Section 4 Mental Health

1. A 52-year-old client states, "My husband is upset because I don't enjoy sex as much as I used to." Which priority client data should a nurse initially collect? 1. History of hysterectomy 2. Date of last menstrual cycle 3. Use of birth control methods 4. History of thought disorder

1. ANS: 2 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify appropriate nursing interventions for clients with sexual dysfunctions and gender dysphoria in children. Page: 534 Heading: Adulthood > The Middle Years—40 to 65 Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback 1 History of hysterectomy is not assessment data that the nurse should initially collect. 2 The nurse should assess the client's last menstrual cycle to determine if the client is experiencing the onset of menopause. Menopause usually occurs around the age of 50. The decrease in estrogen can result in multiple symptoms, including a decrease in biological drives and sexual activity. 3 Use of birth control methods is not assessment data that the nurse should initially collect. 4 History of thought disorders are not assessment data that the nurse should initially collect.

12. When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette's syndrome? 1. Neuroleptic medications 2. Antimanic medications 3. Tricyclic antidepressant medications 4. Monoamine oxidase inhibitor medications

12. ANS: 1 Chapter: Chapter 24, Children and Adolescents Objective: Describe treatment modalities relevant to selected disorders of infancy, childhood, and adolescence. Page: 648 Heading: Neurodevelopmental Disorders > Tourette's Disorder Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The nurse should recognize that neuroleptic (antipsychotic) medications are effective in the treatment of Tourette's syndrome. These medications are used to reduce the severity of tics and are most effective when combined with psychosocial therapy. 2 Antimanic medications are not an appropriate treatment choice. 3 Tricyclic antidepressant medications are not an appropriate treatment choice. 4 Monoamine oxidase inhibitor medications are not an appropriate treatment choice.

13. Which assessment data should a school nurse recognize as a sign of physical neglect? 1. The child is often absent from school and seems apathetic and tired. 2. The child is very insecure and has poor self-esteem. 3. The child has multiple bruises on various body parts. 4. The child has sophisticated knowledge of sexual behaviors.

13. ANS: 1 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Discuss characteristics of victims and victimizers. Page: 706-707 Heading: Application of the Nursing Process > Background Assessment Data > Child Abuse Integrated Process: Assessment Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 The nurse should recognize that a child who is often absent from school and seems apathetic and tired may be a victim of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care. 2 Insecurity and poor self-esteem are not signs of physical neglect. 3 Bruising is a sign of physical abuse. 4 Sophisticated sexual behaviors is a sign of sexual abuse.

1. A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child may have been physically abused? 1. The child shrinks at the approach of adults. 2. The child begs or steals food or money. 3. The child is frequently absent from school. 4. The child is delayed in physical and emotional development.

1. ANS: 1 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Discuss characteristics of victims and victimizers. Page: 706-707 Heading: Application of the Nursing Process > Background Assessment Data > Physical Abuse Integrated Process: Assessment Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns may be a victim of abuse. Maltreatment is considered, whether or not the adult intended to harm the child. 2 Stealing money or food does not indicate physical abuse. 3 Frequently missing school does not indicate physical abuse. 4 Developmental delays do not indicate physical abuse.

1. Approximately two million American children have experienced the deployment of a parent to Iraq or Afghanistan. How many of these children either lost a parent or have a parent who was wounded in these conflicts? 1. 48,000 2. 26,000 3. 11,000 4. 8,000

1. ANS: 1 Chapter: Chapter 29, Military Families Objective: Discuss historical aspects and epidemiological statistics related to members of the U.S military. Page: 780 Heading: Application of the Nursing Process>Assessment>The Impact of Deployment Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Family Dynamics Difficulty: Moderate Feedback 1 More than 48,000 children have either lost a parent or have a parent who was wounded in Iraq or Afghanistan. 2 The number 26,000 does not indicate how many children either lost a parent or have a parent who was wounded in these conflicts. 3 The number 11,000 does not indicate how many children either lost a parent or have a parent who was wounded in these conflicts. 4 The number 8,000 does not indicate how many children either lost a parent or have a parent who was wounded in these conflicts.

1. Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client's home environment should a nurse associate with the development of anorexia nervosa? 1. The home environment maintains loose personal boundaries. 2. The home environment places an overemphasis on food. 3. The home environment is overprotective and demands perfection. 4. The home environment condones corporal punishment.

1. ANS: 3 Chapter: Chapter 22, Eating Disorders Objective: Identify predisposing factors in the development of eating disorders. Page: 572 Heading: Predisposing Factors and Theories of Etiology Associated With Anorexia Nervosa, Bulimia Nervosa, and BED > Family Influences Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 Home environments that maintain loose personal boundaries do not typically lead to anorexia nervosa. 2 Home environments that place an overemphasis on food do not typically lead to anorexia nervosa. 3 The nurse should assess that a home environment that is overprotective and demands perfection may be a major influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against the parents viewed by the child as a means of gaining and remaining in control. 4 Home environments that condone corporal punishment do not typically lead to anorexia nervosa.

1. A nursing instructor is teaching about the Community Health Centers Act of 1963. What was a deterring factor to the proper implementation of this act? 1. Many prospective clients did not meet criteria for mental illness diagnostic-related groups. 2. Zoning laws discouraged the development of community mental health centers. 3. States could not match federal funds to establish community mental health centers. 4. There was not a sufficient employment pool to staff community mental health centers.

1. ANS: 3 Chapter: Chapter 27, Community Mental Health Nursing Objective Discuss the changing focus of care in the field of mental health. Page: 723 Heading: The Changing Focus of Care Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1 A client who did not meet criteria for mental illness was not a deterring factor. 2 Zoning laws were not a deterring factor. 3 A deterring factor to the proper implementation of the Community Mental Health Centers Act of 1963 was that states could not match federal funds to establish community mental health centers. This act called for the construction of comprehensive community mental health centers to offset the effect of deinstitutionalization, the closing of state mental health hospitals. 4 Insufficient staffing was not a deterring factor.

1. Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe intellectual developmental disorder (IDD)? 1. The client can perform some self-care activities independently. 2. The client has more advanced speech development. 3. Other than possible coordination problems, the client's psychomotor skills are not affected. 4. The client communicates wants and needs by "acting out" behaviors.

1. ANS: 4 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 629 Heading: Table 24-1 Developmental Characteristics of Intellectual Developmental Disorder by Degree of Severity Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The client would not be able to perform self-care activities independently. 2 The client will not necessarily have advanced speech development. 3 Individuals diagnosed with severe IDD require complete supervision and have minimal verbal skills and poor psychomotor development. 4 The nurse should identify that a client diagnosed with severe IDD may communicate wants and needs by "acting out" behaviors. Severe IDD indicates an IQ between 20 and 34.

10. A nurse is counseling a client diagnosed with gender dysphoria. What criteria would differentiate this disorder from a transvestic disorder? 1. Clients diagnosed with transvestic disorder are dissatisfied with their gender, whereas clients diagnosed with gender dysphoria are not. 2. Clients diagnosed with gender dysphoria are dissatisfied with their gender, whereas clients diagnosed with transvestic disorder are not. 3. Clients diagnosed with gender dysphoria avoid all forms of sexual intercourse, whereas clients diagnosed with transvestic disorder do not. 4. Clients diagnosed with transvestic disorder avoid all forms of sexual intercourse, whereas clients diagnosed with gender dysphoria do not.

10. ANS: 2 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify appropriate nursing interventions for clients with sexual dysfunctions and gender dysphoria in children. Page: 536 Heading: Types of Paraphilic Disorders > Transvestic Disorder Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Sexuality Difficulty: Moderate Feedback 1 Clients diagnosed with transvestic disorder experience intense sexual arousal from dressing in the clothes of the opposite gender but are not dissatisfied with their gender. 2 The nurse should identify that clients diagnosed with gender dysphoria are dissatisfied with their gender, whereas clients diagnosed with transvestic disorder experience intense sexual arousal from dressing in the clothes of the opposite gender but are not dissatisfied with their gender. 3 Clients with gender disorder do not avoid all forms of sexual intercourse. 4 Clients with transvestic disorder do not avoid all forms of sexual intercourse.

10. A preschool child is admitted to a psychiatric unit with a diagnosis of autism spectrum disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this client's plan of care? 1. Encourage and reward peer contact. 2. Provide consistent caregivers. 3. Provide a variety of safe daily activities. 4. Maintain close physical contact throughout the day.

10. ANS: 2 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 634-635 Heading: Table 24-3 Care Plan for the Child with Autism Spectrum Disorder Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 Encouraging and rewarding peer contact does not help the child feel more secure. 2 The nurse should provide consistent caregivers as part of the plan of care for a child diagnosed with autistic spectrum disorder. Children diagnosed with autistic spectrum disorder have an inability to trust. Providing consistent caregivers allows the client to develop trust and a sense of security. 3 Providing a variety of safe daily activities does not make the child feel more secure. 4 Maintain close physical contact throughout the day does not help the child feel more secure.

10. A client diagnosed with schizophrenia is hospitalized owing to an exacerbation of psychosis related to nonadherence with antipsychotic medications. Which level of care does the client's hospitalization reflect? 1. Primary prevention level of care 2. Secondary prevention level of care 3. Tertiary prevention level of care 4. Case management level of care

10. ANS: 2 Chapter: Chapter 27, Community Mental Health Nursing Objective: Discuss secondary prevention of mental illness within the community Page: 731 Heading: The Community as Client > Secondary Prevention Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 Primary prevention aims are preventing the need of services. 2 The client's hospitalization reflects the secondary prevention level of care. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment. 3 Tertiary prevention aims at reducing the symptoms of a disease or illness. 4 Case management level of care is not a term associated with the public health model.

10. When questioned about bruises, a woman states, "It was an accident. My husband just had a bad day at work. He's being so gentle now and even brought me flowers. He's going to get a new job, so it won't happen again." This client is in which phase of the cycle of battering? 1. Phase I: The tension-building phase 2. Phase II: The acute battering incident phase 3. Phase III: The honeymoon phase 4. Phase IV: The resolution and reorganization phase

10. ANS: 3 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Discuss characteristics of victims and victimizers. Page: 705-706 Heading: Application of the Nursing Process > Background Assessment Data > The Cycle of Battering Integrated Process: Evaluation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 This scenario is not an example of Phase I: The tension-building phase. 2 This scenario is not an example of Phase II: The acute battering incident phase. 3 The client is in the honeymoon phase of the cycle of battering. In this phase, the batterer becomes extremely loving, kind, and contrite. Promises are often made that the abuse will not happen again. 4 This scenario is not an example of Phase IV: The resolution and reorganization phase.

10. A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "My parents watch me like a hawk and never let me out of their sight." Which nursing diagnosis would take priority at this time? 1. Altered nutrition less than body requirements 2. Altered social interaction 3. Impaired verbal communication 4. Altered family processes

10. ANS: 4 Chapter: Chapter 22, Eating Disorders Objective: Formulate nursing diagnoses and outcomes of care for clients with eating disorders. Page: 575-577 Heading: Table 22-3 Care Plan for Client with Eating Disorders: Anorexia Nervosa and Bulimia Nervosa Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Analysis [Analyzing] Concept: Nutrition Difficulty: Moderate Feedback 1 Altered nutrition less than body requirements is not the priority at this time. 2 Altered social interaction is not the priority at this time. 3 Impaired verbal communication is not the priority at this time. 4 The nurse should determine that once the client has been medically cleared, the diagnosis of altered family process should take priority. Clients diagnosed with anorexia nervosa have a need to control and feel in charge of their own treatment choices. Behavioral-modification therapy allows the client to maintain control of eating.

11. A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) 1. Binge eating with a diagnosis of obesity 2. Bingeing and purging with a diagnosis of bulimia nervosa 3. Weight loss with a diagnosis of anorexia nervosa 4. Amenorrhea with a diagnosis of anorexia nervosa 5. Emaciation with a diagnosis of bulimia nervosa

11. ANS: 1, 2 Chapter: Chapter 22, Eating Disorders Objective: Discuss various modalities relevant to treatment of eating disorders. Page: 585 Heading: Treatment Modalities > Psychopharmacology Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1. The nurse should identify that topiramate is the drug of choice when treating binge eating with a diagnosis of obesity. Topiramate is an anticonvulsant that produces a significant decline in binge frequency and reduction in body weight. 2. The nurse should identify that topiramate is the drug of choice when treating bingeing and purging with a diagnosis of bulimia nervosa. Topiramate is an anticonvulsant that produces a significant decline in binge frequency and reduction in body weight. 3. Topiramate (Topamax) is not the drug of choice for weight loss with a diagnosis of anorexia nervosa. 4. Topiramate (Topamax) is not the drug of choice for amenorrhea with a diagnosis of anorexia nervosa. 5. Topiramate (Topamax) is not the drug of choice for emaciation with a diagnosis of bulimia nervosa.

11. A nurse is assessing a client diagnosed with sexual masochistic disorder. What would differentiate this paraphilic disorder from sexual sadistic disorder? 1. Symptoms of sexual masochistic disorder are chronic acts of humiliation, whereas symptoms of sexual sadistic disorder are acute. 2. Symptoms of sexual sadistic disorder are chronic acts of humiliation, whereas symptoms of sexual masochistic disorder are acute. 3. Masochistic acts can be performed alone, whereas sadistic acts must have a consenting or non-consenting partner. 4. Sadistic acts can be performed alone, whereas masochistic acts must have a consenting or nonconsenting partner.

11. ANS: 3 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify appropriate nursing interventions for clients with sexual dysfunctions and gender dysphoria in children. Page: 536 Heading: Types of Paraphilic Disorders > Sexual Masochism Disorder, Sexual Sadism Disorder Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Sexuality Difficulty: Moderate Feedback 1 The identifying feature of sexual sadistic disorder is the recurrent and intense sexual arousal from the physical or psychological suffering of another individual. 2 Both disorders are chronic in nature. 3 The identifying feature of sexual masochistic disorder is recurrent and intense sexual arousal when being humiliated, beaten, bound, or otherwise made to suffer. These masochistic activities may be fantasized and may be performed alone (e.g., self-inflicted pain) or with a partner. The identifying feature of sexual sadistic disorder is the recurrent and intense sexual arousal from the physical or psychological suffering of another individual. 4 Sadistic acts are performed with a partner. Sexual masochistic disorder acts may be performed alone.

11. A preschool child diagnosed with autistic spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate? 1. Place client in restraints until the aggression subsides. 2. Sedate the client with neuroleptic medications. 3. Hold client's head steady and apply a helmet. 4. Distract the client with a variety of games and puzzles.

11. ANS: 3 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 634-635 Heading: Table 24-3 Care Plan for the Child with Autism Spectrum Disorder Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The client should not be placed in restraints as this may cause further agitation or injury. 2 Sedating the client is not indicated, and is usually the treatment for Tourette's syndrome. 3 The most appropriate intervention for head banging is to hold the client's head steady and apply a helmet. The helmet is the least restrictive intervention and will serve to protect the client's head from injury. 4 Distraction with games would be ineffective.

11. Which information should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse? 1. Have ready access to a gun and learn how to use it. 2. Research lawyers that can aid in divorce proceedings. 3. File charges of assault and battery. 4. Have ready access to the number of a safe house for battered women.

11. ANS: 4 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault. Page: 712-714 Heading: Table 26-1 Care Plan for Survivors of Abuse Integrated Process: Implementation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 The nurse would not provide information on keeping a gun to the client. 2 The nurse would not provide information on divorce attorneys. 3 The nurse would not provide information on filing charges of assault and battery. 4 The nurse should provide information about the accessibility of safe houses for battered women when working with a client who has symptoms of domestic physical abuse. Many women feel powerless within the abusive relationship and may be staying in the abusive relationship out of fear.

11. When attempting to provide health-care services to the homeless, what should be a realistic concern for a nurse? 1. Most individuals that are homeless reject help. 2. Most individuals that are homeless are suspicious of anyone who offers help. 3. Most individuals that are homeless are proud and will often refuse charity. 4. Most individuals that are homeless relocate frequently.

11. ANS: 4 Chapter: Chapter 27, Community Mental Health Nursing Objective: Identify treatment alternatives for care of the seriously mentally ill and homeless mentally ill within the community. Page: 745-750 Heading: The Community as Client > Tertiary Prevention > The Homeless Population Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 It is inaccurate to state that most homeless reject help. 2 It is inaccurate to state that most homeless are suspicious of those who offer help. 3 It is inaccurate to state that most homeless refuse charity. 4 A realistic concern in the provision of health-care services to the homeless is that individuals who are homeless relocate frequently. Frequent relocation confounds service delivery and interferes with providers' efforts to ensure appropriate care.

12. A nurse is assessing a client diagnosed with fetishistic disorder. What would differentiate this paraphilic disorder from frotteuristic disorder? 1. To derive sexual excitement, fetishistic disorder involves the use of nonliving objects, whereas frotteuristic disorder involves touching and rubbing against nonconsenting people. 2. To derive sexual excitement, frotteuristic disorder involves the use of nonliving objects, whereas fetishistic disorder involves touching and rubbing against nonconsenting people. 3. Clients diagnosed with frotteuristic disorder are heterosexual cross-dressing males, whereas clients diagnosed with fetishistic disorder are homosexual cross-dressing males. 4. Clients diagnosed with fetishistic disorder are heterosexual cross-dressing males, whereas clients diagnosed with frotteuristic disorder are homosexual cross-dressing males.

12. ANS: 1 Chapter; Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify appropriate nursing interventions for clients with sexual dysfunctions and gender dysphoria in children. Page: 535 Heading: Types of Paraphilic Disorders > Fetishistic Disorder, Frotteuristic Disorder Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Sexuality Difficulty: Moderate Feedback 1 Fetishistic disorder involves recurrent and intense sexual arousal from the use of either nonliving objects or specific nongenital body part(s). 2 Frotteuristic disorder is the recurrent and intense sexual arousal involving touching and rubbing against a nonconsenting person. 3 Transvestic disorder involves recurrent and intense sexual arousal from dressing in the clothes of the opposite gender. 4 This statement is typical of transvestic disorder.

12. A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? (Select all that apply.) 1. "In this disorder, binge eating occurs exclusively during the course of bulimia nervosa." 2. "In this disorder, binge eating occurs, on average, at least once a week for three months." 3. "In this disorder, binge eating occurs, on average, at least two days a week for six months." 4. "In this disorder, distress regarding binge eating is present." 5. "In this disorder, distress regarding binge eating is absent."

12. ANS: 1, 3, 5 Chapter: Chapter 22, Eating Disorders Objective: Identify and differentiate among several eating disorders. Page: 571 Heading: Box 22-3 Diagnostic Criteria for Binge Eating Disorder Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1. According to the DSM-5 criteria for the diagnosis of binge-eating disorder, binge eating should not occur exclusively during the course of anorexia nervosa or bulimia nervosa. 2. This statement regarding binge eating is accurate, indicating that teaching has been effective. 3. The new time frame criteria in the DSM-5 states that binge eating must occur, on average, at least once a week for three months not two days a week for six months. 4. This statement indicates that teaching has been effective. 5. The DSM-5 criteria states that distress regarding binge eating would be present.

12. A homeless client comes to an emergency department reporting cough, night sweats, weight loss, and blood-tinged sputum. Which disease, which has recently become more prevalent among the homeless community, should a nurse suspect? 1. Meningitis 2. Tuberculosis 3. Encephalopathy 4. Mononucleosis

12. ANS: 2 Chapter: Chapter 27, Community Mental Health Nursing Objective: Identify treatment alternatives for care of the seriously mentally ill and homeless mentally ill within the community. Page: 745-750 Heading: The Community as Client > Tertiary Prevention > The Homeless Population Heading: The Homeless Population Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Perfusion Difficulty: Moderate Feedback 1 Meningitis has not recently become more prevalent. 2 The nurse should suspect that the homeless client has contracted tuberculosis. Tuberculosis is a growing problem among individuals who are homeless, owing to being in crowded shelters, which are ideal conditions for the spread of respiratory tuberculosis. Prevalence of alcoholism, drug addiction, HIV infection, and poor nutrition also impact the increase of contracted cases of tuberculosis. 3 Encephalopathy has not recently become more prevalent. 4 Mononucleosis has not recently become more prevalent.

12. A survivor of rape presents in an emergency department crying, pacing, and cursing her attacker. A nurse should recognize these client actions as which behavioral defense? 1. Controlled response pattern 2. Compounded rape reaction 3. Expressed response pattern 4. Silent rape reaction

12. ANS: 3 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Discuss characteristics of victims and victimizers. Page: 711 Heading: Application of the Nursing Process > Background Assessment Data > The Victim Integrated Process: Evaluation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. 2 The client is not experiencing a compounded rape reaction. 3 The nurse should recognize that this client is exhibiting an expressed response pattern. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension. 4 The client is not experiencing a silent rape reaction.

13. The diagnosis of __________________ ___________________includes the symptoms of gross distortion of body image, preoccupation with food, and refusal to eat.

13. ANS: anorexia nervosa Chapter: Chapter 22, Eating Disorders Objective: Identify and differentiate among several eating disorders. Page: 569 Heading: Application of the Nursing Process > Background Assessment Data: Anorexia Nervosa Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback: Anorexia nervosa is characterized by a morbid fear of obesity. Symptoms include gross distortion of body image, preoccupation with food, and refusal to eat.

13. Which of the following characteristics should a nurse identify as "normal" in the development of human sexuality for an 11-year-old child? (Select all that apply.) 1. The child experiments with masturbation. 2. The child may experience homosexual play. 3. The child shows little interest in the opposite sex. 4. The child shows little concern about physical attractiveness. 5. The child is unlikely to want to undress in front of others.

13. ANS: 1, 2, 5 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Describe developmental processes associated with human sexuality. Page: 532-533 Heading: Development of Human Sexuality > Adolescence Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback 1. The nurse should identify that experimenting with masturbation is normal in the development of human sexuality in an 11-year-old child. 2. The nurse should identify that homosexual play is normal in the development of human sexuality in an 11-year-old child. 3. The nurse should identify that showing little interest in the opposite sex is not normal in the development of human sexuality in an 11-year-old child. 4. The nurse should identify that showing little concern about physical attractiveness is not normal in the development of human sexuality in an 11-year-old child. 5. The nurse should identify that not wanting to undress in front of others is normal in the development of human sexuality in an 11-year-old child.

13. Which behavioral approach should a nurse use when caring for children diagnosed with disruptive behavior disorders? 1. Involving parents in designing and implementing the treatment process 2. Reinforcing positive actions to encourage repetition of desirable behaviors 3. Providing opportunities to learn appropriate peer interactions 4. Administering psychotropic medications to improve quality of life

13. ANS: 2 Chapter: Chapter 24, Children and Adolescents Objective: Describe treatment modalities relevant to selected disorders of infancy, childhood, and adolescence. Page: 661-662 Heading: General Therapeutic Approaches > Behavior Therapy Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 Involving parents is important but not a behavioral approach. 2 The nurse should reinforce positive actions to encourage repetition of desirable behaviors when caring for children diagnosed with disruptive behavior disorder. Behavior therapy is based on the concepts of classical conditioning and operant conditioning. 3 Providing opportunities to learn is not a behavioral approach. 4 Administering medications is not a behavioral approach.

13. Which of the following clients should a nurse recommend for a structured day program? (Select all that apply.) 1. An acutely suicidal teenager 2. A chronically mentally ill woman who has a history of medication nonadherence 3. A socially isolated older individual 4. A depressed individual who is able to contract for safety 5. A client who is hearing voices that tell the client to harm others

13. ANS: 2, 4 Chapter: Chapter 27, Community Mental Health Nursing Objective: Identify treatment alternatives for care of the seriously mentally ill and homeless mentally ill within the community. Page: 740-741 Heading: The Community as Client > Tertiary Prevention Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Patient-Centered Care Difficulty: Moderate Feedback 1. A suicidal teenager is not an appropriate candidate for a structured day program. 2. The nurse should recommend a structured day program for a chronically mental ill woman who has a history of medication nonadherence. 3. A socially isolated older adult is not an appropriate candidate for a structured day program. 4. The nurse should recommend a structured day program for a depressed individual who is able to contract for safety. 5. A client hearing voices is not an appropriate candidate for a structured day program.

14. The episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time is termed ________________________.

14. ANS: bingeing Chapter: Chapter 22, Eating Disorders Objective: Identify and differentiate among several eating disorders. Page: 569 Heading: Application of the Nursing Process > Background Assessment Data: Bulimia Nervosa Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback: The episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time is termed bingeing. Bingeing is a classic symptom of the eating disorder defined as bulimia nervosa.

14. A child diagnosed with severe autistic spectrum disorder has the nursing diagnosis disturbed personal identity. Which outcome would best address this client diagnosis? 1. The client will name own body parts as separate from others by day five. 2. The client will establish a means of communicating personal needs by discharge. 3. The client will initiate social interactions with caregivers by day four. 4. The client will not harm self or others by discharge.

14. ANS: 1 Chapter: Chapter 24, Children and Adolescents Objective: Identify nursing diagnoses common to clients with these disorders and select and appropriate nursing interventions for each. Page: 634-635 Heading: Table 24-3 Care Plan for the Child with Autism Spectrum Disorder Integrated Process: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 An appropriate outcome for this client is to name own body parts as separate from others. The nurse should assist the client in the recognition of separateness during self-care activities, such as dressing and feeding. The long-term goal for disturbed personal identity is for the client to develop an ego identity. 2 The client will establish a means of communicating personal needs by discharge does not address the diagnosis. 3 The client will initiate social interactions with caregivers by day four does not address the diagnosis. 4 The client will not harm self or others by discharge does not address the diagnosis.

14. A client diagnosed with an eating disorder experiences insomnia, nightmares, and panic attacks that occur before bedtime. She has never married or dated, and she lives alone. She states to a nurse, "My father has recently moved back to town." What should the nurse suspect? 1. Possible major depressive disorder 2. Possible history of childhood incest 3. Possible histrionic personality disorder 4. Possible history of childhood physical abuse

14. ANS: 2 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Discuss characteristics of victims and victimizers. Page: 709 Heading: Application of the Nursing Process > Background Assessment Data > The Adult Survivor of Incest Integrated Process: Assessment Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 The nurse would not expect a possible major depressive disorder. 2 The nurse should suspect that this client may have a history of childhood incest. Adult survivors of incest are at risk for developing posttraumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders. 3 The nurse would not expect a possible histrionic personality disorder. 4 The nurse would not expect a possible history of childhood physical abuse.

14. Which of the following are characteristics of a Program of Assertive Community Treatment (PACT), as described by the National Alliance on Mental Illness (NAMI)? (Select all that apply.) 1. PACT offers nationally based treatment to people with serious and persistent mental illnesses. 2. PACT is a type of case-management program. 3. The PACT team provides services 24 hours a day, 7 days a week, 365 days a year. 4. The PACT team provides highly individualized services directly to consumers. 5. PACT is a multidisciplinary team approach.

14. ANS: 2, 3, 4, 5 Chapter: Chapter 27, Community Mental Health Nursing Objective: Identify treatment alternatives for care of the seriously mentally ill and homeless mentally ill within the community. Page: 739-740 Heading: The Community as Client > Tertiary Prevention Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Patient-Centered Care Difficulty: Moderate Feedback 1. NAMI defines PACT as a service-delivery model that provides comprehensive, locally, not nationally, based treatment to people with serious and persistent mental illnesses. 2. PACT is a type of case-management program. 3. The PACT team provides these services 24 hours a day, 7 days a week, 365 days a year. 4. PACT is a type of case-management program that provides highly individualized services directly to consumers. 5. It is a team approach and includes members from psychiatry, social work, nursing, substance abuse, and vocational rehabilitation.

14. A nursing instructor is teaching about the various categories of paraphilic disorders. Which categories are correctly matched with expected behaviors? (Select all that apply.) 1. Exhibitionistic disorder: Mary models lingerie for a company that specializes in home parties. 2. Voyeuristic disorder: John is arrested for peering in a neighbor's bathroom window. 3. Frotteuristic disorder: Peter enjoys subway rush-hour female contact that results in arousal. 4. Pedophilic disorder: George can experience an orgasm by holding and feeling shoes. 5. Fetishistic disorder: Henry masturbates into his wife's silk panties.

14. ANS: 2, 3, 5 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify various types of paraphilic and sexual dysfunction disorders and gender dysphoria. Page: 535-536 Heading: Types of Paraphilic Disorders Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Sexuality Difficulty: Moderate Feedback 1. Exhibitionistic disorder is a paraphilic disorder but involves the urge to show one's genitals to unsuspecting strangers. 2. Categories of paraphilic disorders include voyeuristic disorder (observing unsuspecting people, who are naked, dressing, or engaged in sexual activity). 3. Categories of paraphilic disorders include frotteuristic disorder (touching or rubbing against a non-consenting person). 4. Pedophilic disorder is categorized as having sexual urges, behaviors, or sexually arousing fantasies involving sexual activity with a prepubescent child. 5. Categories of paraphilic disorders include fetishistic disorder (using nonliving objects in sexual ways).

15. To rid the body of excessive calories, a client diagnosed with bulimia nervosa may engage in ______________________ behaviors, which include self-induced vomiting, or the misuse of laxatives, diuretics, or enemas.

15. ANS: purging Chapter: Chapter 22, Eating Disorders Objective: Identify and differentiate among several eating disorders. Page: 569-570 Heading: Application of the Nursing Process > Background Assessment Data: Bulimia Nervosa Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback: To rid the body of excessive calories, a client diagnosed with bulimia nervosa may engage in purging behaviors, which include self-induced vomiting or the misuse of laxatives, diuretics, or enemas. In addition to these behaviors, other inappropriate compensatory behaviors, such as fasting or excessive exercise, may be noted.

15. A nursing instructor presents a case study in which a three-year-old child is in constant motion and is unable to sit still during story time. She asks a student to evaluate this child's behavior. Which student response indicates an appropriate evaluation of the situation? 1. "This child's behavior must be evaluated according to developmental norms." 2. "This child has symptoms of attention deficit/hyperactivity disorder." 3. "This child has symptoms of the early stages of autistic disorder." 4. "This child's behavior indicates possible symptoms of oppositional defiant disorder."

15. ANS: 1 Chapter: Chapter 24, Children and Adolescents Objective: Identify nursing diagnoses common to clients with these disorders and select and appropriate nursing interventions for each. Page: 627 Heading: Introduction Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The student's evaluation of the situation is appropriate when indicating a need for the client to be evaluated according to developmental norms. The DSM-5 indicates that emotional problems exist if the behavioral manifestations are not age-appropriate, deviate from cultural norms, or create deficits or impairments in adaptive functioning. 2 Stating "This child has symptoms of attention deficit-hyperactivity disorder" does not indicate appropriate evaluation. 3 Stating "This child has symptoms of the early stages of autistic disorder" does not indicate appropriate evaluation. 4 Stating "This child's behavior indicates possible symptoms of oppositional defiant disorder" does not indicate appropriate evaluation.

15. A client is diagnosed with erectile disorder. Which of the following medications would address this condition, and what is the therapeutic action of the drug? (Select all that apply.) 1. Phentolamine (Oraverse); increases blood flow to the penis 2. Apomorphine (Apokyn); acts directly on the dopamine receptors in the brain 3. Vardenafil (Levitra); blocks the action of phosphodiesterase-5 (PDE5) 4. Goserelin (Zoladex); inhibits the production of gonadotropins 5. Sildenafil (Viagra); blocks the action of phosphodiesterase-5 (PDE5)

15. ANS: 1, 2, 3, 5 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Describe various treatment modalities for clients with sexual disorders. Page: 546-547 Heading: Treatment Modalities for Sexual Dysfunctions > Erectile Disorder Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback 1. Phentolamine has been used in combination with papaverine in an injectable form that increases blood flow to the penis, resulting in an erection. 2. Apomorphine acts directly on the dopamine receptors in the brain. This mode of stimulating dopamine in the brain is thought to enhance the sexual response. 3. Vardenafil (Levitra) was approved by the FDA for the treatment of erectile disorder. This newer impotence agent blocks the action of phosphodiesterase-5 (PDE5), an enzyme that breaks down cyclic guanosine monophosphate (cGMP), a compound that is required to produce an erection. 4. Zoladex is a treatment for prostate cancer, not erectile dysfunction. 5. Sildenafil (Viagra) blocks the action of phosphodiesterase-5 (PDE5).

15. In planning care for a woman who presents as a survivor of domestic abuse, a nurse should be aware of which of the following data? (Select all that apply.) 1. It often takes several attempts before a woman leaves an abusive situation. 2. Substance abuse is a common factor in abusive relationships. 3. Until children reach school age, they are usually not affected by abuse between their parents. 4. Women in abusive relationships usually feel isolated and unsupported. 5. Economic factors rarely play a role in the decision to stay.

15. ANS: 1, 2, 4 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Discuss characteristics of victims and victimizers. Page: 704-706 Heading: Application of the Nursing Process > Background Assessment Data > Intimate Partner Violence Integrated Process: Evaluation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1. When planning care for a woman who is a survivor of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation. 2. When planning care for a woman who is a survivor of domestic abuse, the nurse should be aware that substance abuse is a common factor in abusive relationships. 3. Children can be affected by domestic violence from infancy. 4. When planning care for a woman who is a survivor of domestic abuse, the nurse should be aware that women in abusive relationships usually feel isolated and unsupported. 5. Economic factors often play a role in the victim's decision to stay.

15. Which of the following have been assessed as the most common types of mental illness identified among homeless individuals? (Select all that apply.) 1. Schizophrenia 2. Body dysmorphic disorder 3. Antisocial personality disorder 4. Neurocognitive disorder 5. Conversion disorder

15. ANS: 1, 3, 4 Chapter: Chapter 27, Community Mental Health Nursing Objective: Identify treatment alternatives for care of the seriously mentally ill and homeless mentally ill within the community. Page: 745-750 Heading: The Community as Client > Tertiary Prevention > The Homeless Population Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1. A number of studies have been conducted, primarily in large, urban areas, which have addressed the most common types of mental illness identified among homeless individuals. Schizophrenia is frequently described as the most common diagnosis. 2. Body dysmorphic disorder is not among the most common types of mental illnesses among homeless individuals. 3. Other prevalent disorders include personality disorders, such as antisocial personality disorder. 4. Other prevalent disorders include neurocognitive disorders. 5. Conversion disorder is not among the most common types of mental illnesses among homeless individuals.

16. Order the goals of the levels of prevention as they progress through the public health model set forth by Gerald Caplan. ________ Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness ________ Services aimed at reducing the residual defects that are associated with severe and persistent mental illness ________ Services aimed at reducing the incidence of mental disorders within the population

16. ANS: The correct order is 2, 3, 1. Chapter: Chapter 27, Community Mental Health Nursing Objective: Define the concepts of care associated with the public health model. Page: 724-725 Heading: The Public Health Model Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Health Promotion Difficulty: Moderate Feedback: The premise of the model of public health is based largely on the concepts set forth by Gerald Caplan (1964) during the initial community mental health movement. They include primary prevention, secondary prevention, and tertiary prevention. 1. Primary prevention is aimed at reducing the incidence of mental disorders within the population. 2. Secondary prevention is aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness. 3. Tertiary prevention is aimed at providing services that reduce the residual defects that are associated with severe and persistent mental illness.

16. Which of the following nursing diagnoses are typically appropriate for an adult survivor of incest? (Select all that apply.) 1. Low self-esteem 2. Powerlessness 3. Disturbed personal identity 4. Knowledge deficit 5. Nonadherence

16. ANS: 1, 2 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault. Page: 709 Heading: Application of the Nursing Process > Background Assessment Data > The Adult Survivor of Incest Integrated Process: Assessment Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1. An adult survivor of incest would most likely have low self-esteem. 2. An adult survivor of incest would most likely have a sense of powerlessness. 3. An adult survivor of incest would not likely have disturbed personal identity. 4. An adult survivor of incest would not likely have a knowledge deficit. 5. An adult survivor of incest would not likely have nonadherence.

16. A nurse is planning care for a child diagnosed with gender dysphoria. Which of the following nursing diagnoses could potentially document this client's problems? (Select all that apply.) 1. Low self-esteem R/T rejection by peers 2. Self-care deficit R/T isolative behaviors 3. Disturbed personal identity R/T parenting patterns 4. Impaired social interactions R/T socially unacceptable behaviors 5. Activity intolerance R/T fatigue

16. ANS: 1, 3, 4 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Formulate nursing diagnoses and goals of care for clients with sexual dysfunctions and gender dysphoria in children. Page: 553 Heading: Box 21-4 Diagnostic Criteria for Gender Dysphoria in Children Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Sexuality Difficulty: Moderate Feedback 1. Based on the data collected during a nursing assessment, possible nursing diagnoses for the child with gender dysphoria may include the following: low self-esteem related to rejection by peers. 2. Self-care deficit does not address the typical problems of clients diagnosed with gender dysphoria. 3. Based on the data collected during a nursing assessment, possible nursing diagnoses for the child with gender dysphoria may include the following: disturbed personal identity related to biological factors or parenting patterns that encourage culturally unacceptable behaviors for assigned gender. 4. Based on the data collected during a nursing assessment, possible nursing diagnoses for the child with gender dysphoria may include the following: impaired social interaction related to socially and culturally unacceptable behaviors. 5. Activity intolerance does not address the typical problems of clients diagnosed with gender dysphoria.

16. A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of IDD? 1. Risk for injury R/T self-mutilation 2. Altered social interaction R/T nonadherence to social convention 3. Altered verbal communication R/T delusional thinking 4. Social isolation R/T severely decreased gross motor skills

16. ANS: 2 Chapter: Chapter 24, Children and Adolescents Objective: Identify nursing diagnoses common to clients with these disorders and select and appropriate nursing interventions for each. Page: 629 Heading: Table 24-1 Developmental Characteristics of Intellectual Developmental Disorder by Degree of Severity Integrated Process: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Cognition Difficulty: Moderate Feedback 1 Risk for injury R/T self-mutilation is not the best nursing diagnosis. 2 The appropriate nursing diagnosis associated with this degree of IDD is altered social interaction R/T nonadherence to social convention. A client with an IQ of 47 would be diagnosed with moderate intellectual developmental disorder and may also experience some limitations in speech communications. 3 Altered verbal communication R/T delusional thinking is not the best nursing diagnosis. 4 Social isolation R/T severely decreased gross motor skills is not the best nursing diagnosis.

17. ___________________________ is the constitution and life of an individual relative to characteristics regarding intimacy.

17. ANS: Sexuality Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Describe developmental processes associated with human sexuality. Page: 531 Heading: Core Concept > Sexuality Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback: Sexuality is the constitution and life of an individual relative to characteristics regarding intimacy. It reflects the totality of the person and does not relate exclusively to the sex organs or sexual behavior.

The ________________________ movement closed state mental hospitals and caused the discharge of individuals with mental illness.

17. ANS: deinstitutionalization Chapter: Chapter 27, Community Mental Health Nursing Objective: Relate historical and epidemiological factors associated with caring for the seriously mentally ill and homeless mentally ill within the community. Page: 723 Heading: The Changing Focus of Care Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback: The deinstitutionalization movement closed state mental hospitals and caused the discharge of individuals with mental illness. Congress passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act (often called the Community Mental Health Centers Act) in 1963. This act called for the construction of comprehensive community health centers, the cost of which would be shared by federal and state governments. Unfortunately, many state governments did not have the capability to match the federal funds required for the establishment of these mental health centers.

17. A nursing instructor is teaching about intimate partner violence. Which of the following student statements indicate that learning has occurred? (Select all that apply.) 1. "Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner." 2. "Intimate partner violence is used to gain power and control over the other intimate partner." 3. "Fifty-one percent of victims of intimate violence are women." 4. "Women ages 25 to 34 experience the highest per capita rates of intimate violence." 5. "Victims are typically young married women who are dependent housewives."

17. ANS: 1, 2, 4 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault. Page: 704-706 Heading: Application of the Nursing Process > Background Assessment Data > Intimate Partner Violence Integrated Process: Assessment Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1. Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. 2. It is used to gain power and control over the other intimate partner. 3. Eighty-five percent of victims of intimate violence are women. 4. Women ages 25 to 34 experience the highest per capita rates of intimate violence. 5. Battered women represent all age, racial, religious, cultural, educational, and socioeconomic groups. They may be married or single, housewives or business executives.

17. A physician orders methylphenidate (Ritalin) for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents? 1. If one dose of Ritalin is missed, double the next dose. 2. Administer Ritalin to the child after breakfast. 3. Administer Ritalin to the child just prior to bedtime. 4. A side effect of Ritalin is decreased ability to learn.

17. ANS: 2 Chapter: Chapter 24, Children and Adolescents Objective: Identify nursing diagnoses common to clients with these disorders and select and appropriate nursing interventions for each. Page: 637 Heading: Figure 24-1 Neurobiology of Attention Deficit/Hyperactivity Disorder Integrated Process: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The Ritalin dosage should not be doubled. 2 The nurse should instruct the parents to administer Ritalin to the child after breakfast. Ritalin is a central nervous system stimulant and can cause decreased appetite. Central nervous system stimulants can also temporarily interrupt growth and development. 3 Ritalin can cause weight loss and should be given after breakfast. 4 Ritalin increases ability to concentrate and learn.

18. Order the description of the progressive phases of Walker's model of the "cycle of battering." ________ This phase is the most violent and the shortest, usually lasting up to 24 hours. ________ In this phase, the man's tolerance for frustration is declining. ________ In this phase, the batterer becomes extremely loving, kind, and contrite

18. ANS: The correct order is 2, 1, 3. Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault. Page: 705-706 Heading: Application of the Nursing Process > Background Assessment Data > Intimate Partner Violence Integrated Process: Assessment Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis Concept: Violence Difficulty: Moderate Feedback: In her classic studies of battered women and their relationships, Walker identified a cycle of predictable behaviors that are repeated over time. The behaviors can be divided into three distinct phases that vary in time and intensity both within the same relationship and among different couples. 1. Tension-building phase: In this phase, the man's tolerance for frustration is declining. 2. Acute-battering incident phase: This phase is the most violent and the shortest, usually lasting up to 24 hours. 3. Honeymoon phase: In this phase, the batterer becomes extremely loving, kind, and contrite

18. Which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder? 1. Modify environment to decrease stimulation and provide opportunities for quiet reflection. 2. Convey unconditional acceptance and positive regard. 3. Recognize escalating aggressive behavior and intervene before violence occurs. 4. Provide immediate positive feedback for appropriate behaviors.

18. ANS: 3 Chapter: Chapter 24, Children and Adolescents Objective: Identify nursing diagnoses common to clients with these disorders and select and appropriate nursing interventions for each. Page: 656-657 Heading: Table 24-8 Care Plan for Child/Adolescent with Conduct Disorder Integrated Process: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 After safety has been established, the nurse can modify environment to decrease stimulation and provide opportunities for quiet reflection. 2 After safety has been established, the nurse can convey unconditional acceptance and positive regard. 3 The priority nursing intervention when caring for a child diagnosed with conduct disorder should be to recognize escalating aggressive behavior and to intervene before violence occurs. This intervention serves to keep the client and others safe, which is the priority nursing concern. 4 After safety has been established, the nurse can provide immediate positive feedback for appropriate behaviors.

19. A pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence of an intimate partner is termed ______________________.

19. ANS: battering Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault. Page: 704 Heading: Core Concept > Battering Integrated Process: Assessment Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback: Battering is a pattern of behavior used to establish power and control over another person with whom an intimate relationship is or has been shared through fear and intimidation, often including the threat or use of violence. Battering happens when one person believes they are entitled to control another.

19. A mother questions the decreased effectiveness of methylphenidate (Ritalin) prescribed for her child's ADHD. Which nursing response best addresses the mother's concern? 1. "The physician will probably switch from Ritalin to a central nervous system stimulant." 2. "The physician may prescribe an antihistamine with the Ritalin to improve effectiveness." 3. "Your child has probably developed a tolerance to Ritalin and may need a higher dosage." 4. "Your child has developed sensitivity to Ritalin and may be exhibiting an allergy."

19. ANS: 3 Chapter: Chapter 24, Children and Adolescents Objective: Identify nursing diagnoses common to clients with these disorders and select and appropriate nursing interventions for each. Page: 637-638 Heading: Figure 24-21 Neurobiology of Attention Deficit/Hyperactivity Disorder Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 Ritalin is a nervous system stimulant, this statement provides false information. 2 Antihistamines would not improve the effectiveness of Ritalin; this statement provides false information. 3 The nurse should explain to the mother that the child has probably developed a tolerance to Ritalin and may need a higher dosage. Methylphenidate is a central nervous system stimulant, and tolerance can develop rapidly. Physical and psychological dependence can also occur. 4 These are not signs of an allergic reaction to Ritalin.

20. Physical ________________ of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision

20. ANS: neglect Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault. Page: 707 Heading: Core Concept > Neglect Integrated Process: Assessment Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback: Physical neglect of a child includes refusal of or delay in seeking health care, abandonment, expulsion from the home or refusal to allow a runaway to return home, and inadequate supervision. Children are vulnerable and relatively powerless, and the effects of maltreatment are infinitely deep and long lasting.

2. A woman presents with a history of physical and emotional abuse in her intimate relationships. What should this information lead a nurse to suspect? 1. The woman may be exhibiting a controlled response pattern. 2. The woman may have a history of childhood neglect. 3. The woman may be exhibiting codependent characteristics. 4. The woman may be a victim of incest.

2. ANS: 4 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Discuss characteristics of victims and victimizers. Page: 708-709 Integrated Process: Application of the Nursing Process > Background Assessment Data Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 The nurse would not expect that the client is exhibiting a controlled response pattern. 2 The nurse would not expect a history of childhood neglect. 3 The nurse would not expect codependency. 4 The nurse should suspect that this client may be a victim of incest. Many women who are battered have low self-esteem and have feelings of guilt, anger, fear, and shame. Women in abusive relationships often grew up in an abusive home.

2. In the course of an assessment interview, a female client reveals a history of bisexual orientation. Which action should the nurse initially implement when working with this client? 1. Self-assess personal attitudes toward homosexuality. 2. Review client's possible childhood sexual abuse history. 3. Encourage discussion of aversion to heterosexual relationships. 4. Explore client's family history of homosexuality.

2. ANS: 1 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Discuss variations in sexual orientation. Page: 560-561 Heading: Homosexuality > Special Concerns Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback 1 The nurse should initially self-assess personal attitudes toward homosexuality. The nurse must be able to recognize when negative feelings compromise care. Unconditional acceptance of each individual is an essential component of compassionate nursing. 2 Once the nurse has assessed personal attitudes, the nurse can review the client's possible childhood sexual abuse history. 3 Once the nurse has assessed personal attitudes, the nurse can encourage discussion of aversion to heterosexual relationships. 4 Once the nurse has assessed personal attitudes, the nurse can explore the client's family history of homosexuality.

2. Which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate IDD? 1. Meeting all of the client's self-care needs to avoid injury to the client 2. Providing simple directions and praising client's independent self-care efforts 3. Avoid interfering with the client's self-care efforts in order to promote autonomy 4. Encouraging family to meet the client's self-care needs to promote bonding

2. ANS: 2 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 630-631 Heading: Table 24-2 Care Plan for the Child with Intellectual Disability Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The nurse should allow the client to perform self-care activities independently, but should intervene when necessary. 2 Providing simple directions and praise is an appropriate intervention for a teenager diagnosed with moderate IDD. Individuals with moderate mental retardation can perform some activities independently and may be capable of academic skill to a second-grade level. 3 The nurse should intervene when necessary. 4 The client's independence should be encouraged.

2. A client's altered body image is evidenced by claims of "feeling fat," even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? 1. The client will consume adequate calories to sustain normal weight. 2. The client will cease strenuous exercise programs. 3. The client will perceive personal ideal body weight and shape as normal. 4. The client will not express a preoccupation with food.

2. ANS: 3 Chapter: Chapter 22, Eating Disorders Objective: Identify predisposing factors in the development of eating disorders. Page: 575-577 Heading: Table 22-3 Care Plan for Client with Eating Disorders: Anorexia Nervosa and Bulimia Nervosa Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 Consuming adequate calories to sustain a normal weight may be unrealistic for this client. 2 Ceasing strenuous exercise programs may be unrealistic for this client. 3 The nurse should identify that the appropriate outcome for this client is to perceive personal ideal body weight and shape as normal. 4 Not expressing a preoccupation with food may be unrealistic for this client.

2. A nurse is implementing care within the parameters of tertiary prevention. Which nursing action is an example of this type of care? 1. Teaching an adolescent about pregnancy prevention 2. Teaching a client the reportable side effects of a newly prescribed neuroleptic medication 3. Teaching a client to cook meals, make a grocery list, and establish a budget 4. Teaching a client about his or her new diagnosis of bipolar disorder

2. ANS: 3 Chapter: Chapter 27, Community Mental Health Nursing Objective: Discuss tertiary prevention of mental illness within the community as it relates to the seriously mentally ill and homeless mentally ill. Page: 725 Heading: The Public Health Model Integrated Process: Teaching and Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1 Teaching about pregnancy prevention is primary prevention. 2 Teaching about side effects of a new medication and bipolar disorder is secondary prevention. 3 The nurse who teaches a client to cook meals, make a grocery list, and establish a budget is implementing care within the parameters of tertiary prevention. Tertiary prevention consists of services aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning. 4 Teaching about bipolar disorder to a newly diagnosed client is secondary prevention.

2. Research has shown that an adolescent (13 to 18 years) would typically exhibit which behavior as a reaction to parental military deployment? 1. May exhibit regressive behaviors and assume blame for parent's departure 2. May become sullen, tearful, throw temper tantrums, or develop sleep problems 3. May participate in high-risk behaviors, sexual acting out, and drug or alcohol abuse 4. May respond to schedule disruptions with irritability and/or apathy and weight loss

2. ANS: 3 Chapter: Chapter 29, Military Families Objective: Discuss historical aspects and epidemiological statistics related to members of the U.S military. Page: 780 Heading: Application of the Nursing Process>Assessment>The Impact of Deployment Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Family Dynamics Difficulty: Moderate Feedback 1 Preschoolers (3 to 6 years) may regress in areas such as toilet training, sleep, separation fears, physical complaints, or thumb sucking and may assume blame for parent's departure. School age children (6 to 12 years) are more aware of potential dangers to parent, and may exhibit irritable behavior, aggression, or whininess, and become more regressed and fearful about parent's safety. 2 Toddlers (1 to 3 years) may become sullen, tearful, throw temper tantrums, or develop sleep problems. 3 Adolescents (13 to 18 years) may be rebellious, irritable, or more challenging of authority. Parents need to be alert to high-risk behaviors, such as problems with the law, sexual acting out, and drug or alcohol abuse. 4 Infants (birth to 12 months) may respond to schedule disruptions with irritability and/or apathy and weight loss.

20. After studying the DSM-5 criteria for oppositional defiant disorder (ODD), which listed symptom would a student nurse recognize? 1. Arguing and annoying older sibling over the past year 2. Angry and resentful behavior over a 3-month period 3. Initiating physical fights for more than 18 months 4. Arguing with authority figures for more than 6 months

20. ANS: 4 Chapter: Chapter 24, Children and Adolescents Objective: Identify nursing diagnoses common to clients with these disorders and select and appropriate nursing interventions for each. Page: 650 Heading: Box 24-5 Diagnostic Criteria for Oppositional Defiant Disorder Integrated Process: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The DSM-5 rules out the diagnosis of ODD when only siblings are involved in argumentative interactions. 2 Angry and resentful behavior over more than 6 months, not 3 months, would be considered a symptom of ODD. 3 Initiating physical fights is a symptom of conduct disorder, not ODD. 4 Arguing with authority figures for more than 6 months is listed by the DSM-5 as a symptom for the diagnosis of ODD.

21. Which of the following risk factors, if noted during a family history assessment, should a nurse associate with the development of IDD? (Select all that apply.) 1. A family history of Tay-Sachs disease 2. Childhood meningococcal infection 3. Deprivation of nurturance and social contact 4. History of maternal multiple motor and verbal tics 5. A diagnosis of maternal major depressive disorder

21. ANS: 1, 2, 3 Chapter: Chapter 24, Children and Adolescents Objective: Identify nursing diagnoses common to clients with these disorders and select and appropriate nursing interventions for each. Page: 627-628 Heading: Neurodevelopmental Disorders > Intellectual Disability (Intellectual Developmental Disorder) Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1. The nurse should recognize a family history of Tay-Sachs disease as risk factors that would predispose a child to IDD. 2. The nurse should recognize a family history of childhood meningococcal infections as risk factors that would predispose a child to IDD. 3. The nurse should recognize a family history of deprivation of nurturance and social contact as risk factors that would predispose a child to IDD. 4. A diagnosis of maternal major depressive disorder would not predispose a child to IDD.

22. Which of the following findings should a nurse identify that would contribute to a client's development of ADHD? (Select all that apply.) 1. The client's father was a smoker. 2. The client had a low birth weight. 3. The client is lactose intolerant. 4. The client has a sibling diagnosed with ADHD. 5. The client has been diagnosed with dyslexia.

22. ANS: 2, 4 Chapter: Chapter 24, Children and Adolescents Objective: Identify nursing diagnoses common to clients with these disorders and select and appropriate nursing interventions for each. Page: 636-638 Heading: Neurodevelopmental Disorders > Attention Deficit/Hyperactivity Disorder Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1. Smoking does not lead to the development of ADHD. 2. The nurse should identify that a low birth weight would predispose a client to the development of ADHD. 3. Lactose intolerance does not lead to the development of ADHD. 4. The nurse should identify that having a sibling diagnosed with ADHD would predispose a client to the development of ADHD. 5. A diagnosis of dyslexia does not lead to the development of ADHD.

23. The DSM-5 criteria for ODD specifies that: A persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must be evident and last at least ______________ months.

23. ANS: 6 Chapter: Chapter 24, Children and Adolescents Objective: Identify nursing diagnoses common to clients with these disorders and select and appropriate nursing interventions for each. Page: 650 Heading: Box 24-5 Diagnostic Criteria for Oppositional Defiant Disorder Integrated Process: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback: A persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness must be evident and last at least 6 months according to the DSM-5 criteria for the diagnosis of ODD.

3. A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa should the nurse provide? 1. The emesis produced during purging is acidic and corrodes the tooth enamel. 2. Purging causes the depletion of dietary calcium. 3. Food is rapidly ingested without proper mastication. 4. Poor dental and oral hygiene leads to dental caries.

3. ANS: 1 Chapter: Chapter 22, Eating Disorders Objective: Identify predisposing factors in the development of eating disorders. Page: 570 Heading: Background Assessment Data: Bulimia Nervosa Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 The nurse should explain to the client diagnosed with bulimia nervosa that his or her teeth will eventually deteriorate, because the emesis produced during purging is acidic and corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance. 2 This does not correlate with tooth enamel deterioration. 3 This does not lead to tooth enamel deterioration. 4 This statement does not educate the client about tooth enamel deterioration caused by vomiting.

3. A nursing instructor is developing a lesson plan to teach about domestic violence. Which information should be included? 1. Power and control are central to the dynamic of domestic violence. 2. Poor communication and social isolation are central to the dynamic of domestic violence. 3. Erratic relationships and vulnerability are central to the dynamic of domestic violence. 4. Emotional injury and learned helplessness are central to the dynamic of domestic violence.

3. ANS: 1 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Discuss characteristics of victims and victimizers. Page: 704-706 Heading: Application of the Nursing Process > Background Assessment Data Integrated Process: Planning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 The nursing instructor should include the concept that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession. 2 Poor communication and social isolation are not central to the dynamic of domestic violence. 3 Erratic relationships and vulnerability are not central to the dynamic of domestic violence. 4 Emotional injury and learned helplessness are not central to the dynamic of domestic violence.

3. A widower reports a fear of intimacy because of an inability to achieve and sustain an erection. He has become isolative, has difficulty sleeping, and has lost weight over the past year. Which nursing diagnosis should be a priority for this client? 1. Risk for situational low self-esteem AEB inability to achieve an erection 2. Sexual dysfunction R/T dysfunctional grieving AEB inability to experience orgasm 3. Social isolation R/T low self-esteem AEB refusing to engage in dating activities 4. Disturbed body image R/T penile flaccidity AEB client statements

3. ANS: 2 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Formulate nursing diagnoses and goals of care for clients with sexual dysfunctions and gender dysphoria in children. Page: 544 Heading: Diagnosis and Outcome Identification Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis (Analyzing) Concept: Sexuality Difficulty: Moderate Feedback 1 Risk for situational low self-esteem AEB inability to achieve an erection is not the priority diagnosis. 2 The nurse should prioritize the nursing diagnosis sexual dysfunction R/T dysfunctional grieving AEB inability to experience orgasm. The nurse should assess the client's mood and level of energy, because depression and fatigue can decrease desire for participation in sexual activity. 3 Social isolation R/T low self-esteem AEB refusing to engage in dating activities is not the priority diagnosis. 4 Disturbed body image R/T penile flaccidity AEB client statements is not the priority diagnosis.

3. A child has been diagnosed with autistic spectrum disorder. The distraught mother cries out, "I'm such a terrible mother. What did I do to cause this?" Which nursing response is most appropriate? 1. "Researchers really don't know what causes autistic spectrum disorder, but the relationship between autistic disorder and fetal alcohol syndrome is being explored." 2. "Poor parenting doesn't cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control." 3. "Research has shown that the mother appears to play a greater role in the development of autistic spectrum disorder than the father." 4. "Lack of early infant bonding with the mother has shown to be a cause of autistic spectrum disorder. Did you breastfeed or bottle-feed?"

3. ANS: 2 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 631-633 Heading: Neurodevelopmental Disorder > Autism Spectrum Disorder Integrated Processes: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 This statement may place unintentional blame on the mother. 2 The most appropriate response by the nurse is to explain to the parent that autistic spectrum disorder is believed to be caused by abnormalities in brain structure or function, not poor parenting. 3 This statement is not therapeutic. 4 This statement is inaccurate and may place unintentional blame on the mother.

3. A nursing instructor is teaching about case management. What student statement indicates that learning has occurred? 1. "Case management is a method used to achieve independent client care." 2. "Case management provides coordination of services required to meet client needs." 3. "Case management exists mainly to facilitate client admission to needed inpatient services." 4. "Case management is a method to facilitate physician reimbursement."

3. ANS: 2 Chapter: Chapter 27, Community Mental Health Nursing Objective: Apply steps of the nursing process to care of the seriously mentally ill and homeless mentally ill within the community. Page: 739 Heading: The Community as Client > Tertiary Prevention Integrated Process: Teaching and Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1 This statement indicates that further education is needed. 2 The instructor evaluates that learning has occurred when a student defines case management as providing coordination of services required to meet client needs. Case management strives to organize client care so that specific outcomes are achieved within allotted time frames. 3 This statement indicates that learning has not occurred. 4 This statement indicates that further teaching is required.

3. What is the expected feeling and/or behavior experienced by military families during the "sustainment" cycle of deployment, as described by Pincus and associates? 1. Feelings alternate between denial and anticipation of loss 2. Feelings alternate between excitement and apprehension associated with homecoming 3. Feelings focus on the establishment of new support systems and new family routines 4. Feelings focus on the struggle to take charge of the details of the new family structure

3. ANS: 3 Chapter: Chapter 29, Military Families Objective: Discuss the impact of deployment on families of service members. Page: 780 Heading: Application of the Nursing Process > The Military Family>The Impact of Deployment Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Family Dynamics Difficulty: Moderate Feedback 1 In the predeployment cycle, feelings alternate between denial and anticipation of loss. 2 In the redeployment cycle, feelings alternate between excitement and apprehension associated with homecoming. 3 In the sustainment cycle, families establish new support systems and new family routines. 4 In the deployment cycle, the spouse struggles to take charge of the details of living without his or her partner.

6. A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisor's most appropriate response? 1. "These clients don't know life any other way, and change is not an option until they have improved insight." 2. "These clients have limited cognitive skills and few vocational abilities to be able to make it on their own." 3. "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation." 4. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness."

6. ANS: 4 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Discuss characteristics of victims and victimizers. Page: 706 Heading: Application of the Nursing Process > Background Assessment Data > Why Does She Stay? Integrated Process: Evaluation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 Stating "These clients don't know life any other way, and change is not an option until they have improved insight" is not the most appropriate response. 2 Stating "These clients have limited cognitive skills and few vocational abilities to be able to make it on their own" is not the most appropriate response. 3 Stating "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation" is not the most appropriate response. 4 The nursing supervisor is accurate when stating that clients who are in abuse relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner: for the children, for financial reasons, for fear of retaliation, for lack of a support network, for religious reasons, or because of hopefulness.

4. A client at the mental health clinic tells the case manager, "I can't think about living another day, but don't tell anyone about the way I feel. I know you are obligated to protect my confidentiality." Which case manager response is most appropriate? 1. "The treatment team is composed of many specialists who are working to improve your ability to function. Sharing this information with the team is critical to your care." 2. "Let's discuss steps that will resolve negative lifestyle choices that may have increased your suicidal risk." 3. "You seem to be preoccupied with self. You should concentrate on hope for the future." 4. "This information is secure with me because of client confidentiality."

4. ANS: 1 Chapter: Chapter 27, Community Mental Health Nursing Objective: Apply steps of the nursing process to care of the seriously mentally ill and homeless mentally ill within the community. Page: 739 Heading: The Public Health Model Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Mood Difficulty: Moderate Feedback 1 The most appropriate response by the case manager is to explain that sharing the information with the treatment team is critical to the client's care. This case manager's priority is to ensure client safety and to inform others on the treatment team of the client's suicidal ideation. 2 Stating "Let's discuss steps that will resolve negative lifestyle choices that may have increased your suicidal risk" does not protect the client's safety, which is the priority. 3 Stating "You seem to be preoccupied with self. You should concentrate on hope for the future" does not protect the client's safety, which is the priority. 4 Stating "This information is secure with me because of client confidentiality" does not protect the client's safety, which is the priority.

4. A nurse is assessing a client diagnosed with pedophilic disorder. What would differentiate this sexual disorder from a sexual dysfunction? 1. Symptoms of sexual dysfunction include inappropriate sexual behaviors, whereas symptoms of a sexual disorder include impairment in normal sexual response. 2. Symptoms of a sexual disorder include inappropriate sexual behaviors, whereas symptoms of sexual dysfunction include impairment in normal sexual response. 3. Sexual dysfunction can be caused by increased levels of circulating androgens, whereas levels of circulating androgens do not affect sexual disorders. 4. Sexual disorders can be caused by decreased levels of circulating androgens, whereas levels of circulating androgens do not affect sexual dysfunction.

4. ANS: 2 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify various types of paraphilic and sexual dysfunction disorders and gender dysphoria. Page: 535-537 Heading: Types of Paraphilic Disorders > Pedophilic Disorder, Role of the Nurse Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Sexuality Difficulty: Moderate Feedback 1 Sexual dysfunction involves impairment in normal sexual response. 2 The nurse should identify that pedophilic disorder is a sexual disorder in which individuals partake in inappropriate sexual behaviors. Pedophilic disorder involves having sexual urges, behaviors, or sexually arousing fantasies involving sexual activity with a prepubescent child. 3 Sexual dysfunction is not caused by increased levels of circulating androgens. 4 Sexual disorders are not caused by decreased levels of circulating androgens.

4. A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? 1. Discourage the client from discussing the rape, because this may lead to further emotional trauma. 2. Remain nonjudgmental while actively listening to the client's description of the violent rape event. 3. Meet the client's self-care needs by assisting with showering and perineal care. 4. Probe for further, detailed description of the rape event.

4. ANS: 2 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault. Page: 712-714 Heading: Table 26-1 Care Plan for Survivors of Abuse Integrated Process: Assessment Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 The client should be encouraged to discuss the rape. 2 The most appropriate nursing action is to remain nonjudgmental and actively listen to the client's description of the event. It is important to also communicate to the victim that he/she is safe and that it is not his/her fault. Nonjudgmental listening provides an avenue for catharsis, which contributes to the healing process. 3 Showering would not be an appropriate nursing intervention and may destroy evidence. 4 Probing for further detail would not be appropriate.

4. In planning care for a child diagnosed with autistic spectrum disorder, which would be a realistic client outcome? 1. The client will communicate all needs verbally by discharge. 2. The client will participate with peers in a team sport by day four. 3. The client will establish trust with at least one caregiver by day five. 4. The client will perform most self-care tasks independently.

4. ANS: 3 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 634-635 Heading: Table 24-3 Care Plan for the Child with Autism Spectrum Disorder Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 It may not be realistic for the client to communicate all needs verbally by discharge. 2 It may not be realistic for the client to participate in a team sport. 3 The most realistic client outcome for a child diagnosed with autistic spectrum disorder is for the client to establish trust with at least one caregiver. Trust should be evidenced by facial responsiveness and eye contact. This outcome relates to the nursing diagnosis impaired social interaction. 4 It may not be realistic for the client to perform self-care tasks independently.

4. A nursing instructor is teaching about suicide among active duty military. Which fact should the instructor include in the lesson plan? 1. On average, two suicides per day occur in the U.S. military. 2. From 2005 to 2009, relationship distress factored in more than 25 percent of Army suicides. 3. Statistically, in 2012, suicide rates of service members surpassed the number killed in combat. 4. Military suicides are associated with a narcissistic personality disorder diagnosis.

4. ANS: 3 Chapter: Chapter 29 Military Families Objective: Discuss the impact of deployment on families of service members. Page: 785 Heading: Veterans > Depression and Suicide Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Family Dynamics Difficulty: Moderate Feedback 1 On average, one—not two—suicides a day occur in the U.S. military. 2 From 2005 to 2009, relationship distress factored in more than 50 percent—not 25 percent—of Army suicides. 3 Statistically, in 2012, suicide rates of service members surpassed the number killed in combat. 4 Military suicides are associated with the diagnoses of substance use disorder, major depressive disorder, posttraumatic stress disorder (PTSD), and traumatic brain injury (TBI), not narcissistic personality disorder.

4. A nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this intervention the treatment of choice? 1. It helps the client correct a distorted body image. 2. It addresses the underlying client anger. 3. It manages the client's uncontrollable behaviors. 4. It allows clients to maintain control.

4. ANS: 4 Chapter: Chapter 22, Eating Disorders Objective: Describe appropriate interventions for behaviors associated with eating disorders. Page: 584 Heading: Treatment Modalities > Behavior Modification Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 Behavior modification does not help the client correct distorted body image. 2 Behavior modification does not help the client address underlying client anger. 3 Behavior modification does not help the client manage uncontrollable behaviors. 4 Behavior modification programs are the treatment of choice for clients diagnosed with eating disorders, because these programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques function to restore healthy weight.

5. After an adolescent diagnosed with attention deficit/hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss? 1. The pharmacological action of Ritalin causes a decrease in appetite. 2. Hyperactivity seen in ADHD causes increased caloric expenditure. 3. Side effects of Ritalin cause nausea, and, therefore, caloric intake is decreased. 4. Increased ability to concentrate allows the client to focus on activities rather than food.

5. ANS: 1 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 637-638 Heading: Figure 24-1 Neurobiology of Attention Deficit/Hyperactivity Disorder Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Cognition Difficulty: Moderate Feedback 1 The pharmacological action of Ritalin causes a decrease in appetite, which often leads to weight loss. 2 While hyperactivity causes an increased caloric expenditure, it is caused by the use of Ritalin, with decreases appetite. 3 Ritalin does not cause nausea. 4 Methylphenidate is a central nervous symptom stimulant that serves to increase attention span, control hyperactive behaviors, and improve learning ability.

5. A nursing instructor is preparing a lesson plan related to the history of the diagnosis of PTSD. Which of the following facts would be appropriate to include? (Select all that apply.) 1. Between 1950 and 1970, little was written about PTSD. 2. During the 1970s and 1980s, there was a major increase in research on PTSD. 3. During the 1970s and 1980s, much research was related to World War II veterans. 4. PTSD did not appear until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). 5. PTSD did not appear until the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

5. ANS: 1, 2, 4 Chapter: Chapter 29 Military Families Objective: Describe combat related illnesses common in members and veterans of the U.S. military. Page: 784-785 Heading: Application of the Nursing Process>Veterans > Posttraumatic Stress Disorder Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Family Dynamics Difficulty: Moderate Feedback 1. Very little was written about PTSD during the years between 1950 and 1970. 2. This absence was followed in the 1970s and 1980s with an explosion in the amount of research and writing on the subject. 3. During this time, much research was related to Vietnam, not World War II veterans. 4. PTSD did not appear until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). 5. PTSD appeared in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

5. A female client on an inpatient unit enters the common area for visiting hours dressed in a see-through blouse. Which intervention should be a nurse's first priority? 1. Discuss with the client the inappropriateness of her attire. 2. Avoid addressing her attention-seeking behavior. 3. Lead the client back to her room and assist her with a change of clothing. 4. Restrict client to room until visiting hours are over.

5. ANS: 3 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify appropriate nursing interventions for clients with sexual dysfunctions and gender dysphoria in children. Page: 545-546 Heading: Table 21-1 Care Plan for the Client with a Sexual Disorder Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Analysis [Analyzing] Concept: Sexuality Difficulty: Moderate Feedback 1 Discussing the inappropriate attire would not be the nurse's first priority; having the client change clothing would be. 2 The nurse should address this type of behavior immediately. 3 The most appropriate intervention by the nurse is to lead the client back to her room and assist her with a change of clothing. The client could be exhibiting symptoms of exhibitionistic disorder, which is characterized by urges to expose oneself to unsuspecting strangers. 4 Restricting the client to her room is not therapeutic and may cause behaviors to worsen.

5. A raped client answers a nurse's questions in a monotone voice with single words, appears calm, and exhibits a blunt affect. How should the nurse interpret this client's responses? 1. The client may be lying about the incident. 2. The client may be experiencing a silent rape reaction. 3. The client may be demonstrating a controlled response pattern. 4. The client may be having a compounded rape reaction.

5. ANS: 3 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault. Page: 711 Heading: Application of the Nursing Process > Background Assessment Data Integrated Process: Assessment Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 The client is not likely lying about the incident. 2 The client is not likely to be experiencing a silent rape reaction. 3 This client is most likely demonstrating a controlled response pattern. In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying sobbing, smiling, restlessness, and tension. 4 The client is not likely having a compounded rape reaction.

5. A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects insight related to this disorder? 1. "Skaters need to be thin to improve their daily performance." 2. "All the skaters on the team are following an approved 1,200-calorie diet." 3. "The exercise of skating reduces my appetite but improves my energy level." 4. "I am angry at my mother. I can only get her approval when I win competitions."

5. ANS: 4 Chapter: Chapter 22, Eating Disorders Objective: Describe appropriate interventions for behaviors associated with eating disorders. Page: 572 Heading: Predisposing Factors and Theories of Etiology Associated With Anorexia Nervosa, Bulimia Nervosa, and BED > Family Influences Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 Stating that skaters need to be thin is not likely to contribute to the development of anorexia nervosa. 2 Stating that all skaters are following an approved diet is not likely to contribute to the development of anorexia nervosa. 3 This statement is not likely to contribute to the development of anorexia nervosa. 4 The client reflects insight when referring to feelings toward family dynamics that may have influenced the development of the disease. Families who are overprotective and perfectionistic can contribute to the development of anorexia nervosa.

5. When intervening with a married couple experiencing relationship discord, which nursing action reflects an intervention at the secondary level of prevention? 1. Teaching assertiveness skills in order to meet assessed needs 2. Supplying the couple with guidelines related to marital seminar leadership 3. Teaching the couple about various methods of birth control 4. Counseling the couple related to open and honest communication skills

5. ANS: 4 Chapter: Chapter 27, Community Mental Health Nursing Objective: Discuss secondary prevention of mental illness within the community Page: 726-727 Heading: The Community as Client > Primary Prevention > Maturational Crises Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 Teaching assertiveness skills in order to meet assessed needs is tertiary prevention. 2 Supplying the couple with guidelines related to marital seminar leadership is primary prevention. 3 Teaching the couple about various methods of birth control is primary prevention. 4 Counseling the couple related to open and honest communication skills is a reflection of a nursing intervention at the secondary level of prevention. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment.

6. A nurse assesses an adolescent client diagnosed with conduct disorder who, at the age of 8, was sentenced to juvenile detention. How should the nurse interpret this assessment data? 1. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood. 2. Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood. 3. Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5, and, therefore, improvement is likely. 4. Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive oppositional defiant disorder.

6. ANS: 1 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 653 Heading: Disruptive Behavior Disorders > Conduct Disorder Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The nurse should determine that childhood-onset conduct disorder is more severe than adolescent-onset type. These individuals are likely to develop antisocial personality disorder in adulthood. 2 Individuals with this subtype are usually boys and frequently display physical aggression and have disturbed peer relationships. 3 Childhood-onset conduct disorder is not diagnosed before the age of 5, but rather when symptoms emerge. 4 Childhood-onset conduct disorder has treatment options available.

6. A school nurse provides education on drug abuse to a high school class. This nursing action is an example of which level of preventive care? 1. Primary prevention 2. Secondary prevention 3. Tertiary prevention 4. Primary intervention

6. ANS: 1 Chapter: Chapter 27, Community Mental Health Nursing Objective: Discuss nursing intervention in primary prevention of mental illness within the community. Page: 726 Heading: The Community as Client > Primary Prevention Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 Providing nursing education on drug abuse to a high school class is an example of primary prevention. Primary prevention services are aimed at reducing the incidence of mental health disorders within the population. 2 Secondary prevention is aimed at early detection and prompt intervention. 3 Tertiary prevention is aimed at reduction of symptoms. 4 Primary intervention is not a term associated with the public health model.

6. Which of the following should a nurse identify as stressors in the lives of military spouses and children? (Select all that apply.) 1. Frequent moves 2. School credit transfer issues 3. Complications of spousal employment 4. Spousal loneliness 5. Loss of military privileges during spousal deployment

6. ANS: 1, 2, 3, 4 Chapter: Chapter 29, Military Families Objective: Discuss the impact of deployment on families of service members. Page: 779 Heading: Application of the Nursing Process > The Military Family Integrated Processes: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Family Dynamics Difficulty: Moderate Feedback 1. The lives of military spouses and children are clearly affected when the service-member's active duty assignments require frequent family moves. 2. The lives of military spouses and children are clearly affected when the service-member's active duty assignments require frequent family moves. These include school credit transfer issues. 3. The lives of military spouses and children are clearly affected when the service-member's active duty assignments require frequent family moves. These include complications of spousal employment. 4. The lives of military spouses and children are clearly affected when the service-member's active duty assignments require frequent family moves. These include spousal loneliness. 5. Military privileges are not lost during spousal deployment.

6. The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing response? 1. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." 2. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." 3. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." 4. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

6. ANS: 2 Chapter: Chapter 22, Eating Disorders Objective: Describe appropriate interventions for behaviors associated with eating disorders. Page: 572 Heading: Predisposing Factors and Theories of Etiology Associated With Anorexia Nervosa, Bulimia Nervosa, and BED > Family Influences Heading: Application of the Nursing Process > Planning/Implementation Integrated Processes: Teaching and Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 This statement is not therapeutic to the family. 2 The nurse should educate the family on the correlation between certain familial patterns and anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of anorexia nervosa. 3 This statement is untrue, as family dynamics are linked to eating disorders. 4 This statement may cause family members to become defensive.

6. A nurse is working with a client diagnosed with pedophilic disorder. Which client outcome is appropriate for the nurse to expect during the first week of hospitalization? 1. The client will verbalize an understanding of the importance of follow-up care. 2. The client will implement several relapse-prevention strategies. 3. The client will identify triggers for inappropriate behaviors. 4. The client will attend aversion therapy groups.

6. ANS: 3 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify appropriate nursing interventions for clients with sexual dysfunctions and gender dysphoria in children. Page: 545-546 Heading: Table 21-1 Care Plan for the Client with a Sexual Disorder Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback 1 Verbalizing the importance of follow-up care may not be realistic for the client during the first week of hospitalization. 2 Implementing relapse prevention strategies may not be realistic for the client during the first week of hospitalization. 3 During the first week of hospitalization, identifying triggers for inappropriate behaviors is an appropriate outcome for a client diagnosed with pedophilic disorder. 4 Attending aversion therapy groups may not be realistic for the client during the first week of hospitalization.

7. Owing to the unique challenges experienced by children of active duty military, which of the following fears would a nurse most likely identify? (Select all that apply.) 1. Fear of not being accepted in new schools 2. Fear of being behind academically 3. Fear of not making friends in new schools 4. Fear of losing athletic standing 5. Fear of discrimination from new school faculty

7. ANS: 1, 2, 3, 4 Chapter: Chapter 29, Military Families Objective: Discuss the impact of deployment on families of service members. Page: 780 Heading: Application of the Nursing Process > The Military Family Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Family Dynamics Difficulty: Moderate Feedback 1. Military children face unique challenges. They fear not being accepted. 2. Military children face unique challenges. They fear being behind academically. 3. Military children face unique challenges. They fear not making friends. 4. Military children face unique challenges. They fear losing athletic standing as they move from one school to another. 5. Fear of discrimination from new school faculty has not been shown as a realistic fear in this population.

7. Which finding should a nurse expect when assessing a child diagnosed with separation anxiety disorder? 1. The child has a history of antisocial behaviors. 2. The child's mother is diagnosed with an anxiety disorder. 3. The child previously had an extroverted temperament. 4. The child's mother and father have an inconsistent parenting style.

7. ANS: 2 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 657-658 Heading: Anxiety Disorders > Separation Anxiety Disorder Integrated Processes: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Cognition Difficulty: Moderate Feedback 1 The nurse would not expect a history of antisocial behaviors. 2 The nurse should expect to find a mother diagnosed with an anxiety disorder when assessing a child with separation anxiety. Some parents instill anxiety in their children by being overprotective or by exaggerating dangers. Research studies speculate that there is a hereditary influence in the development of separation anxiety disorder. 3 The nurse would not expect a history of an extroverted temperament. 4 The nurse would not expect a history of an inconsistent parenting style.

7. A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? 1. The client gained two pounds in one week. 2. The client focused conversations on nutritious food. 3. The client demonstrated healthy coping mechanisms that decreased anxiety. 4. The client verbalized an understanding of the etiology of the disorder.

7. ANS: 3 Chapter: Chapter 22, Eating Disorders Objective: Describe appropriate interventions for behaviors associated with eating disorders. Page: 574 Heading: Diagnosis and Outcome Identification > The Client Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 Gaining two pounds in one week is not an appropriate indicator of a positive client behavioral change. 2 Focusing on conversations on nutritious foods is not an appropriate indicator of a positive client behavioral change. 3 The nurse should identify that a client who demonstrates healthy coping mechanisms to decrease anxiety indicates a positive behavioral change. Stress and anxiety can increase bingeing, which is followed by inappropriate compensatory behavior. 4 Verbalizing an understanding of eating disorders in important, but is not appropriate indicator of a positive client behavioral change.

7. A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, "The beatings have been getting worse, and I'm afraid next time he will kill me." Which is the appropriate nursing response? 1. "Leopards don't change their spots, and neither will he." 2. "There are things you can do to prevent him from losing control." 3. "Let's talk about your options so that you don't have to go home." 4. "Why don't we call the police so that they can confront your husband with his behavior?"

7. ANS: 3 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault. Page: 712-714 Heading: Table 26-1 Care Plan for Survivors of Abuse Integrated Process: Implementation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 Imposing judgments is nontherapeutic. 2 Giving advice to the client is nontherapeutic. 3 The most appropriate response by the nurse is to talk with the client about options so that the client does not have to return to the abusive environment. It is essential that clients make decisions on their own without the nurse being the "rescuer." 4 This statement is nontherapeutic to the client.

7. A newly admitted homeless client diagnosed with schizophrenia states, "I have been living in a cardboard box for two weeks. Why did the government let me down?" Which is an appropriate nursing response? 1. "Your discharge from the state hospital was done prematurely. Had you remained in the state hospital longer, you would not be homeless." 2. "Your premature discharge from the state hospital was not intended for patients diagnosed with chronic schizophrenia." 3. "Your discharge from the state hospital was based on firm principles; however, the resources were not available to make the transition a success." 4. "Your discharge from the state hospital was based on presumed family support, and this was not forthcoming."

7. ANS: 3 Chapter: Chapter 27, Community Mental Health Nursing Objective: Identify treatment alternatives for care of the seriously mentally ill and homeless mentally ill within the community. Page: 745-750 Heading: The Community as Client > Tertiary Prevention > The Homeless Population Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 This is inaccurate because the client was not discharged prematurely. 2 This is inaccurate because the client was not discharged prematurely due to schizophrenia. 3 The most accurate nursing response is to explain to the client that the resources were not available to make transitioning out of a state hospital a success. There are several factors that are thought to contribute to homelessness among the mentally ill: deinstitutionalization, poverty, lack of affordable housing, lack of affordable health care, domestic violence, and addiction disorders. 4 This statement is not accurate based on the client's situation.

7. When planning care for a client diagnosed with female sexual interest/arousal disorder, what should the nurse document as an expected outcome of sensate focus exercises? 1. To initiate immediate orgasm 2. To reduce anxiety by eliminating physical touch 3. To focus on touching breasts and genitals 4. To reduce goal-oriented demands of intercourse

7. ANS: 4 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify appropriate nursing interventions for clients with sexual dysfunctions and gender dysphoria in children. Page: 550 Heading: Sexual Arousal Disorders > Female Sexual Interest/Arousal Disorder Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback 1 The outcome is to reduce performance pressures and demands. 2 Sensate focus exercises are highly structured touching activities designed to help overcome performance anxiety and increase comfort with physical intimacy. 3 The expected outcome does not involve focusing on touching breasts and genitals. 4 The expected outcome of sensate focus exercises is to reduce goal-oriented demands of intercourse. The reduction in demands reduces performance pressures and anxiety associated with possible failure.

8. A newly married woman comes to a gynecology clinic reporting anorexia, insomnia, and extreme pain during intercourse that has affected her intimate relationship. What initial intervention should the nurse expect a physician to implement? 1. A thorough physical, including gynecological examination 2. Referral to a sex therapist 3. Assessment of sexual history and previous satisfaction with sexual relationships 4. Referral to the recreational therapist for relaxation therapy

8. ANS: 1 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify appropriate nursing interventions for clients with sexual dysfunctions and gender dysphoria in children. Page: 551-552 Heading: Genito-Pelvic Pain/Penetration Disorder Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback 1 The nurse should expect the physician to implement a thorough physical, including a gynecological examination to assess for any physiological causes of the client's symptoms. If no pathology exists, the client may be diagnosed with genito-pelvic pain/penetration disorder. In this disorder, the individual experiences considerable difficulty with vaginal intercourse and attempts at penetration. Pain is felt in the vagina, around the vaginal entrance and clitoris, or deep in the pelvis. There is fear and anxiety associated with anticipation of pain or vaginal penetration. A tensing and tightening of the pelvic floor muscles occurs during attempted vaginal penetration. 2 Referral to a sex therapist can occur after the physical examination. 3 Assessment of sexual history and previous satisfaction with sexual relationships is not the first intervention the nurse should make. The nurse should first conduct a physical examination. 4 Referral to the recreational therapist for relaxation therapy can occur after the initial physical examination.

8. The nurse is working with a client diagnosed with binge eating disorder. Which medication should the nurse expect to teach the client about? 1. Lisdexamfetamine (Vyvanse) 2. Dexfenfluramine (Redux) 3. Sibutramine (Meridia) 4. Pemoline (Cylert)

8. ANS: 1 Chapter: Chapter 22, Eating Disorders Objective: Discuss various modalities relevant to treatment of eating disorders. Page: 584-585 Heading: Treatment Modalities > Psychopharmacology Integrated Processes: Teaching and Learning Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 The nurse should teach the client about Lisdexamfetamine (Vyvanse). This medication has shown to be successful in the treatment of binge eating disorder. 2 Dexfenfluramine has been removed from the market because of its association with serious heart and lung disease. 3 Several deaths have been associated with the use of sibutramine by high-risk clients. Based on pressure from the U.S. Food and Drug Administration, the manufacturer issued a recall of the drug in October 2010. 4 Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression.

8. A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner? 1. "I know that it was not my fault." 2. "My boyfriend has trouble controlling his sexual urges." 3. "If I don't put myself in a dating situation, I won't be at risk." 4. "Next time I will think twice about wearing a sexy dress."

8. ANS: 1 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Identify nursing diagnoses, goals of care, and appropriate nursing interventions for care of survivors of intimate partner violence, child abuse, and sexual assault. Page: 712-714 Heading: Table 26-1 Care Plan for Survivors of Abuse Integrated Process: Evaluation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 The client who realizes that sexual assault was not her fault is handling the situation in a healthy manner. The nurse should provide nonjudgmental listening and communicate statements that instill trust and validate self-worth. 2 Stating "My boyfriend has trouble controlling his sexual urges" does not indicate that the client is handling the situation in a healthy manner. 3 Stating "If I don't put myself in a dating situation, I won't be at risk" does not indicate that the client is handling the situation in a healthy manner. 4 Stating "Next time I will think twice about wearing a sexy dress" does not indicate that the client is handling the situation in a healthy manner.

8. A child has been recently diagnosed with mild IDD. What information about this diagnosis should the nurse include when teaching the child's mother? 1. Children with mild IDD need constant supervision. 2. Children with mild IDD develop academic skills up to a sixth-grade level. 3. Children with mild IDD appear different from their peers. 4. Children with mild IDD have significant sensory-motor impairment.

8. ANS: 2 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 629 Heading: Table 24-1 Developmental Characteristics of Intellectual Developmental Disorder by Degree of Severity Integrated Processes: Teaching/Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 The child may not need constant supervision. 2 The nurse should inform the child's mother that children with mild IDD develop academic skills up to a sixth-grade level. 3 The child may not appear different than peers. 4 The child may not have a significant sensory-motor impairment.

8. After reporting a sexual assault, a female soldier is diagnosed with a personality disorder. Which of the following consequences may result? (Select all that apply.) 1. Court-martial proceedings 2. Loss of health-care benefits 3. Loss of service-related disability compensation 4. Stigma of a psychiatric diagnosis 5. Service discharge

8. ANS: 2, 3, 4, 5 Chapter: Chapter 29, Military Families Objective: Discuss concerns of women in the military. Page: 781 Heading: Application of the Nursing Process > Women in the Military Integrated Process: Nursing Process Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Family Dynamics Difficulty: Moderate Feedback 1. The report of a sexual assault would not lead to court-martial proceedings for the victim. 2. Some military women who report their sexual assaults are discharged with a psychiatric diagnosis of personality disorder or adjustment disorder. Some of the consequences of this diagnosis are loss of health-care benefits. 3. Some military women who report their sexual assaults are discharged with a psychiatric diagnosis of personality disorder or adjustment disorder. Some of the consequences of this diagnosis are loss of service-related disability compensation. 4. Some military women who report their sexual assaults are discharged with a psychiatric diagnosis of personality disorder or adjustment disorder. Some of the consequences of this diagnosis are the stigma of a psychiatric diagnosis. 5. Some military women who report their sexual assaults are discharged with a psychiatric diagnosis of personality disorder or adjustment disorder.

8. An instructor is teaching nursing students about the difference between partial and inpatient hospitalization. In what way does partial hospitalization differ from traditional inpatient hospitalization? 1. Partial hospitalization does not provide medication administration and monitoring. 2. Partial hospitalization does not use an interdisciplinary team. 3. Partial hospitalization does not offer a comprehensive treatment plan. 4. Partial hospitalization does not provide supervision 24 hours a day.

8. ANS: 4 Chapter: Chapter 27: Community Mental Health Nursing Objective: Identify treatment alternatives for care of the seriously mentally ill and homeless mentally ill within the community. Page: 740-741 Heading: The Community as Client > Tertiary Prevention Integrated Processes: Teaching and Learning Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 Partial hospitalization provides medication administration and monitoring. 2 Partial hospitalization uses an interdisciplinary team. 3 Partial hospitalization offers a comprehensive treatment plan. 4 The instructor should explain that partial hospitalization does not provide supervision 24 hours a day. Partial hospitalization programs generally offer a comprehensive treatment plan formulated by an interdisciplinary team, including medication administration. They have proved to be an effective method of preventing hospitalization.

9. A nurse is instructing a client diagnosed with female sexual interest/arousal disorder. Which symptom and treatment of this disorder should the nurse describe to the client? 1. Avoidance of all genital sexual contact treated by sensate focus exercises 2. Avoidance of all genital sexual contact treated by medicating with tadalafil (Cialis) 3. Anorgasmia treated by vardenafil (Levitra) 4. Anorgasmia treated by systematic desensitization

9. ANS: 1 Chapter: Chapter 21, Issues Related to Human Sexuality and Gender Dysphoria Objective: Identify appropriate nursing interventions for clients with sexual dysfunctions and gender dysphoria in children. Page: 550 Heading: Sexual Arousal Disorders > Female Sexual Interest/Arousal Disorder Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Sexuality Difficulty: Moderate Feedback 1 The nurse should explain to the client that female sexual interest/arousal disorder is characterized by a reduced or absent frequency or intensity of interest or pleasure in sexual activity. Sensate focus exercises are highly structured touching activities designed to help overcome performance anxiety and increase comfort with physical intimacy. 2 Avoidance of all genital sexual contact treated by medicating with tadalafil (Cialis) is not a typical treatment of this disorder. 3 Anorgasmia treated by vardenafil (Levitra) is not a typical treatment of this disorder. 4 Anorgasmia treated by systematic desensitization is not a typical treatment of this disorder.

9. A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement delineates the difference between these two disorders? 1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. 2. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not. 3. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. 4. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.

9. ANS: 1 Chapter: Chapter 22, Eating Disorders Objective: Identify and differentiate among several eating disorders. Page: 569 Heading: Application of the Nursing Process > Background Assessment Data: Anorexia Nervosa Integrated Processes: Nursing Process Client Need: Health Promotion and Maintenance Cognitive Level: Application [Applying] Concept: Nutrition Difficulty: Moderate Feedback 1 The nurse should understand that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia do not. 2 Clients with anorexia can experience amenorrhea. 3 Clients with bulimia nervosa typically do not experience these symptoms. 4 Clients with bulimia often have tooth enamel erosion.

9. A client asks, "Why does a rapist use a weapon during the act of rape?" Which is the most appropriate nursing response? 1. "To decrease the victimizer's insecurity" 2. "To inflict physical harm with the weapon" 3. "To terrorize and subdue the victim" 4. "To mirror learned family behavior patterns related to weapons"

9. ANS: 3 Chapter: Chapter 26, Survivors of Abuse or Neglect Objective: Discuss characteristics of victims and victimizers. Page: 710 Heading: Application of the Nursing Process > Background Assessment Data > Profile of the Victimizer Integrated Process: Implementation Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application Concept: Violence Difficulty: Moderate Feedback 1 Rapists do not use weapons to decrease their own insecurities. 2 Rapists do not use weapons to inflict physical harm. 3 The nurse should explain that a rapist uses weapons to terrorize and subdue the victim. Rape is the expression of power and dominance by means of sexual violence. Rape can occur over a broad spectrum of experience, from violent attack to insistence on sexual intercourse by an acquaintance or spouse. 4 Rapists do not use weapons to mirror learned family behavior patterns related to weapons.

9. When a home health nurse administers an outpatient's injection of haloperidol decanoate (Haldol decanoate), which level of care is the nurse providing? 1. Primary prevention level of care 2. Secondary prevention level of care 3. Tertiary prevention level of care 4. Case management level of care

9. ANS: 3 Chapter: Chapter 27, Community Mental Health Nursing Objective: Discuss tertiary prevention of mental illness within the community as it relates to the seriously mentally ill and homeless mentally ill. Page: 739 Heading: The Community as Client > Tertiary Prevention Integrated Processes: Nursing Process Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Health Promotion Difficulty: Moderate Feedback 1 Primary prevention is aimed at preventing services before they are needed. 2 Secondary prevention is aimed at early detection and fast intervention. 3 When administering medication in an outpatient setting, the nurse is providing a tertiary prevention level of care. Tertiary prevention services are aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning. 4 Case management level of care is not a term associated with the public health model.

9. A nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate IDD. Which student statement indicates that further instruction is needed? 1. "These clients can work in a sheltered workshop setting." 2. "These clients can perform some personal care activities." 3. "These clients may have difficulties relating to peers." 4. "These clients can successfully complete elementary school."

9. ANS: 4 Chapter: Chapter 24, Children and Adolescents Objective: Identify symptomatology and use the information in the assessment of clients with the aforementioned disorders. Page: 629 Heading: Table 24-1 Developmental Characteristics of Intellectual Developmental Disorder by Degree of Severity Integrated Processes: Teaching and Learning Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Cognition Difficulty: Moderate Feedback 1 This statement indicates that teaching has been effective. 2 This statement indicates understanding. 3 This statement indicates that learning has occurred. 4 The nursing student needs further instruction about moderate IDD, because individuals diagnosed with moderate IDD are capable of academic skill up to a second-grade level. Moderate IDD reflects an IQ range of 35 to 49.