Exam 5: Worksheet Questions
A charge nurse is concerned by a nurse's recent behaviors. Which of the following behaviors by the nurse indicates that they are is experiencing burnout? A. Frequently calls in sick B. Does not report known medication error C. Takes regular lunch breaks D. Sets firm professional boundaries with clients
A
A charge nurse is observing a newly hired nurse provide grief-informed care for a client. Which of the following actions by the newly hired nurse requires follow-up by the charge nurse? A. The nurse asks the client why they require care or assistance. B. The nurse advocates for the client to receive bereavement support. C. The nurse determines the effect the death or loss has had on the client. D. The nurse acknowledges that the client experienced a death or loss.
A
A nurse has completed an assessment of a client whose parent recently died. Which of the following client statements is an indication that the client is experiencing death anxiety? A. "I just can't stop thinking about my own death. Life is so short." B. "I am so sad. It is very hard to consider what holidays will be like." C. "I have had trouble sleeping. I wake up and go to my parent's room to find them." D. "I just don't understand why this happened. My thoughts have been so mixed-up since they died."
A
A nurse is assessing a client who has been diagnosed with prolonged grief disorder (PGD). The nurse should identify which of the following findings as an indication that the client has developed separation distress? A. Continuous yearning for the deceased person B. Intense sorrow and emotional pain C. Preoccupation with the person who died D. Preoccupation with the circumstance of the death
A
A nurse is assessing a client who is experiencing grief. The nurse should identify which of the following findings as an indication that the client has developed clinical depression? A. Loss of interest in pleasurable activities B. Has intense moments of sadness C. Loss of appetite D. States that connecting with family is comforting
A
A nurse is caring for a client who has cancer and is terminally ill. The nurse should recognize that the client and their family might be experiencing which of the following types of grief? A. Anticipatory B. Disenfranchised C. Traumatic D. Complicated
A
A nurse is caring for a client who has returned from a bereavement support group. Which of the following client statements demonstrates that the client is meeting the planned outcomes of treatment? A. "I will take the kids to the ocean. We had great times there as a family, and it's time for more memories." B. "People never really understand what my partner's death means to me. I really miss them." C. "Our time together was so short. I just wish I had shown them how much I appreciated them." D. "No matter how much I try, I can't forget the night they died. I wonder if I ever will?"
A
A nurse is caring for a client who is grieving and has experienced sleep disturbances, weight loss, and often feels angry and irritable. The client also states that they feel depressed. Which of the following assessments is the nurse's priority? A. Ability to function B. Spiritual practices C. Cultural practices D. Social support
A
A nurse is caring for an adolescent client whose close friend recently died by suicide. The client tells the nurse, "I should have called back when they texted me. If I had been there, my friend would still be alive." Which of the following information should the nurse understand from this statement? A. This is an expression of emotional pain, and the client needs to be closely monitored. B. This is an expression of normal grief, and the client will respond well if they can just express their feelings. C. This is an expression of delayed grief response, and the client is expressing their thoughts and feelings. D. This is an expression of a lack of self-compassion, and the client needs to focus on being kind to themselves.
A
A nurse is precepting a newly hired nurse. The newly hired nurse asks, "Why is it important for me to attend a training on compassion fatigue and burnout?" Which of the following responses should the precepting nurse make? A. "Compassion fatigue can occur because nurses often experience trauma. We must learn to prioritize our self-care." B. "This is a part of orientation, and you need complete all your required training during orientation." C. "This is something that human resources requires. There has been a lot of patient feedback about care." D. "The patient experience must include compassionate nursing care."
A
A nurse is preparing for a home visit with a client whose partner recently died by suicide. Which of the following actions should the nurse take first when preparing to provide client-centered care? A. Perform self-reflection. B. Review the client's history. C. Review current provider prescriptions. D. Read the client's progress notes.
A
A nurse is preparing to care for a client who is experiencing complicated grief. Which of the following actions demonstrates grief-informed care? A. Acknowledge and recognize that the client has experienced a loss. B. Support the privacy of the client and do not discuss the loss. C. Stand when speaking to the client with door of the room open. D. Contact the provider for directions on how to proceed
A
A nurse is providing care for a client who has recently returned from active combat and experienced the loss of a close friend during combat. Which of the following client statements indicates that the client is experiencing traumatic grief? A. "I should have been the one who had been killed instead of my friend." B. "I can't cry when I talk about my friend because soldiers aren't supposed to show emotions." C. "It has been more than a year, and I still don't want to leave the house." D. "When I have flashbacks, it feels like my heart is going to beat through my chest."
A
A nurse is providing medication education to clinicians who provide care at a local community health center. A small number of clients who regularly attend the community center identify as being part of an underrepresented culture. Which of the following benefits does the provision of culturally competent care provide to the client? A. If the client is comfortable, they are more likely to continue to seek treatment. B. Without culturally competent care, the client might pay more out of pocket for treatment. C. Providing culturally competent care can reduce the client's feelings that they are risking relationships and jobs by seeking care. D. Receiving culturally competent care can reduce the chance that the client will need psychotropic medications.
A
A nurse is talking with a newly hired nurse. The newly hired nurse states, "I really thought that I would easily transition from school to work. I am just exhausted, and now I wonder if I should even be a nurse." This statement that the nurse is experiencing which of the following types of stress? A. Burnout B. Grief C. Trauma grief D. Anxiety
A
The nurse is assessing an adolescent who was brought to the emergency department after collapsing during Olympic figure skating training. The adolescent is diagnosed with severe malnutrition due to anorexia nervosa. Which client statement supports the use of a family-based approach? A. "I just didn't drink enough water during practice." B. "I eat just as much as everyone else on the team." C. "I have to practice until my skating routine is perfect." D. "I'm tired of fighting with my parents about eating."
A "I'm tired of fighting with my parents about eating" indicates there is conflict in the family around the client's eating behaviors. Conflicts arise in a family when a child is starving themself. The AED stands firmly against any model of eating disorders in which family influences are seen as the primary cause of eating disorders, condemns statements that blame families for their child's illness, and recommends that families be included in the treatment. Family-based approaches, such as the Maudsley approach, are supported by clinical evidence.
The nurse is preparing an education program regarding the early identification of students at risk for developing anorexia nervosa. Which client does the nurse recognize as having the highest risk of developing an eating disorder? A. Female ballet dancer B. Female cheerleader C. Male wrestler D. Male swimmer
A A ballet dancer has a seven times greater risk of developing anorexia nervosa among females.
A nurse is providing care to a client is who is recovering from an episode of dissociative amnesia. The nurse should expect the client to exhibit which of the following manifestations? A. Guilt B. Hallucinations C. Delusions D. Anhedonia
A After experiencing an episode of dissociative amnesia, it is common for an individual to experience symptoms of guilt, rage, dysphoria, shame, and psychological conflict.
The nurse assigns the nursing diagnosis "ineffective coping related to feelings of helplessness" to a client diagnosed with bulimia nervosa. Which is the most appropriate outcome related to this nursing diagnosis? A. Exhibits ability to use adaptive strategies to cope with emotional issues B. Achieves and maintains an expected BMI for weight and age C. Demonstrates positive self-esteem by verbalizing positive aspects of self D. Identifies consequences of fluid loss caused by self-induced vomiting.
A Emotional issues must be resolved if these maladaptive responses are to be eliminated. Identifying alternative methods to deal with isolation will provide the client with healthier coping strategies.
The nurse is teaching parents of a 14-year-old client diagnosed with anorexia nervosa about prescribed medications. Which carries a black-box warning? A. Fluoxetine B. Phenelzine C. Topiramate D. Amitriptyline
A Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), carries a black-box warning about the risk of increased suicidal ideation in adolescents.
A nurse is preparing an in-service for a group of staff members about dissociative identity disorder. Which of the following should the nurse identify as a risk factor for this disorder? A. History of trauma during the developmental years B. Borderline personality disorder C. A history of schizophrenia D. A history of self-injurious behavior development of the disorder
A History of trauma during developmental years is the biggest risk factor for dissociative identity disorder.
A nursing instructor is teaching students about eating disorders. Which statement indicates that a student understands the differences between anorexia nervosa and bulimia nervosa? A. "Clients diagnosed with anorexia nervosa exhibit malnutrition and dehydration." B. "Hyperkalemia and hyponatremia are associated with anorexia nervosa." C. "Signs of bulimia nervosa include hypotension, edema, and erosion of tooth enamel." D. "Amenorrhea and parotid gland enlargement are symptoms of bulimia nervosa."
A Individuals diagnosed with anorexia nervosa exhibit nutritional deficits, malnutrition, and dehydration due to caloric restriction.
A newly licensed nurse asks the charge nurse about functional neurological symptom disorder. Which of the following responses should the charge nurse make? A. "The manifestations of this disorder are worse during times of increased stress." B. "Clients who have this disorder exhibit more than one personality." C. "Clients who have this disorder consciously control the manifestations." D. "Feeling outside of one's body is a primary manifestation of this disorder."
A The manifestations of neurological symptom disorder often worsen or become more apparent when a client is experiencing a stressful situation.
The nurse is assessing a client newly admitted to the eating disorders unit. Which findings indicate the client may have a diagnosis of bulimia nervosa? Select all that apply. A. BMI of 24 kg/m2 B. Amenorrhea C. Erosion of tooth enamel D. Lanugo E. Russell's sign
A, C, E A. Most individuals with bulimia nervosa have a BMI within a normal range for weight. The BMI range for normal weight is 18.5 to 24.9 kg/m2. C. Gastric acid in the vomitus contributes to the erosion of tooth enamel among individuals with bulimia nervosa. E. Russell's sign is an indicator of purging and is characterized by calluses on the dorsal surface of the hands, typically the knuckles.
While assessing a client diagnosed with bulimia nervosa, the nurse observes multiple cavities, enamel erosion, and tooth sensitivity. Which best explains the nurse's findings? A. Electrolyte imbalances B. Self-induced vomiting C. Nutritional deficits D. Dehydration
B Erosion of tooth enamel and dental deterioration are results of self-induced vomiting. The acidic emesis produced during purging damages the teeth and oral mucosa.
Which is used as first-line outpatient psychological treatment for adolescents diagnosed with anorexia nervosa? A. Cognitive-based therapy B. Family-based therapy C. Dialectical behavior therapy D. Individual psychotherapy
B Evidence supports the use of family-based treatment as the first-line outpatient psychological treatment for adolescents with anorexia nervosa. CBT is used with clients diagnosed with anorexia, bulimia, and binge eating disorder (BED).
A nurse is providing care to a client who was admitted to the emergency department with superficial lacerations on their leg. The client states, "I was feeling bored, so I used a pair of gardening scissors to cut myself." The client denies current depression and suicidal thoughts. The client is demonstrating manifestations of which of the following disorders? A. Illness anxiety disorder B. Factitious disorder C. Somatic symptom disorder D. Functional Neurological Symptom Disorder
B Factitious disorder is when a client intentionally falsifies their symptoms in order to garnerattention or attain a sick role.
The nurse tells the parents of an adolescent diagnosed with anorexia nervosa, "The social worker will be contacting you to schedule a family meeting." One of the client's parents states, "Why is that necessary? Our child is the one who needs treatment." Which response by the nurse is best? A. "We expect every client and their family to attend two family sessions." B. "Family intervention and support are important in managing eating disorders." C. "The sessions are used to educate all family members about eating disorders. D. "During the meeting you will be able to resolve conflicts with your child."
B Family meetings focus on the needs of the client and their family. The nurse should educate the family on the importance of family involvement and support in the treatment of anorexia nervosa.
A nurse is discussing treatment options with the guardian of a child who has been diagnosed with dissociative identity disorder. The Guardian asks, "How is nursing care different for children diagnosed with dissociative identity disorder compared to adults?" How should the nurse best respond? A. "Nursing interventions for this diagnosis are very limited, regardless of age." B. "Assessing for thoughts of self-harm is important, regardless of age." C. "Usually, older clients have better treatment outcomes." D. "Usually, only adults are on psychiatric medication for this disorder."
B Regardless of the client's age, assessing for thoughts of self-harm or suicidal ideation is apriority.
A nurse is providing education about somatic symptom disorder to a client's family. Which of the following pieces of information should the nurse include in the education? A. "Individuals may intentionally make up the symptoms they are experiencing." B. "Individuals with somatic symptom disorder experience real physical effects, but these manifestations are due to emotional causes rather than physical ones." C. "There are limited effective treatment options for this disorder." D. "Somatic symptom disorder is characterized by suicidal ideations or thoughts of death."Rationale: While suicidal ideation is a potential comorbidity, it is not a defining symptom of the disorder.
B Somatization is when emotional distress and psychological issues are exhibited in physical manifestations that cannot be explained medically.
The nurse is developing nursing diagnoses for a newly admitted client diagnosed with anorexia nervosa. The client has a BMI of 15.8 kg/m2. Which is the priority nursing diagnosis? A. Ineffective coping B. Imbalanced nutrition C. Obesity D. Disturbed body image
B The client weighs less than 85% of expected weight and has a BMI of 15.8 kg/m2. The BMI range for normal weight is 20 to 24.9 kg/m2. The client is at risk of potentially life-threatening symptoms of hypothermia, bradycardia, hypotension with orthostatic changes, peripheral edema, severe electrolyte imbalances, and cardiac muscle damage.
The nurse in the eating disorders clinic asks a client diagnosed with bulimia nervosa, "Can you recall a time when you were able to eat without purging?" Which is the most appropriate rationale for the nurse's question? A. Determine the severity of symptoms. B. Identify previous coping strategies. C. Determine triggers for purging episodes. D. Establish realistic treatment goals.
B The nurse is identifying the client's previous coping strategies to develop interventions that enable the client to utilize adaptive coping skills.
A nurse is caring for a female client who has bulimia nervosa and reports frequent self-induced vomiting. Which of the following findings should the nurse expect? A. Hyperkalemia B. Dental decay C. Amenorrhea D. Lower than normal expected reference range of body weight
B The nurse should expect dental decay for a client who reports frequent self-induced vomitingbecause this causes tooth enamel to become eroded, causing dental decay.
Which is the priority nursing intervention when caring for a client diagnosed with an eating disorder? A. Accompany the client to the bathroom. B. Remain with the client at least 1 hour after meals. C. Encourage the client to keep a diary of food intake. D. Discuss feelings and emotions associated with eating.
B The nurse should remain with the client at least 1 hour after meals, as the client may use this time to discard food that has been stashed from the food tray or to engage in self-induced vomiting.
A 20-year-old client tells the nurse in the outpatient clinic, "I am so disgusted with myself. For the past month, there are times when I eat everything I can find. I want to vomit it all back up, but I have never been able to." Which is the nurse's best reply? A. "It's normal to feel depressed after eating so much." B. "Tell me about relationships with the people in your life." C. "I am not surprised to hear you feel so disgusted with yourself." D. "Have you ever been diagnosed with clinical depression?"
B The statement "Tell me about relationships with the people in your life" is the best reply. The nurse should gain more assessment data before teaching (a nursing intervention). The client demonstrates symptoms of BED, which are similar to those with bulimia nervosa; however, BED does not include compensatory purging. Interpersonal stressors, low self-esteem, and boredom are identified as possible triggers.
A nurse is caring for a client who describes extreme fear of having or acquiring a disease. The client is also exhibiting behaviors like repeated body checking. The nurse should identify that the client is exhibiting manifestations of which of the following disorders? A. Factitious disorder B. Illness anxiety disorder C. Dissociative amnesia D. factitious disorder
B illness anxiety disorder, previously called hypochondriasis, occurs when a client experiences constant thoughts and worry about having an illness.
The nurse is developing a care plan for a client diagnosed with anorexia nervosa and determines "disturbed body image" is the priority nursing diagnosis. Which is the most appropriate outcome criterion A. Achieve and maintain expected body mass index (BMI). B. Verbalize understanding of maladaptive eating behaviors. C. Exhibit decreased preoccupation with own appearance. D. Discuss feelings and emotions associated with eating.
C "Disturbed body image" is defined as "confusion in mental picture of one's physical self." The most important outcome criterion for the client to demonstrate is an increase in self-esteem as manifested by verbalizing positive aspects of self and exhibiting decreased preoccupation with their own appearance.
A nurse is caring for a client who has a prescription for a bone densitometry test. The nurse should identify that this test is used to assess for which of the following conditions? A. Bone fractures B. Hyperphosphatemia C. Osteopenia D. Hypocalcemia
C A bone densitometry test is used to detect osteopenia/osteoporosis, which is a potential complication of anorexia nervosa
The nurse is reviewing the plan of care for a 15-year-old client diagnosed with anorexia nervosa. The treatment team plans to implement cognitive behavior therapy (CBT). Which is the best rationale for the use of CBT for clients diagnosed with anorexia nervosa? A. Recognize maladaptive eating patterns as defense mechanisms. B. Promote autonomy and control overeating behaviors. C. Eliminate emotional components of maladaptive eating patterns. D. Allow client to establish goals of the treatment plan.
C CBT strives to eliminate the emotional components associated with unhealthy eating patterns by confronting irrational thinking patterns and associated feelings.
The clinic nurse is reviewing the assessment findings of a client diagnosed with anorexia nervosa. Which of the following indicate that the client requires immediate hospitalization? A. Body temperature of 98.6ºF B. Potassium level above 3.5 mmol/L C. BMI less than 75% of expected D. Weight less than 90% of expected
C Hospitalization is indicated when the median BMI is less than 75% of that expected for the client's age and sex.
A client diagnosed with bulimia nervosa has been receiving CBT at the eating disorders clinics. Which of the following client actions indicates to the nurse that the client is making progress toward using adaptive eating behaviors? A. Gains 2 lb in 1 week B. Verbalizes importance of adequate nutrition C. Identifies feelings associated with desire to binge D. Takes antidepressant medications as prescribed
C Identifying feelings associated with the desire to binge indicates the client is making progress. Unresolved emotional issues contribute to binging and purging behaviors. Identifying these emotions enables client to replace unhealthy coping behaviors with adaptive behaviors.
A nurse is reviewing the medical record of a client who has somatic symptom disorder. Which of the following would be a likely comorbidity of somatic symptom disorder? A. Schizophrenia B. Bipolar disorder C. Major depressive disorder D. Borderline personality disorder
C Major depressive disorder is the largest comorbidity for somatic symptom disorder.
A nurse is caring for a client who has a new diagnosis of somatic symptoms disorder. The nurse should identify that the client must have been experiencing manifestations of the disorder for how long before diagnosis? A. 1 week B. 3 months C. 6 months D. 4 weeks
C Manifestations must be present for 6 months before a diagnosis can be made. The manifestations must cause significant distress or interruption in daily functioning
A nurse is working with an older adult client who has been diagnosed with somatic symptom disorder. Which of the following should the nurse consider when working with an older adult who has somatic symptom disorder? A. Somatic symptom disorder is usually onset in older adulthood. B. Somatic symptom disorder is usually diagnosed in early childhood. C. Somatic symptom disorder is usually underdiagnosed in the older population. D. Somatic symptom disorder must be diagnosed before 18 years of age
C Manifestations of somatic symptom disorder are usually masked by normal signs of aging inthe older adult population.
A nurse is providing education to a group of clients about the health effects of eating disorders. Which of the following client statements indicates an understanding of the teaching? A. "Eating disorders do not affect the kidneys." B. "Anorexia can cause hypertension." C. "Eating disorders can prevent the onset of the menstrual cycle."Rationale: D. "Bulimia has no long-term health effects."
C Some clients diagnosed with an early age onset of anorexia nervosa have never had their menstrual cycle due to their percentage of low body fat and hormonal deficiencies.
The nurse on the eating disorder unit schedules group therapy sessions immediately after meals. Which is the best rationale for scheduling group therapy at this time? A. Limit time allotted for meals. B. Identify maladaptive eating behaviors. C. Discuss feelings associated with eating behaviors. D. Focus on regaining control.
C The best for scheduling group therapy immediately after meals is to address the emotional issues related to eating behavior, as it enables the nurse to observe clients following meals. Clients may use the time to after meals discard food that has been stashed from the food tray or to engage in self-induced vomiting.
A nurse is conducting a psychoeducation group about the etiology of eating disorders. Which of the following statements should the nurse include? A. "A specific gene has been identified as the primary cause of eating disorders." B. "Western cultural values are the primary cause of eating disorders." C. "There is a mix of biological and psychosocial determinants that contribute to the development of eating disorders." D. "Childhood trauma is the primary contributor to the development of an eating disorder."
C The cause of an eating disorder is multifactorial and best explained by the diathesis-stress model, which poses that there are environmental and psychosocial factors, as well as biological and genetic factors that contribute to the development of an eating disorder.
A nurse is teaching a group of students about the prevalence of eating disorders in the U.S. Which of the following statements by a student indicates an understanding of the teaching? A. "Eating disorders are over diagnosed due to dieting fads." B. "The prevalence of eating disorders in the United States is lower compared to other countries." C. "It is difficult to determine the prevalence of eating disorders due to the secretive nature of these conditions." D. "It is estimated that 10 million people in the United States have an eating disorder."
C The prevalence of eating disorders is difficult to determine due to the secretiveness of these conditions. Many clients who are experiencing an eating disorder will deny that the condition exists and avoid seeking help.
A nurse is teaching a newly licensed nurse about eating disorders. Which of the following statements should the nurse include in the teaching? A. "Eating disorders have a low mortality rate compared to other mental illnesses." B. "Eating disorders are primarily caused by a lack of information about nutrition." C. "There are many different types of eating disorders." D. "Eating disorders only affect females."
C There are a variety of eating disorders, including anorexia nervosa, bulimia nervosa, binge-eating disorder, among others
The nurse in the outpatient clinic determines the priority nursing diagnosis for a client diagnosed with anorexia nervosa is "imbalanced nutrition: less than body requirements." Which is the most appropriate short-term goal for the client? A. Demonstrate adaptive eating behaviors. B. Discuss fears and anxieties. C. Gain 2 lb per week. D. Exhibit no signs of malnutrition and dehydration.
C Weight gain to restore homeostasis is the priority. Excessive weight loss leads to life-threatening malnutrition, dehydration, severe electrolyte imbalances, hypotension, bradycardia, and cardiac arrhythmias.
A nurse is caring for a client. Which of the following client statements should the nurse identify as an indication of anorexia nervosa? A. "I know I am skinny." B. "I have so much energy." C. "I spend lots of time searching for new recipes." D. "I enjoy wearing form-fitting clothes to show off my body."
C Clients who have anorexia nervosa typically demonstrate a high interest in preparing food, butnot in eating.
A nurse is caring for a client who has a binge-eating disorder. Which of the following statements should the nurse expect from this client? A. "My binges usually start off with feeling hungry." B. "I binge to reward myself for completing difficult tasks." C. "I am able to control the pace of my bingeing when I start getting full." D. "I feel so defeated and want to hide after I have binged."
D Binges are associated with emotional distress, including shame, disgust, and embarrassment.
A nurse is observing a group therapy session. Which of the following client statements should the nurse identify as an indication of bulimia nervosa? A. "I feel a sense of power by restricting my food intake." B. "I only use the laxatives when I am feeling constipated." C. "I feel an emotional high during my binge-purge episodes." D. "I have binged and purged for years without my family or friends knowing."
D Clients who have bulimia nervosa typically hide bingeing and purging behaviors from others
An experienced nurse on the eating disorders unit is explaining to a newly hired nurse the rationale for setting limits with clients. Which is the nurse's most appropriate explanation? A. It encourages awareness of emotional issues. B. It encourages understanding of behavior modification plan. C. It promotes sense of control unhealthy eating behaviors. D. It prevents power struggles with staff.
D Restrictions and limits must be established and carried out consistently to avoid power struggles, encourage patient compliance with therapy, and ensure patient safety.
The nurse is reviewing assessment data of a client diagnosed with anorexia nervosa. The client's BMI dropped from 17 to 15.5 kg/m2 over the past 3 months. Which client statement best supports the assessment data? A. "I'm glad I don't make myself throw up." B. "My hair started falling out last week." C. "You don't know what it's like to be fat." D. "At least I am not gaining any weight."
D The subjective statement, "At least I am not gaining any weight" supports the BMI (objective data). According to DSM-5 criteria, the client's illness has progressed from mild (BMI of 17 kg/m2 or greater) to severe (BMI of 15 to 15.99 kg/m2). Anorexia nervosa is characterized by a morbid fear of obesity and gross distortion of body image even when an individual is obviously underweight or emaciated.
A nurse is caring for an adolescent client who was sexually assaulted. The client is having difficulty remembering events related to the assault. Which of the following is the client likely experiencing? A. Factitious disorder B. Dissociative identity disorder C. Depersonalization/derealization experience. D. Dissociative amnesia
D With dissociative amnesia, the client would be unable to recall events related to their history in a way that is not consistent with ordinary forgetfulness.
