Evolve ch 18, 19, 21, 24, 28, 30, 35

___________ disorder is one of the most frequently diagnosed disorders in children and adolescents and is a problem in the adult population as well, with adults experiencing the same type of symptoms. It is characterized by disregard of the rights of others and disdain for societal rules.

conduct

While on an inpatient unit, you are caring for newly admitted Alyssa, a 16 year old diagnosed with anorexia nervosa. Number the following nursing interventions in order of priority: a. initiate a therapeutic relationship b. promote caloric consumption c. assess for suicidal ideation d. review accomplishments made during treatment e. explore feelings of underlying anxiety and low self-esteem

1. a 2. c 3. b 4. e 5. d

Brittany is caring for a patient with bulimia. She recognizes which of the following nursing interventions as being most appropriate? a. monitor the patient on bathroom trips after eating b. allow the patient extensive private time with family members c. provide meals whenever the patient requests them d. encourage the patient to select foods that she likes

A

Shelly is having menstrual problems and asks you which supplement might be helpful to her. Which supplement should you suggest for the patient to discuss with her primary care provider? a. black cohosh b. St. John's wort c. Kava d. ginkgo biloba

A

You are caring for Gabby, a 12 year old patient diagnosed with oppositional defiant disorder. Gabby's mother asks you what type of medication is usually prescribed for this diagnosis. Your answer is based on the knowledge that: a. treatment of this disorder does not usually involve any specific medication but focuses on adaptive coping mechanisms b. interventions for this disorder usually include treatment with mood stabilizers or "off-label" uses of other classifications of medications c. a care plan may include medication, but the patient will outgrow the behavioral problems without any specific treatment d. psychiatric medications have not been proven to work in the child and adolescent population

A

The nurse is planning care for a patient with a binge eating disorder. What outcomes are appropriate? Select all that apply. a. the patient will identify stressors that lead to binge eating b. the patient will identify stressors that lead to binge eating c. the patient will increase dietary intake d. the patient will experience satisfaction in eating alone

A, B

Alicia, a 31 year old patient , is flirting with a peer. She is overheard asking him to convince staff to give her privileges to leave the inpatient mental health unit. Later she offers you a backrub in exchange for receiving her 10:00 pm Xanax an hour early. Which response(s) to such behaviors would be most therapeutic? Select all that apply. a. Label the behavior as undesirable, and explore with Alicia more effective ways to meet her needs b. by role playing, demonstrate other approaches Alicia could use to meet her needs c. advise the other patients that Aliciaa is being manipulative and that they should ignore her when she behaves this way d. bargain with Alicia to determine a reasonable compromise regarding how much of such behavior is acceptable before she crosses the line e. explain that such behavior is unacceptable, and give Alicia specific examples of consequences that will be enacted if the behavior continues f. ignore the behavior for the time being so Alicia will find it rewarding and in turn seek other, and hopefully more adaptive, ways to meet her needs

A, B ,E

Which nursing question(s) should be included in a holistic assessment ? Select all that apply. a. "Are you taking any herbal supplements or other natural remedies?" b. "Have you undergone any surgeries in the past?" c. "What gives you a sense of meaning and purpose in life?" d. "What methods do you use to cope with stress?" e. "Do you feel safe in your relationships? f. "Do you have regular physical exams?"

A, B, C, D, E, F

Perpetrators of domestic violence tend to: Select all that apply. a. have relatively poor social skills and to have grown up with poor role models b. believe they, if male, should be dominant and in charge in relationships c. force their mates to work and expect them to handle financial decisions d. be controlling and willing to use force to maintain their power in relationships e. prevent their mates from having relationships and activities outside the family

A, B, D, E

A patient becomes frustrated and angry when trying to get his MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which intervention(s) would be the most therapeutic? Select all that apply. a. place the patient in seclusion for 1 hour to allow him to deescalate b. tell the patient that any further outbursts will result in a loss of privileges c. offer to help the patient learn how to operate his music player and headset d. explore with the patient how he was feeling as he worked with the music player e. point out the consequences of such behavior and note that it cannot be tolerated f. limit the patients exposure to frustrating experiences until he attains improved coping skills g. encourage the patient to recognize signs of mounting tension and seek assistance

A, D, E, G

An appropriate expected outcome in family therapy regarding the perpetrator of abuse would be: a. a decrease in family interaction so that there are fewer opportunities for abuse to occur b. the perpetrator will recognize destructive patterns of behavior and learn alternate responses c. the perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy d. a triad of treatment modalities, including medication, counseling, and role playing opportunities

B

Caitlin is being seen in the outpatient clinic for medication follow up. She tells you that she is taking St. John's wort to help her symptoms of depression. Your response to make sure to let her primary care provider know is guided by what knowledge? a. many providers do not believe in herbal supplements b. taking St. John's wort along with an SSRI may cause serotonin syndrome c. the patient needs to increase her assertiveness with her provider d. St. John's wort has not been shown to treat depressive symptoms effectively

B

Ed, a registered nurse, is planning care for a patient with primary insomnia. What is an appropriate outcome? a. the patient will sleep 12 hours nightly b. the patient will go to sleep and wake up at consistent times c. the patient will take one nap daily to restore energy d. the patient will drink a warm cup of tea before bedtime

B

Joshua, a 17 year old outpatient, has been diagnosed with intermittent explosive disorder. As you care for Joshua, you anticipate that the psychiatric care provider may prescribe which of the following? a. a benzodiazepine b. an anticonvulsant c. a psychostimulant d. an anticholinesterase inhibitor

B

Josie, a 27 year old patient, complains that most of the staff do not like her or care what happens to her, but you are special and she can tell that you are a caring person. She talks with you about being unsure of what she wants to do with her life and her "mixed-up feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it "makes the numbness stop." Given this presentation, which personality disorder would you suspect? a. obsessive-compulsive b. borderline c. antisocial d. schizotypal

B

Marco, age 83, has dementia and has difficulty feeding himself despite the fact that there is nothing wrong with his motor functions. Which term should the nurse use to document this finding? a. aphasia b. apraxia c. agnosia d. disinhibition anergia

B

Which statement about persons with personality disorders is accurate? a. they, unlike those with mood or psychotic disorders, are at very low risk of suicide b. they tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them c. they are believed to be purely psychological disorders, that is, disorders arising from psychological rather than neurological or other physiological abnormalities d. their symptoms are not as disabling as most other mental disorders; therefore, their care tends to be less challenging and complicated for staff

B

You are caring for Miguel, age 76, who is experiencing delirium. Which nursing response is appropriate when the patient's daughter asks, "Will he ever stop acting like this?" a. "I'm sorry. I know this is hard for you, but your father will most likely be this way from now on." b. "Once we know the underlying medical cause of the delirium, we can begin treatment to attempt to reverse the process." c. "Delirium is caused by infections and electrolyte imbalances, and the damage is permanent." d. "A benzodiazepine will help alleviate the delirium."

B

Nathan, a nursing student, is assigned to care for Shawna, who is recovering from injuries received during an episode of domestic violence, the third such assault for which he has received treatment. Nathan left home at age 17 to escape and abusive father. Which statements about Nathan's situation are accurate? Select all that apply. a. he may be prone to blame the patient for her injuries and abuse b. his personal experiences give him special insight into the needs of this patient c. his experiences are likely to make him more empathetic towards victims. d. caring for victims of abuse will help him cope with his own abuse experiences e. he may experience overwhelming emotions as a result of caring for abuse victims f. he would likely benefit from clinical supervision related to caring for abuse victims

B, C, E, F

Which of the following are true regarding feeding disorders in children? Select all that apply. a. feeding disorders usually reflect poor parenting b. feeding disorders are often manifested in children with developmental delays c. feeding disorders are most often treated with a punishment system d. in many cases, toddler mealtime difficulties spontaneously resolve with no intervention e. behavior modification has been found to be effective in treating feeding disorders

B, D, E

Blake is a 15 year old patient admitted for emergency observation after stealing a care and being pulled over by the police for reckless driving. He also has a history of pyromania. Which of the following is the priority assessment? a. illegal behaviors in the past 6 months b. assessment of childhood development and family interactions c. suicide risk d. feelings of remorse

C

Madelyn, a 29 year old patient recently diagnosed with depression, comes to the mental health clinic complaining of continued difficulty sleeping. One week ago, she was started on a SSRI, fluoxetine, for her depressive symptoms. When educating Madelyn, your response is guided by the knowledge that: a. SSRIs such as fluoxetine more commonly cause hypersomnolence as opposed to difficulty sleeping b. the sleep problem is caused by the depression and is unrelated to the medication c. the neurotransmitters involved in sleep and wakefulness are the same neurotransmitters targeted by many psychiatric medications and the problem may be temporary d. the medication should be discontinued because sleep is the most important element to her recovery

C

The nurse is admitting a patient who weighs 100 pounds, is 66 inches tall, and is below ideal body weight. The patient's blood pressure is 130/80 mmHg, pulse is 72 beats per minute, potassium is 2.5 mmol/L, and ECG is abnormal. Her teeth enamel is eroded, her hands are shaking, and her parotid gland is enlarged. The patient states, "I am really nervous about coming to this unit." What is the priority nursing diagnosis? a. powerlessness b. risk for injury c. imbalanced nutrition: less than body requirements d. anxiety

C

Which patient behavior would alert the nurse to a circadian rhythm sleep disorder? a. excessive sleepiness for at least 1 month, accompanied by prolonged sleep episodes b. multiple episodes of brief daytime sleeping followed by disturbed nighttime sleep c. persistent patterns of sleep disruption after traveling for business d. repeated episodes of upper airway collapse and obstruction that results in sleep fragmentation

C

You are assessing Lindy, a 25 year old woman who came to the emergency department with a broken arm. She states she slipped on the ice on the steps outside her home. She has numerous other bruises in different stages of healing. Her boyfriend, with whom she lives, accompanied her to the emergency department and aggressively responds to questions posed to the patient, while the patient remains silent. What is your best response to the boyfriend? a. "It sounds as if you are a lot about Lindy. She is lucky to have such support." b. "By answering the questions for her, it should as if you don't want her to answer. What are you afraid of?" c. " I now need to examine Lindy in private. Please wait outside the room. I will come get you when we are finished." d. "I am calling security to have you escorted out because you are being obnoxious."

C

You are caring for Ellie, age 91, whose provider has written a "DNR-CCO" order. Which nursing action would be appropriate if Ellie were to go into cardiac arrest? a. immediately call for the code team b. prepare for intubation by physician c. administer prescribed medication morphine for pain control d. initiate cardiopulmonary resuscitation

C

You are caring for Georgia, who questions you about the safety of an herbal supplement. Which nursing response is true? a. "Herbal supplements are regulated by the FDA." b. Natural ingredients in herbal supplements are harmless." c. "Your primary care provider needs to be aware of any supplements you take." d. "Marketing for herbal supplements demonstrates that all supplements are safe."

C

A patient states that he only needs 6 hours of sleep per night to feel rested. How should the nurse interpret this statement? a. the patient is not sleeping enough b. the patient is sleeping too much c. the patient is not getting enough REM sleep d. the patient is sleeping according to his own body's needs

D

Carlton, age 85, is brought to the clinic by his daughter. She states that Carlton's wife and brother both recently passed away. He has been sad and crying frequently, not attending to hygiene, eating less, and sleeping much of the day. Your nursing assessment and intervention are guided by the knowledge that: a. loss and depression are an expected part of the aging process, needing no specific intervention b. older male patients are more likely to be resilient and able to recover from life events c. ECT is the first-line treatment for those in this age with depression d. older male patients have the highest rate of suicide

D

Lacey, a 19 year old patient, shows you multiple fresh, serious (but not life threatening) self inflicted cuts on her forearm. Which response would be most therapeutic? a. "I'm so sorry you felt so bad that you cut yourself! Let's discuss what led up to this action while I take care of your wounds." b. "I will take care of the wounds first, then you will have to be searched for anything else you could injure yourself with." c. "I can give you some Band-Aids for you to put on your cuts, but you need to stop this attention-seeking behavior." d. "After I care for your wounds, I'd like you to write down what you were thinking and feeling before you cut yourself; then we will discuss it."

D

When working on an in patient adolescent mental health unit, staff may be able to maintain safety and a calm environment when they interact with patients using: a. high expressed emotion - "You must stop that immediately!" - using a stern tone b. strict rule adherence - "There are no snacks after 10 pm. No exceptions!" - using a authoritarian tone c. suppressed emotion - "Hey, let's just talk about something else that doesn't upset you!" - using a light, friendly tone d. low expressed emotion - "Please go to your room for quiet time now" - using a neutral, calm tone

D

Which of the following patients may benefit from biofeedback? The one who: a. is afraid of flying b. is about to give birth c. wants to quit smoking d. wants to relax and promote well being

D

You are caring for Maggie, a 78 year old with Alzheimer's disease and Stage III breast cancer who can no longer communicate verbally. What is the appropriate way to assess Maggie's pain? a. the Wong-Baker FACES Pain Rating Scale b. the McGill Pain Questionnaire c. direct questioning with the use of a Likert 1-10 pain rating scale d. the Pain Assessment in Advanced Dementia Scale

D

You are discharging Vanessa, a 30 year old victim of domestic violence, from the emergency department. She has sustained bruises and abrasions but no serious trauma. She is fearful that Children's Services will take custody of her daughter. Her daughter has not been harmed and is safe with Vanessa's mother. Which intervention on your pard is indicated? a. report the assault to the police, because reporting of domestic violence is mandatory b. probe Vanessa for information to use as evidence in prosecuting the perpetrator c. advise Vanessa to leave her abusive partner and move in with her mother d. assist Vanessa to develop a safety plan to rapid escape should abuse happen again

D

You are providing teaching for a patient who has been taking a hypnotic medication to sleep. What education is appropriate? a. "You can use this medication for as long as you would like." b. "It would be better to take an OTC medication instead." c. "Melatonin has been shown to be just as effective as hypnotic medications." d. "Be certain to follow up with your care provider regularly while you take this medication."

D