Mood & Affect #5

An 18-year-old woman is brought to the emergency department by her two roommates after being found unconscious in the bathroom. Laboratory tests are ordered. The nurse reviewing the findings notes that the urinalysis is positive for flunitrazepam. The nurse knows that flunitrazepam is often used for what? 1 As a date rape drug 2 To control symptoms of psychosis 3 To control symptoms of bipolar mania 4 To treat hangover symptoms after excessive alcohol consumption

1

A nurse is assessing a toddler and the dynamics of the child's family, in which abuse is suspected. What behaviors are expected? Select all that apply. 1 The child cringes when approached. 2 The child has unexplained healed injuries. 3 The parents are overly affectionate toward the child. 4 The child lies still while surveying the environment. 5 The parents give detailed accounts of the child's injuries.

1,2,4

A nurse in the emergency department notes large welts and scars on the back of a toddler who has been admitted for an asthma attack. What additional information must be included in the nurse's assessment? 1 History of an injury 2 Signs of child abuse 3 Presence of food allergies 4 Recent recovery from chickenpox

2

A nurse is interviewing a mother accused of physical child abuse. When speaking with this mother, what does the nurse expect her to do? 1 Attempt to rationally explain her behavior. 2 Reveal the belief that her child needed to be disciplined. 3 Offer a detailed explanation of how her child was injured. 4 Ask how she can arrange to visit her child on the pediatric unit

2

Child maltreatment is suspected in a 3-year-old girl admitted to the hospital with many poorly explained injuries. Which statement by the mother further supports this suspicion? 1 "When I get angry, I take her for a walk." 2 "I have no problems with any of my other children." 3 "When she misbehaves, I send her to her room alone." 4 "I make her stand in the corner when she doesn't eat her dinner."

2

Nurses on a psychiatric unit have secluded a client who has the diagnosis of bipolar I disorder, manic episode, and who has been losing control and throwing objects while in the dayroom. What is the most important intervention for a client who is given an as-needed medication and confined to involuntary seclusion? 1 Continue intensive nursing interactions. 2 Evaluate the client's progress toward self-control. 3 Determine whether any staff member has been injured. 4 Observe the client for side effects of the medication given

2

To therapeutically relate to parents who are known to have maltreated their child, what must the nurse do first? 1 Develop a trusting relationship with the child. 2 Identify personal feelings about child abusers. 3 Recognize the emotional needs of the parents. 4 Gather information about the child's home environment

2

What is the nurse's priority responsibility when abuse of an 8-year-old child is suspected? 1 Treating the child's traumatic injuries 2 Protecting the child from future abuse 3 Confirming the child's suspected abuse 4 Having the child examined by the healthcare provider

2

What is the term used to identify the display of anger in a socially inappropriate manner? 1 Abuse 2 Battery 3 Aggression 4 Defensiveness

3

A nurse is teaching a class about child abuse. What defense mechanism most often used by the physically abusive individual should the nurse include? 1 Repression 2 Manipulation 3 Transference 4 Displacement

4

A child would be demonstrating outwardly focused anger or aggression in an overt manner when engaging in which behavior? 1 Dominating a class discussion 2 Intentionally forgetting to do homework 3 Scribbling on a classmate's art assignment 4 Crying when told he or she must wait his or her turn

3

A married woman is brought to the emergency department of a local hospital. Her eyes are swollen shut, and she has a bruise on her neck. She reports that she is being beaten by her husband. How does the nurse expect the husband to behave when he arrives at the emergency department? 1 Fearful 2 Confused 3 Charming 4 Indifferent

3

A nurse is teaching staff members about the legal terminology used in child abuse. What definition of battery should the nurse include in the teaching? 1 Maligning a person's character while threatening to do bodily harm 2 A legal wrong committed by one person against property of another 3 The application of force to another person without lawful justification 4 Behaving in a way that a reasonable person with the same education would not

3

A nurse works in a crisis intervention center. A woman who has experienced sexual abuse comes in and says, "I've got to talk to someone or I'll go crazy. I shouldn't have dated him." What is most important for the nurse to identify after initially assessing the client's physical condition? 1 Support system 2 Sexual background 3 Ability to relay the facts 4 Knowledge of sexual assault terminology

1

A teacher's aide in a kindergarten class informs the school nurse that a male student said that his mother beat him and that he has bruises on the back and shoulders. What is the priority nursing action? 1 Notifying Child Protective Services 2 Reporting this information to the principal 3 Calling the parents to arrange a conference 4 Assessing the child for the presence of bruises

4

A 34-year-old woman who was sexually assaulted is examined in the emergency department within 2 hours of the assault. During assessment she freely discusses the incident, her past psychiatric history, and her past sexual history with the sexual assault nurse examiner (SANE). Which information documented by the nurse indicates that the nurse needs more teaching about appropriate charting? 1 Details of the client's sexual history 2 Verbatim statements made by the client regarding the assault 3 Details of the client's physical trauma documented with a body map or photographs 4 Signs of emotional trauma, including the client's current condition and cooperative behavior

1

A client at 16 weeks' gestation arrives at the prenatal clinic for a routine visit. During the examination the nurse notes bruises on the client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm what? 1 Domestic abuse 2 Hydatidiform mole 3 Excessive exercise 4 Thrombocytopenic purpura

1

A mother and her three young children arrive at the mental health clinic. The woman says that she is seeking help in leaving her husband. She reports that he has been beating her for years but just started hitting the children. What is the best initial action by the nurse? 1 Arranging for a staff member to watch the children so the mother and nurse can talk 2 Calling a facility where the mother and her children will be safe until the crisis is resolved 3 Determining whether the mother is ambivalent about this decision before making permanent plans 4 Suggesting that the mother and her husband return for couples counseling so the marriage can be saved

1

A nurse is teaching a group of parents about child abuse. What definition of assault should the nurse include in the teaching plan? 1 Assault is a threat to do bodily harm to another person. 2 Assault is a legal wrong committed by one person against the property of another. 3 Assault is a legal wrong committed against the public that is punishable by federal law. 4 Assault is the application of force to another person without lawful justification.

1

An older client is treated in the emergency department for soft-tissue injuries that the medical team suspects might be caused by physical abuse. An adult child states that the client is forgetful and confused and falls all the time. A mini-mental examination indicates that the client is oriented to person, place, and time, and the client does not comment when asked directly how the bruises and abrasions occurred. What is the next appropriate nursing action? 1 Interview the client without the presence of family members. 2 Report the abuse to the appropriate state agency for investigation. 3 Accept the adult child's explanation until more data can be collected. 4 Refer the client's clinical record to the hospital ethics committee for review.

1

A hospitalized psychiatric client with the diagnosis of histrionic personality disorder demands a sleeping pill before going to bed. After being refused the sleeping pill, the client throws a book at the nurse. What does the nurse recognize this behavior to be? 1 Exploitive 2 Acting out 3 Manipulative 4 Reaction formation

2

A parent of four is remanded to the psychiatric unit by the court for observation. The client was arrested and charged with abusing a 2-year-old child, who is in the pediatric intensive care unit in critical condition. The nurse approaches the client for the first time. How should the nurse anticipate that the client will likely respond? Select all that apply. 1 By denying beating the child 2 By avoiding talking about the situation 3 By asking where the other three children are 4 By expressing excessive concern for the child 5 By exhibiting an emotional response that is inconsistent with the degree of injury

1,2,5

A nurse is implementing interventions to assist an aggressive client in deescalating the agitated behavior. Select all that apply. 1 Physical contact with the client to show caring 2 Encouraging the client to express perceived needs 3 Avoiding verbal struggles in an attempt to demonstrate authority 4 Providing the client with clear options to the unacceptable behavior 5 Referring to the client in an authoritarian manner to demonstrate control of the situation 6 Explaining the expected outcomes if the client is unable to control the unacceptable behavior

2,3,4,6

An injured child is brought to the emergency department by the parents. While interviewing the parents, the nurse begins to suspect child abuse. Which parental behaviors might support this conclusion? Select all that apply. 1 Demonstrating concern for the injured child 2 Focusing on the child's role in sustaining the injury 3 Changing the story of how the child sustained the injury 4 Asking questions about the injury and the child's prognosis 5 Giving an explanation of how the injury occurred that is not consistent with the injury

2,3,5

A 20-year-old woman is brought to an emergency department after having been raped. She is very anxious and cannot recall any of the circumstances surrounding the assault or provide the police with a description of the rapist. What defense mechanism does the nurse know is being utilized by this woman? 1 Projection 2 Regression 3 Repression 4 Displacement

3

A 6-year-old child with a leg fracture of suspicious origin is brought into the emergency department by the mother and the mother's boyfriend. It is the child's first visit to this hospital. After assessing the child, a nurse anticipates that the healthcare provider will order a skeletal survey. Why is a skeletal survey the preferred diagnostic tool? 1 The exact location and extent of the fracture will be pinpointed. 2 Three separate x-ray films of the leg and hip should be ordered, making it more cost-effective. 3 The skeletal history of the current fracture and any previous healing or healed fractures are identified. 4 It is the first step toward a complete assessment before computed tomography and magnetic resonance imaging are done.

3

A woman with five children comes to the emergency department with multiple facial injuries. The client says, "My husband is an alcoholic, and he just beat me up." The nurse concludes that the client appears to be a victim of abuse. What should the nurse do next? 1 Discuss birth control with her. 2 Report her experiences to the police. 3 Inquire about her and the children's safety. 4 Discuss the possibility of her and the children leaving her husband.

3

The nurse is caring for a client in preterm labor who reports that she fell down the stairs. Bruises are apparent on the left part of the client's lower abdomen, the back of each shoulder, and on both wrists. After instituting electronic fetal monitoring, starting tocolytic therapy, and examining the monitor strips, what action should the nurse take next? 1 Ambulating the client to promote circulation 2 Inserting two small-bore intravenous catheters 3 Determining whether the client feels safe at home 4 Ensuring that the client has her glasses to ambulate

3

A client receiving steroid therapy states, "I have difficulty controlling my temper, which is so unlike me, and I don't know why this is happening." What is the nurse's best response? 1 Tell the client it is nothing to worry about. 2 Reassure that everyone does this at times. 3 Instruct the client to attempt to avoid situations that cause irritation. 4 Interview the client to determine whether other mood swings are being experienced

4

A female client who physically abused her 9-year-old son is undergoing treatment to help her control her behavior. Which statement indicates that the client has developed a safe coping method to help her deescalate? 1 "I promise that I won't get so angry when my son causes trouble again." 2 "If my son gets straightened out, we shouldn't have these kinds of problems." 3 "I think the root of the problem is when my husband comes home after drinking." 4 "If I get angry at my son again, I'm going to need a pillow in the bedroom to punch."

4

A woman who is frequently physically abused tells the nurse in the emergency department that it is her fault that her husband beats her. What is the most therapeutic response by the nurse? 1 "Maybe it was your husband's fault, too." 2 "I can't agree with that—no one should be beaten." 3 "Tell me why you believe that you deserve to be beaten." 4 "You say that it was your fault—help me understand that."

4

A young female client admitted to the trauma center after being sexually assaulted continues to talk about the rape. Toward what goal should the primary nursing intervention be directed? 1 Getting her involved with a rape therapy group 2 Remaining available and supportive to limit destructive anger 3 Exploring her feelings about men to promote future relationships 4 Providing a safe environment that permits the ventilation of feelings

4

An 8-year-old girl visits the school nurse frequently with vague ailments. The nurse spends time listening to the girl, takes her temperature, and always sends her back to class. One Thursday the girl tells the nurse that she no longer wants to visit her grandfather in his home because he "hugs me too tight and touches me down there" (pointing to her genitals). She has told her mother that she does not want to spend the weekend with her grandparents, but her mother says that she has no choice. What is the most appropriate action by the nurse? 1 Planning a home visit to discuss with the mother what her child has shared with the nurse 2 Advising the child to tell her mother why she does not want to go to her grandfather's house 3 Arranging a meeting with the principal and the mother to discuss the possibility of child molestation 4 Reporting the alleged abuse to the local child protective agency and encouraging an investigation before the weekend visit

4

Risk for assaultive behavior is highest in the mental health client who does what? 1 Uses profane language 2 Touches people excessively 3 Exhibits a sudden withdrawal 4 Experiences command hallucinations

4

The nurse is caring for a newly admitted male client with the diagnosis of bipolar disorder who has a history of hyperactivity and combativeness. Later in the evening, a commotion is heard and the new client is found beating another client. What is the legal interpretation of this situation? 1 The client should have been placed in restraints on admission. 2 A client who is known to have been combative should have been kept sedated. 3 A client with bipolar disorder who is in contact with reality does not require supervision. 4 Because it was known that the client was frequently combative, close observation by the nursing staff was indicated.

4

The school nurse is conducting a teacher's in-service on signs that may indicate that a child is a victim of bullying. Which sign should the nurse include in the teaching session? 1 The child wants to try out for the basketball team. 2 The child asks for extra work to make better grades. 3 The child is participating in several extracurricular activities after school. 4 The child asks to go to the nurse's office frequently with vague complaints.

4

What is the best room assignment for a 5-year-old child admitted with injuries that may be related to abuse? 1 In an isolation room 2 With a friendly older child 3 With a child of the same age 4 In a room near the nurses' desk

4

A young adult is being treated in the emergency department for injuries sustained as a result of physical battering by her partner. On learning that there is a history of such abuse, the nurse plans which tertiary nursing interventions? Select all that apply. 1 Contacting family members to provide support 2 Discussing the legal ramifications of not pressing charges 3 Offering to discuss the abusive behavior with the woman's partner 4 Identifying the benefits of attending a support group for battered women 5 Providing her with information regarding local domestic violence shelters

4,5