Mental Health - Exam 3 study guide

Judy is a 17-year-old high school junior who is active in gymnastics. She is 5 ft 7 in tall, weighs 85 lb, and has not had a menstrual period for 5 months. The family physician referred her to the inpatient eating disorders unit with a diagnosis of anorexia nervosa. During the admission interview, Judy is defensive about her weight loss, stating she needs to be thin to be competitive in her sport. Judy points to areas on her buttocks and thighs, saying, "See this? I still have plenty of fat. Why can't everyone just leave me alone?" 1.Identify two nursing diagnoses that would be pertinent for Judy. 2.Write an expected outcome for each identified nursing diagnosis. 3.List three nursing interventions for each nursing diagnosis.

1.Imbalanced nutrition: Less than body requirements and ineffective coping. 2.Nutrition: The client will eat all of her meals and snacks with no purging behaviors. Coping: The client will identify two non-food-related mechanisms. 3.Nutrition: Sit with the client while eating; monitor client 1 to 2 hours after meals and snacks; supervise client's use of the bathroom. Coping: Ask the client how she is feeling, and continue to focus on feelings if the client gives a somatic response; have the client keep a journal including emotions, feelings, and food eaten; teach the client the use of relaxation and distraction, such as music and activities.

Mary Jones, 34 years old, was referred to a chronic pain clinic with a diagnosis of pain disorder. She has been unable to work for 7 months because of back pain. Mary has seen several doctors, has had magnetic resonance imaging, and has tried various antiinflammatory medications. She tells the nurse she is at the clinic as a last resort because none of her doctors will "do anything" for her. Mary's gait is slow, her posture is stiff, and she grimaces frequently while trying to sit in a chair. She reports being unable to drive a car, play with her children, do housework, or enjoy any of her previous leisure activities. 1.Identify three nursing diagnoses that would be pertinent for Mary's plan of care. 2.Identify two expected outcomes for Mary's plan of care. 3.Describe five interventions that the nurse might implement to achieve the outcomes. 4.What other disciplines might make a contribution to Mary's care at the clinic? 5.Identify any community referrals the nurse might make for Mary.

1.Ineffective coping, pain, anxiety. 2.The client will identify the relationship between stress and increased pain; the client will be able to perform activities of daily living. 3.Have the client keep a journal about emotional feelings and the quality or intensity of pain; teach the client relaxation exercises; help the client make a daily schedule of activities, beginning with simple tasks; encourage the client to listen to music or engage in other distracting p. 480 p. 481 activities she may enjoy; talk with the client about her feelings of frustration and anxiety in a sensitive and supportive manner. 4.Physical therapy, vocational rehabilitation, nutrition services. 5.Support group for persons with chronic pain/pain disorder, exercise group, social or volunteer opportunities.

John is a 12-year-old boy newly diagnosed with ODD. His parents have come to the mental health center, reporting they "are having problems at home and don't know what we should do." John argues about everything, will not follow any rules made by his parents, and is having trouble at school, both academic and behavioral. He has been to the principal's office three times in the past week and is facing expulsion for the next violation. John replies, "Good, I hate the principal anyway; that way I won't have to see him." John's parents report trying all kinds of punishment for his behavior, such as no video games, time-out, and talking and bargaining with him with no results. In this past week, John has begun to strike out physically, kicking furniture and making threatening statements to his parents. After meeting with the physician, the parents are referred to parent management training as well as counseling. The physician prescribes risperidone (Risperdal) 0.5 mg PO daily to help with the aggressive and destructive behavior. The nurse meets with the parents to provide teaching and answer questions before they go home. 1.What teaching will the nurse include about risperidone (Risperdal)? 2.What information will the nurse provide about ODD? 3.What suggestions for managing the home environment might be helpful for the parents? 4.What referrals can the nurse make for John and his parents?

1.Risperdal is a second-generation antipsychotic; at low doses, such as 0.5 mg, it can help decrease aggression and irritability. John may then be less labile, have fewer aggressive outbursts, and be more able to participate in therapeutic interventions. Monitor John for any muscle stiffness, sedation, or confusion. Provide calorie-free beverages and candy for dry mouth. Notify the physician if any rapid behavior changes occur or if there is no improvement in 2 weeks. 2.Children with ODD are defiant and disobedient toward authority figures such as parents and the school superintendent, even when there are negative outcomes for that behavior. They do not stop to think about their actions; they just impulsively react. They have difficulty learning appropriate behavior and difficulty refraining from inappropriate behavior. 3.Parents can learn effective behavior management techniques at the parenting classes. The most important (or disruptive) behaviors are identified, and those are targeted for improvement. A consistent reward system is established to reward positive behaviors and to ignore (if possible) or have negative consequences for inappropriate behaviors. Consistency by both parents each time behavior occurs is essential. 4.Parent support group could provide emotional support for the parents. Working with the school to establish a behavioral program there would be beneficial. Respite care to allow parents some time for themselves and/or with other children in the family is also helpful to strengthen relationships among family members.

Dixie, 7 years old, has been brought by her parents to the mental health center because she has been very rough with her 18-month-old brother. She cannot sit still at school or at meals and is beginning to fall behind academically in the first grade. Her parents report that they have "tried everything," but Dixie did not listen to them. She cannot follow directions, pick up toys, or get ready for school on time. After a thorough examination of Dixie and a lengthy interview with the parents, the psychiatrist diagnoses ADHD and prescribes methylphenidate (Ritalin), 10 mg in the morning, 5 mg at noon, and 5 mg in the afternoon. The nurse meets with the parents to provide teaching and answer questions before they go home. 1.What teaching will the nurse include about methylphenidate? 2.What information will the nurse provide about ADHD? 3.What suggestions for managing the home environment might be helpful for the parents? 4.What referrals can the nurse make for Dixie and her parents?

1.Ritalin is a stimulant medication that is effective for 70% to 80% of children with ADHD by decreasing hyperactivity and impulsivity and improving the child's attention. Ritalin can cause appetite suppression and should be given after meals to encourage proper nutrition. Substantial, nutritious snacks between meals are helpful. Giving the medication in the daytime helps avoid the side effect of insomnia. Parents should notice improvements in a day or two. Notify the physician or return to the clinic if no improvements in behavior are noted. 2.The exact cause of ADHD is not known, but it is not due to faulty parenting or anything the parents have done. Taking medications will be helpful with behavioral symptoms, but other strategies are needed as well. The medication will help control symptoms, so Dixie can participate in school, make friends, and so forth. 3.Provide supervision when Dixie is with her brother, and help her learn to play gently with him. Do not forbid her to touch him, but teach her the proper ways to do so. Give Dixie directions in a clear, step-by-step manner, and assist her to follow through and complete tasks. Provide a quiet place with minimal distraction for activities that require concentration, such as homework. Try to establish a routine for getting up and dressing, eating meals, going to school, doing homework, and playing; don't change the routine unnecessarily. Structured expectations will be easier for Dixie to follow. Remember to recognize Dixie's strengths and provide positive feedback frequently to boost her self-esteem and foster continued progress. 4.The parents should contact Dixie's teacher, principal, and guidance counselor to inform them of this diagnosis so that special education classes or tutoring can be made available. It would also be helpful to meet with the school nurse who will be giving Dixie her medication at noon on school days. The nurse can refer the parents to a local support group for parents of children with ADHD and provide pamphlets, books, or other written materials, as well as internet addresses if the parents have access to a computer.

Martha Smith, a 79-year-old widow with Alzheimer disease, was admitted to a nursing home. The disease has progressed during the past 4 years to the point that she can no longer live alone in her own house. Martha has poor judgment and no short-term memory. She had stopped paying bills, preparing meals, and cleaning her home. She had become increasingly suspicious of her visiting nurse and home health aide, finally refusing to allow them in the house. After her arrival at the facility, Martha has been sleeping poorly and frequently wanders from her room in the middle of the night. She seems agitated and afraid in the dining room at mealtimes, is eating very little, and has lost weight. If left alone, Martha would wear the same clothing day and night and would not attend to her personal hygiene. 1.What additional assessments would the nurse want to make to plan care for this client? 2.What nursing diagnoses would the nurse identify for this client? 3.Write an expected outcome and at least two interventions for each nursing diagnosis.

1.What does she like to eat? What were her usual personal hygiene practices? What are her favorite activities? What personal items does she value? 2.Chronic confusion, impaired socialization, disturbed sleep pattern, self-care deficits, and risk for imbalanced nutrition: less than body requirements. 3.The client will experience as little frustration as possible. Interventions: Point out objects, people, and the time of day to prompt the client and decrease confusion. Do not ask the client to make decisions when she is unable to; offer choices only when she can make them. The client will interact with the nurse. The client will participate in going for a walk with the group. Interventions: Involve the client in solitary activities with the nurse initially. Structure group activities that focus on intact physical abilities rather than those requiring cognition. The client will eat 50% of meals and snacks. Interventions: Provide foods the client likes and provide those foods in an environment where she will be likely to eat, such as her room or a table alone. The client will sleep 6 hours per night. Interventions: Provide a soothing nighttime routine every night (e.g., offering a beverage, reading aloud, dimming lights). Decrease stimulation after dinner and discourage daytime naps. The client will participate in hygiene routines with assistance. Interventions: Try to imitate the client's home hygiene routine (bath or shower, morning or evening), and develop a structured routine for hygiene.

A client with somatic symptom disorder has been attending group therapy. Which statement indicates therapy is having a positive outcome for this client? a."I feel better physically just from getting a chance to talk." b."I haven't said much, but I get a lot from listening to others." c."I shouldn't complain too much; my problems aren't as bad as others." d."The other people in this group have emotional problems."

a."I feel better physically just from getting a chance to talk."

Which of the following interventions is most appropriate in helping a client with early-stage dementia complete ADLs? a.Allow enough time for the client to complete ADLs as independently as possible. b.Provide the client with a written list of all the steps needed to complete ADLs. c.Plan to provide step-by-step prompting to complete the ADLs. d.Tell the client to finish ADLs before breakfast or the nursing assistant will do them.

a.Allow enough time for the client to complete ADLs as independently as possible.

A female client comes to an urgent care clinic and says, "I've just been raped." What should the nurse do? a.Allow the client to express whatever she wants. b.Ask the client if staff can call a friend or family member for her. c.Offer the client coffee, tea, or whatever she likes to drink. d.Get the examination completed quickly to decrease trauma to the client. e.Provide the client privacy; let her go to a room to make phone calls. f.Stay with the client until someone else arrives to be with her.

a.Allow the client to express whatever she wants. b.Ask the client if staff can call a friend or family member for her. f.Stay with the client until someone else arrives to be with her.

A client with bulimia is learning to use the technique of self-monitoring. Which intervention by the nurse would be most beneficial for this client? a.Ask the client to write about all feelings and experiences related to food. b.Assist the client in making daily meal plans for 1 week. c.Encourage the client to ignore feelings and impulses related to food. d.Teach the client about nutrition content and calories of various foods.

a.Ask the client to write about all feelings and experiences related to food.

Which behavior is normal adolescent behavior? a.Being critical of self and others b.Defiant, negative, and depressed behavior c.Frequent hypochondriacal complaints d.Unwillingness to assume greater autonomy

a.Being critical of self and others

A nurse doing an assessment with a client with anorexia nervosa would expect which findings? a.Belief that dieting behavior is not a problem b.Feelings of guilt and shame about eating behavior c.History of dieting at a young age d.Performance of rituals or compulsive behavior e.Strong desire to get treatment f.View of self as overweight or obese

a.Belief that dieting behavior is not a problem c.History of dieting at a young age d.Performance of rituals or compulsive behavior f.View of self as overweight or obese

Which is not a goal for treating the severely malnourished client with anorexia nervosa? a.Correction of body image disturbance b.Correction of electrolyte imbalances c.Nutritional rehabilitation d.Weight restoration

a.Correction of body image disturbance

The nurse is assessing an adult client with ADHD. The nurse expects which to be present? a.Difficulty remembering appointments b.Falling asleep at work c.Problems getting started on a project d.Lack of motivation to do tasks

a.Difficulty remembering appointments

A client with late moderate-stage dementia has been admitted to a long-term care facility. Which nursing intervention will help the client maintain optimal cognitive function? a.Discuss pictures of children and grandchildren with the client. b.Do word games or crossword puzzles with the client. c.Provide the client with a written list of daily activities. d.Watch and discuss the evening news with the client.

a.Discuss pictures of children and grandchildren with the client.

Which type of child abuse can be most difficult to treat effectively? a.Emotional b.Neglect c.Physical d.Sexual

a.Emotional

Teaching for methylphenidate (Ritalin) should include which information? a.Give the medication after meals. b.Give the medication when the child becomes overactive. c.Increase the child's fluid intake when he or she is taking the medication. d.Check the child's temperature daily.

a.Give the medication after meals.

Women in battering relationships often remain in those relationships as a result of faulty or incorrect beliefs. Which belief is valid? a.If she tried to leave, she would be at increased risk for violence. b.If she would do a better job of meeting his needs, the violence would stop. c.No one else would put up with her dependent clinging behavior. d.She often does things that provoke the violent episodes.

a.If she tried to leave, she would be at increased risk for violence.

Which is used to treat enuresis? a.Imipramine (Tofranil) b.Methylphenidate (Ritalin) c.Olanzapine (Zyprexa) d.Risperidone (Risperdal)

a.Imipramine (Tofranil)

The nurse is working with a client with anorexia nervosa. Even though the client has been eating all her meals and snacks, her weight has remained unchanged for 1 week. Which intervention is indicated? a.Supervise the client closely for 2 hours after meals and snacks. b.Increase the daily caloric intake from 1,500 to 2,000 calories. c.Increase the client's fluid intake. d.Request an order from the physician for fluoxetine.

a.Supervise the client closely for 2 hours after meals and snacks.

Which is true about clients with illness anxiety disorder? a.They may interpret normal body sensations as signs of disease. b.They often exaggerate or fabricate physical symptoms for attention. c.They do not show signs of distress about their physical symptoms. d.All of the above.

a.They may interpret normal body sensations as signs of disease.

The client's family asks the nurse, "What is illness anxiety disorder?" The best response by the nurse is, "Illness anxiety disorder is a.a persistent preoccupation with getting a serious disease." b.an illness not fully explained by a diagnosed medical condition." c.characterized by a variety of symptoms over a number of years." d.the eventual result of excessive worrying about diseases."

a.a persistent preoccupation with getting a serious disease."

The nurse understands that secondary gain for the client with a somatic symptom illness can include a.acceptable absence from work. b.freedom from daily chores. c.increased attention from family. d.provision of care by others. e.resolution of family conflict. f.temporary relief of anxiety.

a.acceptable absence from work. b.freedom from daily chores. c.increased attention from family. d.provision of care by others.

Nursing interventions that are helpful for the grieving client include a.allowing denial when it is useful. b.assuring the client that it will get better. c.correcting faulty assumptions. d.discouraging negative, pessimistic conversation. e.providing attentive presence. f.reviewing past coping behaviors.

a.allowing denial when it is useful. c.correcting faulty assumptions. e.providing attentive presence. f.reviewing past coping behaviors.

Interventions for clients with dementia that follow the psychosocial model of care include a.asking the clients about the places where they were born. b.correcting the any misperceptions or delusion. c.finding activities that engage the clients' attention. d.introducing new topics of discussion at dinner. e.processing behavioral problems to improve coping skills. f.providing unrelated distractions when clients are agitated.

a.asking the clients about the places where they were born. c.finding activities that engage the clients' attention. f.providing unrelated distractions when clients are agitated.

Examples of child maltreatment include a.calling the child stupid for climbing on a fence and getting injured. b.giving the child a time-out for misbehaving by hitting a sibling. c.failing to buy a desired toy for Christmas. d.spanking an infant who won't stop crying. e.watching pornographic movies in a child's presence. f.withholding meals as punishment for disobedience.

a.calling the child stupid for climbing on a fence and getting injured. d.spanking an infant who won't stop crying. e.watching pornographic movies in a child's presence. f.withholding meals as punishment for disobedience.

Rando's six Rs of grieving tasks include a.react. b.read. c.readjust. d.recover. e.reinvest. f.restitution.

a.react. c.readjust. e.reinvest.

Critical factors for successful integration of loss during the grieving process are a.the client's adequate perception, adequate support, and adequate coping. b.the nurse's trustworthiness and healthy attitudes about grief. c.accurate assessment and intervention by the nurse or helping person. d.the client's predictable and steady movement from one stage of the process to the next.

a.the client's adequate perception, adequate support, and adequate coping.

Which statements are examples of unacceptable behaviors under the JCAHO standards for a culture of safety? a."According to your performance evaluation, you must decrease your absenteeism." b."Don't page me again, I'm very busy." c."If you tell my supervisor, you'll never hear the end of it." d."I don't deserve to be yelled at." e."I haven't seen such stupid behavior since grade school." f."I request a different assignment today."

b."Don't page me again, I'm very busy." c."If you tell my supervisor, you'll never hear the end of it." e."I haven't seen such stupid behavior since grade school."

Which is an example of assertive communication? a."I wish you would stop making me angry." b."I feel angry when you walk away when I'm talking." c."You never listen to me when I'm talking." d."You make me angry when you interrupt me."

b."I feel angry when you walk away when I'm talking."

The nurse has completed teaching sessions for parents about conduct disorder. Which statement indicates a need for further teaching? a."Being consistent with rules at home will probably be a real challenge for me and my child." b."It helps to know that these problems will get better as my child gets older." c."Real progress for our child is likely to take several weeks or even months." d."We need to set up a system of rewards and consequences for our child's behaviors."

b."It helps to know that these problems will get better as my child gets older."

Which statement about anger is true? a.Expressing anger openly and directly usually leads to arguments. b.Anger results from being frustrated, hurt, or afraid. c.Suppressing anger is a sign of maturity. d.Angry feelings are a negative response to a situation.

b.Anger results from being frustrated, hurt, or afraid.

Which type of drugs requires cautious use with potentially aggressive clients? a.Antipsychotic medications b.Benzodiazepines c.Mood stabilizers d.Lithium

b.Benzodiazepines

The nurse observes a client muttering to himself and pounding his fist in his other hand while pacing in the hallway. Which principle should guide the nurse's action? a.Only one nurse should approach an upset client to avoid threatening the client. b.Clients who can verbalize angry feelings are less likely to become physically aggressive. c.Talking to a client with delusions is not helpful, because the client has no ability to reason. d.Verbally aggressive clients often calm down on their own if staff members don't bother them.

b.Clients who can verbalize angry feelings are less likely to become physically aggressive.

Which is the best action for the nurse to take when assessing a child who might be abused? a.Confront the parents with the facts, and ask them what happened. b.Consult with a professional member of the health team about making a report. c.Ask the child which parent caused this injury. d.Say or do nothing; the nurse has only suspicions, not evidence.

b.Consult with a professional member of the health team about making a report.

Which statement is true? a.Anorexia nervosa was not recognized as an illness until the 1960s. b.Cultures in which beauty is linked to thinness have an increased risk for eating disorders. c.Eating disorders are a major health problem only in the United States and Europe. d.Individuals with anorexia nervosa are popular with their peers as a result of their thinness.

b.Cultures in which beauty is linked to thinness have an increased risk for eating disorders.

A nurse assessing a client with IED would expect which finding? a.Blaming others for provoking angry outbursts b.Difficulty coping with ordinary life stressors c.Lack of remorse for aggressive behavior d.Premeditated aggressive outbursts to get what the client wants

b.Difficulty coping with ordinary life stressors

A nurse doing an assessment with a client with bulimia would expect which findings? a.Compensatory behaviors limited to purging b.Dissatisfaction with body shape and size c.Feelings of guilt and shame about eating behavior d.Near-normal body weight for height and age e.Performance of rituals or compulsive behavior f.Strong desire to please others

b.Dissatisfaction with body shape and size c.Feelings of guilt and shame about eating behavior d.Near-normal body weight for height and age f.Strong desire to please others

When planning care for a client with somatic symptom disorder, the nurse would include which intervention(s)? a.Confront the client with negative results from diagnostic testing. b.Encourage the client to participate in daily routine activities. c.Help the client see the relationship between physical symptoms and life stress/events. d.Provide additional 1:1 attention when the client discusses physical symptoms. e.Refuse to discuss or listen to any physical complaints the client may express. f.Validate the client's physical and emotional distress.

b.Encourage the client to participate in daily routine activities. c.Help the client see the relationship between physical symptoms and life stress/events. f.Validate the client's physical and emotional distress.

Treating clients with anorexia nervosa with a selective serotonin reuptake inhibitor antidepressant such as fluoxetine (Prozac) may present which problem? a.Clients object to the side effect of weight gain. b.Fluoxetine can cause appetite suppression and weight loss. c.Fluoxetine can cause clients to become giddy and silly. d.Clients with anorexia get no benefit from fluoxetine.

b.Fluoxetine can cause appetite suppression and weight loss.

A client with delirium is attempting to remove the IV tubing from his arm, saying to the nurse, "Get off me! Go away!" What is the client experiencing? a.Delusions b.Hallucinations c.Illusions d.Disorientation

b.Hallucinations

Emotion-focused coping strategies are designed to accomplish which outcome? a.Helping the client manage difficult situations more effectively b.Helping the client manage the intensity of symptoms c.Teaching the client the relationship between stress and physical symptoms d.Relieving the client's physical symptoms

b.Helping the client manage the intensity of symptoms

Which assessment finding might indicate elder self-neglect? a.Hesitancy to talk openly with nurse b.Inability to manage personal finances c.Missing valuables that are not misplaced d.Unusual explanations for injuries

b.Inability to manage personal finances

The nurse is caring for a client with a conversion disorder. Which finding will the nurse expect during assessment? a.Extreme distress over the physical symptom b.Indifference about the physical symptom c.Labile mood d.Multiple physical complaints

b.Indifference about the physical symptom

When teaching a client about memantine (Namenda), the nurse will include which information? a.Lab tests to monitor the client's liver function are needed. b.Namenda can cause elevated blood pressure. c.Taking Namenda will improve the client's cognitive functioning. d.The most common side effect of Namenda is gastrointestinal bleeding.

b.Namenda can cause elevated blood pressure.

The nurse is evaluating the progress of a client with bulimia. Which behavior would indicate that the client is making positive progress? a.The client can identify calorie content for each meal. b.The client identifies healthy ways of coping with anxiety. c.The client spends time resting in her room after meals. d.The client verbalizes knowledge of former eating patterns as unhealthy.

b.The client identifies healthy ways of coping with anxiety.

Which of the following give cues to the nurse that a client may be grieving for a loss? a.Sad affect, anger, anxiety, and sudden changes in mood b.Thoughts, feelings, behavior, and physiologic complaints c.Hallucinations, panic level of anxiety, and sense of impending doom d.Complaints of abdominal pain, diarrhea, and loss of appetite

b.Thoughts, feelings, behavior, and physiologic complaints

When assessing a client with delirium, the nurse will expect to see a.aphasia. b.confusion. c.impaired level of consciousness. d.long-term memory impairment. e.mood fluctuations. f.rapid onset of symptoms.

b.confusion. c.impaired level of consciousness. f.rapid onset of symptoms.

The nurse understands that effective limit setting for children includes a.allowing the child to participate in defining limits. b.consistent enforcement of limit by entire team. c.explaining the consequences of exceeding limits. d.informing the child of the rule or limit. e.negotiation of reasonable requests for change in limits. f.providing three or four cues or prompts to follow the established limit.

b.consistent enforcement of limit by entire team. c.explaining the consequences of exceeding limits. d.informing the child of the rule or limit.

An effective nursing intervention for the impulsive and aggressive behaviors that accompany conduct disorder is a.assertiveness training. b.consistent limit setting. c.negotiation of rules. d.open expression of feelings.

b.consistent limit setting.

A 7-year-old child with ADHD is taking clonidine (Kapvay). Common side effects include a.appetite suppression. b.dizziness. c.dry mouth. d.hypotension. e.insomnia. f.nausea.

b.dizziness. c.dry mouth. d.hypotension.

A 16-year-old with ODD is most likely to have difficulty in relationships with a.family friends. b.law enforcement. c.parents—mother or father or both. d.peers of the same age group. e.school superintendent. f.store manager at work.

b.law enforcement. c.parents—mother or father or both. e.school superintendent. f.store manager at work.

The nurse is talking with a woman who is worried that her mother has Alzheimer disease. The nurse knows that the first sign of dementia is a.disorientation to person, place, or time. b.memory loss that is more than ordinary forgetfulness. c.inability to perform self-care tasks without assistance. d.variable with different people.

b.memory loss that is more than ordinary forgetfulness.

Which statement indicates the caregiver's accurate knowledge about the needs of a parent at the onset of the moderate stage of dementia? a."I need to give my parent a bath at the same time every day." b."I need to postpone any vacations for 5 years." c."I need to spend time with my parent doing things we both enjoy." d."I need to stay with my parent 24 hours a day for supervision."

c."I need to spend time with my parent doing things we both enjoy."

Which statement would indicate that teaching about somatic symptom disorder has been effective? a."The doctor believes I am faking my symptoms." b."If I try harder to control my symptoms, I will feel better." c."I will feel better when I begin handling stress more effectively." d."Nothing will help me feel better physically."

c."I will feel better when I begin handling stress more effectively."

Which statement by the caregiver of a client newly diagnosed with dementia requires further intervention by the nurse? a."I will remind Mother of things she has forgotten." b."I will keep Mother busy with favorite activities as long as she can participate." c."I will try to find new and different things to do every day." d."I will encourage Mother to talk about her friends and family."

c."I will try to find new and different things to do every day."

A client is pacing in the hallway with clenched fists and a flushed face. She is yelling and swearing. In which phase of the aggression cycle is she? a.Anger b.Triggering c.Escalation d.Crisis

c.Escalation

Which is true about domestic violence between same-sex partners? a.Such violence is less common than that between heterosexual partners. b.The frequency and intensity of violence are greater than between heterosexual partners. c.Rates of violence are about the same as between heterosexual partners. d.None of the above.

c.Rates of violence are about the same as between heterosexual partners.

A teenager is being evaluated for an eating disorder. Which finding would suggest anorexia nervosa? a.Guilt and shame about eating patterns b.Lack of knowledge about food and nutrition c.Refusal to talk about food-related topics d.Unrealistic perception of body size

c.Refusal to talk about food-related topics

Which is an example of a cognitive-behavioral technique? a.Distraction b.Relaxation c.Self-monitoring d.Verbalization of emotions

c.Self-monitoring

Situations that are considered risk factors for complicated grief are a.inadequate support and old age. b.childbirth, marriage, and divorce. c.death of a spouse or child, death by suicide, and sudden and unexpected death. d.inadequate perception of the grieving crisis.

c.death of a spouse or child, death by suicide, and sudden and unexpected death.

A teaching plan for the parents of a child with ADHD should include a.allowing as much time as needed to complete any task. b.allowing the child to decide when to do homework. c.giving instructions in short simple steps. d.keeping track of positive comments that the child is given. e.providing a reward system for completion of daily tasks. f.spending time at the end of the day reviewing the child's behavior.

c.giving instructions in short simple steps. d.keeping track of positive comments that the child is given. e.providing a reward system for completion of daily tasks.

The nurse would expect to see all the following symptoms in a child with ADHD, except a.distractibility and forgetfulness. b.excessive running, climbing, and fidgeting. c.moody, sullen, and pouting behavior. d.interrupting others and inability to take turns.

c.moody, sullen, and pouting behavior.

A client who developed numbness in the right hand could not play the piano at a scheduled recital. The consequence of the symptom, not having to perform, is best described as a.emotion-focused coping. b.phobia. c.primary gain. d.secondary gain.

c.primary gain.

The nurse has been teaching a caregiver about donepezil (Aricept). The nurse knows that teaching has been effective when the caregiver makes which statement? a."Let's hope this medication will stop the Alzheimer disease from progressing any further." b."It is important to take this medication on an empty stomach." c."I'll be eager to see if this medication makes any improvement in concentration." d."This medication will slow the progress of Alzheimer disease temporarily."

d."This medication will slow the progress of Alzheimer disease temporarily."

Parents of a child with ODD are referred to a parent management training program. The parents ask the nurse what to expect from these sessions. The best response by the nurse is a."This is a method of parenting that involves negotiation of responsibilities with your child." b."This is a support group for parents to discuss the difficulties they are having with their children." c."You will have a chance to learn how to manage all of your child's negative behaviors." d."You will learn behavior management techniques to use at home with your child."

d."You will learn behavior management techniques to use at home with your child."

A child is taking pemoline (Cylert) for ADHD. The nurse must be aware of which side effect? a.Decreased thyroid-stimulating hormone b.Decreased red blood cell count c.Elevated white blood cell count d.Elevated liver function tests

d.Elevated liver function tests

The nurse recognizes which as a common behavioral sign of autism? a.Clinging behavior toward parents b.Creative imaginative play with peers c.Early language development d.Indifference to being hugged or held

d.Indifference to being hugged or held

Paroxetine (Paxil) has been prescribed for a client with a somatic symptom illness. The nurse instructs the client to watch out for which side effect? a.Constipation b.Increased appetite c.Increased flatulence d.Nausea

d.Nausea

The nurse is teaching a 12-year-old with intellectual disability about medications. Which intervention is essential? a.Speak slowly and distinctly. b.Teach the information to the parents only. c.Use pictures rather than printed words. d.Validate client understanding of teaching.

d.Validate client understanding of teaching.

Behaviors observed during the recovery phase of the aggression cycle include a.angry feelings. b.anxiety. c.apologizing to staff. d.decreased muscle tension. e.lowered voice volume. f.rational communication.

d.decreased muscle tension. e.lowered voice volume. f.rational communication.

Physiologic responses of complicated grieving include a.tearfulness when recalling significant memories of the lost one. b.impaired appetite, weight loss, lack of energy, and palpitations. c.depression, panic disorders, and chronic grief. d.impaired immune system, increased serum prolactin level, and increased mortality rate from heart disease.

d.impaired immune system, increased serum prolactin level, and increased mortality rate from heart disease.