More practice questions Psych Exam 3
The mother of a 3-year-old boy just diagnosed with autism spectrum is tearful and states, "The doctor said we need to start therapy right away. I just don't understand how helpful it will be—he's only 3 years old!" What response should the nurse provide to the mother's statement? "You are right, 3 years old is very young to start therapy, but it will make you feel better to be doing something." "Starting him on treatment now gives Taylor a much greater chance for a productive life." "If your child starts therapy now, he will be able to stop therapy sooner." "If you have questions, its best to ask the doctor."
"Starting him on treatment now gives Taylor a much greater chance for a productive life." Early intervention for children with autism can greatly enhance their potential for a full, productive life. 3 years old is not too young to start therapy since the sooner therapy is started, the better the outcome. The patient will most likely not be able to stop therapy as interventions will continue indefinitely. Telling the mother to ask her provider abdicates the nurse's responsibility to provide education to patients and families.
The nurse is preparing to set goals for a 10-year-old diagnosed with an impulse control disorder. To best ensure the expected therapeutic outcomes, the nurse includes goals that focus on what client need? Client centered and includes the client's input Age appropriate and achievable in a short period of time Simple and easily defined Family centered and long term in nature
Client centered and includes the client's input Whenever possible, outcomes should be client centered and agreed upon by both the nurse and the client or the client's designee. While the other options may be appropriate, they are not the priority.REF: 401
The mother of a 6-year-old child expresses concern over the child's frequent temper outbursts. He deals with any frustration by bullying and hitting and seldom shows any remorse for his actions. The nurse who gathers this data will note that the child's behaviors are most consistent with which diagnosis? Social phobia Conduct disorder Oppositional defiant disorder Attention deficit hyperactivity disorder (ADHD)
Conduct disorder The data are most consistent with the aggressive pattern of childhood-onset conduct disorder of the aggressive type.REF: 399, Table 21-1
The family members of a client with early-stage Alzheimer's disease cannot provide adequate supervision for the client. What would be a reasonable alternative for the nurse to explore with them to meet their current needs? Day care Acute care hospitalization long-term institutionalization Group home residency
Day care Day care is a good option for clients with early-stage Alzheimer's disease. It provides supervision, a protected environment, and supportive interactions. The other options may be considered as the client moves into the advances stages of the disease disorder.REF: 443; Table 23-8
Which comorbid conditions are commonly associated with oppositional defiant disorder? Select all that apply Conversion disorder Attention deficit hyperactivity disorder (ADHD) Depression Anxiety Substance Abuse
Depression adhd anxiety
A client diagnosed with conduct disorder craves what experience? Excitement without concern for possible negative outcomes Control of situations and constantly strategizes for such power Friendship but from those older than themselves Material possessions but lacks focus and direction
Excitement without concern for possible negative outcomes People with conduct disorder crave excitement and do not worry as much about consequences as other people do. None of the other options demonstrates a need associated with conduct disorder.REF: 397
Which statement is true about the characteristics of the oppositional defiant child? The defiance is generally directed toward parents and siblings. These behaviors are a predictor of future mental health disorders. Arguing tends to be more prevalent in boys. Girls display more blaming than do boys.
These behaviors are a predictor of future mental health disorders. Oppositional defiant disorder is often predictive of emotional disorders in young adulthood. None of the other statements are necessarily correct.REF: 394
What older concept of care is being used currently to help in violence reduction in disruptive clients? Aired grievances Trauma-informed care Shared governance Learned helplessness
Trauma-informed care Trauma-informed care is an older concept of providing care that has been reintroduced. It is based on the notion that disruptive patients often have histories that include violence and victimization. These traumatic histories can impede patients' ability to self-soothe, result in negative coping responses, and create a vulnerability to coercive interventions (e.g., restraint) by staff. Trauma-informed care focuses on the patients' past experiences of violence or trauma and the role it currently plays in their lives. None of the other options refer to a care concept that helps reduce violence.DIF: Cognitive Level: Understand (Comprehension)REF: page 9TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity
A 9-year-old patient has been diagnosed with an intellectual development disorder (IDD). Which assessment findings support this diagnosis? Select all that apply. Unable to explain the phrase, "Raining cats and dogs" Reads below age level Is capable of providing effective oral self-care Enjoy interacting with developmentally similar peers Physically lashes out when frustrated
Unable to explain the phrase, "Raining cats and dogs" Reads below age level pysically lashes out when frustrated IDD is characterized by severe deficits in three major areas of functioning: intellectual, social, and managing daily life. These children demonstrate difficulty with self care and with almost any social interactions.
When parents share that their 8-year-old child seems to "always try to be annoying and hateful," the nurse suspects the child is demonstrating which characteristic? Emotionally immature Anxiety Vindictiveness Depression
Vindictiveness
Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of which personal characteristic? Isolation Confidence Hopelessness Vulnerability
Vulnerability The progression is vulnerability, perception of event as a threat, arousal, and then uneasiness and anxiety. Anger is not as influenced by any of the other options.REF: 507
Which child is demonstrating behaviors that support a diagnosis of adolescent onset conduct disorder? A 12-year-old male who steals a bicycle as a gang initiation A 9-year-old male who smokes half a pack of cigarettes a day A 12-year-old female who regularly bullies her younger siblings A 9-year-old female who engages in sexually provocative behaviors
A 12-year-old male who steals a bicycle as a gang initiation In adolescent-onset conduct disorder, no symptoms are present prior to age 10. Affected adolescents tend to act out misconduct with their peer group (e.g., early onset of sexual behavior, substance abuse, risk-taking behaviors). Males are more likely to fight, steal, vandalize, and have school discipline problems, whereas girls tend to lie, be truant, run away, abuse substances, and engage in prostitution.
How is anger best defined? An unhealthy way of releasing anxiety Doing intentional harm to others An expression of conflict with others A normal response to a perceived threat
A normal response to a perceived threat Anger is an emotional response to frustration of desires, a threat to one's needs (emotional or physical), or a challenge. It is a normal emotion that can even be positive when it is expressed in a healthy way. All the other options describe anger as being abnormal and/or dysfunctional.REF: 505
Which assessment finding is the best predictor of violence in a newly admitted client? A recent assault on a drinking companion A family history of bipolar disorder The nurse's subjective feeling that the client is uncooperative A childhood history of being bullied at school
A recent assault on a drinking companion The best predictor of violence is past episodes of violent behavior. None of the remaining options have the predictability of a previous demonstration of anger.REF: 508, Assessment Guidelines
Which event is most likely to contribute to a client's escalating anger? Watching violence on television Another client's depressed mood A staff member challenging them A staff member asking them to help another client
A staff member challenging them Punitive, threatening, accusatory, or challenging statements to the client should be avoided since they are likely to escalate the client's anger. None of the other options is as likely to escalate existing angry behavior.REF: 514
The family of a child diagnosed with attention deficit hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What is the focus of child's evaluation? select all apply Academic performance Activities of daily living Physical growth Social relationships personal perception
Academic performance Activities of daily living Social relationships Personal perception For the family and child with ADHD, evaluation will focus on the symptom patterns and severity. For those with ADHD, inattentive type, the focus of evaluation will be academic performance, activities of daily living, social relationships, and personal perception. For those with ADHD, hyperactive-impulsive type or combined type, the focus will be on both academic and behavioral responses.
The nurse caring for a client diagnosed with Alzheimer's disease can anticipate that the family will need information about which medication therapy? Immunosuppressants Benzodiazepines Antihypertensives Acetylcholinesterase inhibitors
Acetylcholinesterase inhibitorsMemory deficit is thought to be related to a lack of acetylcholine at the synaptic level. Acetylcholinesterase inhibitor drugs prevent the chemical that destroys acetylcholine from acting, thus leaving more available acetylcholine.REF: 441-442
A client diagnosed with Alzheimer's disease looks confused and cannot recall many common household objects by name, such as a pencil or glass. The nurse should document this loss of function using which term? Apraxia Agnosia Aphasia Anhedonia
Agnosia Agnosia is a loss of the ability to recognize familiar objects. The loss is not associated with any of the other options.REF: 437
A 78-year-old patient diagnosed with Alzheimer's disease picks up a glass from the bedside table but does not recognize the purpose of the object. This inability is associated with which characteristic of the disorder? Apraxia Agnosia Aphasia Agraphia
Agnosia Agnosia is the loss of sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write.DIF: Cognitive Level: Remember (Knowledge)REF: page 5TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at high risk for developing which comorbid disorder? Antipersonality disorder Obsessive-compulsive disorder Kleptomania Depression
Antipersonality disorder Individuals with childhood-onset conduct disorder are more likely to have problems that persist through adolescence, and without intensive treatment, they develop antisocial personality disorder as adults. Research does not support any of the other options.
Assessment for oppositional defiant disorder should include which interventions? Assessing the history, frequency, and triggers for violent outbursts Assessing moral development, belief system, and spirituality for the ability to understand the impact of hurtful behavior on others, to empathize with others, and to feel remorse Assessing issues that result in power struggles and triggers for outbursts Assessing sibling birth order to understand the dynamics of family interaction
Assessing issues that result in power struggles and triggers for outbursts Oppositional defiant disorder is characterized by defiant behavior, power struggles, outbursts, and arguing with adults, so assessment of these factors would be important. Assessing for violent outbursts refers to assessment for intermittent explosive disorder. Oppositional defiant disorder is not characterized by violent behaviors. Assessing for the ability to understand the impact of hurtful behaviors on others refers to assessment for conduct disorder. Birth order is not known to play a part in oppositional defiant disorder.DIF: Cognitive Level: Apply (Application)REF: page 26TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
A 62-year-old patient who is recovering from a urinary tract infection that has required hospitalized for delirium. Based on research regarding possible postdelirium complications, what are important areas for the provider to assess regularly after discharge? Sleeping habits Sexual functioning Symptoms of posttraumatic stress Depression and level of cognition
Depression and level of cognition Although delirium is usually a short-term condition, it may have long-term consequences. In patients with preexisting cognitive impairment, there is an acceleration of cognitive decline. Although there are reports of long-term cognitive impairment (in the absence of preexisting cognitive impairment) and functional decline following delirium, results of studies have been inconsistent. An association also exists with depression after delirium. Although a holistic examination would assess sleep, this is not the area that research has found to be problematic. A holistic examination would include sexual functioning, but it is not the priority at this time. Posttraumatic stress symptoms have been seen in younger patients who experienced delirium while hospitalized.DIF: Cognitive Level: Analyze (Analysis)REF: page 25TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial
The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character for the client who truly has early stage Alzheimer's disease? Select all that apply. Easily frustrated by cognitive losses Charming behavior designed to hide memory deficit Confabulation to compensate for forgotten information Avoidance of questions by subject changing
Easily frustrated by cognitive losses Frustration and anger are characteristics of the middle stage of Alzheimer's. During early-stage Alzheimer's disease the client is aware of memory impairment and may attempt to disguise it or cover it by being evasive or using confabulation. The remaining options are associated with the early stage of Alzheimer's disease.REF: 438; Table 23-3
Which nursing intervention is appropriate for the management of intermittent explosive disorder? Providing intensive family therapy Establishing a trusting relationship with the patient Setting up loose boundaries so the patient will feel relaxed Limiting decision-making opportunities to avoid frustration
Establishing a trusting relationship with the patient Establishing rapport with the patient is essential in working to set goals, boundaries, and consequences, and providing opportunities for goal achievement. Intensive family therapy would not be a basic level RN intervention. Boundaries and structure are essential. Opportunities for patients to make good decisions and reach goals should be given, not limited.DIF: Cognitive Level: Apply (Application)REF: page 34TOP: Nursing Process: PlanningMSC: NCLEX: Psychosocial Integrity
A 17-year-old patient is admitted to the psychiatric unit after threatening his mother during an argument and is diagnosed with conduct disorder. Which of the following would be an appropriate short-term outcome for this patient? Engages in appropriate coping skills to manage stressors Expresses feelings Maintains self-control during hospitalization Mother will improve communication skills to interact with Eli.
Expresses feelings Expressing feelings is an appropriate short-term outcome and would be a good start to working with the patient to establish rapport, develop coping skills, and set goals. Engaging in appropriate coping skills and maintaining self-control are desired outcomes. Outcomes for the patient are being discussed, not outcomes for the patient's mother.DIF: Cognitive Level: Apply (Application)REF: page 35TOP: Nursing Process: Outcome IdentificationMSC: NCLEX: Psychosocial
A 12-year-old male patient diagnosed with Tourette's disorder is visiting his provider. The nurse will prepare medication teaching on which class of medication to help manage the tics associated with this disorder? Select all that apply. Mood stabilizers Antianxiety agents Anticholinesterase inhibitors First-generation antipsychotics Second-generation antipsychotics
First-generation antipsychotics Second-generation antipsychotic Antianxiety agents
When treating impulse control disorders, psychodynamic psychotherapy is directed toward which goal? Mastering relaxation techniques identifying the triggers of the rage Teaching the client self-distracting techniques Helping the client replace the rage with acceptable alternative feelings
Identifying the triggers of the rage Psychodynamic psychotherapy focuses on underlying feelings and motivations and explores conscious and unconscious thought processes. In working with impulse control problems, the therapist may help the patient to uncover underlying feelings and reasons behind rage or anger. This may help them to develop better ways to think about and control their behavior. None of the other options are considered goals of this form of therapy.
An adolescent male is swearing and shouting at his physician who refused to give him a pass to leave the unit. What is the primary importance of this behavior? It is acceptable if directed at staff but not when directed at other clients. It may reduce tension and prevent the client from physically acting out. It is a major indicator that the client may become physically aggressive. It can be attributed to lack of parental controls applied at an early age.
It is a major indicator that the client may become physically aggressive. Physical aggression is preceded by anger, which may be expressed by swearing and shouting, pacing, and other menacing behaviors. It is not acceptable behavior regardless of its focus nor is it generally associated with a lack of parental controls. The release of tension is not the focus of this question.REF: 507; Box 27-1
What initial intervention should the nurse suggest to the family members of a client diagnosed with Alzheimer's disease who has become incontinence of urine? Label the bathroom door with a picture. Provide toileting on an as-needed basis. Apply disposable diapers. Encourage hourly toileting.
Label the bathroom door with a picture. Labeling doors and various items with pictures can be helpful for a client who has forgotten where things are and what certain items are. The remaining options may need to be implemented eventually when such prompting is no longer effective.REF: 437
An 8-year-old patient is newly diagnosed with attention deficit hyperactivity disorder (ADHD). It is important that the parents be educated to the fact that symptoms will take which form? (Select all that apply). of, inattention, and impulsivity have to be apparent: Select all that apply. Low frustration tolerance Poor school performance Impulsive behaviors Easily intimidated Mood swings
Low frustration tolerance Poor school performance Impulsive behaviors Mood swings
When preparing educational materials for the family of a client diagnosed with progressive dementia, the nurse should include information related to which local resourses? Day care centers Legal professionals Home health services Family support groups Professional counseling
Professional counseling Family support groups Home health services Day care centers Most importantly, families need to know where to get help. Help includes professional counseling and education regarding the process and progression of the disease. Families especially need to know about and be referred to community-based groups that can help shoulder this tremendous burden (e.g., day care centers, senior citizen groups, organizations providing home visits and respite care, and family support groups). While legal professionals may be of interest to the family, client and family education does not include such services.REF: 439 and 443; Tables 23-8
What are the foundational concerns regarding the use of restraint and seclusion when providing care to children? Select all that apply. Parents may initiate a lawsuit if injury occurs. Staff have conflicted feelings leading to ineffectiveness. Research suggests both are psychologically and physically harmful. Staff tends to be undertrained in the use of restraints in children. The principle of least restrictive intervention is a primary concern.
Research suggests both are psychologically and physically harmful. The principle of least restrictive intervention is a primary concern. Restraint and seclusion have been shown to be psychologically harmful and may also be physically harmful and result in injury or death. To ensure that the civil and legal rights of individuals are maintained, techniques are selected according to the principle of least restrictive intervention. This principle requires that you use more-restrictive interventions only after attempting less restrictive interventions to manage the behavior that have been unsuccessful. The other options are not correct reasons why restraint and seclusion are controversial in children.DIF: Cognitive Level: Analyzing
Which nursing diagnosis is the priority when planning care for a client who displays considerable anger and occasional aggression? Social isolation Risk for other-directed violence Ineffective coping: overwhelmed Ineffective coping: maladaptive
Risk for other-directed violence Risk for other-directed violence is the priority diagnosis. The nurse then must determine which of two other diagnoses—ineffective coping: overwhelmed or ineffective coping: maladaptive—is appropriate. Social isolation is not an initial concern.REF: 508
A 21-year-old client asks the nurse, "What's wrong with my brain causing me to be so angry and aggressive?" The nurse's response should be grounded on what research-supported basis? The diminishment of stress hormones causes anger and aggression. No abnormalities of the brain have been identified that correlate with anger and aggression. The limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression. Personality type plays a much greater part in anger and aggression than physical factors.
The limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression.
Which of the following classifications of medication may be prescribed in intermittent explosive disorder? Anticonvulsants Psychostimulants Antianxiety agents such as benzodiazepines Monoamine oxidase (MAO) inhibitors
anticonvulsants
A 72-year-old patient is hospitalized diagnosed with pneumonia and experiencing delirium. When the client points to the IV pole and screams, "Get him out of here! He's going to hurt me!", the nurse recognizes the response as a(n) hallucination. delusion. illusion. confabulation.
illusion. Illusions are errors in perception of sensory stimuli. The stimulus is a real object in the environment; however, it is misinterpreted and often becomes the object of the patient's projected fear. Hallucinations are false sensory stimuli. For example, individuals experiencing delirium may become terrified when they "see" giant spiders crawling over the bedclothes or "feel" bugs crawling on or under their bodies. A delusion is described as thinking or believing something that is not true and is seen more often in schizophrenia. For example, a patient may firmly believe that government agencies can read and are monitoring his or her thoughts or that neighbors can see him or her through walls. Confabulation is the creation of stories or answers in place of actual memories to maintain self-esteem.DIF: Cognitive Level: Understand (Comprehension)REF: page 6TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity
