MH Exam 3 Textbook Questions

1. While entering the building, an elementary school nurse observes a person in the distance emerging from a forest and approaching the school. The person is dressed in black from head to toe, wearing a backpack and carrying a long, narrow, dark object. Which action should the nurse take first? a. Move to a secure location b. Observe the intruder's features c. Take note of the intruder's location d. Activate the school code for an intruder

1. Answer - a. Page 325 (Figure 20-1). This scenario presents a potential adventitious crisis in phase one. The nurse must first consider safety. After moving to a secure location, the nurse can activate the school's code for an intruder and describe the intruder to law enforcement.

1. Sixteen years ago a toddler died in a tragic accident. Once a year, the parents place flowers at the accident site. How would the nurse characterize the parents' behavior? a. Mourning b. Bereavement c. Complicated grief d. Disenfranchised grief

1. Answer - a. Page 390. Mourning refers to all of the ways in which a person outwardly expresses grief and the efforts taken to manage grief. It does not have a designated time frame and may continue for many years. A once-a-year ritual is an adaptive coping technique to recognize the parents' loss.

1. An emergency department nurse assesses a woman suspected of being abused by an intimate partner. Which assessment finding most clearly confirms the suspicion? a. Leathery facial tone b. Injuries in a bikini pattern c. Reluctance to be examined d. Lack of eye contact with the nurse

1. Answer - b. Page 325 (Box 21-1). The majority of the victims of reported intimate partner violence are women. Intimate partner violence is the number one cause of emergency department visits by women. Patterns of damage are often in locations that cannot be noticed easily, such as the torso, back, upper arms, upper legs, inside body orifices, and under the hair.

1. A parent tells the nurse about the death of a child 2 years ago. Which comment by this parent warrants the nurse's priority attention? a. "I still have some of my child's toys and clothes." b. "A parent should never live longer than their child." c. "I never returned to church again after the death of my child." d. "My child has been dead a long time, but it seems like only yesterday."

1. Answer - b. Page 366. The correct response represents a covert message and suggests possible suicidal thinking by the parent. The nurse should further assess the meaning of the comment.

1. While interacting with a 62-year-old adult diagnosed with a progressive neurocognitive disorder, the nurse observes that the adult has slow responses and difficulty finding the right words. What is the nurse's best initial action? a. Suggest words that the adult may be trying to remember. b. Ask the adult, "Are you having problems saying what you mean?" c. Use silence to allow the adult an opportunity to compose responses. d. Discontinue the interaction to prevent further frustration for the adult.

1. Answer - c. Page 291. Silence is a therapeutic communication technique. It is respectful and provides an opportunity for the adult to compose responses.

1. An elderly widow tells the nurse, "Since my sister-in-law's death, her husband has been making advances at me. He tried to come in my home with a bottle of wine. Even though he's family, I'm afraid of what might happen if I let him in." Which action should the nurse take first? a. Support the widow to clarify her thoughts and feelings about the situation. b. Explain to the widow how to obtain an order of protection (restraining order). c. Positively reinforce the widow for addressing the problem with a caring professional. d. Educate the widow about sexual assault and violence, including the importance of prevention.

1. Answer - c. Pages 350, 353. The scenario presents the risk for sexual assault. Many people are sensitive about sexual matters, so the nurse should first give recognition to the widow for her willingness to share the problem. The most common drug used to facilitate the crime of rape is alcohol. Sexual violence occurs across all ages to men, women, and children. Cultural and societal factors play a part in forming attitudes about sexual violence.

1. Select the completion of this sentence that demonstrates an adult is coping in a healthy way: "I am feeling so angry right now... a. I'm afraid I'm going to cry." b. I would like to punch something." c. I want to talk to someone about it." d. I want to curl up and sleep for a long time."

1. Answer - c. Pages 375, 384. Talking about one's feelings is healthier than violence or avoidance.

1. A young adult has heavily abused alcohol and prescription drugs since mid-adolescence. This individual now has an ataxic gait and uses a cane. Which comment by the nurse presents reality while demonstrating compassion? a. "I know you must feel self-conscious about using a cane at your age, but it will help prevent falls." b. "Addiction is a fatal disease. If you continue to drink like you have done in past, you will not live another 10 years." c. "It's time to face your addiction. You are disappointing your family and must stop drinking for the sake of the people who love you." d. "Addiction is powerful. You are young yet cannot walk without a cane. If you don't make changes, your health will continue to suffer."

1. Answer - d. Pages 296, 300, 305, 310, 312. The correct response recognizes the power of addiction but presents the reality of the consequences of continued use.

2. An emergency department nurse talks with a newly admitted victim of reported rape. Which communication should the nurse offer to comfort this patient? a. "You are safe now. I will stay with you in this private room." b. "Would you like your friend to stay with you during your examination?" c. "You made a good decision to come to the hospital after you were raped." d. "What questions do you have about your examination by the sexual assault nurse examiner?"

2. Answer - a. Page 354. A sexual assault victim who arrives at the emergency department needs compassionate, supportive care and should not be left alone.

2. An emergency department nurse assesses a child with a fractured ulna. The nurse also observes yellow and purple bruises across the child's back and shoulders. Which comment by the parents should prompt the nurse to consider making a report to Child Protective Services? a. "We do not believe in immunization of our children." b. "This child is always creating problems for the family." c. "Our child would rather play alone than with other children." d. "We homeschool our children in order to include religious education."

2. Answer - b. Page 344 (Box 21-3). The acute injury, coupled with bruises of different ages, suggest that the child may be abused. Abusive parents may perceive the child as bad or evil or project blame. The nurse is required to report suspicions of abuse to child protective services.

2. A patient diagnosed with major depressive disorder was hospitalized for 2 weeks on an acute psychiatric unit. One day after discharge, the patient completed suicide. Recognizing likely reactions among staff, which action should the nursing supervisor implement first? a. Assess each staff member individually for suicidal intent and/or plans. b. Provide a private setting for staff members to talk about feelings associated with the event. c. Remind staff members that suicide is a risk for the patient population and they are not at fault. d. Invite a guest speaker to conduct an educational session for staff members about suicide risk factors.

2. Answer - b. Page 365 (Box 23-1). All health care members who provided care for a suicide victim, including medical staff, nursing staff, and ancillary staff, are at risk for being traumatized by suicide. Staff also may experience symptoms of posttraumatic stress disorder with guilt, shock, anger, shame, and decreased self-esteem. To reduce the trauma associated with the sudden loss, posttrauma loss debriefing can help to initiate an adaptive grief process and prevent self-defeating behaviors.

2. The nurse at a local medical clinic reviews phoned-in requests from patients for prescription refills. As the nurse confers with the health care provider about which prescription refill requests should be authorized, which refill request should be considered first? a. Codeine 10 mg PO q4h PRN for an adult with a persistent cough b. Hydroxyzine (Vistaril) 25 mg PO TID PRN for an adult who experiences uncomfortable muscle spasms c. Lorazepam (Ativan) 1 mg PO BID for an adult who has taken it daily for 3 years for episodes of anxiety d. Paregoric (camphorated tincture of opium) 2 mg PO q6h PRN for an adult experiencing severe diarrhea

2. Answer - c. Page 301 (Table 19-2). Lorazepam is a benzodiazepine. Sudden withdrawal from this class of medications has medical complications, including the possibility of death; hence this refill request has priority.

2. An adult has had long-term serious medical problems resulting in decreased libido and sexual performance. The adult's spouse privately says to the nurse, "I don't feel loved anymore. I feel sexual urges but my partner is not interested." Select the nurse's therapeutic response. a. "Tell me about how your partner shows love for you." b. "You're describing a scenario that many couples face." c. "Let's consider some other ways you can satisfy your needs." d. "I'm glad you are able to talk about and accept your situation."

2. Answer - c. Page 326. The scenario presents a maturational crisis. Helping the spouse to consider other options is the nurse's most therapeutic action.

2. In a hostile voice, a patient experiencing mania yells at the nurse: "You WILL listen to me and not interrupt. I have some really important stuff to say. I'm tired of you nurses and doctors acting like you have all the answers." To facilitate effective communication, which initial response should the nurse provide? a. "You are our patient, so we always listen to you." b. "I can talk with you better if you use a calm voice." c. "It's our job to help you get through this manic episode." d. "Patients have an important role in treatment planning."

2. Answer - c. Pages 375, 379. The patient's behavior is aggressive. Aggressive behaviors reflect rage, hostility, and potential for physical assault or verbal destructiveness and can be directed at others or oneself. Aggression is a hostile reaction that occurs when control over anger is lost. It is used in an attempt to regain control over the stressor or flee the situation. By suggesting an appropriate behavior, the nurse offers an opportunity for the patient to regain control.

2. An adult diagnosed with stage 2 Alzheimer's disease begins a new prescription for rivastigmine (Exelon). Which nursing diagnosis has the highest priority to add to the plan of care? a. Risk for constipation b. Risk for altered sensory perception c. Risk for impaired oral mucous membranes d. Risk for imbalanced nutrition, less than body requirements

2. Answer - d. Page 290. Side effects of rivastigmine (Exelon) include nausea, vomiting, diarrhea, weight loss, loss of appetite, and muscle weakness.

2. A recently widowed adult says, "I've been calling my neighbors often but they act like they don't want to talk to me. I just need to talk about it, you know?" What is the nurse's best action? a. Say to the person, "You may call me anytime you need to talk." b. Ask the person, "What do you mean by 'I just need to talk about it'?" c. Educate the person about the importance of finding alternative activities. d. Tell the person the location and time of a local bereavement support group.

2. Answer - d. Page 397 (Table 25-3). This person is mourning. A grief or bereavement support group is indicated and can provide comfort.

3. Which newly hospitalized patient should the nurse monitor closely for development of delirium? a. 48-year-old who usually drinks a six-pack of beer daily b. 68-year-old who takes aspirin 650 mg twice daily for arthritic pain c. 72-year-old who says, "I have a glass of wine every evening to stimulate my appetite." d. 78-year-old diabetic whose blood glucose levels are consistently greater than 250 mg/dL

3. Answer - a. Page 274 (Box 18-1). Withdrawal from alcohol, anxiolytics, opioids, and central nervous system stimulants presents a significant risk for development of delirium. The correct response identifies a patient who is likely to have tolerance to alcohol and is thus at risk for alcohol withdrawal delirium.

3. A patient tells the nurse, "I was raped 8 years ago but never told anyone. Nevertheless, the memories haunt me every day. I should be over it by now." Which comment should the nurse offer next? a. "It sounds like you're judging yourself for continuing to struggle with your reaction." b. "Rape is criminal behavior. You should have reported the incident to law enforcement." c. "Are you now ready to engage in counseling to deal with your reactions to this experience?" d. "While it's important to learn from such life events, it's more important to put things in the past."

3. Answer - a. Pages 354-355. The correct response demonstrates use of reflection, a therapeutic communication technique. Consequences of rape can cause serious, long-term psychological trauma. Rape-trauma syndrome is a common sequela. Later in this interaction, the nurse should encourage the patient to consider professional counseling.

3. On the sixth anniversary of her spouse's death a widow says, "Sometimes life does not seem worth living anymore. I wish I could go to sleep and never wake up." Which response by the nurse has priority? a. "Are you considering suicide?" b. "You still have so much to live for." c. "Grief can sometimes last for many years." d. "Why do you continue to grieve something from long ago?"

3. Answer - a. Pages 362-363. The nurse should always take an individual very seriously if he or she mentions some form of suicidal ideation and ask directly about suicide.

3. A physician informed an adult of the results of diagnostic tests that showed lung cancer. Later in the day the patient says to the nurse, "My doctor said I have breathing problems, right?" Which nursing diagnosis is applicable? a. Denial related to acceptance of new diagnosis b. Chronic sorrow related to unresolved life conflicts c. Situational low self-esteem related to stress of new diagnosis d. Acute confusion related to metastatic changes to cerebral function

3. Answer - a. Pages 390-391. While emotional responses to grief vary from one individual to the next, a common first response is 474that of denial. The person is emotionally unable to accept his or her painful loss. Denial functions as a buffer against intolerable pain and allows the person to acknowledge the reality of a loss slowly.

3. A patient tells the nurse, "After many years, I finally quit smoking. Now I use e-cigarettes only." Which response should the nurse provide? a. "Using e-cigarettes is now more socially acceptable than using traditional cigarettes." b. "Congratulations on quitting, but e-cigarettes contain nicotine and other hazardous chemicals." c. "Nicotine is a powerful addiction. Quitting smoking is a big step toward adopting a healthier lifestyle." d. "I am glad you have quit smoking. Your loved ones will no longer be exposed to the hazards of secondhand smoke."

3. Answer - b. Page 297. The nurse should educate the patient. E-cigarettes are advertised as safe; however, they contain nicotine as well as other hazardous chemicals.

3. The nurse in a high school meets with small groups of students the day after a school bus accident resulted in the death of five students. Which comment should the nurse use to begin the session? a. "Sometimes life is not fair. Yesterday's tragedy is an example of just how unfair it can be." b. "We're grateful that you are safe. Our discussion is to talk about feelings associated with yesterday's tragedy." c. "We've had a terrible loss. I also feel your pain. You need to talk about your feelings associated with the event." d. "Thank you for coming today. As school leaders, we know it is very important to respond to yesterday's tragedy."

3. Answer - b. Page 327. In phase 1 of a crisis, a person faces a conflict or problem that threatens the self-concept and responds with increased feelings of anxiety. The nurse should first assure students that they are safe and then specify the reason for the session.

3. A woman in a relationship characterized by a long history of battering and abuse tells the nurse, "We've had a rough time lately. I admit it: He beat me last night but then said he was sorry." Which event would the nurse expect to occur next in this relationship? a. Another beating by the abusive partner b. Love, gifts, and praise from the abusive partner c. A brief period during which the partners ignore each other d. The abusive partner leaves the relationship for a short time

3. Answer - b. Page 340 (Figure 21-1). The cycle of violence consists of three phases: (1) tension-building phase, (2) acute battering phase, and (3) honeymoon phase. The question scenario shows acute battering, so a period of loving calm is likely to follow.

3. A female nurse is appointed to a committee with seven men. At the beginning of the meeting, the chairman asks the nurse to be the secretary. The nurse responds, "No. You're just asking me to be secretary because I'm the only the woman here." Which response would have been more effective? a. "There are others more qualified than I am to be secretary." b. "I would be glad to perform another role for our committee." c. "I'm probably overreacting, but I find your request offensive." d. "Thank you for asking, but your request is sexually discriminatory."

3. Answer - b. Pages 375, 379. In the original response, the nurse personalized the request and responded in an aggressive manner. The correct answer demonstrates an assertive response, which would have been more effective.

4. A patient who had a stroke 3 days ago tearfully tells the nurse, "What's the use in living? I'm no good to anybody like this." Which action should the nurse employ first when caring for a patient demonstrating hopelessness? a. Implement the institutional protocol for suicide risk. b. Support the patient to clarify and express feelings of grief. c. Educate the patient about the success of stroke rehabilitation. d. Offer the patient an opportunity to confer with the pastoral counselor.

4. Answer - a. Page 369 (Table 23-1). The patient's comment suggests hopelessness, helplessness, and worthlessness. Physical illnesses play a role in increasing suicide risk. Suicide precautions should be initiated.

4. An 84-year-old tells the nurse, "I do four or five number puzzles every day to keep my brain healthy and sharp." When considering a holistic approach to maintaining mental health, the nurse should respond: a. "It is more important for you to have physical activity every day." b. "Let's think of some other activities we can add to your daily routine." c. "Repetition of the same activity is not helpful for keeping your brain healthy." d. "There are some herbal preparations that will also help keep your brain sharp."

4. Answer - b. Pages 282, 292. Important considerations for promoting mental health in the older adult include the need for older adults to continue to include social, intellectual, and physical activity in their routine. Older adults can continue to learn and contribute even when physiological changes occur.

4. A young adult tells the nurse, "I have a new prescription for medical marijuana. I use it several times a day for my frequent muscle spasms." What information should the nurse provide first to this patient? a. Guidance that the prescription should not be shared with peers b. Directions to weigh self once a week and maintain a log of the results c. Instructions about safety issues associated with driving or operating machinery d. Information about the potential for amotivational syndrome and memory problems

4. Answer - c. Page 297. All of the options are correct, but safety is the nurse's first concern. Marijuana is a psychoactive substance. Effects include euphoria, sedation, perceptual distortions, and hallucinations; therefore driving or operating machinery may be hazardous.

4. An emergency department nurse prepares to discharge a victim of reported rape. Which comment by the victim indicates that the nurse's teaching was effective? a. "I should bathe frequently over the next week." b. "I am required to follow up with law enforcement." c. "It's important for me to follow up with counseling." d. "I should delay any sexual activity for at least 3 months."

4. Answer - c. Pages 355-336 (Table 22-2). Prior to leaving the emergency department, the patient should have a scheduled follow-up appointment with a rape counselor or crisis counselor.

4. An 8-year-old tells a parent, "I like to scare kids at school by showing them pictures of clowns. Some kids are terrified." How should the nurse counsel the parents regarding this behavior? a. Recommend family therapy for the child, siblings, and parents. b. Suggest the parents enroll the child in an anger management program. c. Educate both parents about bullying, including possible origins and long-term effects. d. Teach the parents about the developmental phase and tasks for an 8-year-old child.

4. Answer - c. Pages 375, 379. Bullying is an intentional display and a use of violence, though it may appear mild in some instances. Bullying can be defined as an offensive, intimidating, malicious, condescending behavior designed to humiliate. The scenario identifies an instance of lateral bullying. All kinds of bullying behaviors create a toxic environment. Those who are bullied are prone to negative feelings about self, humiliation, poor self-concept, and great emotional pain, and many can suffer severe, long-term reactions. After educating the parents about bullying, the nurse should assist them in setting limits with the child.

4. A patient on an acute psychiatric unit removed the cap from the ceiling sprinkler, resulting in rapid flooding of the unit. After moving patients to a safe area, which action should the nurse take next? a. Conduct individual sessions with patients regarding the experience. b. Increase the volume of overhead music to distract patients from the event. c. Implement a psychomotor activity to reduce anxiety associated with the event. d. Lead a group session with patients to discuss feelings associated with the event.

4. Answer - d. Page 330 (Table 20-2). After addressing safety concerns, the nurse should take steps to help patients feel safe and lower anxiety, such as providing a quiet environment, building 473rapport, and acknowledging their crisis experience. A group session will allow patients who are unable to articulate their feelings to hear from patients who are able to discuss it.

4. The nurse assessed an elderly person who was abused by the caregiver. Afterward, which internal dialogue should prompt the nurse to seek guidance? a. "Sometimes I get so discouraged and frustrated with my job." b. "It's incredible that anyone could hurt a child or elderly person." c. "The abuser was probably a victim of abuse at some point in life." d. "I hope the abuser gets victimized so they know what it feels like."

4. Answer - d. Page 342. Nurses must be self-aware, particularly in highly charged situations. Wishing harm on an abuser may be understandable, but it is an indicator of the nurse's need for guidance.

4. A nurse leads a bereavement group. Which participant's comment best demonstrates that the work of grief has been successfully completed? a. "Our time together was too short. I only wish we had done more things together." b. "I know our life together was a blessing that I did not deserve. I wish I had said 'I love you' more often." c. "Other people knew my loved one as a good and helpful person. I hope people see me in the same way." d. "Our best vacations always involved water. When I see pictures of the ocean, those memories come flooding in."

4. Answer - d. Pages 390-391. The work of grief is over when the bereaved can realistically remember the pleasures and the disappointments of the relationship with the lost loved one. Brief periods of intense emotions may still occur at significant times, but the person or family members have energy to reinvest in new relationships that bring shared joys, security, satisfaction, and comfort.

5. Three weeks after being assaulted by a patient, a nurse develops headaches, insomnia, and gastrointestinal problems. The nurse has four absences from work over a 2-week period. Which action should the nursing supervisor employ? a. Refer the nurse for counseling and support. b. Ask the nurse about current personal problems. c. Direct the nurse to take paid vacation for the following week. d. Schedule the nurse for administrative tasks rather than patient care.

5. Answer - a. Page 327. Nurses need to monitor their thoughts and feelings and learn to recognize when they need self-care, support, or professional help. This is especially true in the aftermath of violence. Nurses often suppress their own feelings in order to effectively handle the immediate situation and react later with anxiety.

5. A university football coach invites the campus nurse to talk to the team about healthy relationships in the community. Which topic has priority for the nurse to include? a. Appropriate behavior with intimate partners b. University resources for counseling and support c. The importance of role modeling for children and teens d. Public recognition of children with life-threatening illnesses

5. Answer - a. Page 338. While the nurse may include any of the topics, appropriate behaviors with intimate partners has priority. Characteristics of the game of football, the physical power required to be a player, and the risk for drug or alcohol misuse among this age group are factors that increase the risk for intimate partner violence.

5. A woman experienced a double mastectomy yesterday. Now she cheerfully says to the nurse, "I didn't need those things anyway. No more wet T-shirt contests for me!" How should the nurse interpret this comment? a. The patient is realistically accepting her loss. b. The comment is sarcastic, which may reflect anger. c. The patient is experiencing a distorted body image. d. The comment suggests guilt regarding prior behavior.

5. Answer - b. Page 375. Sarcasm is a veiled form of anger.

5. A nurse who has worked for a community hospice organization for 8 years says, "My patients and their families experience overwhelming suffering. No matter how much I do, it's never enough." Which problem should the nursing supervisor suspect? a. The nurse is experiencing spiritual distress. b. The nurse is at risk for burnout and compassion fatigue. c. The nurse is not receiving adequate recognition from others. d. The nurse is at risk for overhelping, which creates dependency.

5. Answer - b. Page 395. The nurse's comment suggests a negative self-judgment. Burnout, decreased work performance, and compassion fatigue (the emotional pain or cost of working with traumatized persons) may result in stress responses for nurses.

5. A nurse teaches a patient diagnosed with an alcohol addiction about a new prescription for naltrexone (ReVia, Vivitrol). Which comment by the patient indicates the teaching was effective? a. "This medicine will stop my cravings for alcohol." b. "I should take this medication only when I feel cravings to drink alcohol." c. "This medicine is one part of a bigger treatment plan to help me stay sober." d. "I should not use products that contain alcohol, such as cough medicine and aftershave lotion."

5. Answer - c. Page 304 (Table 19-5). Naltrexone (ReVia, Vivitrol) reduces the desired pleasant feelings related to alcohol or opioid intake and helps to reduce drug cravings. It is part of a total program for maintaining sobriety.

5. A family member asks the nurse, "I know my uncle's Alzheimer's disease has progressed but is there any medication that can help him now?" Which response by the nurse is correct? a. "I'm sorry, but there are no medications that help with severe Alzheimer's disease." b. "Alzheimer's disease sometimes stabilizes. Let's hope that happens in this situation." c. "There are a few medications that may help. Let's discuss it with the health care provider." d. "It sounds like you're having difficulty accepting that your uncle's disease is irreversible. Would you like to talk about those feelings?"

5. Answer - c. Pages 281-282. Memantine (Namenda), an N-methyl-D-aspartate (NMDA) antagonist, and some cholinesterase inhibitors may be prescribed to treat symptoms of moderate to severe Alzheimer's disease.

5. A single adult says to the nurse, "Both of my parents died several years ago and my only sibling committed suicide 2 weeks ago. I feel so alone." After determining that the adult has no suicidal ideation, the nurse should: a. Explore the adult's feelings of survivor's guilt. b. Assess the adult's cultural beliefs and spirituality. c. Refer the adult for cognitive behavioral therapy (CBT). d. Refer the adult to a self-help group for suicide survivors.

5. Answer - d. Page 366 (Box 23-2). Referrals need to be made available to family members and friends to assist them in dealing with and addressing the many emotional reactions and problems that easily may develop after suicide of a family member or friend. Self-help groups are extremely beneficial for survivors.

5. A victim of reported sexual assault tells the nurse, "This was entirely my fault. I should never have gone to that party alone." Which response by the nurse is most therapeutic? a. "This was a frightening experience for you." b. "What do you think you should have done differently?" c. "Would you like to tell me more about what happened?" d. "It sounds like you're blaming yourself for the assailant's behavior."

5. Answer - d. Pages 355-356 (Table 22-2). Common emotional reactions after a sexual assault include anger, fear, anxiety, guilt, humiliation, embarrassment, self-blame, and mood swings. Compassionate care involves approaching the person who has been sexually assaulted in a nonjudgmental and empathic manner. Patients need to hear and understand that the rape is not their fault. It is important to help survivors separate the issues of vulnerability from blame.