization with 30% fat and 36-65% protein helps them achieve weight gain, with better than average results, and no incidents of refeeding syndrome or medical complications.
The nurse is caring for a patient who is experiencing alcohol withdrawal. Which nursing diagnosis receives priority for a patient in alcohol withdrawal? 1. Risk for Injury 2. Ineffective Coping 3. Disturbed Sensory Perception 4. Disturbed Thought Processes
Answer: 1 Explanation: 1. A patient who is experiencing alcohol withdrawal is at risk for injury from delirium tremens. Death from delirium tremens can occur from volume depletion, electrolyte imbalance, or cardiac arrhythmia. Disturbed thought processes and disturbed sensory perceptions are diagnoses used for delusions, hallucinations, and illusions that may occur during delirium tremens, however, these are not highest priority diagnoses. Ineffective coping is not the priority for the patient experiencing alcohol withdrawal. Page Ref: 461
The nurse is caring for a patient with a personality disorder who has manifestations of emotional reactivity. According to the biological perspective, which neurotransmitter is most likely altered? 1. Norepinephrine 2. Serotonin 3. Acetylcholine 4. Dopamine
Answer: 1 Explanation: 1. According to the biological perspective, various neurotransmitters are associated with behavior. Alterations in specific neurotransmitters lead to various manifestations. An alteration in norepinephrine may lead to emotional reactivity. Alterations in serotonin levels lead to problems with inhibition and affect. Alterations to acetylcholine lead to lethargy. Finally, alterations in dopamine levels lead to histrionic traits.
The nurse caring for a patient with an eating disorder knows that which domain's characteristics result in the central theme of distorted body image and belief and fear of being fat? 1. Cultural 2. Spiritual 3. Sociological 4. Psychological
Answer: 1 Explanation: 1. Distorted body image and belief and fear of being fat, which are essentially cultural in origin, are criteria of both anorexia nervosa and bulimia nervosa. All connections are overshadowed and replaced with a self-perpetuating cycle of food consumption, restriction, and loss of control to expel all nutrients at the cost of the patient in the spiritual domain for patients with eating disorders. The sociological domain includes environmental factors, such as family and peer relationships and media portrayals of thinness, which reinforce eating disorder behaviors. The psychological domain includes distorted thoughts and perceptions of self on body shape and the ability to control weight.
The nurse is providing patient education about addiction. Which statement by the patient demonstrates that the patient has understood the teaching? 1. "Addiction is a biopsychosocial problem." 2. "Addiction is an emotional attachment." 3. "Addiction is a behavioral habit." 4. "Addiction is a moral disease."
Answer: 1 Explanation: 1. How and why addiction occurs can be best understood from a perspective that includes all of the wellness domains — biological, sociological, psychological, cultural, and spiritual. Addiction is not a moral disease, a behavioral habit, or an emotional attachment. Page Ref: 438-439
A nurse is assessing a patient with an obsessive-compulsive personality disorder. Which would the nurse expect to find during assessment? 1. Difficulty completing projects 2. A sense of spontaneity 3. Open expression of feelings 4. Ability to tolerate mistakes
Answer: 1 Explanation: 1. Individuals with obsessive-compulsive personality disorder strive at all times to keep the world predictable and organized. These individuals have difficulty in completing projects. Individuals with obsessive-compulsive disorder are excessively conscientious and rigid and are unable to tolerate mistakes or spontaneity. These individuals feel required to fulfill unending duties, responsibilities, and tasks, are self-critical, and adhere strictly and concretely to rules. Individuals with obsessive-compulsive disorder rarely express their feelings openly. Page Ref: 396
The nurse is planning care for a client with a schizoid personality disorder. Which nursing diagnosis will the nurse likely use for this client? 1. Social Isolation related to inadequate social skills, craving of solitude 2. Risk for Violence, Self-Directed, related to poor impulse control 3. Fear related to feelings of abandonment 4. Ineffective Individual Coping related to high dependency needs
Answer: 1 Explanation: 1. Individuals with schizoid personality disorder show a preference for solitary interests and claim to enjoy being alone. These individuals typically work at occupations that require minimal social interaction. Risk for violence and fear would be appropriate diagnoses for a patient with borderline personality disorder. Ineffective individual coping related to high dependency needs would be an appropriate nursing diagnosis for dependent personality disorder. Page Ref: 403
The nurse is caring for a patient with schizotypal personality disorder. The nurse anticipates providing patient education regarding which type of medication? 1. Typical antipsychotic 2. Atypical antipsychotic 3. Tricyclic antidepressant 4. Mood stabilizer
Answer: 1 Explanation: 1. Patients who have schizotypal personality disorder are best treated with typical antipsychotics. It is thought that a dopamine dysregulation is a primary cause of the psychotic symptoms these patients experience. It is for this reason that typical antipsychotics work best for these patients. Atypical antipsychotics work best for patients with Cluster B disorders, specifically borderline personality disorder. Tricyclic antidepressants are helpful in treating emotional dysregulation; however, these medications increase the lethality of suicide attempts due to their cardiotoxicity. Mood stabilizers work best for patients experiencing emotional dysregulation.
) What factor does the nurse recognize as the greatest contributing factor to poor outcomes for patients with anorexia nervosa? 1. The patient resents or refuses treatment. 2. There are limited treatments for this condition. 3. Changes in the patient's behavior are irreversible. 4. Treatment approaches are fragmented and controversial.
Answer: 1 Explanation: 1. Patients with anorexia nervosa generally resent the attempts of others to influence them. These individuals experience extreme denial that they have a problem and, therefore, typically resist treatment. It is not true that patient behaviors are irreversible or that there are limited treatments available to treat this condition. The treatment approach is not the predominant contributor to a poor outcome.
A nurse is caring for a patient with a binge-eating disorder. What condition or appearance will the nurse most likely find in the patient? 1. Obesity 2. Hunger 3. Anorexia 4. Emaciation
Answer: 1 Explanation: 1. Patients with binge-eating disorder are usually overweight or obese. Patients who are obese experience impaired functioning on psychosocial measures and impairment in physical functioning related to obesity as compared to individuals without eating disorders. Patients who binge eat are less likely to become hungry, anorexic, or emaciated. Page Ref: 304
The nurse caring for a patient with binge-eating disorder knows that the health care provider ordered orlistat (Xenical) in conjunction with cognitive-behavioral therapy for which reason? 1. To help reduce dietary fat absorption and, therefore, binge-eating disorder (BED) symptoms 2. To increase the ability to lose weight and help with disordered thinking 3. To reduce the depression that is associated with the inability to lose weight 4. To provide significant weight reduction and provide adequate remission from binging
Answer: 1 Explanation: 1. Research shows that orlistat (Xenical) in combination with cognitive-behavioral therapy (CBT) results in a reduction of binge eating, remission rates, and weight loss. Orlistat (Xenical) reduces dietary fat absorption and, when combined with CBT, significantly reduces BED symptoms and enhances weight loss. Orlistat (Xenical) does not reduce depression or help with disordered thinking.
) The nurse knows that which action is most important prior to implementing care for a patient with anorexia nervosa? 1. Determining patient willingness 2. Developing a therapeutic relationship 3. Educating the patient about the disorder 4. Establishing specific, realistic, and measurable goals
Answer: 1 Explanation: 1. While all the answer choices are important when taking care of patients with eating disorders, the most important intervention prior to implementing care is to first determine the patient's willingness to participate in treatment and make changes. This is especially important when taking care of patients with anorexia nervosa as they tend to be disinterested in treatment and resistant to change.
The nurse assessing a patient diagnosed with bulimia nervosa expects to see which characteristics? 1. Anxiety, low self-esteem, and impulsivity 2. Irritability, preoccupation with food, and rituals 3. Depression, devalued self-worth, and loss of libido 4. Social withdrawal, early menarche, and reduced concentration
Answer: 1 Explanation: 1. Within the psychological domain, patients with bulimia nervosa may experience a pervasive devalued self-worth, impulsivity, dysregulated emotions, anxiety, depression, low self-esteem, early menarche, and dieting. Patients with anorexia nervosa may experience depressed mood, irritability, social withdrawal, loss of libido, preoccupation with food, obsessional ruminations and rituals, and reduced alertness and concentration.
The nurse is assessing a patient who has come to the mental health clinic complaining that inability to focus at work is making it difficult to keep a job. The nurse observes that the patient has cuts along the arms that are in various stages of healing. Which statements by the patient indicate that the patient may need to be evaluated for borderline personality disorder? Select all that apply. 1. "My grades and work performance have always been erratic." 2. "I often drink alcohol to relieve stress." 3. "It's hard to maintain friendships. People seem to get tired of me." 4. "I get bored really easily." 5. "I get so anxious sometimes, I feel like I can't breathe
Answer: 1, 2, 3
Which nursing interventions are appropriate for a a patient with bulimia nervosa? Select all that apply. 1. Monitoring trips to the bathroom 2. Providing emotional support during mealtimes 3. Reviewing events and feelings prior to an episode 4. Providing negative feedback to reframe feelings of purging 5. Encouraging engagement with previously enjoyed activities and experiences
Answer: 1, 2, 3, 5
) The nurse is caring for a patient with a suspected personality disorder. The nurse suspects the diagnosis will be confirmed based on which indicators? Select all that apply. 1. The patient's symptoms do not correlate with any other mental disorder. 2. The patient experiences symptoms in a variety of settings and does not seem able to change or prevent them. 3. The patient reports being unable to keep a job or go to school because of the symptoms. 4. The patient's symptoms began in adolescence and are variable. 5. The patient is not taking any medications at this time.
Answer: 1, 2, 3, 5 Explanation:
The nurse at an inpatient behavioral health center is providing care to several patients with different substance use disorders who are in various stages of the detoxification process. Which nursing interventions will take priority? Select all that apply. 1. Vital signs 2. Medication administration 3. Motivational interviewing 4. Intake and output 5. Neurological assessment
Answer: 1, 2, 4, 5
The nurse is caring for a patient who presented to the emergency department with acute hallucinogenic intoxication. What manifestations will the nurse expect to see during the assessment of this patient? Select all that apply. 1. Tremors 2. Sweating 3. Constricted pupils 4. Tachycardia 5. Dilated pupils
Answer: 1, 2, 4, 5
When developing a plan of care for clients with feeding and eating disorders, the nurse knows that which factor makes them challenging to treat? Select all that apply. 1. Hormone dysregulation 2. Peer influences 3. Co-morbid medical illness 4. Exposure to different forms of media 5. Loss of connection to family or culture
Answer: 1, 2, 4, 5
The nurse is caring for a patient with borderline personality disorder (BPD) who is experiencing psychotic symptoms. Which medication will the nurse anticipate the health care provider ordering for the patient? Select all that apply. 1. Olanzapine (Zyprexa) 2. Lorazepam (Ativan) 3. Ripiprazole (Abilify) 4. Haloperidol (Haldol) 5. Thiothixene (Navane)
Answer: 1, 3 Explanation: 1. For patients with BPD experiencing psychotic symptoms and disinhibition, atypical antipsychotics, particularly olanzapine (Zyprexa) and aripiprazole (Abilify), have been found to have a greater range of efficacy than typical antipsychotics, such as haloperidol (Haldol) and thiothixene (Navane). Lorazepam (Ativan) is used for sedation in patients with extreme agitation, not for those with BPD experiencing psychotic symptoms. 3. For patients with BPD experiencing psychotic symptoms and disinhibition, atypical antipsychotics, particularly olanzapine (Zyprexa) and aripiprazole (Abilify), have been found to have
) The nurse knows that which factors are the main differences between binge-eating disorder and bulimia nervosa? Select all that apply. 1. Eating more rapidly than normal 2. Bingeing due to feelings of boredom 3. Bingeing is used as a dietary restraint 4. Using food as a compensatory method of control 5. Feeling distressed about a lack of control over food consumed
Answer: 1, 4
Which information source does the nurse recognize as presenting many societal influences on the perception of attractiveness, which is detrimental to the patient with an eating disorder? 1. Articles about eating disorders 2. Media that glamorizes thinness 3. Information about coping behaviors 4. Programs that emphasize good nutrition
Answer: 2 Explanation: 2. Attractiveness is strongly equated with thinness, which is frequently glamorized in the media. This is detrimental to the patient with an eating disorder. Articles about eating disorders, programs that emphasize good nutrition, and information about coping behaviors would be beneficial to the patient with an eating disorder, not detrimental. Page Ref: 311-312
The nurse knows that which aspect of the Maudsley Model family approach is appropriate for an adolescent admitted with bulimia nervosa? 1. 20 to 30 inpatient family sessions 2. A gradual reduction in parental authority 3. Conjoint family sessions over a 3 month time frame 4. Outpatient therapy focusing on strict dietary restrictions and weight control
Answer: 2 Explanation: 2. Family approaches are effective with children and adolescents with illness duration of less than 3 years. The Maudsley model approach is the best-studied approach and occurs in an outpatient setting with 10-20 family sessions spaced out over 6 to 12 months. The recommended format is conjoint during the initial phase, with directed parental authority that is coached on effective means of controlling the child or adolescent's eating and weight. A gradual reduction in parental authority is directed as the child or adolescent complies with expectations.
The nurse is caring for a patient with a personality disorder who is acutely aggressive and is a danger to himself and others. What pharmacologic therapy will the nurse anticipate the health care provider ordering? 1. Valproic acid (Depakote) 2. Haloperidol (Haldol) 3. Clozapine (Clozaril) 4. Carbamazepine (Tegretol)
Answer: 2 Explanation: 2. Haloperidol (Haldol) may be given as a single medication or in combination with other medications to sedate patients who are acutely aggressive and are dangerous. Valproic acid (Depakote), carbamazepine (Tegretol), or clozapine (Clozaril) may be prescribed for patients who need help controlling aggression, but they are not appropriate for patients who require immediate assistance to lower their acuity and reduce their risk of endangering themselves or others.
The nurse is caring for an adolescent patient with a suspected personality disorder. Why must the health care provider be cautious about diagnosing an adolescent patient with a personality disorder? 1. Adolescents are too young to develop a personality disorder. 2. The patterns of behavior and thinking could reflect adolescent experimentation. 3. Adolescents develop different types of personality disorder. 4. The patterns of behavior and thinking cannot be assessed in an adolescent patient.
Answer: 2 Explanation: 2. Health care providers are typically hesitant about diagnosing an adolescent patient with a personality disorder because the patterns of behavior and thinking associated with a personality disorder could reflect adolescent experimentation.
A 16-year-old girl with a anorexia nervosa is newly admitted to an outpatient treatment program for individuals with feeding and eating disorders. The nurse assigned to her plans which intervention to assist in developing the nurse-patient relationship? 1. Identifying mealtime triggers 2. Teaching deep breathing 3. Discussing ways to reframe disordered thoughts 4. Determining what foods the patient prefers
Answer: 2 Explanation: 2. In the initial stages of patient care, providing interventions aimed at reducing stress, such as teaching deep breathing exercises, can assist in developing the therapeutic alliance. Interventions aimed at reducing problematic eating patterns are likely to be less effective until the therapeutic alliance has been established and the patient becomes less resistant to treatment. Identifying mealtime triggers, discussing ways to reframe disordered thoughts, and determining what foods the patient prefers should wait until the therapeutic relationship has been established. Page Ref: 309
The nurse is caring for a patient in the outpatient setting who has been diagnosed with a personality disorder. Which will the nurse recognize as indicators that the patient has schizotypal personality disorder? 1. The patient is awkward and has a flat affect. 2. That patient has odd mannerisms and eccentric dress. 3. The patient is suspicious and distrustful. 4. The patient shows a lack of remorse for others.
Answer: 2 Explanation: 2. Patients with schizotypal personality disorder are often seen in the outpatient setting. Manifestations associated with this disorder include odd mannerisms, peculiar personality, and eccentric dressing. Schizoid personality disorder manifests as social awkwardness and blunted affect. Paranoid personality disorder manifests as extreme suspiciousness and mistrust. Antisocial personality disorder manifests as a lack of remorse for others. This type of personality disorder may be referred to as a sociopathic personality disorder. Page Ref: 396
) The nurse is receiving report on a patient who will be transferred to the inpatient substance abuse treatment facility to be treated for heroin addiction. Prior to the patient's admission, what must occur? 1. The patient must be at least 48 hours from last use of substances of dependence. 2. The patient must be completely detoxified from substances of use and dependence. 3. The patient must sign an advance directive. 4. The patient must sign a nurse-patient contract.
Answer: 2 Explanation: 2. Prior to the patient's admission to an inpatient substance abuse treatment facility, the patient must be completely detoxified from substances of use and dependence. The patient does not need to sign an advance directive or a nurse-patient contract prior to admission to the inpatient treatment facility. Page Ref: 458
The nurse knows that the primary health care professional will order which medication to help with disordered thinking for the patient with anorexia nervosa? 1. Amitriptyline (Elavil) 2. Olanzapine (Zyprexa) 3. Bupropion (Wellbutrin) 4. Tranylcypromine (Parnate)
Answer: 2 Explanation: 2. Research shows that second-generation antipsychotic medications such as olanzapine may be effective in achieving more rapid weight gain, reducing obsessional thinking, and limiting the denial that assumes delusional proportions in size and body shape. Bupropion should be avoided due to risk of seizures; tricyclic antidepressants (such as amitriptyline) and MAOIs (such as tranylcypromine) should not be considered in underweight patients and have an overall potential for lethality and toxicity.
) The nurse is working at an outpatient substance abuse treatment facility that specializes in the administration of methadone. The nurse is giving a patient education session. What will the nurse explain is the goal of methadone treatment? 1. To address the physiological symptoms associated with dependency of opioids/opiates 2. To address the craving associated with withdrawal from opioids/opiates 3. To address the craving associated with withdrawal from amphetamines 4. To address the physiological symptoms associated with dependency of amphetamines
Answer: 2 Explanation: 2. The goal of treatment using methadone is to address the craving associated with withdrawal from opioids/opiates. The goal of methadone treatment is not to address the physiological symptoms associated with dependency of opioids/opiates; rather, it is used for the treatment of withdrawal, not dependency. Methadone is not used in the treatment of amphetamine addiction or withdrawal. Page Ref: 457
) The nurse is caring for a patient with a substance abuse disorder whose outpatient treatment plan includes a residential option. Which choice does the nurse recognize as having the most structure? 1. Support groups 2. Halfway houses 3. Three-quarter houses 4. Early intervention programs
Answer: 2 Explanation: 2. The most structured residential outpatient treatment option is a halfway house. Though three-quarter houses, support groups, and early intervention programs are residential outpatient treatment options, these do not provide the most structure. Page Ref: 458
The nurse is caring for a patient who requires an opiate medication for chronic pain associated with a previous injury. The patient tells the nurse, "Even though I don't feel like I'm addicted to the medication, I get tremors in my hands if I miss a dose." What is the nurse's best response? 1. "You may be addicted to the medication, but not necessarily physically dependent." 2. "You may be physically dependent on the medication, but not necessarily addicted." 3. "The symptoms you describe are indicative of addiction, whether you feel you are or not." 4. "The symptoms you describe relate to your disease state and are not normal."
Answer: 2 Explanation: 2. The patient may be physically dependent on the substance, but not necessarily addicted. Increasing frequency and amount of use creates physical dependence, in which the body becomes so dependent on the substance that without it, withdrawal symptoms will begin. Continued use leads to a breakdown in patterns of daily living, part of the addictive process. Addiction, not physical dependence, is considered a disease state.
A nurse is caring for a patient who is suspected of having an obsessivecompulsive personality disorder. Which characteristics of obsessivecompulsive personality disorder will the nurse observe in the patient? 1. Order in all areas of the patient's life and that of the patient's relatives 2. Fear, anxiety, and an excessive need for order 3. The need for perfection in others but not self 4. Order in the patient's work life but the ability to relax when away from work
Answer: 2 Explanation: 2. The person with obsessive-compulsive personality disorder strives at all times to keep the world predictable and organized. These individuals suffer from fear and anxiety. They feel required to fulfill unending duties, responsibilities, and tasks, are self-critical, and adhere strictly and concretely to rules. These patients seek order in their own lives, but cannot necessarily achieve this in others. Obsessive-compulsive individuals do not view taking work home or working long hours as an imposition, because work organizes their lives and binds their anxiety.
The nurse is caring for a patient who has abused alcohol for many years. On assessment, the nurse notes that the patient has alterations in movement coordination. This suggests that which area of the brain is likely damaged due to the patient's long-term use of alcohol? 1. Hippocampus 2. Cerebellum 3. Cerebral cortex 4. Frontal lobe
Answer: 2 Explanation: 2. Various areas of the brain, including the hippocampus, cerebellum, and cerebral cortex, are more susceptible to damage from alcohol. The patient who is experiencing alterations in movement coordination likely has damage to the cerebellum. Patients with damage to the hippocampus would likely present with impaired memory and learning. Damage to the cerebral cortex would manifest in difficulties with problem solving and decision making. The frontal lobe of the brain is not especially vulnerable to the damaging effects of alcohol. Page Ref: 439
The nurse is caring for a patient with substance use disorder. The patient asks if there is a difference between substance use disorder and addiction. How will the nurse explain how substance use disorder differs from addiction? 1. Substance use disorder refers to chemical dependency; addiction does not. 2. Substance use disorder is a diagnostic term; addiction is an active disease state. 3. Substance use disorder does not refer to chemical dependency; addiction does. 4. Substance use disorder is an active disease state; addiction is a diagnostic term.
Answer: 2 Explanation: 2. While many may use the terms substance use disorder and addiction interchangeably, these concepts vary. Substance use disorder is a diagnostic term used to describe the continued use of a substance without regard to negative consequence, including physiological and psychological symptoms. Addiction refers to an active disease state. Neither substance use disorder nor addiction refers to chemical dependency only. Page Ref: 437
The nurse caring for a patient with a feeding and eating disorder knows that which diagnostic features differentiate anorexia nervosa from bulimia nervosa? Select all that apply. 1. Brain atrophy 2. Alterations in metabolism 3. Alterations in brain structure 4. Alterations in neurochemistry 5. Risk genes on chromosomes 1, 4, and 10
Answer: 2, 3, 4
20) The nurse is planning care for a patient with a personality disorder. Which interventions is the nurse likely to consider including in the plan of care? Select all that apply. 1. Patient teaching about vegetative symptoms 2. Limit setting to enforce boundaries 3. Patient teaching about healthy coping skills 4. Discussing the importance of memory prompts 5. Strengthening reality orientation
Answer: 2, 3, 5
7) The nurse is caring for a patient with a substance use disorder who is addicted to heroin. The nurse understands that areas of the brain and nervous system have been connected to substance abuse and addiction. What is true regarding the nervous system and substance abuse and addiction? Select all that apply. 1. Changes in neuroanatomy cause the behavior seen in addiction. 2. Addictive substances act on the mesolimbic system of the brain. 3. Addictive substances stimulate surges of dopamine. 4. Addictive substances act on the mesocerebral system of the brain. 5. Changes in neurochemistry cause behaviors seen in addiction.
Answer: 2, 3, 5
The nurse is caring for an adolescent patient with a personality disorder. The nurse understands that, with age, the patient may experience improvement or remission of symptoms associated with the disorder. What disorder does the patient likely have? Select all that apply. 1. Schizoid 2. Borderline 3. Obsessive-compulsive 4. Schizotypal 5. Avoidance
Answer: 2, 5 Explanation: 2. Patients with borderline and avoidance personality disorders are more likely to experience improvement or remission of symptoms as they grow older. Schizoid, schizotypal and obsessive-compulsive personality disorders are not associated with improvement as the patient ages. 5. Patients with borderline and avoidance personality disorders are more likely to experience improvement or remission of symptoms as they grow older. Schizoid, schizotypal and obsessive-compulsive personality disorders are not associated with improvement as the patient ages.
The nurse is assessing a male patient who is suspected of having an eating disorder. What additional information is most important in the assessment of this patient? 1. Ethnic origin 2. Relationship with peers 3. Serum testosterone level 4. Cholesterol level
Answer: 3 Explanation: 3. A common sign/symptom seen in males with eating disorders is decreased serum testosterone level. Ethnic origin and peer relationships are not the most important factors to assess in a patient suspected of an eating disorder. Cholesterol level is not part of the assessment for a patient with a feeding or eating disorder. Page Ref: 311
The nursing student is preparing a presentation for the class on cognitive and behavioral perspectives of personality disorders. Which information will the student include in the presentation? 1. Behaviors result from an imbalance in brain chemistry. 2. Behaviors occur due to a history of childhood trauma and parental dysfunction. 3. Learned behaviors become inflexible and maladaptive. 4. Learned behaviors result from cultural influences.
Answer: 3 Explanation: 3. According to cognitive and behavioral perspectives, personality disorders stem from learned behaviors that have become inflexible and maladaptive. The biological perspective suggests that personality disorders stem from an imbalance in brain chemistry. The sociological perspective suggests that personality disorders stem from a history of childhood trauma and parental dysfunction. The cultural perspective suggests that personality disorders stem from cultural influences.
) A school nurse is preparing a presentation for school faculty and staff on substance use disorders and addiction. How will the nurse explain behavior observed in the addictive process? 1. History of a behavior disorder 2. History of a cognitive disorder 3. Changes in neurochemistry 4. Changes in emotional state
Answer: 3 Explanation: 3. Addiction and substance abuse were previously thought to be caused by behaviors only. However, research has shown that changes in neurochemistry are the basis for the behavior observed in the addictive process. Behavior and cognitive disorders, as well as emotional states, do not result in behavior observed in the addictive process. Page Ref: 437
The nurse assessing a patient diagnosed with anorexia nervosa knows that this diagnosis is characterized by which compensatory behavior? 1. Repeated regurgitation of food 2. Episodes of binging and purging 3. Excessive exercise and diuretic misuse 4. Lack of interest in food and in eating food
Answer: 3 Explanation: 3. Anorexia nervosa is characterized by food restriction, preoccupation with food, excessive exercise, self-induced vomiting, and laxative and/or diuretic misuse. Bulimia nervosa is characterized by episodes of binging and purging; rumination disorder involves the repeated regurgitation of food; avoidant/restrictive food intake disorder is characterized by a lack of interest in food and in eating food. Page Ref: 298-299
) A community health nurse is preparing education on opioid use in the community. Which topic will the nurse focus on as a priority in the education session? 1. Seizure precautions 2. Risk for long-term vision problems 3. Dangers of overdose 4. Signs of withdrawal
Answer: 3 Explanation: 3. Death from overdose is a priority concern of opioid use. Seizures are not associated with opioid use. The nurse will not focus the education on signs of withdrawal but, rather, on the dangers of overdose. Opioid use is not linked to long-term vision problems. Page Ref: 463
A nurse is working with a patient who has a diagnosis of obsessive-compulsive personality disorder. It is important for the nurse and patient to discuss: 1. The effect of anger on perfectionism 2. The need to feel superior 3. The link between anxiety and perfectionism 4. The need for medication
Answer: 3 Explanation: 3. Individuals with obsessive-compulsive personality disorder strive at all times to keep the world predictable and organized. These individuals suffer from excessive fear and anxiety. Anger is not a prominent characteristic of obsessive-compulsive personality disorder. Medications are not a first line of treatment for personality disorders. Feelings of superiority are associated with narcissistic personality disorder.
The student nurse is learning about the theories that seek to explain the etiology of personality disorders. What will the student learn is true regarding parenting and the development of personality disorders? 1. Engulfing parenting may force a child to separate before he or she is ready. 2. Indifferent parenting does not allow a child to separate and individuate. 3. Narcissism may develop due to a parental lack of empathy. 4. Pessimism may develop due to inconsistent parenting.
Answer: 3 Explanation: 3. Narcissism, characterized by excessive interest in or preoccupation with the self, may develop due to a parental lack of empathy. Indifferent parenting may force a child to separate before he or she is ready. Engulfing parenting does not allow a child to separate and individuate. Inconsistent parenting affects the child's ability to view him or herself as an individual but is not associated with the development of pessimism.
The nurse knows that, if left untreated, the patient with bulimia nervosa is at risk for which priority nursing diagnosis? 1. Fatigue 2. Powerlessness 3. Risk for injury 4. Coping, Ineffective
Answer: 3 Explanation: 3. Purging fulfills the need for self-control, power, and relief from tension. These needs are ways that the patient with bulimia nervosa ineffectively copes with stressors and their feelings. The body may become fatigued from the biological stress, but the priority diagnosis would be a risk for injury because the patient is unable to control the binge and purge cycles independently, and this may increase risk for injury in a number of areas, including cardiovascular issues, gastrointestinal illness, and damage to tooth enamel. Page Ref: 311
The nurse is caring for a patient with an alcohol use disorder. The patient asks the nurse, "Can my children inherit this?" What does the nurse explain is role of genetics on the development of a substance use disorder? 1. The role of genetics is minor in comparison to the role of the environment. 2. Genetics does not seem to play a role in the development of substance use disorders. 3. The role of genetics in substance use disorders has not been determined. 4. Genetics plays a major role in the development of substance use disorders.
Answer: 3 Explanation: 3. Research has not yet determined the relationship between genetics and substance use disorders, particularly regarding why some people are more prone to addiction than others. Page Ref: 437
The novice psychiatric-mental health nurse begins working at an outpatient substance abuse treatment facility that specializes in SBIRT. What does the nurse learn is the core concept behind SBIRT's approach to substance abuse intervention and treatment? 1. It employs the cognitive approach utilizing rational emotive behavior therapy. 2. It helps clinicians recognize when individuals are able to acknowledge the impact of drug use on their lives and their willingness to change behaviors that support drug use. 3. It may be used to help individuals identify and address problems in life that arise from substance use/misuse or abuse. 4. It asks individuals to examine their own actions and accept responsibility.
Answer: 3 Explanation: 3. SBIRT is an approach to substance abuse intervention and treatment that may be used to help individuals identify and address problems in life that arise from substance use/misuse or abuse. SBIRT stands for screening, brief intervention, and referral to treatment. SMART (Self-Management and Recovery Training) Recovery is an abstinence-based model that employs the cognitive approach utilizing rational emotive behavior therapy (REBT). The SMART Recovery model also asks individuals to examine their own actions and accept responsibility. The Stages of Change model is an approach to substance abuse intervention and treatment that helps clinicians recognize when individuals are ready to acknowledge the impact drug use has on their lives and their willingness to change behaviors that support drug use. Page Ref: 453-454
The nurse caring for a patient with a personality disorder is conducting a safety assessment. Why is a safety assessment so important for the patient with a personality disorder? 1. Fall injuries from antipsychotic medications are common. 2. Patients with personality disorders lack safety awareness. 3. Self-injurious behaviors and suicide are common. 4. Patients with personality disorders are unable to make safe decisions.
Answer: 3 Explanation: 3. Self-injurious behaviors and suicide are common in those with personality disorders. While fall injuries from antipsychotic medications do occur, this is not the primary reason why a safety assessment is so important for the patient with a personality disorder. Not all patients with personality disorders lack safety awareness or the ability to make safe decisions; however, these patients are more vulnerable to accident due to self-injurious behaviors and suicide.
) A patient who has recently been diagnosed with a personality disorder has returned for a follow-up appointment. Which potential co-morbid disorder will the nurse include as a priority for assessment? 1. Cardiovascular disease 2. Insomnia 3. Substance abuse 4. Schizophrenia
Answer: 3 Explanation: 3. Substance abuse is more prevalent in patients with a personality disorder. Assessment of safety in the patient with a personality disorder includes assessing for substance abuse. Assessment for signs and symptoms of other disorders would follow the safety assessment and depend on patient history and presentation.
The nurse caring for a patient with avoidant personality disorder is alert for which potential challenge regarding the patient's medication regimen? 1. The medication regimen often is complex and overwhelming for the patient. 2. Medications often do not work with this personality disorder. 3. The patient may not adhere to the medication regimen. 4. The medication regimen will need to be modified frequently
Answer: 3 Explanation: 3. The patient with avoidant personality disorder often does not adhere to the medication regimen. Typically the medication regimen for a patient with avoidant personality disorder is not complex, does work, and does not need to be modified frequently. Page Ref: 401
) The nurse is caring for a patient with a substance use disorder who is admitted to the rehabilitation unit of the inpatient treatment facility. The nurse collaborates with the patient to establish and redefine mutual goals of treatment. What is the primary purpose of this action? 1. It develops the nurse-patient relationship. 2. It allows the nurse to self-reflect. 3. It encourages patient responsibility. 4. It provides evaluation of outcomes.
Answer: 3 Explanation: 3. The primary purpose of collaboration with the patient to establish and redefine mutual goals of treatment is to encourage patient responsibility. While this action may help to develop the nurse-patient relationship, this is not its primary purpose. The primary purpose of collaboration is not to allow the nurse to self-reflect, nor is it to provide evaluation of outcomes. Page Ref: 458
5) A nurse is working with a patient with a personality disorder. Which situation best describes the patient's external response to stress? 1. The client attends group therapy. 2. The client uses meditation when upset. 3. The client changes the environment when upset. 4. The client engages in self-awareness exercises.
Answer: 3 Explanation: 3. When feeling threatened, the client with a personality disorder will try to change the environment instead of changing him- or herself. Meditation, self-awareness exercises, and group therapy attendance are attempts to understand or change one's behavior.
The nurse is assessing a patient suspected of having a substance use disorder. The nurse understands that individuals with a substance use disorder display some symptoms that are universal regardless of the substance involved. Which symptoms of substance use disorder will the nurse include in the assessment? Select all that apply. 1. Disregard for religious beliefs while abusing the substance 2. Absence of desire to quit abusing the substance 3. Need for greater amounts of the substance to achieve the same effect 4. Neglect of normal activities due to focus on obtaining or using more of the substance 5. Persistent craving for the substance
Answer: 3, 4, 5
) The nurse knows that which nursing diagnoses are most important when considering care of a patient with anorexia nervosa? Select all that apply. 1. Anxiety 2. Powerlessness 3. Body Image, Disturbed 4. Self-Esteem, Chronic Low 5. Nutrition, Imbalanced: Less Than Body Requirements
Answer: 3, 5 Explanation: 3. While all the answer choices represent possible nursing diagnoses for patients with eating disorders, at the core of most eating disorder pathology is the over evaluation of the importance of body shape and the control of body weight. Therefore, the primary nursing diagnoses patients with eating disorders will be either disturbed body image or, for those patients whose priority is weight restoration, imbalanced nutrition: less than body requirements. 5. While all the answer choices represent possible nursing diagnoses for patients with eating
) The nurse is caring for a patient who is an intravenous drug user. The nurse anticipates the need for assessment for which cardiac complication? 1. Cardiac tamponade 2. Myocardial infarction 3. Congestive heart failure 4. Infective endocarditis
Answer: 4 Explanation: 4. A relatively uncommon disease in the general population, infective endocarditis involves an infection of the interior surface of the heart, usually stemming from bacteria in the bloodstream. These infections then lead to destruction of cardiac tissue,
Ten hours after admission to the ICU following an auto accident, a patient begins to exhibit mild tachycardia, irritability, and tremors. Three hours later the patient has a grand mal seizure. Which condition does the nurse suspect? 1. Wernicke encephalopathy 2. Korsakoff syndrome 3. Undetected internal bleeding 4. Alcohol withdrawal syndrome
Answer: 4 Explanation: 4. Alcohol withdrawal syndrome is marked by mild tachycardia, irritability, and tremors. Korsakoff syndrome is a disturbance in short-term memory that occurs in individuals who have been drinking for many years. Wernicke encephalopathy is a neurologic disease characterized by ataxia, sixth cranial nerve palsy, nystagmus, and confusion. An undetected internal hemorrhage would not present with the symptoms outlined. Page Ref: 462
The nurse speaks to a patient about treatment options for alcohol use disorder. The patient asks the nurse, "What's Alcoholics Anonymous all about?" Which reply by the nurse best describes Alcoholics Anonymous (AA)? 1. "It is a group that learns about drinking from a group leader." 2. "It is a form of group therapy led by a psychiatrist." 3. "It is a group that advocates strong punishment for drunk drivers." 4. "It is a self-help group that emphasizes sobriety."
Answer: 4 Explanation: 4. Alcoholics Anonymous (AA) is a self-help group whose key concept is that total abstinence is essential to recovery. AA is based on the fellowship among its members, and anyone who desires to stop using alcohol is welcome. The other answer choices do not correctly describe AA. Page Ref: 445
A teen is brought to the emergency department by a parent. The nursing assessment reveals that the patient has been acting strangely for the past three hours and is hypervigilant, grandiose, and irritable. Vital signs reveal hypertension, tachycardia, and some arrhythmias. Which substance does the nurse suspect that the teen has been using? 1. Alcohol 2. Marijuana 3. Heroin 4. Amphetamines
Answer: 4 Explanation: 4. Amphetamine intoxication includes symptoms of hypervigilance, grandiosity, and irritability. Marijuana intoxication manifests in euphoria and relaxation and does not typically cause hypertension, tachycardia, or arrhythmias. Heroin intoxication causes decreased respiratory rate and depth and bradycardia, not tachycardia. Alcohol intoxication may manifest in relaxed euphoria, lack of concentration, and decreased inhibitions. Page Ref: 448
) A patient admitted to the clinic complains of a lack of interest in most things, but especially food. After a comprehensive examination, the nurse suspects which disorder? 1. Pica 2. Bulimia nervosa 3. Rumination disorder 4. Avoidant/restrictive food intake disorder
Answer: 4 Explanation: 4. Avoidant/restrictive food intake disorder is characterized by a lack of interest in food and eating food. Pica is the persistent eating of substances other than food. Bulimia nervosa characterized by recurrent binge-eating episodes. Rumination disorder is the repeated regurgitation of food that is re-chewed, re-swallowed, or spit out. Page Ref: 298-299
) The nurse caring for a patient with bulimia nervosa knows that which intervention is considered the first-line treatment? 1. Art therapy 2. SSRI therapy 3. Dialectical behavior therapy 4. Cognitive-behavioral therapy
Answer: 4 Explanation: 4. Cognitive-behavioral therapy is considered the first-line treatment in bulimia nervosa. It is often used in conjunction with dialectical behavior therapy to help further reduce both behavioral and psychological symptoms associated with eating disorders. SSRI therapy has proven effective in reducing binging and purging behaviors and eating-disordered attitudes, but it is not a first-line treatment. Art therapy is not a first-line treatment for individuals with disordered eating behaviors.
A patient who abuses heroin seeks treatment at a methadone clinic. The patient's family member asks the nurse, "I don't understand the reason for the methadone treatment. Why replace heroin with methadone?" What is the best response by the nurse? 1. "Methadone is safe even in large doses." 2. "Methadone replaces a more potent drug." 3. "Methadone is a deterrent to using other drugs." 4. "Methadone blocks the craving for and the action of opiates."
Answer: 4 Explanation: 4. Methadone blocks the craving for and the action of opiates such as heroin. Methadone does not replace more potent drugs or act as a deterrent to other drug use. The doses of methadone are strictly regulated and administered by health professionals. Page Ref: 457
Which behavior will the nurse anticipate in the patient with anorexia nervosa? 1. Positive self-image 2. Constant overeating 3. Flexible rules regarding food 4. Obsessive rituals regarding food
Answer: 4 Explanation: 4. Individuals with anorexia nervosa develop obsessive rituals regarding food. These individuals generally have rigid, not flexible, rules regarding food. Individuals with anorexia nervosa generally have a negative self-image and do not overeat. Page Ref: 303
The nurse knows that it is important for the patient suffering from an eating disorder to maintain connections with friends and family in order to avoid which belief? 1. That the eating disorder will bring happiness 2. That forgiveness of inadequacies is acceptable 3. That maintaining the disorder leads to a loss of spirit 4. That despite the sacrifice of dieting, happiness will never come
Answer: 4 Explanation: 4. It is important that nurses are able to recognize when patients begin to lose the ability to have faith, hope, forgiveness, and the ability to trust in themselves and others (spiritual domain). A lack of spirit affects biological, psychological, cultural, and sociological connections and can leave patients with the incorrect belief that their eating disorder will bring them happiness and an ideal body weight and shape. A reconnection of spirit allows the patient to forgive the inadequacies surrounding the disorder and embrace themselves without judgment. Page Ref: 302
A patient who abuses alcohol has been placed on naltrexone (Trexan). What information about the effects of this medication will the nurse include in the patient education? 1. The patient needs to avoid use of over-the-counter decongestants. 2. If alcohol is ingested, the patient may experience a lethal reaction. 3. The patient needs to avoid use of over-the-counter products that contain alcohol. 4. The patient will feel less pleasure from using alcohol while taking the medication
Answer: 4 Explanation: 4. Naltrexone (Trexan) blocks the craving for alcohol and the pleasure derived from drinking. A potentially lethal reaction may occur in patients taking disulfiram (Antabuse), not naltrexone, who ingest alcohol. Because naltrexone does not react with alcohol or with decongestants, it is not necessary to limit the use of over-the-counter products that contain alcohol or decongestants.
) A nursing student is researching the various domains of eating disorders. From a psychoanalytic perspective, what are eating disorders related to? 1. Disturbance in the body system 2. Learned behavior regarding the effect of food 3. Conscious intrapersonal and interpersonal conflict 4. Refusal of food due to an unconscious fear of oral impregnation
Answer: 4 Explanation: 4. Psychoanalytic theory considers eating disorders to be expressions of unconscious conflicts. Psychoanalytic theory relates anorexia nervosa to a food refusal due to an unconscious fear of oral impregnation and bulimia as an "ominous variant." Conscious intrapersonal and interpersonal conflicts, learned behavior regarding the effect of food, and disturbance in the body system are not aspects of the psychoanalytic perspective of eating disorders.
The nurse is caring for a patient with a substance abuse disorder and addiction who is being treated at a Level III treatment facility for substance detoxification. What nursing intervention is most likely to be the focus of care at this level of treatment? 1. Providing daily outpatient care and monitoring 2. Providing a referral to a halfway house in the patient's community 3. Providing the patient with intensive medical and psychiatric care 4. Providing safe, round-the-clock care that supports wellness and recovery
Answer: 4 Explanation: 4. The five levels of care are: • Level 0.5 Early Intervention • Level I Outpatient Services • Level II Intensive Outpatient/Partial Hospitalization • Level III Residential/Inpatient Treatment • Level IV Medically Managed Intensive Inpatient Services Level III residential/impatient treatment provides safe, round-the-clock medical care for patients with less complex health concerns. More intensive care is available for patients with complex health conditions in Level IV treatment
) The nurse knows that which is the priority nursing diagnosis for patient with anorexia nervosa who is exhibiting signs and symptoms of refeeding syndrome? 1. Anxiety 2. Body Image, Disturbed 3. Self-Esteem, Chronic Low 4. Nutrition, Imbalanced: Less Than Body Requirements
Answer: 4 Explanation: 4. The priority nursing diagnosis for the patient with anorexia nervosa who is exhibiting signs and symptoms of refeeding syndrome is Nutrition, Imbalanced: Less Than Body Requirements. This patient's life may be at risk. Anxiety, disturbed body image, and chronic low self-esteem can be addressed once the patient's physical safety has been restored. Page Ref: 311
) The nurse caring for a patient with anorexia nervosa who has a BMI of 16.5 kg/m2 recognizes the patient is in which stage of severity? 1. Mild 2. Severe 3. Extreme 4. Moderate
Answer: 4 Explanation: 4. There are four stages of severity of anorexia according to the DSM-5: mild, BMI of 17-18.5 kg/m 2; moderate, BMI 16-16.99 kg/m 2; severe, BMI 15-15.99 kg/m 2; and extreme, BMI ≤ 15 kg/m 2. In contrast, a BMI indicating a normal weight is 18.5-24.9 kg/m2.
The nurse knows that some patients with bulimia nervosa fulfill which need when purging? 1. Attention 2. Self-control 3. Powerlessness 4. Quest for perfection
Explanation: 2. While patients with eating disorders are plagued by low self-esteem and self-worth, which are dependent upon a quest for perfection of extreme thinness, they also struggle with the need to control how the body gains/loses weight and the type of body shape that they perceive to be acceptable. With this struggle for control, disordered eating patterns become evident. The perception of thinness and personal competence are linked to improved social status and self-regard. Purging fulfills the need for self-control, power, and relief from tension. Patients with bulimia nervosa are not seeking attention.
