Adult Quiz 4

Terry is a young male in a chemical dependency program. Recently he has become increasingly distracted and disengaged. The nurse concludes that Terry is

not ready to change

Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his "nice" mom, that he loves school, and gets above average grades. The strongest explanation of this response is

resilience

Which activity is most appropriate for a child with ADHD

tennis

Opioid use disorder is characterized by

tolerance

A nurse named Darryl has been hired to work in a psychiatric intensive care unit. He has undergone training on recognizing escalating anger. Which statement indicates that he understands danger signs in regard to aggression

"An obvious change in behavior is a risk factor for aggression.

Which statement made by a 9-year-old child after hitting a classmate is a typical comment associated with childhood conduct disorder?

"He deserved it for being a sissy.

Which statement demonstrates a well-structured attempt at limit setting?

"Hitting me when you are angry is unacceptable.

What assessment question should the nurse ask when attempting to determine a teenager's mental health resilience?

"How did you cope when your father deployed with the Army for a year in Iraq?" "Who did you go to for advice while your father was away for a year in Iraq?" "Where do you see yourself in 10 years

Which patient statement indicates the helpfulness of the nursepatient relationship?

"I appreciate the time you spent with me. I have a better understanding of what I can do to manage my problem.

Which statement made by a widow demonstrates that her grief work has been effective?

"I can remember how much my deceased husband loved chocolate chip ice cream." "Painting is my new passion, and I really enjoy learning the various strokes." "Jim could be very stubborn when he thought he was right.

Cognitive-behavioral therapy is going well when a 12-year- old patient in therapy reports to the nurse practitioner:

"I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd

Which statement about crisis theory will provide a basis for nursing intervention?

A crisis is an acute time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable

Which statement concerning a crisis experience is true and should be used as a guideline for crisis management care?

A crisis is self-limiting and usually resolves within 4 to 6 weeks. The nurse should maintain a nondirective role. The goal of crisis management is to return the patient to at least the precrisis level of functioning.

When considering an eating disorder, what is a physical criterion for hospital admission?

A daytime heart rate of less than 50 beats per minute

Which intervention will promote independence in a patient being treated for bulimia nervosa

Allow the patient to make limited choices about eating and exercise as weight gain progresses

Which individuals are most at risk for displaying aggressive behavior?

An adolescent embarrassed in front of friends. A young male who feels rejected by the social group. A middle-aged adult who feels that concerns are going unheard. A patient who was discovered telling a lie

Lilly, a single mother of four, comes to the crisis center 24 hours after a fire in which all the houses within a one-block area were wiped out. All of Lilly's household goods and clothing were lost. Lilly has no other family in the area. Her efforts to mobilize assistance have been disorganized, and she is still without shelter. She is distraught and confused. You assess the situation as:

An adventitious crisis

Twenty-four-hour observation is a good choice for restraint in which of the following patients?

An inmate with suicidal ideation on hospice care

Which intervention(s) should the nurse implement when helping a patient expresses anger in an inappropriate manner?

Approach the patient in a calm, reassuring manner. Provide suggestions regarding acceptable ways of communicating anger. Set limits on the angry behavior that will be tolerated

In the 2 months after his wife's death, Aaron, aged 90 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate

Arrange for an appointment with a therapist for evaluation and treatment of suspected depression

The nurse is engaged in crisis intervention with a patient reporting, "I have no reason to keep on living." What is the nurse's initial intervention

Ask the patient, "Do you have any plan to hurt yourself or anyone else

Which comorbid condition would result in cautious use of a selective serotonin reuptake inhibitors for a patient with chronic aggression?

Bipolar disorder

An effective method of preventing escalation in an environment with violent offenders is to develop a level of trust through

Brief, frequent, nonthreatening encounters

Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to: a. Limited executive function

Cerebellum maturation

In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in:

Children of color and poor economic conditions being underserved Increased stress in the family unit Premature termination of services

When discussing oppositional defiant disorder with a group of parents, what information should the nurse include about the disorder?

Classic symptoms include anger, irritation, and defiant behavior. Children generally outgrow the behaviors without formal treatment. Severity is considered mild when symptoms are present in only one setting. Argumentative and defiant are terms often used to describe the patient.

What action should you take when a female staff member is demonstrating behaviors associated with a substance use disorder

Confront her about your concerns and/or report your concerns to a supervisor immediately

Tommy, a 12-year-old boy admitted to the pediatric psychiatric unit, has recently been diagnosed with conduct disorder. In the activity room, the games he wanted to play were already in use. He responded by threatening to throw furniture and to hurt his peers who had the game he wanted. Nancy, a registered nurse, recognizes that Tommy's therapy must include:

Consistency in implementing the consequences of breaking rule

Chronic obstructive pulmonary disease, spinal injury, seizure disorder, and pregnancy are conditions that:

Contraindicate restraint and seclusion

Obesity can be the end result of a binge-eating disorder. The nurse understands that the best treatment option in persons with a binge-eating disorder promotes

Coping strategies

Some cultures have lower rates of diagnosed conduct disorders than observed in Western societies. The lower rate of incidence may be contributed to:

Cultural expression of anger as normal behavior

What assessment data would support a diagnosis of conduct disorder?

Evidence of social isolation Arrested twice for disorderly conduct Expresses difficulty in keeping employment

Nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels. Specialized skills training and continuing education are helpful to diffuse nursing stress, as well as

Expressing emotions by journaling Engage in exercise and relaxation activities Having realistic patient expectation

Which statement made by a family member tends to support a diagnosis of delirium rather than dementia

She was fine last night but this morning she was confused.

What is a common behavior observed in a patient diagnosed with intermittent explosive disorder?

Short attention span Threatens suicide Uses alcohol to excess

Ophelia, a 69-year-old retired nurse, attends a reunion of her former coworkers. Ophelia is concerned because she usually knows everyone, and she cannot recognize faces today. A registered nurse colleague recognizes Ophelia's distress and "introduces" Ophelia to those attending. The nurse practitioner recognizes that Ophelia seems to have a deficit in:

Social cognition

Which factor has the greatest influence on the hospice nurse's ability to provide respectful professional care

The existence of a healthy, well-balanced personal life

A bereavement group run by a local hospice includes a woman who is distraught over her supervisor's death. The woman appears severely distressed. She has trouble functioning with activities of daily living and making the simplest of decisions. The group facilitator recognizes that this woman is suffering from disenfranchised grief after learning:

The woman was in love with her married supervisor

Which statement made by a patient demonstrates acceptance of criteria required of hospice care?

There is no cure for my illness. I've accepted that

April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April's mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:

Time-out is no longer an effective therapeutic measure

Which statement made by the primary caregiver of a patient diagnosed with dementia demonstrates accurate understanding of providing the patient with a safe environment

We've installed locks on all the outside doors.

Claude is a new nurse on the psychiatric unit. He asks a senior nurse on staff for the "best advice" when working with oppositional defiant disorder. Which statement reflects advice on solid therapeutic communication

When setting limits, be specific and outline consequences.

Darnell is an 84-year-old widower who has lived alone since his wife died 6 years ago. A neighbor called Darnell's son to tell him that Darnell was trying to start his car from the passenger's side. He became angry and aggressive when the car would not start. After a medical assessment, Darnell was diagnosed with a major neurocognitive disorder. The nurse realized additional family teaching is necessary when Darnell's son states

With person-centered care, my father will be able to remain in his home.

Safety measures are of concern in eating-disorder treatments. Patients with anorexia nervosa are supervised closely to monitor:

Foods that are eaten Attempts at self-induced vomiting Weight

Considering the subject of medically assisted death, which statements identify the pros and cons of the argument associated with the issue of nonmaleficence?

From the patient's perspective, there is no difference between ending life by providing a lethal prescription and by stopping treatment that prolongs life. b. Assisted death violates the oath to "do no harm" and destroys trust between patient and nurse

Which statement made to the grieving patient demonstrates effective therapeutic communication

"Your loved one was irreplaceably special." . "I would like to take the flowers from the funeral home to your house." . "Your loss must be devastating. I can't imagine how you must be feeling right now.

Which event experienced in the patient's childhood increases the risk of the development of behaviors associated with intermittent explosive disorder?

Physically abused from ages 3 to 10

Holly is a 53-year-old female with terminal breast cancer. Holly's nurse in the hospital brings up the subject of hospice care. Holly becomes upset and states, "I am not ready to give up and die." You respond that hospice is:

A model of healthcare that emphasizes quality of life for you and your family

Which belief would be least helpful for a nurse working in crisis intervention?

A person in crisis is incapable of responding to instruction

Malika has been overweight all of her life. Now an adult, she has health problems related to her excessive weight. Seeking weight loss assistance at a primary care facility Malika is surprised when the nurse practitioner suggests:

A trial of SSRI antidepressant therapy

Nancy is a nurse. After talking with her mother, she became concerned enough to drive over and check on her. Her mother's appearance is disheveled, words are nonsensical, smells strongly of urine, and there is a stain on her dressing gown. Nancy recognizes that her mother's condition is likely temporary due to:

A urinary tract infection

Larry, a middle-aged male in a treatment facility, is loudly displaying anger in the day room with a visiting family member. It is obvious to the nurse this pattern has played out before. Violence is often escalated when family members or authority figures:

Engage in a power struggle

Maxwell is a 30-year-old male who arrives at the emergency department stating, "I feel like I am having a stroke." During the intake assessment, the nurse discovers that Maxwell has been working for 36 hours straight without eating and has consumed eight double espresso drinks and 12 caffeinated sodas. The nurse suspects

Dehydration and caffeine overdose

A female nurse had been sexually assaulted as a teenager. She finds it difficult to work with patients who have undergone the same trauma. What is the most helpful response?

Discussing these feelings with a mental health professional

The dying patient with a neurocognitive disorder such as Alzheimer's disease is especially challenging to provide care for. They may have symptoms or pain that they are unable to adequately describe or define. Reversible conditions that respond to treatment that may affect level of consciousness, anxiety, or agitation include:

Distended bladder, constipation, or nausea

The nursing diagnosis ineffective denial is especially useful when working with substance use disorders and gambling. Which statements describe this diagnosis?

Does not perceive danger of substance use or gambling Minimizes symptoms Refuses healthcare attention Unable to admit impact of disease on life patter

The highest-priority goal of crisis intervention is:

Patient safety

John Patrick is a widower with four daughters. He has enjoyed a healthy relationship with all of them until they reached puberty. As each girl began to mature physically, he acted in an aggressive manner, beating her without provocation. John Patrick is most likely acting on:

Frustration of unhealthy desire

Lester and Eileen have always enjoyed gambling. Lately, Eileen has discovered that their savings account is down by $50,000. Eileen insists that Lester undergo therapy for his gambling behavior. The nurse recognizes that Lester is making progress when he states

Gambling activates the reward pathways in my brain.

Taylor, a psychiatric registered nurse, orients Regina, a patient with anorexia nervosa, to the room where she will be assigned during her stay. After getting Regina settled, the nurse informs Regina:

I need to go through the belongings you have brought with you.

Malika agrees to try losing weight according to the nurse practitioner's outlined plan. Additional teaching is warranted when Malika states

I prefer to have a gastric bypass rather than use this plan

A newly admitted male patient has a long history of aggressive behavior toward staff. Which statement by the nurse demonstrates the need for more information about the use of restraint? "

I'll call the primary provider and get an as needed (prn) seclusion/restraint order.

Which patient statement acknowledges the characteristic behavior associated with a diagnosis of pica?

I'm ashamed of it, but I eat my hair.

Which patient statement supports the diagnosis of anorexia nervosa?

I'm terrified of gaining weight.

What is the rationale for providing a patient diagnosed with dementia easily accessible finger foods thorough the day

Increases input throughout the day

What side effects should the nurse monitor for when caring for a patient prescribed donepezil (Aricept)?

Insomnia Bradycardia Signs of dizziness Reports of headache

A patient with a history of alcohol use disorder has been prescribed disulfiram (Antabuse). Which physical effects support the suspicion that the patient has relapsed?

Intense nausea Diaphoresis Confusion Dyspnea

Which guidelines should direct nursing care when deescalating an angry patient?

Intervene as quickly as possible Identify the trigger for the anger Behave calmly and respectfully Recognize the patient's need for increased personal space

There is conflict surrounding the dying experience in modern medicine. The medical model of treatment in the United States has traditionally been focused on the prolongation of life. What intrinsic factor plays into this medical model

Keeping people alive as long as possible is the ethical thing to do.

Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness?

Limited language skills Level of cognitive development Level of emotional development

The impulse control spectrum can begin in childhood and continue on into adulthood, often morphing into criminal behaviors. Working with patients diagnosed with these disorders, the best examples of expressed emotion by the nursing staff are:

Low to prevent emotional reactions

A patient diagnosed with opioid use disorder has expressed a desire to enter into a rehabilitation program. What initial nursing intervention during the early days after admission will help ensure the patient's success?

Manage the patient's withdrawal symptoms well

When considering the pathophysiology responsible for both delirium and dementia, which intervention is appropriate for delirium specifically

Monitor neurological status on an ongoing basis

Donald, a 49-year-old male, is admitted for inpatient alcohol detoxification. He is cachexic, has multiple scabs on his arms and legs, and has lower extremity edema. An appropriate nursing diagnosis for Donald along with an expected outcome is

Nutrition: Less than body requirements/Maintains nutrient intake for metabolic needs

Guadalupe is the matriarch of a large family. She is terminally ill and none of her family members know her end-of-life wishes. The best action for the nurse is to

Organize a family meeting with Guadalupe's permission to discuss her goals and wishes

When considering the need for monitoring, which intervention should the nurse implement for a patient with anorexia nervosa

Provide scheduled portion-controlled meals and snacks. Limit time spent in bathroom during periods when not under direct supervision. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained

Which assessment data confirm the suspicion that a patient is experiencing opioid withdrawal?

Pupils are dilated Extreme anxiety

When responding to the patient in question 7, the intervention that takes priority is to:

Reduce anxiety.

A patient whose history includes experiences with abusive partners is being treated for major depressive disorder. The patient's care plan includes rape-trauma syndrome among its nursing diagnoses. What goal is directly associated with this diagnosis

Reports feeling stronger and having a sense of hopefulness