Chapter 23/24

Which is true of the time-out strategy that may be used for persons with conduct disorder? A) It is a punishment. B) It should only be used as a last resort. C) Eventually, the goal is for the client to avoid time-out. D) Time-out is retreat to a neutral place, so clients can regain self-control.

D) Time-out is retreat to a neutral place, so clients can regain self-control.

The nurse is using limit setting with a child diagnosed with conduct disorder. Which statement reflects the most effective way for the nurse to set limits with the child? A) "That is not allowed here. You will lose a privilege. You need to stop." B) "Stop what you are doing. Go to your room." C) "I would appreciate if you would not do that." D) "Why do you do these things?"

"That is not allowed here. You will lose a privilege. You need to stop."

The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which intervention should the nurse implement first? A) Administer an antianxiety drug such as lorazepam (Ativan) at these times. B) Explain the unit routine and the reasons for increased activity to the client. C) Keep unit activity to a minimum. D) Move the client to a quieter area during these times

D) Move the client to a quieter area during these times

A nurse is educating a group of elderly community members about cognitive disorders. Which would the nurse include as a measure most likely to prevent Alzheimer's disease and other dementias? A) Crafts B) Cooking C) Watching television D) Reading

D) Reading

An 11-year-old child talks to the school nurse about a single episode of disruptive behavior in class. The child states, "I had a stomachache and felt like vomiting. I couldn't help it. I was just so mad at my dad." Which would be the most appropriate response by the nurse? A) "I can see that you're angry. Let's look at better ways to express it." B) "I can understand your anger, but you can't disrupt the classroom." C) "if you can get rid of your anger, perhaps your stomachache will go away." D) "Perhaps it would be helpful if you let your dad know you're angry."

A) "I can see that you're angry. Let's look at better ways to express it."

The caregiver of a client with Alzheimer's disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm him down. The nurse teaches the caregiver to use distraction techniques. Which response would be best to teach as an example of this technique? A) "Let's look at what is on television." B) "If you stop yelling, I will get your dessert." C) "Don't you want to finish your meal?" D) "I don't understand what you are saying."

A) "Let's look at what is on television."

Which patient is most likely suffering from dementia? A) A 90-year-old male who has experienced progressive mental decline that started with forgetfulness B) An 80-year-old female who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff C) A 6-year-old child who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that her parents have three sets of eyes D) A 22-year-old male who was involved in a motorcycle crash without wearing a helmet now unable to remember where he is

A) A 90-year-old male who has experienced progressive mental decline that started with forgetfulness

A client with dementia is unable to recognize ordinary objects, such as a pen or notebook. Which would this be a symptom of? A) Agnosia B) Amnesia C) Apraxia D) Aphasia

A) Agnosia

Which are most likely included in the history of a child with conduct disorder? Select all that apply. A) Disturbed relationships with peers B) Major antisocial violations C) Aggression toward people or animals D) Destruction of property E) Serious violation of rules

A) Disturbed relationships with peers C) Aggression toward people or animals D) Destruction of property E) Serious violation of rules

Which is believed to be a risk factor specific to the development of delirium? A) Increased severity of physical illness B) Older age C) Baseline cognitive impairment D) Gradual decline in functioning

A) Increased severity of physical illness

The nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. Which should the nurse include in planning the living environment? A) Plan for the same caregivers to provide care to individuals as much as possible. B) Open the windows and doors to allow fresh air to circulate through the environment. C) Provide a buffet-style menu with many food choices. D) Assign peer-led exercise activates on a daily basis.

A) Plan for the same caregivers to provide care to individuals as much as possible.

A child has been displaying behaviors associated with conduct disorder. The nurse should further assess for which common risk factors seen in children with conduct disorder. Select all that apply. A) Poor family functioning B) Strict disciplinary practices C) Family history of substance abuse D) Possible child abuse E) Poverty conditions

A) Poor family functioning C) Family history of substance abuse D) Possible child abuse E) Poverty conditions

The nurse is meeting with a family of a client with conduct disorder. The nurse discusses changes the parents can make to help their child change problematic behaviors. Which parenting technique would the nurse encourage the parents to use? A) Provide consistent consequences for behaviors. B) Set earlier curfews than the child's peers adhere to. C) Release the child from household responsibilities until he can demonstrate dependable behavior. D) Avoid discussing feelings and expectations with the child.

A) Provide consistent consequences for behaviors.

The nurse is performing a health history with a client exhibiting signs of delirium. The nurse asks the client and family members about possible causes of the delirious state. Which would the nurse likely attribute as underlying causes for the client's delirium? Select all that apply. A) Recent alcohol use B) Dehydration C) Use of antihistamines D) Sleep disturbances E) Use of megadoses of vitamins F) Exposure to paint or gasoline

A) Recent alcohol use B) Dehydration C) Use of antihistamines D) Sleep disturbances F) Exposure to paint or gasoline

Which steps are involved in limit setting? Select all that apply. A) State expected behavior. B) Inform clients or the rule or limit. C) Threaten incarceration. D) Explain the consequences if clients exceed the limit. E) Occasionally limit enforcement.

A) State expected behavior. B) Inform clients or the rule or limit. D) Explain the consequences if clients exceed the limit.

A client with dementia is starting pharmacotherapy to slow the progression of cognitive decline. The client has a history of moderate but steady alcohol use over the past 45 years. Which medication should the nurse question as least suitable for this client? A) Tacrine (Cognex) B) Memantine (Namenda) C) Donepezil (Aricept) D) Rivastigmine (Exelon

A) Tacrine (Cognex)

Which are possible sources of frustrations for nurses caring for persons with dementia? Select all that apply. A) The clients do not retain explanations or instructions, so the nurse must repeat the same things continually. B) The nurse may get little or no positive response or feedback from clients with dementia. C) It can be difficult to remain positive and supportive to clients and family because the outcome is so bleak. D) It can be helpful for the nurse to talk to colleagues or even a counselor about personal feelings of depression and grief as the dementia progresses. E) The clients may seem not to hear or respond to anything the nurse does.

A) The clients do not retain explanations or instructions, so the nurse must repeat the same things continually. B) The nurse may get little or no positive response or feedback from clients with dementia. C) It can be difficult to remain positive and supportive to clients and family because the outcome is so bleak E) The clients may seem not to hear or respond to anything the nurse does.

Which are characteristics of intermittent explosive disorder (IED)? Select all that apply. A) The episode may occur with seemingly no warning. B) They usually last less than 30 minutes. C) Afterward, the person with IED will not have any remorse. D) It involves repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outbursts. E) The intensity of the emotional outburst is usually within proportion to the stressor or situation.

A) The episode may occur with seemingly no warning. B) They usually last less than 30 minutes. D) It involves repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outbursts.

Which are actions of the parents of a child with conduct disorders that may contribute to the problems of the child? Select all that apply. A) The parents may not behave appropriately themselves because of a lack of knowledge. B) The parents blame the school when the child causes a disturbance in school and receives detention. C) The parents engage in yelling at, hitting, or simply ignoring the behavior of their child. D) The parents make reasonable curfews that are appropriate for the age of the client. E) The parents establish household responsibilities that are appropriate for the age of the client.

A) The parents may not behave appropriately themselves because of a lack of knowledge. B) The parents blame the school when the child causes a disturbance in school and receives detention. C) The parents engage in yelling at, hitting, or simply ignoring the behavior of their child.

Which may be concerns that a nurse has when caring for clients who have conduct disorders? Select all that apply. A)-Thinking that the client should be able to refrain from hostility and aggression through use of will power. B)-Having conflicted feelings regarding holding clients accountable for their behaviors without having a punitive attitude. C) Discussing feelings, fears, or frustrations with colleagues. D)-Having anxiety and fears for the nurse's personal safety. E) Believing that aggression is the most productive way to deal with aggression.

A) Thinking that the client should be able to refrain from hostility and aggression through use of will power. B) Having conflicted feelings regarding holding clients accountable for their behaviors without having a punitive attitude. D) Having anxiety and fears for the nurse's personal safety.

The nurse caring for an elderly woman with dementia has asked the woman's children to bring old photo albums when they visit. Which best describes the usefulness of viewing photos when caring for the dementia client? A) Viewing photos is a form of reminiscence therapy for the client. B) Sharing photos will encourage interaction with other clients. C) This can help the children to correctly identify old photographs. D) Talking about the photos will encourage the client to live in the past.

A) Viewing photos is a form of reminiscence therapy for the client.

The nurse is caring for a client with cognitive impairment. To determine whether the client is suffering from delirium or dementia, the nurse reviews the symptoms and course of each disorder. Place the letter "A" beside terms describing delirium and the letter "B" beside terms describing dementia. ____ Rapid onset ____ Progressive decline ____ Long-term memory impairment ____ Slurred speech ____ Hallucinations

A, B, B, A, A

The nurse encourages the client with dementia to meet nutritional needs. Which is the best approach to assist in meeting adequate dietary intake? A) Sit with the client as long as necessary to complete the meal. B) Provide entertainment during meals such as television or music. C) Avoid between-meal snacks to encourage appetite. D) Serve meals in small, bite-size pieces.

D) Serve meals in small, bite-size pieces.

The nurse has been working with the family of a small child with oppositional defiant disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best nursing action at this time? A) Review effective disciplinary practices with the parents again. B) Refer the parents to a family therapist. C) Try to remember that the parents are trying to the best of their ability to carry out the suggestions. D) Explore alternative living arrangements for the child.

C) Try to remember that the parents are trying to the best of their ability to carry out the suggestions.

A 14-year-old girl is being treated for conduct disorder. She refuses to attend class today, stating that yesterday the other nurse told her she did not have to go to class if she did not want to. Which would be the best response by the nurse? A) "Fine, but you're confined to your room." B) "Missing class is against the rules." C) "You and I both know you're lying." D) "Why do you keep fighting the system?"

B) "Missing class is against the rules."

Which client would have an increased risk for delirium? A) An elderly woman with abdominal pain B) A 3-year-old child with a temperature of 103.2∞F C) A middle-aged woman newly diagnosed with multiple sclerosis D) A young adult male with gastroenteritis and dehydration

B) A 3-year-old child with a temperature of 103.2∞F

The nurse is developing interventions to promote socialization in a client with moderate dementia. Which would provide a safe and secure environment for the client? A) A card game with other clients B) An activity with the nurse C) Decorating a bulletin board with the group D) Morning stretch group with music

B) An activity with the nurse

The adult son of a client with dementia asks the nurse how he should respond when his mother repeatedly says she has had a busy day at work. The mother has not worked in over 20 years. Which is the best guidance that the nurse could offer? A) Ask her to explain what she did at work today that kept her busy. B) Go along with her thought of it having been a busy day, but do not refer to her work. C) Reorient her that she is at home and did not go to work. D) Give her 5 to 10 minutes of rest, and she will have no memory of the incident.

B) Go along with her thought of it having been a busy day, but do not refer to her work.

Which is the most effective intervention for clients with delirium? A) Giving detailed explanations B) Managing environmental stimuli C) Promoting rest with PRN medications D) Providing activities for distraction

B) Managing environmental stimuli

Which is the most commonly used treatment for oppositional defiant disorder? A) Pharmacologic treatment B) Parent training models of behavioral interventions C) Individual therapy D) Boot camp

B) Parent training models of behavioral interventions

Which disorder is exemplified by vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity? A) Intermittent explosive disorder B) Mild conduct disorder C) Oppositional defiance Disorder D) Moderate conduct disorder

D) Moderate conduct disorder

Which are important points for the nurse to consider when working with clients with disruptive behavior disorders and their families? Select all that apply. A) Most behavior disorders are caused by being raised by parents who had behavior disorders in their own childhoods. B) Remember to focus on the client's strengths and assets, as well as their problems. C) Transient conduct disorders are common in all children. D) Avoid a "blaming" attitude toward clients and/or families. E) Focus on positive actions to improve situations and/or behaviors.

B) Remember to focus on the client's strengths and assets, as well as their problems. D) Avoid a "blaming" attitude toward clients and/or families. E) Focus on positive actions to improve situations and/or behaviors

The nurse understands that when working with a child with a disruptive behavior disorder, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child? A) Support transferring the child to a healthy living environment. B) Teach the parents age-appropriate expectations of the child. C) Reinforce the parents' expectations of the child's behavior. D) Interpret the child's thoughts and feelings to the parent.

B) Teach the parents age-appropriate expectations of the child.

A nurse working in an assisted living facility is holding an in-service for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest? A) The clients should be able to ask us for items they need. B) The clients may not recognize their family when they come to visit. C) The clients who are ambulatory can still carry out activities of daily living independently. D) The clients should know when to come to the dining room for meals.

B) The clients may not recognize their family when they come to visit.

A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, "I feel like all my work doesn't do them any good." Which should the nurse's supervisor encourage the nurse to do? A) Cease giving instructions because the clients will not remember them anyway. B) Try to stay supportive and meet the clients' needs at the current moment. C) Seek counseling if personal feelings get in the way of client care. D) Consider transferring to a different client care specialty area.

B) Try to stay supportive and meet the clients' needs at the current moment.

A client with moderate Alzheimer's disease is living with her grown daughter. Which statement by the daughter would indicate the need for intervention by the nurse? A) "It's distressing when my mother forgets my name." B) "I wish my sister would come to visit more often." C) "Mother won't let anyone else do anything for her." D) "Taking care of my mother is a big responsibility."

C) "Mother won't let anyone else do anything for her."

The daughter of a woman with dementia asks the nurse if her mother will ever be able to live independently again. Which would be the most appropriate response by the nurse? A) "You sound like you aren't ready for her to be dependent on caregivers." B) "Her confusion is a temporary complication of her physical illness and should subside when the illness gets better." C) "Symptoms of dementia gradually get worse. Unfortunately she will not be independent again." D) "With early treatment, mild dementia can be reversed. It may be possible."

C) "Symptoms of dementia gradually get worse. Unfortunately she will not be independent again."

A client with conduct disorder starts yelling at another client and calling the client insulting names. Which is the most appropriate response by the nurse? A) "How would you feel if someone yelled at you like that?" B) "What's the matter with you? Don't you know any better?" C) "Yelling at others is unacceptable. You need to let staff know you're upset." D) "You're still having problems controlling your anger."

C) "Yelling at others is unacceptable. You need to let staff know you're upset."

The nurse is working with a client who has hallucinations and delusions. The client tells the nurse she cannot take a shower because she is waiting for her husband to take her home. Which response by the nurse is best in this situation? A) "It would be best if you just took your shower now." B) "You seem anxious and upset." C) "You have plenty of time to shower before it's time to go home." D) "Why are you thinking you're going home?"

C) "You have plenty of time to shower before it's time to go home."

Which distinguishes delirium from dementia? A) Delirium has an acute onset and is progressive in course. B) Delirium has a gradual onset and can be resolved. C) Dementia has a gradual onset and is progressive in course. D) Dementia has an acute onset and can be resolved.

C) Dementia has a gradual onset and is progressive in course.

The nurse is encouraging a group of clients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation? A) Show an instructional video just prior to the activity. B) Describe the exercise immediately before performing it. C) Demonstrate the exercises while clients simultaneously perform them. D) Perform the same routine daily to avoid the need for repeated instruction.

C) Demonstrate the exercises while clients simultaneously perform them.

Which is an effective way for parents to deal with problem behaviors in children and to prevent later development of conduct disorders? A) Administering medications B) Avoiding setting limits C) Group-based parenting classes D) Being overprotective of the child

C) Group-based parenting classes

The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. Which will be accomplished by this intervention? A) Decrease environmental misinterpretation B) Improve memory retention C) Increase frustration D) Slow the progress of the disease

C) Increase frustration

The nurse is assessing a client with early signs of dementia. What is the nurse trying to determine when the nurse asks the client what he ate for breakfast that morning? A) Orientation B) Food preferences C) Recent memory D) Remote memory

C) Recent memory

When presenting information about conduct disorders to a community group, the nurse is asked, "which is the best setting for care of a client with conduct disorders when parents cannot provide safe, structured environments and adequate supervision for the client?" Which would be the most appropriate reply by the nurse? A) The acute care setting B) School C) Residential treatment settings D) Jail-diversion program

C) Residential treatment settings

A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which of the following best explains the nurse's behavior? A) The nurse was unsure of how to calm the client. B) The nurse was frustrated and needed to take a "time-out." C) The nurse gave the client a chance to calm down before resuming the meal. D) The nurse stepped away to verify the safety of other clients.

C) The nurse gave the client a chance to calm down before resuming the meal.

Which is the most important reason for the nurse who cares for children with conduct disorders to discuss feelings, fears, or frustrations with colleagues? A) To make the nurse feel better and avoid burnout. B) To encourage camaraderie between colleagues. C) To keep negative emotions from interfering with the ability to provide care to clients with problems with aggression. D) To ensure that all caregivers have the same attitudes and beliefs about children with conduct disorders.

C) To keep negative emotions from interfering with the ability to provide care to clients with problems with aggression.

The daughter of a client with dementia has been the primary caregiver for 5 months. The daughter expresses to the nurse, "At times it is so overwhelming! I feel I do not have a life anymore!" Which is the most helpful response by the nurse? A) "Are you saying you don't want to care for your mother anymore?" B) "I know it is really hard. It takes a lot of work and you are doing such a good job." C) "Your mother really appreciates what you do for her. You are the best one to care for her." D) "Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?"

D) "Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?"

Which statement made by the nurse would be most appropriate to an 89-year-old patient who is confused but has no history of dementia and is hospitalized for an acute urinary tract infection? A) "You are likely to become progressively more confused now." B) "This should be just a temporary situation." C) "Don't worry about it; everyone is confused when they are in the hospital." D) "I know things are upsetting and confusing right now, but your confusion should clear as you get better."

D) "I know things are upsetting and confusing right now, but your confusion should clear as you get better."

Which statement by the nurse would be most appropriate to the family member who is the primary caregiver to a client with dementia? A) "Most people seek help when they really need it." B) "What is wrong with your family? Can't they see you need help?" C) "You should be grateful that you still have your family member around." D) "Yes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role."

D) "Yes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role."

A child is expelled from school for repeated fighting and vandalizing school property. The school nurse and counselor meet with the parents to explain that the child may benefit from counseling as the child is experiencing signs of which disorder? A) Oppositional defiant disorder B) Asperger's syndrome C) Attention deficit hyperactivity disorder D) Conduct disorder

D) Conduct disorder

A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client approaches the nurse and states, "I'm going to take walk outside. I'll be back in about 10 minutes." Which is the most appropriate nursing action? A) Further assess the client's motives for wanting to walk. B) Give the client permission to go on a walk on the grounds. C) Tell the client the walk is not allowed and restrict him to the unit. D) Designate a staff member to accompany the client on the walk.

D) Designate a staff member to accompany the client on the walk.

During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium? A) Unable to identify a water pitcher B) Unable to transfer to sitting position C) Difficulty with verbal expression D) Disoriented to person

D) Disoriented to person

Which is likely to be most effective for adolescents with conduct disorder? A) Involvement with the legal system B) Focusing on the parenting education C) Incarceration D) Early intervention

D) Early intervention