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Which behavior indicates that the treatment plan for a child diagnosed with autism spectrum disorder was effective? a. Plays with one toy for 90 minutes. b. Repeats words spoken by a parent. c. Holds the parent's hand while walking. d. Spins around and claps hands while walking.

ANS: C Holding the hand of another person suggests relatedness. Usually, a child with autism would resist holding someone's hand and stand or walk alone, perhaps flapping arms or moving in a stereotypical pattern. The other options reflect behaviors that are consistent with autistic disorder.

When group therapy is to be used as a treatment modality, the nurse should suggest placing a 9-year-old in a group that focuses on what? a. Play activities exclusively. b. Group discussion exclusively. c. Talk focused on a specific issue. d. Play and then talk about the play activity.

ANS: D Group therapy for young children takes the form of play. For elementary school children, therapy combines play and talk about the activity. For adolescents, group therapy involves more talking.

If an older adult patient must be physically restrained, who is responsible for the patient's safety? a. Nurse assigned to care for the patient. b. Nursing assistant who applies the restraint. c. Health care provider who ordered the application of the restraint. d. Family member who agrees to the application of the restraint.

ANS: A If an older adult patient must be physically restrained, who is responsible for the patient's safety? a. Nurse assigned to care for the patient. b. Nursing assistant who applies the restraint. c. Health care provider who ordered the application of the restraint. d. Family member who agrees to the application of the restraint.

A child diagnosed with attention-deficit/hyperactivity disorder (ADHD) is going to begin medication therapy. The nurse should plan to teach the family about which classification of medications? a. Central nervous system stimulants and nonstimulants b. Monoamine oxidase inhibitors (MAOIs) c. Antipsychotic medications d. Anxiolytic medications

ANS: A Central nervous system stimulants and nonstimulants increase blood flow to the brain and have proven helpful in reducing hyperactivity in children and adolescents with ADHD. The other medication categories listed would not be appropriate.

Which beliefs facilitate provision of safe, effective care for older adult patients? (Select all that apply.) a. Sexual interest declines with aging. b. Older adults are able to learn new tasks. c. Aging results in a decline in restorative sleep. d. Older adults are prone to become crime victims. e. Older adults are usually lonely and socially isolated.

ANS: B, C, D Myths about aging are common and can negatively impact the quality of care older patients receive. Older individuals are more prone to become crime victims. A decline in restorative sleep occurs as one ages. Learning continues long into life. These factors affect care delivery.

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A health care provider writes these new prescriptions for a resident in a skilled care facility: "2 g sodium diet; restraint as needed; limit fluids to 2000 mL daily; 1 dose milk of magnesia 30 mL orally if no bowel movement occurs for 3 days." Which prescription should the nurse question? a. Restraint b. Fluid restriction c. Milk of magnesia d. Sodium restriction

ANS: A Restraints may be applied only on the written order of the health care provider that specifies the duration during which the restraints can be used. The Joint Commission guidelines and Omnibus Budget Reconciliation Act regulations also mandate a number of other conditions that must be considered and documented before restraints are used. The other orders may be appropriate for implementation.

An 11-year-old child, who has been diagnosed with oppositional defiant disorder (ODD), becomes angry over the rules at a residential treatment program and begins shouting at the nurse. What is the best method to defuse the situation? a. Assign the child to a short time-out. b. Administer an antipsychotic medication. c. Place the child in a therapeutic hold. d. Call a staff member to seclude the child.

ANS: A Time-out is a useful strategy for interrupting the angry expression of feelings and allows the child an opportunity to exert self-control. This method is the least restrictive alternative of those listed and should be tried before resorting to more restrictive measures.

A nurse and social worker co-lead a reminiscence group for six "baby boomer" adults. Which activity is appropriate to include in the group? a. Post-World War II music b. Learning to send and receive email c. Discussing national leadership during the Vietnam War d. Identifying the most troubling story in today's newspaper

ANS: A "The baby boomer generation (individuals born between 1946 and 1964). This group would be familiar with events and circumstances associated with post World War II culture. Reminiscence groups share memories of the past. Sending and receiving email is not an aspect of reminiscence. The other incorrect options are less relevant to this age group

Which finding would prompt the nurse to carefully assess an 8-year-old child for development of a psychiatric disorder? a. Being raised by a parent with chronic major depressive disorder b. Moving to three new homes over a 2-year period c. Not being promoted to the next grade d. Having an imaginary friend

ANS: A If the caregiver is unable to respond positively to the child, there is an increased risk of insecure attachment, developmental problems, and mental disorders. The chronicity of the parent's depression means it has been a consistent stressor. The other factors do not create ongoing stress.

A 12-year-old child has been the neighborhood bully for several years. The parents say, "We can't believe anything our child says." Recently, the child shot a dog with a pellet gun and set fire to a trash bin outside a store. The child's behaviors are most consistent with which disorder? a. Conduct disorder (CD) b. Defiance of authority c. Anxiety over separation from a parent d. Attention-deficit/hyperactivity disorder (ADHD)

ANS: A The behaviors mentioned are most consistent with the DSM-5 criteria for CD: aggression against people and animals; destruction of property; deceitfulness; rule violations; and impairment in social, academic, or occupational functioning. The behaviors are not consistent with ADHD and separation anxiety and are more pervasive than defiance of authority.

A patient asks the nurse, "I already have a living will. Why should I have a durable power of attorney for health care also?" The nurse should provide what as the truth related to a durable power of attorney for health care? a. It gives your agent the authority to make decisions about your care if you are unable to during any illness. b. It can be given only to a relative, usually the next of kin, who has your best interests at heart. c. It authorizes your physician to make decisions about your care that are in your best interest. d. It can be used only if you have a terminal illness and become incapacitated.

ANS: A A durable power of attorney for health care is an instrument that appoints a person other than a health care provider to act as an individual's agent in the event that he or she is unable to make medical decisions. The patient does not have to be terminally ill or incompetent for the appointed person to act on his or her behalf. DIF: Cognitive Level: Comprehension (Understanding)

A 78-year-old nursing home resident diagnosed with hypertension and cardiac disease is usually alert and oriented. This morning, however, the resident says, "My family visited during the night. They stood by the bed and talked to me." In reality, the patient's family lives 200 miles away. The nurse should first suspect what as the trigger for the resident's experience? a. A side effects associated with medications. b. Early Alzheimer's disease associated with advanced age. c. A transient ischemic attack and developed sensory perceptual alterations. d. Previously unidentified alcohol abuse and is beginning alcohol withdrawal delirium.

ANS: A A resident taking medications is at high risk for becoming confused because of medication side effects, drug interactions, and delayed excretion. The nurse should report the event and continue to assess for cognitive impairment. Symptoms of dementia develop slowly but persist over time. Alcohol abuse and withdrawal are not the nurse's first suspicion in this scenario.

What is the highest priority for assessment by nurses caring for older adults who self-administer medications? a. Use of multiple drugs with anticholinergic effects b. Overuse of medications for erectile dysfunction c. Misuse of antihypertensive medications d. Trading medications with others

ANS: A Anticholinergic effects are cumulative in older adults and often have adverse consequences related to accidents and injuries. The incorrect options may be relevant but are not of the highest priority.

A person diagnosed with severe and persistent mental illness enters a shelter for the homeless. Which intervention should be the nurse's initial priority? a. Develop a relationship. b. Find supported employment. c. Administer prescribed medication. d. Teach appropriate health care practices

ANS: A Basic psychosocial needs do not change because a person is homeless. The nurse's initial priority should be establishing rapport. Once a trusting relationship is established, then the nurse can pursue other interventions.

A community mental health nurse plans an educational program for staff members at a home health agency that specializes in the care of older adults. What topic is of high priority? a. Identifying depression in older adults b. Providing cost-effective foot care for older adults c. Identifying nutritional deficiencies in older adults d. Psychosocial stimulation for those who live alone

ANS: A Depression is the most common, most debilitating, and also most treatable psychiatric disorder in the older adult. Home health staff are often better versed in the physical aspects of care and less knowledgeable about mental health topics. Statistics show that older adult patients with mental health problems are less likely than young adults to be diagnosed accurately. This is especially true for those with depression and anxiety, both of which are likely to be misinterpreted as normal aging. Undiagnosed and untreated depression and anxiety result in unnecessary suffering. The other options are of lesser importance.

A tricyclic antidepressant is prescribed for an older adult patient diagnosed with major depressive disorder. Nursing assessment should include careful collection of information regarding what focus? a. Use of other prescribed medications and over-the-counter products b. Evidence of pseudoparkinsonism or tardive dyskinesia c. A history of psoriasis and any other skin disorders d. A current immunization status

ANS: A Drug interactions, with both prescription and over-the-counter products, can be problematic for the geriatric patient taking tricyclic antidepressant medications. Careful collection of information is important. The incorrect options do not pose problems with tricyclic antidepressant medications.

A homeless patient diagnosed with severe and persistent mental illness became suspicious and delusional. The patient was given depot antipsychotic medication and housing was arranged at a local shelter. After 2 weeks, which statement by the patient indicates significant improvement? a. "I am feeling safe and comfortable here. Nobody bothers me." b. "They will not let me drink. They have many rules in the shelter." c. "Those guys are always watching me. I think someone stole my shoes." d. "That shot made my arm sore. I'm not going to take any more of them."

ANS: A Evaluation of a patient's progress is made based on patient satisfaction with the new health status and the health care team's estimation of improvement. For a formerly delusional patient to admit to feeling comfortable and free of being "bothered" by others denotes an improvement in the patient's condition. The other options suggest that the patient is in danger of relapse

A patient says, "I often make careless mistakes and have trouble staying focused. Sometimes it's hard to listen to what someone is saying. I have problems putting things in the right order and often lose equipment." Which problem should the nurse document? a. Inattention b. Impulsivity c. Hyperactivity d. Social impairment

ANS: A Inattention refers to the failure to stay focused. A number of the other problems are the result of failure to pay attention, which contributes to problems with organization. Impulsivity refers to acting without thinking through the consequences. Hyperactivity refers to excessive motor activity. Social impairment refers to the failure to use appropriate social skills.

A patient diagnosed with severe and persistent mental illness lives in a homeless shelter. The priority nursing diagnosis for this patient is Powerlessness. Which intervention should be included in the plan of care? a. Encourage mutual goal setting. b. Verbally communicate empathy. c. Reinforce participation in activities. d. Demonstrate an accepting attitude.

ANS: A Mutual goal setting is an intervention designed to promote feelings of personal autonomy and dispel feelings of powerlessness. Although it might be easier and faster for the nurse to establish a plan and outcomes, this action contributes to the patient's sense of powerlessness. Involving the patient in decision making empowers the patient and reduces feelings of powerlessness.

. A parent diagnosed with schizophrenia and her 13-year-old child live in a homeless shelter. The child has formed a trusting relationship with a shelter volunteer. The child says, "My three friends and I got an A on our school science project." The nurse can assess that the child is demonstrating what characteristic? a. Resiliency b. Shy temperament c. Early posttraumatic stress disorder d. Uses intellectualization to deal with problems

ANS: A Resiliency enables a child to handle the stresses of a difficult childhood. Resilient children can adapt to changes in the environment, take advantage of nurturing relationships with adults other than parents, distance themselves from emotional chaos occurring within the family, learn, and use problem-solving skills. None of the distractors demonstrate a means of handling stress.

A nurse asks the following questions while assessing an older adult. The nurse will add the Geriatric Depression Scale as part of the assessment if the patient answers "yes" to which question? a. "Would you say your mood is often sad?" b. "Are you having any trouble with your memory?" c. "Have you noticed an increase in your alcohol use?" d. "Do you often experience moderate-to-severe pain?"

ANS: A Sadness may be a symptom of depression. Sad moods occurring with regularity should signal the need to assess further for other symptoms of depression. The incorrect options do not focus on mood.

When admitting older adult patients, health care agencies receiving federal funds must provide written information about what topic? a. Advance health care directives b. The financial status of the institution c. How to sign out against medical advice d. The institution's policy on the use of restraints

ANS: A The Patient Self-Determination Act of 1990 requires that patients have the opportunity to prepare advance directives. None of the distractors are addressed by this Act.

A nurse wants to perform a preliminary assessment for suicidal ideation in an older adult patient. Which question would obtain the desired data? a. "What thoughts do you have about a person's right to take his or her own life?" b. "If you felt suicidal, would you communicate your feelings to anyone?" c. "Do you have any risk factors that potentially contribute to suicide?" d. "Do you think you are vulnerable to developing a depressed mood?"

ANS: A The correct response is clear, direct, respectful, and open-ended. It will produce information relative to the acceptability of suicide as an option to the patient. If the patient deems suicide unacceptable, then no further assessment is necessary. If the patient deems suicide as acceptable, then the nurse can continue to assess the patient's intent, plan, and means to carry out the plan, as well as the lethality of the chosen method. The incorrect options are less direct

An adult patient tells the case manager, "I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends." Which resources should the nurse suggest for the patient? (Select all that apply.) a. Psychoeducation classes b. Vocational rehabilitation c. Social skills training d. Homeless shelter e. Crisis intervention

ANS: A, B, C The patient does not understand the illness and the need for adhering to the medication regimen. Psychoeducation for the patient (and family) can address this lack of knowledge. Work gives meaning and purpose to life; vocational rehabilitation can assist with this aspect of care. The patient, who considers himself friendless, could also profit from social skills training to improve the quality of interpersonal relationships. Many patients with severe mental illness have such poor communication skills that others are uncomfortable interacting with them. Interactional skills can be effectively taught by breaking down each skill into small verbal and nonverbal components. The patient presently has a home and does not require the services of a homeless shelter. The nurse case manager functions in the role of crisis stabilizer, so no related referral is needed.

Which information should a nurse include in health teaching for adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and their significant others? (Select all that apply.) a. Tendency for genetic transmission b. Prevention strategies related to substance abuse c. Negative reinforcement strategies to help modify behaviors d. Selective serotonin reuptake inhibitors (SSRIs) are usually prescribed for hyperactivity e. Cognitive therapy may help resolve internalized negative beliefs about self

ANS: A, B, E Evidence suggests that ADHD has a biological basis. This fact can help adults with the disorder to cope with low self-esteem. Cognitive therapy is helpful in reframing negative beliefs about self. Adults diagnosed with ADHD have a higher incidence of substance abuse problems. Psychostimulant medications, rather than SSRIs, are usually prescribed.

A nurse caring for an older adult patient population should be familiar with which legal and ethical issues that are common concerns for this group? (Select all that apply.) a. Physical abuse b. Autonomous decision making c. Emotional abuse d. Financial abuse e. Need for medication therapy

ANS: A, C Among the most important of many legal and ethical issues for practicing nurses to be familiar with are the following are decision making about health care and the various forms of elder abuse. Medication therapy does not appear as a common source of concern for this age group.

A nurse leads a staff development session about ageism among health care workers. What information should the nurse include about the consequences of ageism? (Select all that apply.) a. Failure of older adults to receive necessary medical information b. Development of public policy that favors programs for older adults c. Staff shortages because caregivers prefer working with younger adults d. Perception that older adults consume a small share of medical resources e. More ancillary than professional personnel discriminate with regard to age

ANS: A, C Because of society's negative stereotyping of older adults as having little to offer, some staff members avoid working with older patients. Staff shortages in long-term care facilities are often greater than those for acute care settings. Older adult patients often receive less information about their conditions and are offered fewer treatment options than younger patients; some health care staff members perceive them as less able to understand. This problem exists among professional and ancillary personnel. Public policy discriminates against programs for older adults. Societal anger exists because older adults are perceived to consume a disproportionately large share of the medical resources.

Which economic factors are most critical to the success of discharge planning for a patient diagnosed with severe and persistent mental illness? (Select all that apply.) a. Access to housing b. Individual psychotherapy c. Income to meet basic needs d. Availability of health insurance e. Ongoing interdisciplinary evaluation

ANS: A, C, D The success of discharge planning requires careful attention to the patient's economic status. Access to housing is the first priority of the seriously mentally ill, and lack of income and health insurance is a barrier to effective treatment and rehabilitation. Although important aspects of ongoing care of the seriously mentally ill patient, ongoing interdisciplinary evaluation and individual psychotherapy are not economic factors.

Which statements most clearly indicate that the speaker views mental illness with stigma? (Select all that apply.) a. "Everyone is a little bit crazy." b. "If people with mental illness would go to church, their problems would be solved with faith." c. "Many mental illnesses are genetically transmitted. It is no one's fault that the illness occurs." d. "Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people." e. "People with mental illness are lazy. They expect the government to take care of everything they need."

ANS: A,B,E Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. It is evidenced in stereotypical statements, by oversimplification, and by multiple other messages of guilt or shame.

How is severe and persistent mental illness best characterized? a. Mental illness with longer than 2 weeks' duration. b. Major ongoing mental illness marked by significant functional impairments. c. Mental illness accompanied by physical impairment and severe social problems. d. Major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities.

ANS: B "Severe mental illness" has replaced the phrase "chronic mental illness." Global impairments in function are evident, including social skills. Physical impairments may or may not be present. Severe mental illness can be treated, but remissions and exacerbations are part of the course of the illness. The distractors fail to effectively address the issue of functional impairment.

A nurse will prepare teaching materials regarding which medication for the parents of a child diagnosed with enuresis? a. Haloperidol b. Desmopressin c. Methylphenidate d. Carbamazepine

ANS: B Pharmacological treatment of enuresis commonly includes desmopressin, oxybutynin, various stimulants, indomethacin, and/or SSRI antidepressants. Limited evidence exists for the use of imipramine. None of the other drugs are appropriate to treat enuresis.

A patient diagnosed with severe and persistent mental illness lives independently. This patient often has command hallucinations and shouts warnings to neighbors. After a short hospitalization, the patient's landlord says, "You can't come back here. You cause too much trouble." What problem is the patient experiencing? a. Grief b. Stigmatization c. Recidivism d. Lack of insurance parity

ANS: B The inability to obtain shelter because of negative attitudes about mental illness is an example of stigmatization. Stigma is defined as damage to reputation, shame, and ridicule society places on mental illness. Data are not present to identify grief as the patient's problem. Recidivism refers to repetition of a previous offense. Insurance parity is not relevant to this scenario.

A 79-year-old white man tells a visiting nurse, "I've been feeling sad lately. My family and friends are all dead. My money is running out, and my health is failing." How should the nurse analyze this comment? a. Normal negativity of older adults b. Evidence of suicide risk c. A cry for sympathy d. Normal grieving

ANS: B The patient describes the loss of significant others, economic insecurity, and declining health. He describes mood alteration and expresses the thought that he has little to live for. Combined with his age, sex, and single status, each is a risk factor for suicide. Older adult white men have the highest risk for completed suicide.

A student nurse visiting a senior center tells the instructor, "It's so depressing to see all these old people. They are so weak and frail. They are probably all confused." The student is expressing what attitude? a. Reality b. Ageism c. Empathy d. Distrust

ANS: B Ageism is defined as a bias against older people because of their age. None of the other options can be identified from the ideas expressed by the student.

A clinic nurse interviews four patients between 70 and 80 years of age. Which patient should have further assessment regarding the risk of alcohol addiction? a. One with a history of intermittent problems of alcohol misuse early in life and who now consumes one glass of wine nightly with dinner. b. One with no history of alcohol-related problems until age 65 years, when the patient began to drink alcohol daily "to keep my mind off my arthritis." c. One who drank socially throughout adult life and continues this pattern, saying, "I've earned the right to do as I please." d. One who abused alcohol between the ages of 25 and 40 years but now abstains and occasionally attends Alcoholics Anonymous.

ANS: B Alcohol addiction can develop at any age, and the geriatric population is particularly at risk. The geriatric problem drinker is defined as someone who has no history of alcohol-related problems but develops an alcohol-abuse pattern in response to the stresses of aging. The incorrect responses profile alcohol use that is not problematic.

When assessing a 2-year-old diagnosed with autism spectrum disorder, what should a nurse expects? a. Hyperactivity and attention deficits b. Failure to develop interpersonal social skills c. History of disobedience and destructive acts d. High levels of anxiety when separated from a parent

ANS: B Autism spectrum disorder involves distortions in the development of social skills and language that include perception, motor movement, attention, and reality testing. Caretakers frequently mention the child's failure to develop interpersonal skills. The distractors are more relevant to ADHD, separation anxiety, and CD.

A 75-year-old patient comes to the clinic reporting frequent headaches. After an introduction at the beginning of the interview, what should the nurse address? a. Initiate a neurological assessment. b. Assess if the patient can hear the spoken word clearly. c. Suggest that the patient lie down in a darkened room to rest. d. Administer medication to relieve the patient's pain prior to the assessment.

ANS: B Before proceeding, the nurse should assess the patient's ability to hear questions. Hearing ability often declines with age. Impaired hearing could lead to inaccurate answers. The nurse should not administer medication (an intervention) until after the assessment is complete.

A man tells the nurse, "All my life, I have felt and acted like a woman while living in a man's body. For the past year, I have lived and dressed as a woman. I changed jobs to protect my new identity." Which request is the patient likely to make to the health care provider? a. "Can you refer me for psychological testing?" b. "Will you prescribe hormonal therapy?" c. "Will you alter my medical records?" d. "What should I tell my parents?"

ANS: B Before sexual reassignment surgery, the step that follows living as a member of the other sex is hormone therapy. The patient's decision to live as a woman makes this a natural request. Psychological testing occurs before sexual reassignment surgery, often after hormone therapy has begun. The patient has likely told his parents by this point.

An adult diagnosed with attention-deficit/hyperactivity disorder (ADHD) says, "I've always been stupid. I never had friends when I was a child. My parents often punished me because I made mistakes. Now, I can't keep a job." The nurse managing care should consider suggesting what intervention? a. Aversive therapy to extinguish negative behaviors. b. Cognitive therapy to help address internalized beliefs. c. Group therapy to allow comparison of feelings with others. d. Vocational counseling to identify needed occupational skills.

ANS: B Cognitive therapy and knowledge of ADHD will make it possible for the patient to reframe the past and present in a more positive and realistic light and to challenge internalized false beliefs about self this improving self-image. Aversive therapy would not be useful for the patient. Group therapy may be valuable later to allow for the testing of new coping behaviors in a safe environment. Vocational counseling can help the patient explore suitable career options while pursuing treatment.

A nurse prepares for an initial interview with a patient with suspected adult attention-deficit/hyperactivity disorder (ADHD). Questions should be focused to elicit information about which problem? a. Headaches b. Inattention c. Sexual impulses d. Trichotillomania

ANS: B Inattention usually persists from childhood into adult ADHD, although hyperactivity, impulsivity, and social impairments may also be present. Headaches would not be expected. Sexual impulses may be affected by adult ADHD, but this area is assessed later. Trichotillomania refers to pulling out one's hair as a tension-relieving behavior.

A 74-year-old patient is regressed and apathetic. This patient responds to others only when they initiate the interaction. Which therapy would be most useful to promote resocialization? a. Medication b. Re-motivation c. Group psychotherapy d. Individual psychotherapy

ANS: B Re-motivation therapy is designed to re-socialize patients who are regressed and apathetic by focusing on a single topic, creating a bridge to reality as group members talk about the world in which they live and work, and hobbies related to the topic. Group leaders give group members acceptance and appreciation.

A nurse counsels a patient diagnosed with serious and persistent mental illness. The patient lives at home with family. Which resource could the nurse suggest assisting the patient and family to cope with the stigma of mental illness as well as provide support and education? a. American Psychiatric Association (APA) b. National Alliance on Mental Illness (NAMI) c. Community Mental Health Centers (CMHCs) d. Programs of Assertive Community Treatment (PACT)

ANS: B Stigma represents the bias and prejudice commonly held regarding mental illness. NAMI actively seeks to dispel misconceptions about mental illness. The organization also offers patient and family support and education about living with mental illness. Community Mental Health Centers (CMHCs) are government agencies that provide outpatient services to persons diagnosed with SPMI. The APA is the professional organization of psychiatrists. Programs of Assertive Community Treatment (PACT) use a treatment team approach to improve symptom management and quality of life for persons diagnosed with SPMI.

The treatment team believes medication will help a patient diagnosed with adult attention-deficit/hyperactivity disorder (ADHD). Which class of medications does the nurse expect will be prescribed? a. Benzodiazepines b. Stimulants c. Antipsychotics d. Anxiolytics

ANS: B Stimulants, such as methylphenidate and amphetamines, provide the basis for treatment of both adult and childhood ADHD. They are the most commonly used medications; therefore, the nurse could expect the health care provider to prescribe a drug in this class. None of the other drugs listed as options have proved useful in the treatment of ADHD.

For patients diagnosed with severe and persistent mental illness, what is the major advantage of case management? a. Modification of traditional psychotherapy b. Efficient access and use of resources c. Focus on social skills training and self-esteem building d. Bringing groups of patients together to discuss common problems

ANS: B The case manager not only provides entrance into the system of care, but he or she also coordinates the multiple referrals that so often confuse the patient who is severely and persistently mentally ill and the patient's family. Case management promotes the efficient use of services. The other options are lesser advantages or may be irrelevant

Which is the best statement for a nurse to use when beginning an interview with an older adult patient? a. "Hello, [call patient by first name]. I am going to ask you some questions to get to know you better." b. "Hello. My name is [nurse's name]. I am a nurse. Please tell me how you would like to be addressed by the staff." c. "I am going to ask you some questions about yourself. I would like to call you by your first name if you don't mind." d. "You look as though you are comfortable and ready to participate in an admission interview. Shall we get started?

ANS: B The correct response identifies the nurse's role and politely seeks direction for addressing the patient in a way that will make him or her comfortable. This is particularly important when a considerable age difference exists between the nurse and the patient. The nurse should address a patient by name but should not assume the patient wants to be called by his or her first name. The nurse should always introduce himself or herself.

The health care provider prescribes medication for a child diagnosed with attention-deficit/hyperactivity disorder (ADHD). What is the desired behavior for which the nurse should monitor? a. Increased expressiveness in communicating with others. b. Improved ability for cooperative play with other children. c. Ability to identify anxiety and implement self-control strategies. d. Improved socialization skills with other children and authority figures.

ANS: B The goal is improvement in the child's hyperactivity, distractibility, and play. The incorrect options are more relevant for a child with a developmental or anxiety disorder.

An 80-year-old patient has difficulty walking because of arthritis and says, "It's awful to be old. Every day is a struggle. No one cares about old people." Which is the nurse's most therapeutic response? a. "Everyone here cares about old people. That's why we work here." b. "It sounds like you're having a difficult time. Tell me about it." c. "Let's not focus on the negative. Tell me something good." d. "You are still able to get around, and your mind is alert."

ANS: B The nurse uses therapeutic communication and empathic understanding to encourage the patient to express frustration and clarify the "struggle" for the nurse. The other options are nontherapeutic and block communication.

A patient tells the nurse of the recent deaths of a spouse of 50 years as well as an adult child in an automobile accident. The patient has no other family and only a few friends in the community. What is the priority nursing diagnosis? a. Spiritual distress, related to being angry with God for taking the family b. Risk for suicide, related to recent deaths of significant others c. Anxiety, related to sudden and abrupt lifestyle changes d. Social isolation, related to loss of existing family

ANS: B The patient appears to be experiencing normal grief related to the loss of the family; however, because of age and social isolation, the risk for suicide should be determined and has high priority. No defining characteristics exist for the diagnosis of anxiety or spiritual distress. Risk for suicide is a higher priority than social isolation.

. An older patient reports drinking a six-pack of beer daily. The patient tells the community health nurse, "I've been having trouble with my arthritis lately, so I take acetaminophen four times a day for pain." What are the nurse's priority interventions? (Select all that apply.) a. Inquiring about sleep disturbances caused by mixing alcohol and analgesic medications b. Determining the safety of the daily acetaminophen dose the patient is ingesting c. Advising the patient of harmful effects of alcohol and acetaminophen on the liver d. Suggesting an increase in the acetaminophen dose because alcohol produces faster excretion e. Assessing the patient for declining functional status associated with medication-induced dementia

ANS: B, C The nurse should be concerned with the patient's use of alcohol and acetaminophen because the toxicity of acetaminophen is enhanced by alcohol and by the age-related decrease in clearance. The nurse must determine whether the acetaminophen dose is within safe limits or is excessive and provide this information to the patient. Next, the nurse must provide health education regarding the danger of combined use of acetaminophen and alcohol. The patient will need to discontinue or reduce alcohol intake. Another analgesic with less hepatotoxicity could be used. Additional acetaminophen would cause greater liver damage. The scenario does not suggest dementia.

A nurse prepares the plan of care for a 15-year-old adolescent diagnosed with moderate intellectual developmental disorder (IDD) is believed capable of ultimately functioning at a second-grade level. What are the highest outcomes realistic for this person to demonstrate within 5 years? (Select all that apply.) a. Live unaided in an apartment. b. Obtain employment in a local sheltered workshop. c. Correctly use public buses to travel in the community. d. Independently perform his or her own personal hygiene. e. Complete high school or earn a general equivalency diploma (GED).

ANS: B, C, D Individuals with moderate intellectual developmental disorder progress academically to about a second-grade level. These people can learn to travel in familiar areas and perform unskilled or semiskilled work. With supervision, they can function in the community, but independent living is not likely.

A nurse assessing an older adult patient for depression should include questions about mood as well as which other symptoms? (Select all that apply.) a. Increased appetite b. Sleep pattern changes c. Anhedonia and anergia d. Increased social isolation e. Increased concern with bodily functions

ANS: B, C, D, E These symptoms are often noted in older adult patients experiencing depression. Somatic symptoms are often present but are missed by nurses as being related to depression. Anorexia, rather than polyphagia (increased eating), is observed in major depressive disorder. Low self-esteem is more often associated with major depressive disorder.

What are the primary distinguishing factors between the behavior of children diagnosed with oppositional defiant disorder (ODD) and those diagnosed with conduct disorder (CD)? The child diagnosed with: (Select all that apply.) a. ODD relives traumatic events by acting them out. b. ODD tests limits and disobeys authority figures. c. ODD has difficulty separating from the parents. d. CD uses stereotypical or repetitive language. e. CD often violates the rights of others.

ANS: B, E Children with ODD are negativistic, disobedient, and defiant toward authority figures without seriously violating the basic rights of others, whereas children with CD frequently behave in ways that violate the rights of others and age-appropriate societal norms. Reliving traumatic events occurs with posttraumatic stress disorder. Stereotypical language behaviors are observed in autistic children. Separation problems with resultant anxiety occur with separation anxiety disorder.

When making a distinction as to whether a patient is experiencing confusion related to depression or dementia, what information would be most important for the nurse to consider? a. The patient with dementia is persistently angry and hostile. b. Early morning agitation and hyperactivity occur in dementia. c. Confusion seems to worsen at night when dementia is present. d. A patient who is depressed is preoccupied with somatic symptoms.

ANS: C Both dementia and depression in older adults may produce symptoms of confusion. Noting whether the confusion seems to increase at night, which occurs more often with dementia than with depression, will help distinguish whether depression or dementia is producing the confused behavior. The other options are not necessarily true.

Health maintenance and promotion efforts for patients diagnosed with severe mental illness should include education about the importance of what regular intervention? a. Home safety inspections b. Monitoring of self-care abilities c. Screening for cancer, hypertension, and diabetes d. Determination of adequacy of a patient's support system

ANS: C Individuals diagnosed with severe and persistent mental illness have an increased prevalence of medical disorders. Patients should be taught the importance of regular visits to a primary care physician for screening for these illnesses. Home safety inspections are more often suggested for patients with physical impairments. Caregivers and family members usually evaluate self-care abilities, rather than the patient. Assessment of a patient's support system is not usually considered part of health promotion and maintenance.

A patient diagnosed with schizophrenia tells the community mental health nurse, "I threw away my pills because they interfere with God's voice." The nurse identifies what as the likely cause of the patient's ineffective management of the medication regimen? a. Inadequate discharge planning b. Poor therapeutic alliance with clinicians c. Impaired reasoning secondary to schizophrenia d. Dislike of the side effects of antipsychotic medications

ANS: C The patient's ineffective management of the medication regimen is most closely related to impaired reasoning abilities. The patient believes in being an exalted person who hears God's voice, rather than an individual with a serious mental illness who needs medication to control symptoms. Data do not suggest that any of the other factors often relate to medication nonadherence.

A nurse and social worker co-lead a reminiscence group for eight adults aged 65 to 70. Which activity is most appropriate to include in the group? a. Singing a song from World War II b. Learning how to join an online social network c. Discussing national leadership during the Vietnam War d. Identifying the most troubling story in today's newspaper

ANS: C "Young-old" adults are persons 65 to 74 years of age. These adults were attuned to conflicts in national leadership associated with the Vietnam War. Reminiscence groups share memories of the past. Learning how to join a social network would not be an aspect of reminiscence. Singing a song from World War II is more appropriate for an elite old reminiscence group. The other incorrect option is less relevant to this age group.

A 15-year-old adolescent has run away from home six times. After the adolescent was arrested for prostitution, the parents told the court, "We can't manage our teenager." The adolescent is physically abusive to the mother and defiant with the father. The adolescent's problem is most consistent with criteria for which disorder? a. Attention-deficit/hyperactivity disorder (ADHD) b. Childhood depression c. Conduct disorder (CD) d. Autism spectrum disorder (ASD)

ANS: C CDs are manifested by a persistent pattern of behavior in which the rights of others and age-appropriate societal norms are violated. The Diagnostic and Statistical Manual of Mental Disorders (5th edition) (DSM-5) identifies CDs as serious violations of rules. The patient's clinical manifestations do not coincide with the other disorders listed.

An adult has been feeling significant tension since losing a home through foreclosure. This person goes to a park, feeds the birds, and then impulsively exposes himself to a group of parents and children. Which term applies to this behavior? a. Voyeurism b. Frotteurism c. Exhibitionism d. Sexual masochism

ANS: C Exhibitionism is obtaining sexual pleasure from exposing one's genitalia to unsuspecting strangers. Voyeurism refers to obtaining sexual pleasure from observing people who are naked. Frotteurism is associated with obtaining sexual arousal by rubbing one's genitals against an unsuspecting person. Sexual masochism refers to deriving sexual pleasure from being humiliated, beaten, or otherwise made to suffer

The father of a child diagnosed with schizophrenia says, "I lost my job, so we have no health insurance." The mother says, "I must watch this child all the time. Without supervision, our child becomes violent and destructive." A sibling says, "My parents don't pay attention to me." These comments signify what related stress? a. Life-cycle stressors b. Psychobiological issues c. Family burden of mental illness d. Stigma associated with mental illness

ANS: C Family burden refers to the meaning that the experience of living with a person who is mentally ill has for families. The stressors mentioned are not related to live-cycle issues. The stressors described are psychosocial. Stigma refers to shame and ridicule associated with mental illness.

An adolescent diagnosed with generalized anxiety disorder says, "My parents focus all their attention on my brother instead of me. He's perfect in their eyes." Which type of therapy might promote the greatest change in this adolescent's behavior? a. Bibliotherapy b. Play therapy c. Family therapy d. Behavior modification therapy

ANS: C Family therapy focuses on problematic family relationships and interactions. The patient has identified problems within the family. Bibliotherapy and play therapy are appropriate for children rather than adolescents. The adolescent's problem is interpersonal and relates to relationships and self-perception; therefore, behavior modification therapy would not help

Which nursing diagnosis is likely to apply to the plan of care for a homeless individual diagnosed with severe and persistent mental illness? a. Insomnia b. Substance abuse c. Chronic low self-esteem d. Impaired environmental interpretation syndrome

ANS: C Many individuals with severe mental illness do not live with their families and are homeless. Life on the street or in a shelter has a negative influence on the individual's self-esteem, making this nursing diagnosis one that should be considered. Insomnia may be noted in some patients but is not a universal problem. While substance abuse may be a comorbid problem, it is not an approved North American Nursing Diagnosis Association International (NANDA-I) diagnosis. Impaired environmental interpretation syndrome refers to persistent disorientation, which is not observed in a majority of the homeless population.

Before working with patients regarding sexual concerns, what is a prerequisite for providing nonjudgmental care? a. Sympathy b. Assertiveness training c. Sexual self-awareness d. Effective communication

ANS: C Only when a nurse has accepted his or her own feelings and values related to sexuality can he or she provide fully nonjudgmental care to a patient. If the nurse is uncomfortable, the patient might misinterpret discomfort as disapproval. The distractors are not prerequisites.

The child most likely to receive propranolol to manage tremors is one diagnosed with which disorder? a. Attention-deficit/hyperactivity disorder (ADHD) b. Posttraumatic stress disorder (PTSD) c. A motor disorder d. Separation anxiety

ANS: C Propranolol is useful for managing tremors associated with various motor disorders. This medication is not indicated in any of the other disorders.

A desired outcome for a 12-year-old diagnosed with oppositional defiant disorder (ODD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care? a. Bibliotherapy b. Music therapy c. Social skills groups d. Behavior modification

ANS: C Social skills training teaches the child to recognize the impact of his or her behavior on others. It uses instruction, role-playing, and positive reinforcement to enhance social outcomes. The other therapies would have lesser or no impact on peer relationships.

Shortly after a 15-year-old's parents announce a plan to divorce, the adolescent stops participating in sports, sits alone at lunch, and avoids former friends. The adolescent says, "All the other kids have families. If my parents loved me, then they would stay together." Which nursing intervention is most appropriate? a. Develop a plan for activities of daily living. b. Communicate disbelief relative to the adolescent's feelings. c. Assist the adolescent to differentiate reality from perceptions. d. Assess and document the adolescent's level of depression daily

ANS: C The patient's perceptions that "all the other kids" are from two-parent households and that he or she is different are not based in reality. Assisting the patient to test the accuracy of the perceptions is helpful.

The parent of a child diagnosed with Tourette's disorder says to the nurse, "I think my child is faking the tics because they come and go." Which response by the nurse is accurate? a. "Perhaps your child was misdiagnosed." b. "Your observation indicates the medication is effective." c. "Tics often change frequency or severity. That does not mean they aren't real." d. "This finding is unexpected. How have you been administering your child's medication?"

ANS: C Tics are sudden, rapid, involuntary, repetitive movements, or vocalizations characteristic of Tourette's disorder. They often fluctuate in frequency and severity and are reduced or absent during sleep.

When a 5-year-old child is disruptive, the nurse says, "You must take a time-out." The expectation is that the child will demonstrate what behavior? a. Go to a quiet room until called for the next meal. b. Slowly count to 20 before returning to the group activity. c. Sit on the edge of the activity until able to regain self-control. d. Sit quietly on the lap of a staff member until able to apologize for the behavior

ANS: C Time-out is designed so that staff can be consistent in their interventions. Time-out may require having the child sit on the periphery of an activity until he or she gains self-control and reviews the episode with a staff member. Time-out may not require having the child go to a designated room and does not involve special attention such as holding. Having the child count to 10 or 20 is not sufficient.

A nurse prepares to lead a discussion at a community health center regarding children's health. The nurse wants to use current terminology when teaching about these issues. Which terms are appropriate for the nurse to use? (Select all that apply.) a. Mental retardation b. Asperger's disorder c. Autism spectrum disorder d. Pervasive developmental disorder e. Intellectual development disorder

ANS: C, E Using dated terminology contributes to the stigma and misconceptions about mental illness. It's important for the nurse to use current terminology. The term mental retardation has been replaced with intellectual development disorder. The term autism spectrum disorder now encompasses Asperger's disorder and pervasive developmental disorder.

. An older adult with a history of major depressive disorder has taken an antidepressant daily for 3 years. The patient tells the nurse, "I want to stop taking this medication. I don't think I need it anymore." What is the nurse's best response to assure safety the patient's safety? a. "Why do you think you don't need this medication anymore?" b. "Have you talked with your family members about this decision?" c. "If you stop the medication, your depression will return worse than ever. d. "This medication should be gradually stopped. Let's talk to your health care provider about a plan."

ANS: D It is the patient's right to decide whether to take the medication. Some patients experience discontinuation symptoms if medications in this group are stopped abruptly. A gradual discontinuation is needed. The incorrect options may be reasonable statements but are not directly related to safety.

Which statement about aging provides the best rationale for focused assessment of older adult patients? a. Older adults are often socially isolated and lonely. b. As people age, they become more rigid in their thinking. c. The majority of older adults sleep more than 12 hours per day. d. The senses of vision, hearing, touch, taste, and smell decline with age.

ANS: D Only the correct answer is true and cues the nurse to assess carefully the sensory functions of the older adult patient. The incorrect options are myths about aging

A patient diagnosed with severe and persistent mental illness who recently moved to a homeless shelter says, "My life is out of control. I'm like a leaf at the mercy of the wind." The nurse formulates the diagnosis Powerlessness. Outcomes will focus on which goal? a. Instilling hope b. Controlling anxiety c. Planning social activities d. Developing personal autonomy

ANS: D Powerlessness is associated with feeling unable to control events in one's life. It is often associated with low self-esteem. The goal is to increase one's sense of autonomy. The scenario does not indicate hopelessness or anxiety. Socialization is not the primary need.

Recognizing the risk for acquired immunodeficiency syndrome (AIDS) among older adults, nurses should provide health teaching focused on what? a. Discouraging sexual expression b. Using birth control measures c. Avoiding blood transfusions d. Encouraging condom use

ANS: D Safe sex continues to be important and should be taught to the older adult population. Because the risk for pregnancy is nonexistent in postmenopausal women, condom use is diminished, which places older adults at risk for AIDS and other sexually transmitted diseases. Sexual expression is a basic human need. Little to no danger exists from blood transfusions.

A nurse assesses the four children below. Which assessment findings should prompt the nurse to refer the child for further evaluation? a. A 4-year-old who stuttered for 3 weeks after the birth of a sibling. b. A 9-month-old who does not eat vegetables and likes to be rocked. c. A 3-month-old who cries after feeding until burped and sucks a thumb. d. A 3-year-old who is mute, passive toward adults, and twirls while walking.

ANS: D Symptoms consistent with an autistic spectrum disorder (ASD) are evident in the correct answer. The behaviors of the other children are expected and within normal ranges.

A 5-year-old child moves and talks constantly. The child awakens before the parents every morning. The child attends kindergarten, but the teacher reports difficulty handling the behavior. What is this child's most likely problem? a. Tic disorder b. Oppositional defiant disorder (ODD) c. Intellectual development disorder (IDD) d. Attention-deficit/hyperactivity disorder (ADHD)

ANS: D The constant motion and excessive talkativeness suggest ADHD. Tic disorder is associated with stereotypical, rapid, and involuntary motor movements. Developmental delays would be observed if intellectual development disorder was present. ODD includes serious violations of the rights of others.

Which nursing action should occur first when preparing to work with a patient who has a problem of sexual functioning? a. Acquire knowledge of the patient's sexual roles and preferences. b. Develop an understanding of human sexual responses. c. Assess the patient's sexual functioning. d. Clarify the nurse's own personal values.

ANS: D Before a nurse can be helpful to patients with sexual dysfunction, he or she must be aware of and comfortable with his or her own feelings about sex and sexuality. Nurses must be comfortable with the idea that patients have a right to their own values and must avoid criticism and censure.

A patient tells the nurse, "My sexual functioning is normal when my partner wears lace. Without it, I'm not interested in sex." This comment evidences which sexual disorder? a. Exhibitionism b. Voyeurism c. Pedophilia d. Fetishism

ANS: D A person with a sexual fetish finds it necessary to have some external object present, in fantasy or in reality, to be sexually satisfied. Exhibitionism refers to exposing one's genitalia publicly. Voyeurism refers to viewing others in intimate situations. Pedophilia refers to the preference for having sexual relations with a child.

An adult says, "When I was a child, I took medication because I couldn't follow my teachers' directions. I stopped taking it when I was about 13. I still have trouble getting organized, which causes difficulty at my job." Which disorder is most likely? a. Stress intolerance disorder b. Generalized anxiety disorder (GAD) c. Borderline personality disorder d. Adult attention-deficit/hyperactivity disorder (ADHD)

ANS: D Adult ADHD is usually diagnosed in early life and treated until adolescence. Treatment is often stopped because professionals think the disorder resolves itself because the hyperactive impulsive behaviors may diminish; the inattentive and disorganized behaviors tend to persist, however. Stress intolerance disorder is not found in the DSM-5. The scenario description is inconsistent with generalized anxiety disorder and borderline personality disorder.

An advance directive gives valid direction to health care providers when a patient is demonstrating what characteristic? a. Aggression b. Dehydration c. Ineffective verbally communicate d. Unable to make health care decisions

ANS: D Advance directives are invoked when patients are unable to make their own decisions. Aggression, dehydration, or an inability to speak does not mean the patient is unable to make a decision.

A nurse assesses a 3-year-old diagnosed with autism spectrum disorder. Which finding is most associated with the child's disorder? a. Has occasional toileting accidents. b. Is unable to read children's books. c. Cries when separated from a parent. d. Continuously rocks in place for 30 minutes.

ANS: D Autism spectrum disorder involves distortions in development of social skills and language that include perception, motor movement, attention, and reality testing. Body rocking for extended periods suggests autism spectrum disorder. The distracters are expected findings for a 3-year-old.

A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child has formed a trusting relationship with a volunteer. The teen says, "I have three good friends at school. We talk and sit together at lunch." What is the nurse's best suggestion to the treatment team? a. Suggest foster home placement. b. Seek assistance from an intimate partner violence program. c. Make referrals for existing and emerging developmental problems. d. Encourage healthy characteristics and existing environmental supports.

ANS: D Because the teenager shows no evidence of poor mental health, the best action would be to foster existing healthy characteristics and environmental supports. No other option is necessary or appropriate under the current circumstances.

A 15-year-old adolescent is referred to a residential program after an arrest for theft and running away from home. At the program, the adolescent refuses to participate in scheduled activities and pushes a staff member, causing a fall. Which approach by the nursing staff would be most therapeutic? a. Neutrally permit refusals. b. Coax to gain compliance. c. Offer rewards in advance. d. Establish firm limits.

ANS: D Firm limits are necessary to ensure physical safety and emotional security. Limit setting will also protect other patients from the teenager's thoughtless or aggressive behavior. Permitting refusals to participate in the treatment plan, coaxing, and bargaining are strategies that do not help the patient learn to abide by rules or structure.

An older adult patient brings a bag of medication to the clinic. The nurse finds one bottle labeled "Ativan" and one labeled "lorazepam," and both are labeled "Take two times daily." Bottles of hydrochlorothiazide, Inderal, and rofecoxib, each labeled "Take one daily," are also included. Which conclusion is accurate? a. Rofecoxib should not be taken with Ativan. b. The patient's blood pressure is likely to be very high. c. This patient should not self-administer any medication. d. Lorazepam and Ativan are the same drug; consequently, the dose is excessive.

ANS: D Lorazepam and Ativan are generic and trade names for the same drug, creating an accidental overdose situation. The patient needs medication education and help with proper, consistent labeling of bottles. No evidence suggests that the patient is unable to self-administer medication. The distractors are not factual statements.

A nurse cares for a patient diagnosed with paraphilia. The nurse expects the health care provider may prescribe which type of medication to reduce paraphilic behaviors? a. Stimulants b. Erectile dysfunction medication c. Atypical antipsychotic medication d. Mood stabilizer

ANS: D Pharmacological treatment typically involves medications that reduce impulsive or compulsive behavior, such as antidepressants, naltrexone, antipsychotics, mood stabilizers, or medications that interfere with the production of sexual hormones in order to reduce sexual urges. The other medications are not indicated for this disorder.

A 37 year old is involuntarily committed to outpatient treatment after sexually molesting a 12-year-old child. The patient says, "That girl looked like she was 19 years old." Which defense mechanism is this patient using? a. Denial b. Identification c. Displacement d. Rationalization

ANS: D Rationalization is used to justify upsetting behaviors by creating reasons that would allow the individual to believe that the behaviors were warranted or appropriate. The patient is rationalizing molestation of a minor. Denial is used to avoid dealing with the problems and responsibilities related to one's behaviors. Identification is incorporating the image of an emulated person and then acting, thinking, and feeling like that person. Displacement is the discharge of pent-up feelings onto something or someone else in the environment that is less threatening than the original source of the feelings.

A 4-year-old child cries and screams from the time the parents leave the child at preschool until the child is picked up 4 hours later. The child is calm and relaxed when the parents are present. The parents ask, "What should we do?" What is the nurse's best recommendation? a. "Send a picture of yourself to school to keep with the child." b. "Arrange with the teacher to let the child call home at playtime." c. "Talk with the school about withdrawing the child until maturity increases." d. "Talk with your health care provider about a referral to a mental health professional."

ANS: D Separation anxiety disorder becomes apparent when the child is separated from the attachment figure. The symptoms are considered normal up to age 1. Often, the first-time separation occurs is when the child goes to kindergarten or nursery school. Separation anxiety may be based on the child's fear that something will happen to the attachment figure. The child needs professional help. None of distractors accounts for the severity and length of the child's reaction.

The parent of an adult diagnosed with severe and persistent mental illness asks the nurse, "Why are you making a referral to that vocational rehabilitation program? My child won't ever be able to hold a job." Which is the nurse's best reply? a. "We made this referral to maintain eligibility for federal funding." b. "Are you concerned that we're trying to make your child too independent?" c. "If you think the program would be detrimental, we can postpone it for a time." d. "Most patients are capable of employment at some level, competitive or supported."

ANS: D Studies have shown that most patients who complete vocational rehabilitation programs are capable of some level of employment; also, they demonstrate significant improvement in assertiveness and work behaviors, as well as decreased depression, and improved self-esteem and socialization.

A nurse prepares a plan of care for a patient diagnosed with adult attention-deficit/hyperactivity disorder (ADHD). Which intervention should be included? a. Remind the patient of priorities and deadlines. b. Teach work-related skills such as basic computer literacy. c. Establish penalties for failing to organize and prioritize tasks. d. Give encouragement and strategies for managing and organizing

ANS: D The nurse's major responsibilities lie with encouraging the patient to learn and use necessary skills, assisting the patient to stay on task. The nurse is not an ever-present taskmaster or disciplinarian. The nurse does not teach work-related skills; vocational staff members assume those types of tasks

A 5-year-old child diagnosed with attention-deficit/hyperactivity disorder (ADHD) bounces out of a chair in the waiting room, runs across the room, and begins to slap another child. What is the nurse's best action? a. Call for emergency assistance from another staff member. b. Instruct the parents to take the child home immediately. c. Direct this child to stop, and then comfort the other child. d. Take the child into another room with toys to act out feelings.

ANS: D The use of play to express feelings is appropriate; the cognitive and language abilities of the child may require the acting out of feelings if verbal expression is limited. The incorrect options provide no outlet for feelings or opportunity to develop coping skills.

The manager of a health club put a hidden camera in the women's locker room and videotaped women as they showered and dressed. Which sexual dysfunction is evident? a. Frotteurism b. Exhibitionism c. Pedophilia d. Voyeurism

ANS: D Voyeurism is the viewing of others in intimate situations such as undressing, bathing, or having sexual relations. Voyeurs are often called "peeping Toms." Frotteurism is touching or rubbing against a nonconsenting person to achieve sexual gratification. Exhibitionists are interested in exposing their genitals to others. Pedophiles seek sexual contact with prepubescent children.