psych test 3

A client is prescribed disulfiram as part of his alcohol treatment program to prevent relapse. The client asks a nurse, "How will this drug help me?" Which response by the nurse would be most appropriate?

" it will help prevent you from drinking" Disulfiram is not a treatment or cure for alcoholism, but it can be used as adjunct therapy to help deter some individuals from drinking while using other treatment modalities to teach new skills on coping with altering abuse behaviors. Disulfiram plus even small amounts of alcohol produces adverse effects. Disulfiram does not affect withdrawal symptoms and does not eliminate alcohol from the body

A client with a history of alcohol abuse is participating in a 12-step Alcoholics Anonymous (AA) program. The nurse determines that the client is at step 2 when he states which of the following?

"I realize that there is a higher power that can help me"

While caring for a client with anorexia nervosa, a nurse anticipates that the client would have difficulty making which of the following comments?

"I'm mad at you because you won't let me go on a pass unless I gain weight!" most people with anorexia avoid conflict and have problems expressing negative emotions

A nurse is performing an admission assessment for an adolescent girl with an eating disorder who is being admitted to the psychiatric unit. Which statement would the nurse interpret as most likely supporting the client's diagnosis?

"I've never really liked myself." Body dissatisfaction is strongly related to low self-esteem and is a key characteristic of anorexia nervosa. Results of numerous studies have shown that low self-esteem, body dissatisfaction, and feelings of ineffectiveness and inadequacy put individuals at risk for an eating disorder. A father's body type has little impact on the development of this disorder. Families of individuals with anorexia are often labeled as overprotective, enmeshed, unable to resolve conflicts, and rigid related to boundaries. Thus, a close relationship would not be associated with this disorder.

werniksie encephalopathy

degenerative brain disorder caused by a thiamine deficiency characterized by vision impairment, ataxia, hypotension, confusion, and coma

After educating a group of nursing students about intellectual disability and adaptive behavior, the instructor determines that additional education is needed when the group identifies which of the following as a type of skill involved with adaptive behavior?

intellectual skills After educating a group of nursing students about intellectual disability and adaptive behavior, the instructor determines that additional education is needed when the group identifies which of the following as a type of skill involved with adaptive behavior?

A nurse is interviewing a client diagnosed with bulimia nervosa about her family and her relationship with her mother. Which statement by the client would the nurse least likely associate with bulimia nervosa?

"My mother and I are close but not joined at the hip." The statement about being close but not joined at the hip is not reflective of a family associated with bulimia. The families of individuals who experience bulimia nervosa are reported to be chaotic, with few rules and unclear boundaries. Often there is an overly close or enmeshed relationship between the daughter and mother. Daughters may relate that their mother is their "best friend." The boundaries are blurred in that the mother may interact with the daughter as a confidante, and this unhealthy relating further impedes the separation-individuation process. The daughters often feel guilty about separation and responsible for their mother's happiness and emotional well-being.

A nurse is assessing the sleep patterns of a female client age 70 years with a mental disorder. Based on the knowledge of circadian rhythms and the influence of age, which of the following would the nurse anticipate that the client would report about her sleep pattern?

"Now it seems like I have difficulty falling asleep or staying asleep even when circumstances are adequate for sleep." insomnia = greater prevalence among older people, divorced, separated, widowed, inc age, female sex, and comorbid disorders (e.g. medical, mental disorders, and substance use) all are risks for dev insomnia disorder

A client with a mental disorder is being discharged from an inpatient unit. During the hospital stay, the client eventually was able to get an adequate night's sleep even though he had experienced chronic insomnia over the years. The client's spouse asks the nurse what the family can do in the home environment to promote healthy sleep. Which response by the nurse would be most appropriate?

"Remember to keep stimulating activities at a minimum before he goes to bed." Family and friends should be encouraged to support the new habits that the client is trying to establish. Avoiding stimulating activities and engaging in relaxing activities before bedtime are crucial, and family and friends can help create an environment conducive to sleep. Alcohol, spicy foods, and caffeine should be avoided.

A nurse is working with a psychiatric client who was admitted to the inpatient facility and is being discharged. The client asks the nurse what he should do when he goes home to promote getting adequate sleep. Which response by the nurse would be most appropriate?

"Save your bedroom for sleeping; that means no work and no TV in the bedroom." The nurse can help the client develop bedtime rituals and good sleep hygiene. Bedtime should be at a regular hour, and the bedroom should be conducive to sleep. Preferably, the bedroom should not be a place where the individual watches television or does work- related activities. The bedroom should be viewed as a room for sleeping and sex, and the environment should be cool, with minimal lighting.

A client has been admitted to the psychiatric unit with a diagnosis of narcolepsy. Which client statement would the nurse interpret as reflecting this condition?

"Sometimes I fall asleep when I'm driving my car home from work." The overwhelming urge to sleep is the primary symptom of narcolepsy. This irresistible urge to sleep occurs at any time of the day, regardless of the amount of sleep the patient has had. Falling asleep often occurs in inappropriate situations, such as while driving a car or reading a newspaper. These sleep episodes are usually short, lasting 5 to 20 minutes, but may last up to an hour if sleep is not interrupted. Individuals with narcolepsy may experience sleep attacks and report frequent dreaming. They usually feel alert after a sleep attack, only to fall asleep unintentionally again several hours later. Excitement with leg restlessness, worrying, an inability to relax, and the use of sleeping pills are not associated with narcolepsy.

A nurse is initiating a group for adolescent girls diagnosed with anorexia nervosa. Many of the clients in the group are irritable and resent having to attend. One of them comments, "This is a stupid waste of time!" Which response by the nurse would be most appropriate?

"You sound irritated; tell me about what is bothering you." A nonjudgmental, accepting approach is best when working with clients with anorexia. This response is nonjudgmental and accepting; it also gives the client feedback about how the client is perceived by others and conveys that the nurse is interested in what the client is feeling. It is best to avoid a power struggle over control issues. Telling the client to leave or to sit down and be quiet is not therapeutic.

A female client who is receiving counseling at a community health center has complained during the last three weekly sessions about being unable to sleep. A nurse interviews the family members to determine the effect of the client's problem on them. Which response would the nurse most likely expect to hear?

"its been exhausting living with her the past few weeks" Living with a family member with insomnia is challenging. Irritability, complaints of sleeplessness, and chronic fatigue interfere with quality interpersonal relationships. It would be highly unlikely that things are not problematic or that the effects of the insomnia would be positive.

look over the 12 steps!!!

*** step 1 - admitting powerlessness over alch step 2 - "realize that a higher power can help " step 5 - "ive admitted to myself and others the wrong doings ive done" step 9 - making amends

A child is prescribed atomoxetine to treat attention deficit hyperactivity disorder. When educating the child and parents about common side effects, which of the following would the nurse include? Select all that apply.

- Headache - Abdominal pain - Decreased appetite Common side effects of atomoxetine include headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea. Nervousness and dyskinesias are associated with methylphenidate.

A client has been prescribed naltrexone for treatment of alcohol dependence. The nurse has explained the drug's purpose to the client. The nurse determines that the client has understood the instructions when the client identifies which of the following about the drug?

- reduces the appeal of alcohol - effects of naltrexone is unknown 100%

Varenicline Tartrate

- smoking cessation aid - prevents nic forom accessing receptor site

A nurse is conducting a class about eating disorders for a group of adolescents. One of the adolescents asks, "What can I do if I think my friend has an eating disorder?" Which response by the nurse would be most appropriate? Select all that apply.

- try reaching out to an adult if your friend refuses help - try to talk about other things besides food and weight Helpful strategies for family and friends of individuals with eating disorders include telling the person of the concern and offering assistance, suggesting they seek help from a professional, reaching out to an adult if the person refuses to seek help, not discussing weight or the number of calories being consumed, talking about things other than food, and avoiding power struggles (not forcing the person to eat).

effects of naltrexone

1) reduce craving 2) can help maintain abstinence 3) can interfere with the tendency to want to drink more if a recovering client slips and has a drink

A nurse is caring for a family with a child who has autism spectrum disorder. When developing an education plan for the parents, which of the following would the nurse most likely emphasize?

A structured physical environment is important for the child. The nurse should explain to the parents of a child with autism spectrum disorder that a structured physical environment will most likely be important. Keeping furniture, dishes, and toys in the same place helps ease anxiety and fosters secure feelings. The nurse should identify the child's specific needs for structure in the physical environment, and record what occurs when the physical environment is changed. Approximately 25% of children with autism spectrum disorder have seizure disorders, and about 50% have intellectual disability. Dyslexia is associated with a learning disorder.

A group of nursing students is reviewing the similarities and differences between bulimia nervosa and binge-eating disorder (BED). The students demonstrate understanding when they identify which characteristics as specific to BED? Select all that apply. a) clients are typically obese b) clients refrain from purging behaviors c) binge eater periods are shorter d0 clients engage in over-exercising e) feelings of guilt do not occur after binging

A, B, BED is seen in a number of studies that have uncovered a group of individuals who binge in the same way as those with bulimia nervosa, but who do not purge or compensate for binges through other behaviors (such as overexercising). Individuals with BED also differ from those with other eating disorders in that most of them are obese. In addition, investigators have shown that individuals with BED have less dietary restraint and have a higher weight than those with bulimia nervosa. Binge-eating episodes are not shorter. Feelings of guilt occur with both bulimia nervosa and BED.

A nurse is obtaining a history from a client who drinks about six cups of coffee and several diet cola drinks per day. The client states, "I just cut down my coffee and soda intake to one per day." Which of the following would the nurse most likely expect to assess? Select all that apply. a) headache b) fatigue c) yawning d) flushing e) diuresis

A, B, C The client's decreased intake of caffeine could lead to caffeine withdrawal, manifested by headache, drowsiness, fatigue, craving, impaired psychomotor performance, difficulty concentrating, yawning, and nausea. Flushing and diuresis would be characteristic of caffeine overdose.

A nurse is completing the admission of a client who is seeking treatment for alcoholism. He tells the nurse that the last time he had any alcohol to drink was at 10 a.m., before he left for the hospital. The nurse closely monitors the client. Which of the following would lead the nurse to suspect that the client is experiencing stage 1 of alcohol withdrawal syndrome? Select all that apply. a) slight diaphoresis b) hand tremors c) intermittent confusion d) HR of 135 BPM e) normal BP

A, B, E A person in stage 1 of alcohol withdrawal syndrome exhibits slight diaphoresis, hand tremors, no confusion, elevated heart rate, and normal or slightly elevated blood pressure. A heart rate of 135 beats/min indicates stage 3, or severe alcohol withdrawal syndrome.

A nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which of the following would the nurse incorporate into the presentation as being common to both anorexia nervosa and bulimia nervosa? Select all that apply. a) body dissatisfaction b) feelings of control c) obsessiveness d) boundary problems e) sexuality fears f) cognitive disorders

A, C, F Characteristics common to both anorexia and bulimia nervosa include body dissatisfaction, powerlessness (lack of control), obsessiveness, and cognitive distortions. Boundary problems are associated with bulimia nervosa. Sexuality fears are associated with anorexia nervosa.

After teaching a class about circadian rhythm disorders, a nursing instructor determines that the education was successful when the class identifies which of the following as a subtype identified in the DSM-5? Select all that apply. a) delayed sleep phase b) night mare c) sleep terror d) shift work type e) jet lag type

A, D According to the DSM-5, subtypes of circadian rhythm disorders include a delayed sleep phase and shift work type. Although jet lag type is a circadian rhythm sleep-wake disorder, it is not included in the DSM-5. Nightmare and sleep terror are separate disorders.

A nursing instructor is describing the prevalence of sleep-wake disorders as being greater among individuals with mental health disorders. Which disorders would the instructor include as being associated with sleep-wake disorders? Select all that apply. a) depression b) borderline personality disorder c) schizophrenia d) PTSD e) anxiety

A, D Sleep-wake disorders occur independent of a diagnosis of other mental disorders, but they also occur in people with mental disorders. For example, a core feature of posttraumatic stress disorder (PTSD) is sleep disturbance. Insomnia often increases the risk for relapse of the mental disorder. Documented comorbid conditions include cardiovascular disorders, diabetes, musculoskeletal disorders, respiratory disorders, digestive disorders, pain conditions, and mental disorders including depression, PTSD, and other sleep disorders such as sleep apnea and restless legs syndrome. Obstructive sleep apnea is not associated with borderline personality disorder or schizophrenia.

A nurse is preparing an education session for parents of children with autism spectrum disorder. When describing problems associated with communication, which of the following would the nurse most likely include as common? Select all that apply. a) repetition of words and phrases b) abstract interpretation of language c) early language development d) reversal of pronouns e) abnormal intonation

A, D, E The impairment in communication is severe and affects both verbal and nonverbal communication. Children with autism spectrum disorder may manifest delayed and deviant language development, as evidenced by echolalia (repetition of words or phrases spoken by others) and a tendency to be extremely concrete in interpretation of language. Pronoun reversals and abnormal intonation are also common.

A nursing instructor is reviewing the various theories related to anorexia nervosa. Which of the following would the instructor include when describing theories related to the biologic domain? Select all that apply. a) genetic vulnerability b) separation-individuation c) role presssures d) dieting leading to starvation e) pursuit of thinness f) decreased serotonin activity

A, F Theories related to the biologic domain include increased genetic vulnerability, dieting leading to starvation, and decreased serotonin activity. Separation-individuation and role pressures reflect psychological theories. Pursuit of thinness reflects social theories.

A child with a tic disorder is prescribed an antipsychotic agent as part of his treatment plan. Which of the following would the nurse expect to be prescribed?

Aripiprazole Two classes of drugs are commonly used in the treatment of tics: antipsychotics and a- adrenergic receptor agonists. Aripiprazole is replacing the use of older antipsychotics, such as haloperidol and pimozide. These potent dopamine blockers are often effective at low doses. The a2-adrenergic receptor agonist clonidine has been used in treating Tourette's disorder for more than 30 years. Guanfacine is a newer a2-adrenergic receptor agonist that has only recently been studied in children with Tourette's disorder.

After teaching a group of nursing students about pharmacotherapy and attention deficit hyperactivity disorder (ADHD), the instructor determines that the education was successful when they identify which agent as the first- line choice?

Atomoxetine

The history of a child newly diagnosed with attention deficit hyperactivity disorder reveals that the child is experiencing sleeping difficulties. Which agent would the nurse most likely use?

Atomoxetine A sleep history should be taken before medications are prescribed. If problems exist, atomoxetine should be considered before psychostimulants such as methylphenidate. Bupropion is a second-line agent used. Clonidine, an alpha agonist, may be prescribed if symptoms do not improve with atomoxetine, psychostimulants, or second-line agents.

A client is brought to the emergency department after having overdosed on cocaine. When assessing the client, which of the following would a nurse expect to find? Select all that apply. a) euphoria b) seizures d) cardiac arrhythmias d) paranoia e) insomnia

B, C Manifestations of cocaine overdose include cardiac dysrhythmias or arrest, increased or reduced blood pressure, respiratory depression, chest pain, vomiting, seizures, psychosis, confusion, dyskinesia, dystonia, and coma. Euphoria, paranoia, and insomnia are effects of cocaine.

A client with a history of substance abuse is a member of a skills training group. Which of the following would the client be involved in to enhance intrapersonal coping skills? Select all that apply. a) substance refusal skills b) problem solving c) anger awareness d) emergency planning e) social support networking

B, C, D Topics in skills training groups addressing intrapersonal issues include problem solving, awareness and management of anger, and planning for emergencies. Substance refusal skills and social support networking are skills addressing interpersonal issues.

A group of nursing students is reviewing information about substances that are abused. The students demonstrate understanding of the information when they identify which of the following as stimulants? Select all that apply. a) alcohol b) cocaine c) herion d) nicotine e) phencyclidine

B, D alcohol - depressant heroin - opioid derivative nicotine could be both a stimulant and a depressant??? - phencyclidine is a hallucinogen

A client diagnosed with an eating disorder is to be hospitalized. When reviewing the client's medical record, which of the following would the nurse expect to find? Select all that apply. a) blood pressure of 100/60 b) hypokalemia c) hyperphosphatemia d) HR of 44 BPM e) suicidal ideation

B, D, E Criteria for hospitalization for eating disorders includes acute weight loss (<85% below ideal), temperature less than 36.1°C, heart rate near 40 beats/minute, hypokalemia, hypophosphatemia, hypomagnesemia, poor motivation to recover, blood pressure less than 80/50 mm Hg, risk for suicide, severe depression, failure to comply with treatment, and inadequate response to treatment at another level of care.

A nurse is assessing a girl age 8 years with a mood disorder. Which of the following would the nurse most likely expect to assess?

Behavioral problems Children with mood disorders may not spontaneously express their feelings (sadness, irritability) and are more likely to show their suffering through their behavior. These children may act out their feelings rather than discuss them. Thus behavior problems may accompany depression. Recurrent obsessions and ritualistic behavior would suggest obsessive-compulsive disorder.

When describing the characteristic similarities and differences between anorexia nervosa and bulimia nervosa, which of the following would the nurse identify as specific to bulimia?

Boundary problems Boundary problems are specific to bulimia nervosa. Low self-esteem, perfectionism, and obsessiveness are characteristics of both disorders.

A nurse is preparing to initiate a behavioral treatment program for a child with encopresis. Which of the following would the nurse most likely implement first?

Bowel cleansing Before initiating behavioral treatment, cleaning out the bowel is usually necessary in many cases. The bowel catharsis is usually followed by administration of mineral oil, which is often continued during the bowel retraining program. A high-fiber diet is often recommended. The behavioral treatment program follows, which involves daily sitting on the toilet for a predetermined period after each meal.

An adolescent is brought to the emergency department by her parents because they were concerned about their daughter's appearance. The client appears emaciated and pale. The parents tell the nurse that the client has been diagnosed with anorexia nervosa. A history, physical examination, and laboratory testing are completed. Which of the following would lead the nurse to suspect that the client will be admitted to the hospital? Select all that apply. a) blood pressure of 110/60 b) elevated serum potassium concentration c) dec serum magnesium concentration d) HR of 40 BPM e) statements of feeling hopeless

C, D, E Indicators for hospitalization include a heart rate near 40 beats/min, blood pressure less than 80/50 mm Hg, decreased serum potassium concentration, decreased serum magnesium concentration, and severe depression and risk for suicide.

A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which of the following would the nurse expect to implement in conjunction with pharmacologic therapy?

Cognitive behavioral therapy Although behavioral, interpersonal, and family therapy may be used, the combination of cognitive behavioral therapy and pharmacologic interventions is best for producing an initial decrease in symptoms.

A nurse is caring for several hospitalized clients with anorexia nervosa. The nurse would be especially alert for which of the following if noted in the clients' histories?

Depression Depression is common in individuals with anorexia nervosa, and these individuals are at risk to attempt suicide. Paranoia and insomnia are not comorbid conditions associated with anorexia nervosa. Clients with anorexia nervosa have difficulty expressing anger, so aggression would be unlikely.

The sleep history of a client experiencing sleep problems reveals that the client ingests a significant amount of caffeine each day. When reviewing with the client the effect of caffeine on sleep, which of the following would the nurse incorporate into the discussion as a caffeine effect?

Decreased REM sleep Caffeine causes increased sleep latency, decreased total sleep time, and decreased REM sleep. It does not affect slow-wave sleep.

While talking with a client with an eating disorder, the client states, "I've gained 2 pounds, so I'll be up by 100 pounds soon." The nurse interprets this as which of the following?

Dichotomous thinking The client's statement reflects dichotomous, or all-or-none, thinking. Magnification reflects overemphasizing, such as, "I binged last night, so I can't go out with anyone tonight." Selective abstraction reflects a narrow focus, such as, "I can only be happy 10 pounds lighter." Overgeneralization reflects taking an idea and expanding it, such as, "I didn't eat anything yesterday, and I did okay, so not eating for a week won't hurt me."

A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which of the following would the nurse include?

Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders Counteracting the influence of media should be stressed; both boys and girls are at risk for developing eating disorders. Other preventive educational strategies include the need to improve self-esteem and the importance of the influence of peer pressure on eating and weight.

A nurse is planning to explain the purpose of the behavioral therapy technique of self- monitoring to a client with bulimia nervosa. The nurse would emphasize keeping a diary to record which of the following?

Environmental stimuli Self-monitoring is accomplished using a diary in which the client records binges and purges, precipitating emotions, and environmental cues. Emotional and environmental cues are identified, and alternative responses are suggested, tried, and reinforced. When a cue or stimulus leads to a dysfunctional or unhealthy response, the response can be eliminated or an alternate, healthier response to the cue can be substituted, tried, and then reinforced.

A client with insomnia is prescribed zolpidem. When describing the action of this medication to the client, the nurse would incorporate information related to the medication's effect on which of the following?

Gamma-aminobutyric acid (GABA) - it facilitates GABA effects

A nurse is counseling a family whose child, age 4 years, has mild intellectual disability. The nurse is working with the family on realistic long-term goals. Which of the following would be most appropriate?

Having the child function independently as an adult The long-term goal for this family and child is to have the child function independently as an adult. Independence may be delayed but is not impossible.

A client is receiving methadone maintenance therapy. After teaching the client about this treatment, the nurse determines that the education was successful when the client states which of the following?

I should eat small frequent meals if I get nauseated A client receiving methadone maintenance therapy may experience nausea. Therefore, the client should eat small, frequent meals to treat the nausea and loss of appetite, and should take the drug with food and lie quietly to minimize the nausea. Alcohol should be avoided. Constipation may occur, necessitating the use of a mild laxativ

A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which of the following would a nurse expect to find?

Impulsivity Clients with bulimia often demonstrate impulsivity. Situations that produce feelings of being overwhelmed and powerless need to be explored, as does the client's ability to set boundaries, control impulsivity, and maintain quality relationships. These underlying issues precipitate binge eating

A nurse is counseling a parent whose child has a communication disorder. Which of the following would the nurse emphasize when educating the parent on this disorder?

Initiating conversations with the child frequently For a child with a communication disorder, interventions focus on fostering social and communication skills and making referrals for specific speech or language therapy. Modeling appropriate communication in spontaneous situations with the child can be a useful intervention for some children. Nonverbal activities or stopping the child if stuttering begins would not foster the development of communication skills. Medication therapy is not used for communication disorders.

A nurse is working with a client diagnosed with insomnia. When developing an education plan for the client, which sleep promotion intervention would the nurse implement first?

Instructing the client to keep regular bedtimes and rising times Nonpharmacologic, health-promoting interventions are the first choice before administering pharmacologic agents. Sleep hygiene strategies, such as keeping regular times for going to bed and rising, are effective and should be encouraged. The goal is to normalize sleep patterns to improve well- being.

A nurse is talking with a client 57 years of age who has been a heavy drinker for many years. The client is being treated for alcoholism, and this is her second week as an inpatient on the psychiatric unit. It is 5 a.m. and the client has been having difficulty sleeping. The client is an orthopedic nurse, and although she is clothed in a hospital-issued gown and robe, she is wearing a stethoscope around her neck that the nurse recognizes as belonging to one of the staff nurses. When the nurse asks her why she is wearing the stethoscope and where she got it, the client gives her a long and involved reply that describes how her nursing supervisor came to visit and gave it to her to wear "so she'd remember to get well." The nurse suspects that the client may be experiencing which of the following?

Korsakoff amnesic syndrome Korsakoff's amnesic syndrome, also known as psychosis, is associated with alcoholism and involves the heart and the vascular and nervous systems, but the *primary problem is acquiring new information and retrieving memories.* Symptoms include amnesia, confabulation, (i.e., telling a plausible but imagined scenario to compensate for memory loss), attention deficit, disorientation, and vision impairment.

3. A nurse is assessing a child who is suspected of having attention deficit hyperactivity disorder. Which of the following would the nurse identify as reflecting impulsiveness in the child?

Risk-taking behavior Impulsiveness is the tendency to act on urges, notions, or desires without adequately considering the consequences. This is manifested by risk-taking behaviors and use of poor judgment, often leading to more than the usual bumps, lumps, and bruises. An inability to wait his turn and restlessness reflect hyperactivity. Difficulty completing a task reflects inattention.

A child diagnosed with autism spectrum disorder is hospitalized in an inpatient mental health unit. When developing the plan of care for this child, which of the following would be most important for the nurse to include?

Providing a consistent, structured environment with predictable routines When children with autism spectrum disorder are hospitalized, a consistent, structured environment with predictable routines for activities, mealtimes, and bedtimes (termed milieu management) is necessary for successful treatment. Changes in routine, including numerous caregivers, stimulation, or "time-out," may provoke disorganization in the child, leading to emotional disequilibrium and explosive behavior. The safety of the inpatient unit offers an opportunity to try behavioral strategies, such as rewards for managing transitions. Time-out would be appropriate for aggressive or assaultive behavior.

A client with bulimia nervosa is being treated at an outpatient clinic and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which of the following would the nurse include when teaching the client about the prescribed medication?

Report any weight changes that occur during the first few weeks this medication is taken. The most important concern when using SSRIs is decreased appetite and weight loss during the first few weeks of administration. Weight should be monitored, especially during this period. The intake of medication must be monitored for possible purging after administration. The effect of the medication will depend on whether it has had time to absorb. Monitoring fluid intake and menstrual irregularities are not associated with this group of medications.

An adolescent client tells a nurse that he or she occasionally "sniffs airplane glue." When discussing the effects of long-term use of inhalants, which of the following would the nurse most likely include?

brain damage and cognitive abnormalities long-term inhalant use is linked to widespread brain damage and cognitive abnormalities that can range from mild impairment to severe dementia.

A nurse is preparing to discharge a client who has been hospitalized with anorexia nervosa. Which of the following would the nurse include in the education plan?

Setting realistic goals Because these clients tend to be perfectionist and set unrealistic goals for themselves, the nurse should educate the client about setting realistic and attainable goals. Other topics such as weight monitoring, resources, and effects of restrictive eating should be included in the nurse's educational plan.

The mother of a child with autism spectrum disorder tells the nurse that her child has few playmates. She states, "He has real trouble interacting with other children and when there is a change in his routine, he throws a tantrum." Based on this information, the nurse identifies which nursing diagnosis as the priority?

Social Isolation related to poor social skills Based on the mother's comments, the priority nursing diagnosis is Social Isolation related to poor social skills of the child. This nursing diagnosis is substantiated by the mother's statement that the child has few playmates and has difficulty interacting with other children. There is no information provided to suggest a self-care deficit or risk for injury. Statements about the family's issues with the child and his disorder would support a nursing diagnosis of Compromised Family Coping.

A client is brought into the emergency department because he was involved in an automobile accident. His blood alcohol level (BAL) is 0.10 mg%. Based on this finding, the nurse would expect to assess which of the following?

difficulty with coordination

a client with a history of opioid abuse is exhibiting manifestations of moderate withdrawal. which of the following would the nurse assess

dilated pupils mild withdrawal = rhinorrhea, lacrimation, and dysphoria

A school nurse is caring for a child age 7 years who has demonstrated a significantly lower-than-average score for mental age on standardized tests in reading. However, the child's IQ scores were within the average range. The nurse interprets this information as suggesting which of the following?

dyslexia The nurse suspects that the child is exhibiting symptoms of dyslexia or a reading disability, which is considered a learning disorder. A communication disorder involves speech or language impairments. Attention deficit hyperactivity disorder involves a persistent pattern of inattention, hyperactivity, and impulsiveness. Asperger syndrome is characterized by severe and sustained impairment in social interaction and restricted, repetitive patterns of behavior, interests, and activities in conjunction with age-appropriate language and intelligenc

A nurse is discussing strategies to enhance sleep with a client who is experiencing insomnia. Which of the following would be most appropriate for the nurse to suggest?

establish a regular time for going to bed and getting up in the morning Routines are important, especially when preparing the body to sleep. Therefore, establishing and maintaining a regular time for bedtime and awakening is appropriate. Clients with insomnia should be counseled not to eat anything heavy for several hours before retiring. Spicy foods, alcohol, and caffeine should be avoided. Additionally, exercise promotes sleep, but regular exercise should be planned for 3 hours before bedtime

A nurse is reviewing the plan of care for a client with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis?

imbalanced nutrition: less than. body requirements A behavioral plan for increasing weight is part of a refeeding program that is instituted for a nursing diagnosis of Imbalanced Nutrition: Less Than Body Requirements. Interventions for Disturbed Body Image and Anxiety involve addressing interoceptive awareness, helping clients understand their feelings, and initiating interpersonal therapy. Interventions for Ineffective Coping would address integrating the clients back into school, renewing friendships and relationships, and promoting participation in family therapy.

A nurse is preparing an in-service program about substance abuse and its etiology. Which of the following would the nurse most likely include in the presentation when discussing possible etiologies?

genetic predisposition substance abuse encompasses the body, the mind, and societies influence. human and animal studies confirm a genetic predisposition for drinking behaviors and self administering mind-alternating drugs but as yet no precise genetic marker has been established. Temperament, self-concept, age, motivation for change, social consequences for problematic behaviors, parental and family relationships, and peer pressure all contribute to expression of substance abuse— a chronic and progressive disorder. Dysfunctional family and peer influence reflect social etiologies.

A child with autism spectrum disorder engages in a repetitive rocking behavior that does not pose a threat to the child's safety. When educating the child's family on managing this behavior, which of the following would be appropriate for the nurse to suggest?

ignore it - it is not a harm to. the child Managing the repetitive behaviors of these children depends on the specific behavior and its effects on others or the environment. If the behavior has no negative effects, such as rocking, ignoring it may be the best approach. If the behavior is unacceptable, such as head banging, redirecting the child and using positive reinforcement are recommended. In some cases, especially in children with severe delays, these strategies may not work, and environmental alterations and perhaps protective headgear are needed.

A man 20 years of age arrives at the emergency department by ambulance. He is unconscious, with slow respirations and pinpoint pupils. There are "tracks" visible on his arms. The friend who came with him reports that the client had just "shot up" heroin when he became unconscious. Which medication would the nurse most likely expect to administer?

naloxone Naloxone, an opioid antagonist, is given to reverse respiratory depression, sedation, and hypertension.

A nurse is working with a client who is addicted to heroin. The nurse engages in harm reduction by educating the client about which of the following?

needle exchange programs Harm reduction initiatives range from widely accepted designated driver campaigns to controversial initiatives such as provision of condoms in schools, safe injection rooms, needle exchange programs, and heroin maintenance programs.

A nurse is implementing a brief intervention with a client who is abusing alcohol. The nurse most likely would be involved with which of the following?

negotiating a conversation with the client to reduce use Brief intervention involves a negotiated conversation between the nurse and the client that is designed to reduce the substance use. Asking the client questions about substance use refers to screening. Pointing out inconsistencies reflects confrontation. Helping the client change his or her way of thinking reflects a cognitive approach.

A student nurse is preparing a nursing care plan for a client who has insomnia and is experiencing sleep deprivation. Which nursing diagnosis would the nurse most likely identify as reflecting a priority care issue?

risk for injury Safety is a priority for people with insomnia. Sleep deprivation can lead to accidents, falls, and injuries, especially in older clients. Sedating medication could potentially increase falls.

A group of nurses is reviewing medications used to treat attention deficit hyperactivity disorder. The students demonstrate understanding of the information when they identify methylphenidate as which of the following?

psychostimulant Methylphenidate is a psychostimulant. Fluoxetine is an example of a selective serotonin reuptake inhibitor. Atomoxetine is a noradrenergic reuptake inhibitor. Alpha agonists include guanfacine and clonidine.

A group of nursing students is reviewing the various agents used to treat insomnia. The students demonstrate an understanding of the information when they identify which agent as a melatonin receptor agonist?

ramelton Ramelteon is a melatonin receptor agonist. Trazodone and mirtazapine are sedating antidepressants. Estazolam is a benzodiazepine classified as a benzodiazepine receptor agonist.

A nurse is interviewing a client about his sleep patterns. He tells the nurse that he goes to bed about 11 p.m. and usually falls asleep by 11:15 p.m. The nurse identifies this time period as which of the following?

sleep latency Sleep latency is the time period measured from lights out, or bedtime, to initiation of sleep. Sleep architecture is the pattern of non- rapid eye movement (NREM) and rapid eye movement that are in approximately a 90- to 110-minute cycle. Sleep occurs in stages, and the timing of sleep is regulated by circadian rhythms. Sleep efficiency is the ratio of total sleep time to time in bed. Slow-wave sleep is the deepest state of sleep, occurring during stages 3 and 4 of NREM sleep.

A client with insomnia is taught to avoid watching television, eating, and doing work in the bedroom. Which technique is being used?

stimulus control Stimulus control is a technique used when the bedroom environment no longer provides cues for sleep, but has become the cue for wakefulness. Clients are instructed to avoid behaviors in the bedroom that are incompatible with sleep, including watching television, doing homework, and eating. This allows the bedroom to be reestablished as a stimulus for sleep. Clients often increase their time in bed to provide more opportunity for sleep, resulting in fragmented sleep and irregular sleep schedules. With sleep restriction, clients are instructed to spend less time in bed and to avoid napping. Relaxation training involves the use of progressive relaxation, autogenic training, and biofeedback to relieve physical or emotional distress affecting sleep. Cognitive-behavioral therapy identifies the maladaptive behavior, bringing the distortions to the client's attention and extinguishing the association between effort to sleep and increased arousals.

A client tells a nurse that he is committed to trying to quit smoking. When educating the client on smoking cessation, which of the following would the nurse include?

success usually involved more than one type of intervention - including social support and education

A nurse is using motivational therapy with a female client suffering from alcoholism. The client, who is unwilling to consider changing her drinking behavior, emphatically states, "I am not an alcoholic; you can't make me stop drinking." Which response by the nurse would be most appropriate?

you are the only one who can make yourself stop drinking FRAMES - summarizes elements of brief interventions with clients using motivational interviewing. The nurse should emphasize both the client's freedom to choose to change as well as the client's responsibility to change. Telling the client to stop drinking and driving is confrontational and not therapeutic in this situation; telling the client to think about what she is doing to her marriage is inappropriate because the client has yet to acknowledge that she has a problem. Telling the client that she is not an alcoholic only reinforces the client's denial.