nurs 203 final prepu questions
The nurse working with a client who is newly diagnosed with schizophrenia would include which in the client's education? a. "Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine." b. "Schizophrenia is caused by pathology in the cerebellum, and there are medications that are helpful in this area." c. "Schizophrenia has been found to be nonresponsive to medications, and we will work mostly on helping you with daily activities." d. "Schizophrenia is curable if the correct medication and dosages are achieved."
a. "Schizophrenia is an illness that involves neurotransmitters, more specifically dopamine." Schizophrenia has been shown to be an illness in which the dopamine system is affected. It is not caused by pathology in the cerebellum nor is it curable. It is responsive to medications.
Which client being treated for anorexia displays assessment values that warrant hospitalization? a. A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL b. A 32-year-old with a temperature of 98° F and a pulse rate of 54 bpm c. A 16-year-old with serum potassium of 3.8 mEq/L and a blood pressure of 98/66 mmHg d. A 10-year-old whose weight has remained unchanged in spite of a 3-inch growth spurt
a. A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL A 25-year-old whose weight is 70% of ideal and who has a serum glucose of 58mg/dL should be hospitalized because both values are troublesome. The values of the other clients do not meet the criteria for hospitalization.
The mental health nurse is preparing a presentation about prescription drug abuse to a local community group. When describing the incidence, which age group would the nurse identify as experiencing an increase? a. Adolescents b. Chronically ill females c. Cognitively impaired older adults d. Middle-age males
a. Adolescents Alcohol, tobacco, marijuana, and illegal prescription drug use have reached epidemic proportions in the United States, with the incidence rising in younger age groups, particularly among adolescents and young adults.
A client diagnosed with schizophrenia has been prescribed clozapine. Which is a potentially fatal side effect of this medication? a. Agranulocytosis b. Neuroleptic malignant syndrome c. Tardive dyskinesia d. Dystonia
a. Agranulocytosis Agranulocytosis is manifested by a failure of the bone marrow to produce adequate white blood cells. Neuroleptic malignant syndrome is a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles.
When assuming the management of the care of a delusional client, which should be the nurse's priority intervention? a. Assure the client that he or she is safe in this milieu b. Acknowledge that there may be some truth in the delusion c. Encourage the client to talk about the reasoning behind his or her delusion d. Identify what triggers the delusion
a. Assure the client that he or she is safe in this milieu Assuring the client that he or she is in a safe environment is the first step in the establishment of a therapeutic relationship that is vital to successful psychiatric treatment.
Disulfiram has been prescribed for a client receiving treatment for alcoholism. Which should be included in the client's plan of care? a. Avoid all products containing alcohol b. Do not drive heavy machinery c. Have weekly blood alcohol levels drawn d. Limit alcohol consumption to a moderate level
a. Avoid all products containing alcohol The client must read product labels carefully because any product containing alcohol can produce symptoms, such as sweating, nausea and vomiting, and severe hypotension. The medication does not affect motor response. The client will not need weekly blood alcohol levels drawn.
The recommended first-line pharmacologic agents for managing severe alcohol withdrawal symptoms are in which class of medications? a. Benzodiazepines b. Serotonin reuptake inhibitors c. Atypical antipsychotics d. Major tranquilizers
a. Benzodiazepines The benzodiazepines reduce withdrawal severity, reduce the incidence of delirium, reduce seizures, and have better overall documented efficacy.
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 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 distortions
a. Body dissatisfaction c. Obsessiveness f. Cognitive distortions 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.
Which is a cardiac complication of an eating disorder? a. Bradycardia b. Hypertension c. Enlarged heart d. Thrombocytopenia
a. Bradycardia Cardiac complications include bradycardia, hypotension, small heart, and loss of cardiac muscle. Thrombocytopenia is a hematologic complication of eating disorders.
A client with schizoaffective disorder is engaging in an extremely long conversation about a current affairs in the world. The client goes on to provide the nurse with minute details. The nurse interprets this as suggesting what? a. Circumstantiality b. Neologism c. Verbigeration d. Clang association
a. Circumstantiality The client is demonstrating circumstantiality, which refers to extremely detailed and lengthy discourse about a topic.This can be commonly found in a client with euphoric or elevated mood due to the affective component of schizoaffective disorder. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. Neologisms are words invented by the client. A verbigeration is the stereotyped repetition of words or phrases that may or may not have meaning to the listener.
For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions? For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions? a. Cognitive-behavioral therapy (CBT) including self-monitoring b. One-on-one time with psychiatric staff and antidepressant medication therapy c. Daily reinforcement of sound dietary principles and meditation sessions d. Clearly stated unit rules and a supportive milieu
a. Cognitive-behavioral therapy (CBT) including self-monitoring For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. The primary interventions include CBT, including self-monitoring.
Individuals with anorexia nervosa concentrate on which body cue? a. Controlling food intake b. Hunger c. Weakness d. Anxiety
a. Controlling food intake Individuals with anorexia nervosa ignore body cues, such as hunger and weakness, and concentrate all efforts on controlling food intake.
Despite being admitted to the hospital yesterday for the treatment of complications of anorexia nervosa, a 19-year-old client continues to refuse fluids and is only taking small bites of food during mealtime. Which nursing diagnosis is paramount in this client's care? a. Deficient fluid volume related to refusal to drink b. Impaired social interaction related to aggressive behavior c. Anxiety related to inadequate coping mechanisms d. Hyperactivity related to restlessness
a. Deficient fluid volume related to refusal to drink The risk of dehydration posed by the client's refusal to drink likely supersedes the risk of imbalanced nutrition in the short term. Both diagnoses are more immediate concerns than the client's social interactions. There is no evidence of anxiety or hyperactivity related to restlessness.
A nurse is assessing a client diagnosed with schizophrenia. When documenting the findings, which would the nurse identify as a positive symptom? Select all that apply. a. Delusions b. Hallucinations c. Alogia d. Anhedonia e. Avolition
a. Delusions b. Hallucinations Positive symptoms reflect an excess or distortion of normal functions, including delusions and hallucinations. Negative symptoms reflect a lessening (or complete loss) of normal functions, such as restriction or flattening in the range and intensity of emotion (diminished emotional expression); reduced fluency and productivity of thought and speech (alogia); withdrawal and inability to initiate and persist in goal-directed activity (avolition); and inability to experience pleasure (anhedonia).
A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, a nurse identifies signs and symptoms of a dystonic reaction. Which agent would the nurse expect to administer? a. Diphenhydramine b. Propranolol c. Risperidone d. Aripiprazole
a. Diphenhydramine For dystonic reactions, the drug of choice is benztropine mesylate or diphenhydramine. Propranolol could be used to treat akathisia. Risperidone and aripiprazole are antipsychotic agents used to treat schizophrenia.
A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which would the nurse include? a. Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders b. Emphasis on the need for teachers to focus their prevention efforts on female students c. Stressing the need to allow students to eat without undue attention or supervision in order to prevent inadvertently influencing eating patterns d. Clarification that peer pressure is not typically problematic in children who are in the fifth and sixth grades
a. 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 group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions? a. Dopamine b. Serotonin c. Norepinephrine d. Gamma-aminobutyric acid (GABA)
a. Dopamine Although research is demonstrating that schizophrenia does not result from dysregulation of a single neurotransmitter or biogenic amine (such as serotonin, norepinephrine, or dopamine), positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by dopamine hyperactivity in the mesolimbic tract. Researchers are also hypothesizing a role for GABA but have yet to identify any specific information.
Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by hyperactivity of which neurotransmitter? a. Dopamine b. Acetylcholine c. Norepinephrine d. Epinephrine
a. Dopamine Positive symptoms of schizophrenia, such as delusions and hallucinations, are thought to be caused by dopamine hyperactivity in the mesolimbic tract at the D2 receptor site in the striatal area, where memory and emotion are regulated. Hyperactivity of acetylcholine, norepinephrine, and epinephrine are not associated with schizophrenia.
The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience? a. Dopamine b. Serotonin c. Acetylcholine d. Norepinephrine
a. Dopamine The ingestion of mood-altering substances stimulates dopamine pathways in the limbic system, which produces pleasant feelings or a "high" that is a reinforcing, or positive, experience.
Which is a dental complication associated with purging? a. Erosion of dental enamel b. Seizures c. Elevated blood urea nitrogen (BUN) d. Enlarged pancreas
a. Erosion of dental enamel Erosion of dental enamel is a dental complication associated with purging. Seizures, elevated BUN, and enlarged pancreas are not dental complications associated with purging, but are overall complications.
How often must clients receiving clozapine get white blood cell counts drawn? a. Every week for the first 6 months b. Every 3 months c. Every 6 months d. Every year
a. Every week for the first 6 months Clients taking clozapine must have weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter.
Exacerbation of anorexia nervosa results from the client's effort to do what? a. Gain control of one part of life b. Manipulate family members c. Diminish conflict d. Live up to family expectations
a. Gain control of one part of life A client with anorexia nervosa is unconsciously attempting to gain control over the only part of the client's life the client feels the client can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. This eating disorder carries with it a high incidence in families that emphasize achievement.
During an admission assessment, a client with schizoaffective disorder states that the client hears the voice of God in the client's head and the voice is telling the client that the client is worthless. What would the nurse document this symptom as? a. Hallucination b. Delusion c. Avolition d. Alogia
a. Hallucination Hallucinations are sensory perceptions with a compelling sense of reality but with no actual objective basis. During auditory hallucinations (the most common form), clients may hear the voice of God or close relatives, two or more voices with a running commentary about the client's behavior, or voices that command certain acts. Delusions are false, fixed beliefs. Avolition involves the withdrawal and inability to initiate and persist in goal-directed activity. Alogia refers to the reduced fluency and productivity of thought and speech.
A client is admitted to the emergency department after using MDMA (Ecstasy). The nurse identifies this drug as which of the following? a. Hallucinogen b. Stimulant c. Opioid d. Sedative
a. Hallucinogen MDMA (3-4 methylenedioxymethamphetamine), or Ecstasy or Molly, is a hallucinogen and is known as a "designer drug" because it is used by teens and young adults as part of the nightclub, bar, and rave scenes. MDMA, similar in structure to methamphetamine, causes serotonin to be released from neurons in greater amounts than normal. Once released, this serotonin can excessively activate serotonin receptors.
When a client is working toward the prevention of an alcohol abuse relapse, the nurse is acting in a therapeutic role when doing what? a. Helping the client identify positive coping mechanisms b. Discussing the pros and the cons of alcohol abuse c. Monitoring the effects of treatment d. Providing education to the client's family
a. Helping the client identify positive coping mechanisms When a client is working toward the prevention of an alcohol abuse relapse, the nurse is most therapeutic when helping the client identify positive coping mechanisms.
Which area of the brain has been associated with the symptoms of eating disorders? a. Hypothalamus b. Cerebellum c. Pons d. Medulla
a. Hypothalamus The hypothalamus has been associated with the symptoms of eating disorders.
A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this client, which would a nurse expect to find? a. Impulsivity b. Panic c. Hyperactivity d. Delusions
a. 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. Panic, hyperactivity, and delusions are not associated with bulimia nervosa.
Which is the central focus of persecutory delusions? a. Injustice that must be remedied by legal action b. Involving bodily functions or sensations c. Unfaithfulness d. A great, unrecognized talent
a. Injustice that must be remedied by legal action The focus of persecutory delusions is often on some injustice that must be remedied by legal action. Clients often see satisfaction by repeatedly appealing to courts and other government agencies. The central theme of somatic delusions involves bodily functioning or sensations. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Clients representing with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery.
When discussing methadone treatment with a client, the nurse should include what? a. It decreases the severity of heroin withdrawal symptoms. b. The cure rate is extremely high. c. It takes 1 to 2 years to cure an opiate addict. d. It is a nonaddictive treatment.
a. It decreases the severity of heroin withdrawal symptoms. Methadone is a substitute for heroin, reducing the severity of heroin withdrawal symptoms. It does not cure heroin addiction, and it is an addictive drug.
Which statement incorrectly identifies positive aspects regarding methadone for heroin addiction? a. It is available in IV form. b. It is a legal medication. c. It is controlled by a physician. d. It is available in tablet form.
a. It is available in IV form. Methadone is safer because it is legal, controlled by a physician, and available in tablet form. It is not available in IV form.
A group of nursing students is reviewing information about nutritional supplementation used during alcohol detoxification. The students demonstrate the need for additional review when they identify which of the following as being used? a. Naloxone b. Thiamine c. Folic acid d. Magnesium sulfate
a. Naloxone Naloxone (Narcan), an opioid antagonist, is given to reverse the respiratory depression, sedation, and hypertension for opioid intoxication. Multivitamins and adequate nutrition are essential for clients who are withdrawing from alcohol. Because malnutrition is common, other vitamin replacement may be necessary for certain individuals. Thiamine (vitamin B1) is initiated during detoxification, given to decrease ataxia and other symptoms of deficiency. It is usually given orally, 100 mg four times daily, but can be given intramuscularly or by intravenous infusion with glucose. Folic acid deficiency is corrected with administration of 1.0 mg orally four times daily. Magnesium deficiency also is found in those with long-term alcohol dependence. Magnesium sulfate, which enhances the body's response to thiamine and reduces seizures, is given prophylactically for clients with histories of withdrawal seizures.
A 20-year-old client arrives at the emergency department by ambulance. The client is unconscious, with slow respirations and pinpoint pupils. There are "tracks" visible on the client's arms. The friend who came with the client reports that the client had just "shot up" heroin when the client became unconscious. Which medication would the nurse most likely expect to administer? a. Naloxone b. Naltrexone c. Bupropion d. Varenicline
a. Naloxone Naloxone, an opioid antagonist, is given to reverse respiratory depression, sedation, and hypertension. Naltrexone is used to treat alcohol dependence. Bupropion and varenicline are used to promote smoking cessation.
A client had been withdrawn in the client's room for 3 days, not eating or sleeping, prior to his admission to the inpatient unit. Upon interview, the client demonstrates difficulty answering questions, appears to have no facial expressions, and cannot follow simple instructions. This cluster of symptoms can be described as what? a. Negative symptoms b. Delusions c. Thought disorder d. Positive symptoms
a. Negative symptoms Common negative symptoms of schizophrenia include alogia, affective blunting, avolition, anhedonia, and attentional impairment.
The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what? a. Provide the client with a feeling of responsibility and control over the client's behavior b. Provide the therapist with a strategy for client compliance c. Allow the client a tool by which to negotiate behavior d. Provide the nurse with a tool for evaluating the plan of care
a. Provide the client with a feeling of responsibility and control over the client's behavior Refeeding involves establishing a contract that spells out expected behaviors, rewards, privileges, and consequences of noncompliance. Such a contract may be useful in eliminating power struggles with the client. Even though clients may rebel against contract terms, it reassures them to know that consistent limits are being maintained and that they can trust the staff to help maintain control, and ultimately it enables the client to feel more in control.
A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client? a. Self-monitoring b. Guided imagery c. Distraction d. Music therapy
a. Self-monitoring Self-monitoring is a type of behavioral therapy. It is designed to help the client with bulimia. Guided imagery, distraction, and music therapy can be used to manage emotions, such as anxiety, by using relaxation techniques.
An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care? a. Set up a strict eating plan for the client b. Restrict visits with the family until the client begins to eat c. Provide privacy during meals d. Encourage the client to exercise, which will reduce the client's anxiety
a. Set up a strict eating plan for the client Establishing a consistent eating plan and monitoring the client's weight are important for this disorder. The family should be included in the client's care. The client should be monitored during meals—not given privacy. Exercise must be limited and supervised.
A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions? a. Somatic b. Jealous c. Nihilistic d. Grandiose
a. Somatic Persons who have somatic delusions believe they have a physical ailment. Clients with somatic delusions use excessive health care resources. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Nihilistic delusions focus on death or calamity. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery; a less common presentation is the delusion of a special relationship with a prominent person or actually being a prominent person.
A client diagnosed with schizophrenia states to the nurse, "My intestines are being eaten by snakes." This statement represents which type of delusion? a. Somatic delusion b. Persecutory delusion c. Grandiose delusion d. Referential delusion
a. Somatic delusion Somatic delusions are generally vague and unrealistic beliefs about the client's health or bodily functions. Persecutory delusions involve the client's belief that "others" are planning to harm the client or are spying, following, or belittling the client in some way. Grandiose delusions are characterized by the client's claim to associate with famous people or celebrities or the client's belief that he or she is famous or capable of great feats. Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her.
The nurse should consider which during a psychiatric assessment of a newly immigrated client who is being evaluated for possible religious delusions? a. Some cultures hold religious beliefs that might be confused with delusional thought b. Most cultures contain well-accepted religious beliefs c. Delusions are often focused on the client's cultural religious beliefs d. The nurse's cultural religious beliefs may differ from those of the client's
a. Some cultures hold religious beliefs that might be confused with delusional thought Some cultures have widely held and culturally sanctioned beliefs that might be considered delusional in other cultures.
Which statement most accurately describes the etiology of substance-related disorders? a. Substance-related disorders result from the interplay of biologic, genetic, and psychosocial factors. b. Substance-related disorders are primarily a result of the presence of an individual's inherently addictive personality. c. The primary predictors of substance-related disorders are childhood trauma and parental abuse or neglect. d. Substance abuse is a learned behavior.
a. Substance-related disorders result from the interplay of biologic, genetic, and psychosocial factors. Substance-related disorders have a complex etiology, and contributions have been noted from a combination of neurological, genetic, behavioral, and sociocultural sources.
The psychiatric nurse managing the care of a client experiencing alcohol withdrawal instructs unit staff to anticipate that the client may experience which neurological response? a. Tactile hallucinations b. Gustatory hallucinations c. Somatic delusions d. Nihilistic delusions
a. Tactile hallucinations Alcohol withdrawal can be the origin of tactile hallucinations. Alcohol withdrawal is not usually the origin of gustatory hallucinations or delusions of any type.
A client has been taking neuroleptic medications for many years as a treatment for schizophrenia. The client is exhibiting tongue protrusion, facial grimacing, and excessive blinking. These manifestations are characteristic of which extrapyramidal side effects (EPS)? a. Tardive dyskinesia b. Dystonia c. Neuroleptic malignant syndrome d. Akathisia
a. Tardive dyskinesia Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness.
A nurse is conducting a class for a group of high school students about marijuana use and abuse. The nurse determines that the class needs further discussion when they state which of the following? a. Use of marijuana does not lead to addiction. b. It interferes with coordination and balance. c. Marijuana can produce the same respiratory problems as tobacco. d. It is not known if marijuana smoke contributes to the risk of lung cancer.
a. Use of marijuana does not lead to addiction. Marijuana use impairs the ability to form memories, recall events, and shift attention from one thing to another. It disrupts coordination of movement, balance, and reaction time. Contrary to popular belief, marijuana is addictive, is an irritant to the lungs, and can produce the same respiratory problems experienced by tobacco users (daily cough, phlegm). People who smoke marijuana miss work more than those who do not smoke, but it is not yet known whether marijuana smoke contributes to the risk of lung cancer.
An appropriate goal for a client newly admitted to the unit for alcohol withdrawal is what? a. Verbalize feeling safe and comfortable. b. Demonstrate knowledge of the deleterious effects of alcohol. c. Attend two Alcoholics Anonymous meetings each week. d. Make amends to people in his or her life that he or she has harmed.
a. Verbalize feeling safe and comfortable. The client should verbalize feeling safe and comfortable. The other answer choices are goals for longer-term treatment—i.e., after the detoxification process has been successfully completed.
High doses of alcohol produce which effect? a. Vomiting b. Decreased muscle tension c. Increased inhibitions d. Calmness
a. Vomiting An overdose, or excessive alcohol intake in a short period, can result in vomiting, unconsciousness, and respiratory depression.
Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder what? a. Whether any family members have been diagnosed with schizophrenia b. When the delusion first began c. If the client has complied with the treatment plan d. If any family member shows symptoms of depression
a. Whether any family members have been diagnosed with schizophrenia Some studies have found that delusional disorders are more common among relatives of individuals with schizophrenia than would be expected by chance; thus, asking whether any family members have been diagnosed with schizophrenia could be helpful.
When assessing a person with delusional disorder, which finding would the nurse expect to assess? a. few, if any, psychological deficits b. changes in mental status c. altered personality d. high level of intelligence
a. few, if any, psychological deficits Clients with delusional disorder show few, if any, psychological deficits. In these clients, average or marginally low intelligence is characteristic. Mental status is not generally affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact.
Which statement made by the nurse managing the care of an anorexic teenager demonstrates an understanding of the client's typical, initial reaction to the nurse? a. "I'm sorry that you are angry but you cannot throw food at me." b. "I realize this must be very difficult for you but try to remember I'm not your enemy." c. "I'm not the root of your problem." d. "I'm not going to take your insults personally but you need to be more respectful."
b. "I realize this must be very difficult for you but try to remember I'm not your enemy." The client initially may view the nurse, who is responsible for making the client eat, as the enemy. The client may hide or throw away food or become overtly hostile as anxiety about eating increases. The nurse must remember that the client's behavior is a symptom of anxiety and fear about gaining weight and not personally directed toward the nurse. The other options are nurse rather than client focused.
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 what? a. "I can have a glass of wine with dinner if I choose." b. "I should eat small frequent meals if I get nauseated." c. "I should take the drug on an empty stomach." d. "I might experience diarrhea with this drug."
b. "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 laxative.
The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective? a. "I know if I eat pasta, I'll binge." b. "I'll eat small meals and snacks regularly." c. "I'll take my medication when I feel the urge to binge." d. "How I feel about my body has little to do with my binging."
b. "I'll eat small meals and snacks regularly." Clients with bulimia need to normalize their eating patterns. Therefore, the statement about eating small meals and snacks regularly indicates understanding of the need to normalize eating patterns. Emotional and environmental cues, not specific foods, influence the eating patterns in bulimia. Medication, if prescribed, is taken regularly, not just when the client experiences the urge to binge. Body image dissatisfaction is an underlying factor associated with bulimia.
A nurse is providing care to a client with an eating disorder. Which client statement best demonstrates an understanding of the etiology of the disorder? a. "My strict dieting led to my problem with anorexia." b. "There are many factors involved with how I developed anorexia ." c. "Society told me I needed to be thin and I believed that." d. "There is a history of obsessive-compulsive disorder in my family."
b. "There are many factors involved with how I developed anorexia ." The etiology of anorexia nervosa is multidimensional. Some of the risk factors (discussed later) and the etiologic factors overlap. Initially, dieting may be the stimulus that leads to their development. Biologic vulnerability, developmental problems, and both family and social influences can be associated. However, the statement about many factors reflects the multidimensional nature of the disorder.
Which client exhibits the characteristics that are typical of the prodromal phase of schizophrenia? a. A 25-year-old does not express any of the symptoms of schizophrenia. b. A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. c. A 30-year-old has experienced a relapse after deciding that the client's atypical antipsychotic is unnecessary. d. A 28-year-old has been displaying the behaviors characteristic of schizophrenia for many months and has just been diagnosed with the disease.
b. A 20-year-old is experiencing a gradual decrease in the ability to concentrate, be productive, and sleep restfully. Gradual, subtle behavioral changes appear during the prodromal phase of schizophrenia, such as tension, the inability to concentrate, insomnia, withdrawal, or cognitive deficits. No symptoms are present in the premorbid phase, and relapses occur in the progressive and chronic phases. Diagnosis of the disease marks the beginning of the onset phase.
A client is 5 feet 6 inches tall, weighs 105 pounds, exercises 4 hours per day, and does not engage in any binging or purging behaviors. The client believes that he or she is becoming obese and states, "I'm shocked that you think I'm underweight. You don't understand me." The most likely diagnosis for this client is what? a. Anorexia nervosa, binge eating, and purging type b. Anorexia nervosa, restricting type c. Bulimia nervosa, nonpurging type. d. Eating disorder not otherwise specified
b. Anorexia nervosa, restricting type Anorexia nervosa is characterized by a voluntary refusal to eat and a weight less than 85% of normal for height and age. Clients with anorexia nervosa, restricting type have a distorted body image, eat very little, and often obsessively pursue vigorous physical activity to burn "excess calories."
A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which would the nurse expect to implement in conjunction with pharmacologic therapy? a. Behavioral therapy b. Cognitive behavioral therapy c. Interpersonal therapy d. Family therapy
b. 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.
The nurse must be aware that individuals from diverse ethnic groups might describe troubling experiences in terms of physical problems or specific culture-bound syndromes. The syndrome of ghost sickness is exhibited by which culture? a. Indian b. Native American c. West African d. Chinese
b. Native American The culture-bound syndrome of ghost sickness is seen in the Native American tribal culture. This culture exhibits a preoccupation with death and the deceased. Bad dreams, weakness, feelings of danger, anxiety, and hallucinations may occur. The other options are not related to the culture-bound syndrome of ghost sickness.
A nurse is implementing a brief intervention with a client who is abusing alcohol. The nurse most likely would be involved with which action? a. Asking the client questions about alcohol use b. Negotiating a conversation with the client about the need to change c. Pointing out the inconsistencies in thoughts, feelings, and actions d. Helping the client change the way the client thinks about a situation
b. Negotiating a conversation with the client about the need to change 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.
Safety is the nursing priority for a client who is at risk for alcohol withdrawal. A care plan for the client who is in withdrawal must include which nursing interventions? a. Vital signs and medications as prescribed b. Observation for symptoms, vital signs, seizure and fall precautions, medications as ordered c. Suicide precautions because suicide attempts are frequent during withdrawal d. Seizure precautions and vital signs
b. Observation for symptoms, vital signs, seizure and fall precautions, medications as ordered Nursing care of the client experiencing withdrawal centers on safety first. The nurse must implement frequent vital sign assessment, seizure precautions, and fall precautions to ensure the client's safety. Withdrawal symptoms must be controlled with medications.
A client has been prescribed quetiapine for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which information? a. Quetiapine can cause breast milk production. b. One of the common side effects is dry mouth. c. If dizziness is experienced, the client must call the doctor immediately. d. Quetiapine can cause one to crave sugar.
b. One of the common side effects is dry mouth. Dry mouth is a common, sometimes bothersome, side effect. Quetiapine does not cause breast milk production. Dizziness may occur due to orthostatic hypotension but will decrease as the body becomes accustomed to the medication. It is not an emergency. Quetiapine can cause changes in blood sugar but will not induce sugar cravings.
A client with schizophrenia believes that the cook at the psychiatric hospital is trying to poison the client. The nurse would record this type of delusion as what? a. Conjugal b. Persecutory c. Grandiose d. Erotomanic
b. Persecutory Clients with persecutory delusions believe that they are being conspired against, spied on, poisoned, drugged, cheated, harassed, maliciously maligned, or obstructed in some way. A client convinced that a spouse or significant other is unfaithful exhibits conjugal paranoia. Grandiose delusions exist when a client believes that he or she possesses unrecognized talent or insight or has made an important discovery. A person with erotomanic delusions believes that someone of elevated social status loves him or her.
A client is brought to the emergency department stating, "I'm scared because the Federal Bureau of Investigation is now tapping my home phone, and I can hear them talking between my two telephones during the night." The client's eyes dart around the room while the nurse is trying to interview the client, and the client is tapping the client's fingers on the table. The nursing priority with this client is what? a. Assess the client's family for dysfunctional dynamics. b. Reassure the client that the client is in a safe place where the client will be helped. c. Speak with the client about calling members of the client's family to come in. d. Give the haloperidol IM to reduce the client's paranoia.
b. Reassure the client that the client is in a safe place where the client will be helped. Safety needs are paramount. The person with schizophrenia is likely to be anxious and fearful around others due to disordered thought processes. Therefore the nurse builds a trusting relationship and assumes responsibility for the client's well-being by reassuring the client of the client's safety and security.
What are the signs and symptoms of schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders? a. Schizophrenia can be diagnosed as soon as an individual states he or she is hearing voices b. Schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms. c. Schizophrenia lasts at least 1 month and must include the symptom of hallucinations. d. Schizophrenia can be diagnosed as soon as an individual states he or she is hallucinating and delusional.
b. Schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptom According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, (DSM-5), schizophrenia lasts at least 6 months and includes at least 1 month of 2 or more active-phase symptoms such as bizarre delusions, hallucinations (e.g., a running commentary of two voices conversing), disorganized speech, grossly disorganized or catatonic behavior, and negative behavior.
A nursing student is aware that which accounts for more deaths, illnesses, and disabilities across the life span than any other preventable condition? a. Motor vehicle accidents b. Substance abuse disorders c. Falls d. Mood disorders
b. Substance abuse disorders Substance abuse disorders across the life span account for more deaths, illnesses, and disabilities than any other preventable health condition.
The nurse is carrying out the nursing process in the care of a client who has been diagnosed with body image disturbance. Which goal should be prioritized in the planning of this client's care? a. The client will experience diminished episodes of delusional thinking. b. The client will verbalize acceptance of appearance. c. The client will demonstrate measures to reduce body mass index. d. The client will demonstrate actions that promote health maintenance.
b. The client will verbalize acceptance of appearance. Central to body image disturbance is a lack of acceptance of physical appearance. Consequently, acceptance of appearance is a priority in the care of a client with this problem. The thinking that characterizes the disorder is not classified as delusional. Promoting health maintenance is a relevant goal but is not specific to body image disturbance. Reducing body mass index does not address the etiology of this condition.
A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind? a. Methadone is a not physiologically addictive. b. The drug helps to satisfy the craving for the opioid. c. Methadone is a non-opioid drug. d. Methadone simulates the high of heroin.
b. The drug helps to satisfy the craving for the opioid. Methadone maintenance is the treatment of people with opioid addiction with a daily, stabilized dose of methadone. Methadone is used because of its long half-life of 15 to 30 hours. Methadone is a potent opioid and is physiologically addicting, but it satisfies the opioid craving without producing the subjective high of heroin.
Which data support a nursing diagnosis of impaired verbal communication? a. Ambivalence, delusional thinking, and avolition b. The presence of neologism, echolalia, and clanging c. The presence of neologism, delusions, and anergia d. Rapid pacing and running
b. The presence of neologism, echolalia, and clanging Although the client may be indecisive, have false beliefs, and lack motivation, these do not support a diagnosis of impaired verbal communication. Invented words, repetition of words heard, and rhyming do get in the way of the ability to use or understand language in the human interaction. Fixed false beliefs and an absence of energy do not support a diagnosis of impaired verbal communication, nor do pacing and running.
A client is admitted to the emergency department for intoxication with alcohol. The client has an unsteady gait, myopathy, and neuropathy and cannot remember past or recent events. When treated with thiamine, the client's symptoms greatly improve. Which condition was the client likely experiencing? a. Scurvy b. Wernicke-Korsakoff syndrome c. Alcohol dependence with memory impairment d. Alcoholic dementia
b. Wernicke-Korsakoff syndrome Wernicke-Korsakoff syndrome is the coexistence of Wernicke's encephalopathy and Korsakoff's psychosis. Wernicke's encephalopathy is characterized by ataxia, nystagmus, ophthalmoplegia, and mental status changes. Korsakoff's psychosis involves gait disturbances, short-term memory loss, disorientation, delirium, confabulation, and neuropathy.
A nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client's eyes are fixed on the ceiling. The nurse interprets this finding as: a. akathisia. b. oculogyric crisis. c. retrocollis. d. tardive dyskinesia.
b. oculogyric crisis. The nurse should contact the client's physician because the client is exhibiting a dystonic reaction termed oculogyric crisis in which the muscles that control eye movements tense and pull the eyeball so that the client is looking toward the ceiling. Akathisia is manifested by restlessness, with clients often reporting that they feel driven to keep moving. Retrocollis involves the neck muscle, causing the head to be pulled back. Tardive dyskinesia involves abnormal, involuntary movements that are constant.
A client diagnosed with schizophreniform disorder must have symptoms present for at least 1 month but with a duration of less than how long? a. 2 weeks b. 4 weeks c. 6 months d. 12 months
c. 6 months The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder.
The dentist of a client noticed that the client's teeth were losing enamel and that the client looked extremely thin. The dentist refers the client for follow up based on the understanding that eating disorder is most often associated with dental caries and enamel loss? a. Bulimia nervosa, purging type b. Anorexia nervosa, restricting type c. Anorexia nervosa, purging type d. Binge eating disorder
c. Anorexia nervosa, purging type The dental enamel erosion is related to repeated induced vomiting associated with purging. This, in conjunction with the client's appearance, suggests anorexia nervosa, purging type. Individuals with bulimia typically maintain normal weight. Binge eating disorder does not involve purging.
A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect? a. Anorexia nervosa b. Bulimia nervosa c. Binge eating disorder d. Eating disorder not otherwise specified
c. Binge eating disorder Binge eating disorder 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. Individuals with binge eating disorder also differ from those with other eating disorders in that most of them are obese. The client does not restrict eating so anorexia is not appropriate. Eating disorder not otherwise specified refers to partial syndromes but does not met the criteria for anorexia or bulimia.
While a nurse talks to the mother of a 15-year-old client, the mother expresses concern over the client's eating and exercise habits. The mother says that as soon as the client comes home from school, the client exercises for 2 to 3 hours every day. She says the client eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. The client was complaining of tooth pain, and when the mother took the client to the dentist, the client had over 10 cavities. Which disorder is the client most likely suffering from? a. Anorexia nervosa b. Binge-eating disorder c. Bulimia nervosa d. Eating disorder not otherwise specified
c. Bulimia nervosa Bulimia is characterized by episodic, uncontrolled, rapid ingestion of large quantities of food. It may occur alone or in conjunction with the food restriction of anorexia. Clients with bulimia nervosa compensate for excessive food intake by self-induced vomiting, obsessive exercise, use of laxatives and diuretics, or all of these behaviors. They may consume an incredible number of calories (an average of 3,415 per binge) in a short period, induce vomiting, and perhaps repeat this behavior several times a day. Clients with bulimia may develop dental cavities from the frequent contact of tooth enamel with food and acidic gastric fluids.
While conducting an admission interview with a client, the nurse suspects the client may be in alcohol withdrawal. Which screening tool can help the nurse identify the severity of withdrawal symptoms? a. PERSONS b. CAGE c. CIWA-Ar d. MSE
c. CIWA-Ar Once alcohol withdrawal is suspected, a screening tool such as the CIWA-Ar can assist nurses to identify the severity of symptoms.
A client enters the emergency room exhibiting tremors, agitation, and restlessness. Upon assessment, the client's blood pressure is 160/90, pulse is 110, and respirations are 22. It has been 36 hours since the client's last drink of alcohol. The nurse would suspect which conditions to be occurring? a. Alcohol tolerance b. Korsakoff's psychosis c. Delirium tremens d. Wernicke's encephalopathy
c. Delirium tremens Delirium tremens may occur 24 to 72 hours after the client's last drink. Elevation of vital signs accompanies restlessness, tremulousness, agitation, and hyperalertness. Tolerance is a need for markedly increased amounts of alcohol to achieve the desired effect. Korsakoff's psychosis is a form of amnesia characterized by a loss of short-term memory and the inability to learn new skills. Wernicke's encephalopathy is an inflammatory hemorrhagic, degenerative condition of the brain caused by a thiamine deficiency.
A nurse is caring for several hospitalized clients with anorexia nervosa. The nurse would be especially alert for which if noted in the clients' histories? a. Paranoia b. Primary insomnia c. Depression d. Aggression
c. 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.
A client diagnosed with schizoaffective disorder and severe depression is being treated with antipsychotic medications. The client tells the nurse about difficulty with self-care activities. With which intervention should the nurse respond? a. Gain assistance from family members. b. Contact the physician for a change in medications. c. Establish a routine and set goals. d. Outline the side effects of the medications.
c. Establish a routine and set goals. The most useful approach for the nurse to try is to help the client establish a routine and set goals for accomplishing the activities of daily living.
Which medication has been found to be worthy of a trial in clients with bulimia nervosa who have obsessive-compulsive traits? a. Lithium b. Haloperidol c. Fluoxetine d. Bupropion
c. Fluoxetine Clients who display obsessive-compulsive traits particularly may benefit from treatment with clomipramine or fluoxetine. Fluoxetine is the only antidepressant with Food and Drug Adminstration approval for the treatment of bulimia nervosa.
The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next? a. Throat and esophagus b. Condition of mouth and gums c. Heart rate and rhythm d. Patterns of activity and rest
c. Heart rate and rhythm Physical examination may reveal numerous symptoms related to disturbances in nutrition and metabolism. Possible findings include dehydration, hypokalemia, cardiac dysrhythmia, hypotension, bradycardia, dry skin, brittle hair and nails, lanugo, frequent infections, dental caries, inflammation of the throat and esophagus, swollen parotid glands (from purging), amenorrhea, and hypothermia. A priority area to assess during physical examination is electrolyte abnormalities and associated cardiac dysfunction.
The nurse in an outpatient rehabilitation program is speaking with a group of clients who have recently recovered from alcohol abuse. Which issue should the nurse raise before the clients leave for the day? a. Remind them that substance dependency is a disease, not a mental disorder. b. Suggest that they try to confront other issues in their lives, such as estranged relationships or financial issues. c. Help them to identify appropriate diversional activities. d. Ask them to make a list of all the people they harmed during their addictions.
c. Help them to identify appropriate diversional activities. Clients in recovery typically have devoted much time to their addiction. Substance use is integral to their existence and occupies most of their leisure time. In some cases, it also takes up work and family time. During treatment, clients may find themselves lonely, bored, idle, or conflicted about what to do with so much "free" time. They need to plan activities to minimize the temptation to revert to alcohol or drug use.
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? a. Disturbed body image b. Anxiety c. Imbalanced nutrition: less than body requirements d. Ineffective coping
c. 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 47-year-old client has been admitted to the hospital after being found unconscious in a park. Upon regaining consciousness, the client admits to heavy alcohol use over many years. Assessment reveals a low body mass index, low electrolyte levels, and impaired skin integrity. Vital signs are within normal ranges. What nursing diagnosis should be prioritized in the care of this client? a. Risk for injury related to chronic alcohol intake b. Deficient knowledge regarding the effects of alcohol intake c. Imbalanced nutrition: less than body requirements related to chronic alcohol intake d. Ineffective coping related to effects of chemical use
c. Imbalanced nutrition: less than body requirements related to chronic alcohol intake High alcohol intake is associated with malnutrition, which can result in low electrolyte levels, low body mass index, and impaired skin integrity. This diagnosis is of more immediate concern than the client's coping, knowledge, or future risk for injury.
A comprehensive nursing assessment for neuroleptic malignant syndrome (NMS) should include checking for which in a client taking an antipsychotic medication? a. Headache, muscle aches, and paresthesias b. Confusion, giddiness, and hyperalertness c. Muscular rigidity, tremors, and difficulty swallowing d. Dry mouth, flushing, and urinary retention
c. Muscular rigidity, tremors, and difficulty swallowing NMS is characterized by muscular rigidity, tremors, difficulty swallowing, fever, hypertension, and diaphoresis.
During a client interview, a client diagnosed with delusional disorder states, "I know my spouse is being unfaithful to me with a colleague from work."The nurse interprets the client's statements as suggesting which type of delusion? a. Referential b. Sexual c. Persucatory/paranoid d. Grandiose
c. Persucatory/paranoid The client's statements reflect persucatory/paranoid delusions that focus on the unfaithfulness or infidelity of a spouse or lover. Such delusions involve the belief that others are untrustworthy in some way. With referential delusions, the ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her. In the sexual delusion subtype, ideas involve the belief that the client's sexual behavior is known to others. With grandiose delusions, individuals believe that they have a great, unrecognized talent or have made an important discovery.
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 about the drug? a. Causes itching if alcohol is consumed b. Produces the euphoria of alcohol c. Reduces the appeal of alcohol d. Improves appetite and nutritional status
c. Reduces the appeal of alcohol Naltrexone's effect is unknown. Reports from successfully treated clients suggest three kinds of effects: (1) can reduce craving (the urge or desire to drink), (2) can help maintain abstinence, and (3) can interfere with the tendency to want to drink more if a recovering client slips and has a drink.
A 24-year-old with schizophrenia and paranoid delusions is admitted to the hospital. The student nurse asks the charge nurse about what approach to take with the client, who has been exhibiting hostility and isolation. Which approach would be the most appropriate direction from the charge nurse? a. Inform the client that the client must receive care and you will assist the client. b. Greet the client by gently touching the client's arm and telling the client that the client can trust you. c. Respect the client's need for personal space and avoid physical contact. d. Tell the client that if the client does not comply with the rules, you will inform the doctor.
c. Respect the client's need for personal space and avoid physical contact. A newly admitted client with paranoid schizophrenia needs a sense of trust before the nurse attempts to touch the client. Using emphatic tones and veiled threats will only increase the client's anxiety and lead to increased potential for hostility and anger.
A client who is abusing substances is to undergo brief intervention. The nurse understands that this technique is most effective for a client who exhibits which symptoms? a. Multiple problems involving drug use b. High levels of dependence c. Short history of drug use d. Unstable backgrounds
c. Short history of drug use Brief intervention is most successful when working with individuals who are experiencing few problems with their drug use, have low levels of dependence, have a short history of drug use, and have stable backgrounds.
Clients with delusional disorder do not normally seek help independently because of their inability to establish what? a. Rapport b. Stability c. Trust d. Residency
c. Trust Clients with delusional or shared psychotic disorders do not normally seek help independently because of their inability to establish trust.
The nurse is interviewing an 18-year-old client about eating behaviors. The client's parents have brought the client to treatment because the client's mother suspects that the client has been binge eating and vomiting. The nurse asks the client if the client ever feels that the client cannot control the client's eating. The client's mother states, "I know the client can't control it; the client ate an entire cake last night!" Which comment by the nurse is best? a. "I see. What are your thoughts on what your mother has said?" b. "Do you often have to answer for your child?" c. " Is what your mother said true?" d. "I see. Do you ever feel as though you cannot control your eating?"
d. "I see. Do you ever feel as though you cannot control your eating?" Parents in enmeshed families frequently try to protect their children by speaking for them, as in, "My child feels happy most of the time." Members are not accustomed to identifying and expressing their own feelings and need frequent prompting from the nurse. The nurse encourages members to speak for themselves and not for one another.
The nurse is performing a history and physical examination on a client with chronic alcoholism. The client has a history of gastritis, esophagitis, elevated liver enzymes, cardiomyopathy, and pancreatitis. Which of these conditions are attributable to the client's history of alcohol abuse? a. Pancreatitis and elevated liver enzymes b. Gastritis and elevated liver enzymes c. Pancreatitis, esophagitis, gastritis, and elevated liver enzymes d. All the conditions are attributable to the alcohol abuse
d. All the conditions are attributable to the alcohol abuse Various medical conditions may alert the nurse to the early recognition of alcohol abuse problems, including gastritis or gastric ulcers, pancreatitis, esophagitis, mild to moderate hypertension, cardiomyopathy, arrhythmias, alcoholic hepatitis, cirrhosis of the liver, decreased white blood cell production, decreased granulocyte adherence, and thrombocytopenia, or cancers of the mouth, pharynx, larynx, esophagus, pancreas, stomach, and colon.
After assessing a client with schizophrenia, the nurse notes that the client exhibits signs and symptoms related to being unable to experience pleasure. The nurse documents this finding as what? a. Diminished emotional expression b. Alogia c. Avolition d. Anhedonia
d. Anhedonia Anhedonia refers to the inability to experience pleasure. Diminished emotional expression is reflected by a restriction or flattening in the range and intensity of emotion. Alogia refers to a reduced fluency and productivity of thought and speech. Avolition refers to withdrawal and inability to initiate and persist in goal-directed activity.
Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders? a. Antipsychotics b. Stimulants c. Mood stabilizers d. Antidepressants
d. Antidepressants Medications are useful for some clients with eating disorders. Because one theory posits that the cause of eating disorders is disturbed serotonin regulation, researchers have studied the effectiveness of antidepressants. Although pharmacologic therapy usually is not the primary intervention for anorexia, antidepressants or antianxiety drugs may benefit clients with depressive, anxious, or obsessive-compulsive symptoms.
A nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which would the nurse most likely document? a. Disorientation b. Reduced attention span c. Above average intelligence d. Body complaints
d. Body complaints Somatic delusions involve bodily functions or sensations, with clients believing that they have physical ailments. Clients with delusional disorder show few, if any, psychological deficits. These clients characteristically have average or marginally low intelligence. Mental status generally is not affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact.
A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected? a. Respiratory distress and dyspnea b. Bacterial gastrointestinal infections and overhydration c. Metabolic acidosis and constricted colon d. Dental erosion and chronic edema
d. Dental erosion and chronic edema In bulimia, dental erosion (from frequent vomiting) and chronic edema (from fluid imbalances) are common. Dyspnea, bacterial gastrointestinal infections, and metabolic acidosis are not characteristics of bulimia.
A client with schizophrenia is exhibiting emotional withdrawal and poor eye contact. The mental health nurse knows that these symptoms are suggestive of which neurotransmitter imbalance? a. Decreased serotonin and dopamine b. Increased histamine c. Increased GABA d. Increased serotonin and dopamine
d. Increased serotonin and dopamine Negative symptoms are thought to be due to cerebral atrophy, an inadequate amount of dopamine and serotonin, or other organic functions in the brain.
The nurse is providing teaching to a client diagnosed with schizoaffective disorder. The nurse should explain to the client that which is true about this disorder? a. It is more common than schizophrenia. b. It is usually diagnosed in late adulthood. c. It is most common with somatoform disorders. d. It is a mix of psychotic and mood symptoms.
d. It is a mix of psychotic and mood symptoms. Schizoaffective disorder is a mix of psychotic and mood symptoms and is typically diagnosed in early adulthood. It is not more common than schizophrenia and is not commonly adjunct to somatoform disorder although people diagnosed with schizoaffective disorder can present with somatic delusions.
A client with schizophrenia is receiving antipsychotic therapy. The nurse understands that which is a medical emergency should it develop in the client? a. Tardive dyskinesia b. Parkinsonism c. Akathisia d. Neuroleptic malignant syndrome
d. Neuroleptic malignant syndrome Although tardive dyskinesia, parkinsonism, and akathisia can occur with antipsychotic therapy, neuroleptic malignant syndrome is a life-threatening condition and medical emergency that requires immediate treatment.
A 44-year-old client has been experiencing intense job stress. In recent weeks, the client has confided in the client's spouse that the client believes the client's firm monitors every aspect of the client's personal performance and that the firm is engaged in deception and cover-up of its "true purpose." A nurse would recognize that the primary theme of the client's delusional disorder is what? a. Grandiose b. Somatic c. Conjugal d. Persecutory
d. Persecutory Clients who exhibit persecutory delusions believe that they are being conspired against, spied on, poisoned or drugged, cheated, harassed, maliciously maligned, or obstructed in some way. This delusion is not characteristic of somatic, conjugal, or grandiose subtype.
A client begins to exhibit hallucinations and delusions along with disorganized speech after forgetting to take antipsychotic medication. The nurse suspects that the client is at which point in the clinical course of the disorder? a. Prodromal phase b. Acute illness c. Stabilization d. Relapse
d. Relapse Relapse involves a return of the symptoms, most often due to the client's failure to follow the medication regimen. The prodromal phase is associated with small changes in overall function, such as difficulties at work or school, within relationships, or in daily activities accompanied by transient or weak symptoms of psychosis. Acute illness is the initial onset of changes in thought and bizarre or disruptive behavior. Stabilization occurs when symptoms become less acute, following the initial diagnosis and initiation of treatment.
An obese client is admitted to the facility for abusing amphetamines in an attempt to lose weight. Which nursing intervention is appropriate for this client? a. Encouraging the client to suppress feelings regarding obesity b. Reinforcing the client's concerns over physical appearance c. Using an abrupt, forceful manner to communicate with the client d. Teaching the client alternative ways to lose weight
d. Teaching the client alternative ways to lose weight Teaching the client alternative ways to lose weight is the appropriate intervention. Instead of encouraging the client to suppress feelings, the nurse should encourage the client to express feelings, especially those related to obesity. Reinforcing the client's concerns about physical appearance may make the client's anxiety worse and lead to more self-destructive behavior. Using an abrupt, forceful manner discourages therapeutic communication with the client.
Which factor would contraindicate the use of disulfiram in the treatment of a client who has an alcohol use disorder? a. The client has a demonstrated family history of alcoholism. b. The client engages in binge drinking a few times a week rather than drinking consistently each day. c. The client uses marijuana in addition to alcohol. d. The client had six drinks a few hours ago.
d. The client had six drinks a few hours ago. Disulfiram may not be administered to a client who is acutely intoxicated. A family history of alcoholism, marijuana use, and binge drinking do not preclude the use of the drug.
A client with schizophrenia is prescribed an antipsychotic medication. Which immediate side effects would the nurse include in the education plan for this medication? a. Risk for hypertension b. Risk for hypoprolactinemia c. The potential for weight loss d. The potential for sedation
d. The potential for sedation Sedation with antipsychotic medication will likely happen immediately after initiating the medication. The nurse should be sure to inform the client they he or she will experience this side effect readily. The other options are examples of side effects that are possible with longer term treatment using antipsychotic medications. Weight gain is commonly associated with many antipsychotic medications. The potential for weight loss with antipsychotic medication is not typically discussed with clients.
