Psych Final

Origin: Chapter 29, 21 21. When assessing a client with dementia, a nurse identifies that the client is experiencing hallucinations. Based on the nurse's understanding of this disorder, which type of hallucination would the nurse expect as most common? A) Auditory B) Visual C) Gustatory D) Olfactory

Ans: B Feedback: Hallucinations occur frequently in dementia and are usually visual or tactile (they can also be auditory, gustatory, or olfactory). Visual, rather than auditory, hallucinations are the most common type in people with dementia.

Origin: Chapter 28, 18 18. The mother of a child age 4 years with autism spectrum disorder tells the nurse that the child rocks continuously but that "she doesn't hurt herself." Which of the following would be most appropriate for the nurse to suggest? A) Ignore the behavior. B) Tell the child to stop. C) Hold the child until she stops rocking. D) Put the child in time-out for 4 minutes

Ans: A Feedback: Managing the repetitive behaviors depends on the specific behavior and its effect on others and the environment. Because the rocking has no negative effects, ignoring it may be the best approach. If the behavior is unacceptable, redirecting the child and using positive reinforcement are recommend.

Origin: Chapter 25, 14 14. A client is brought into the emergency department because he was involved in an automobile accident. His blood alcohol level (BAL) is 0.10 mg%. Based on this finding, the nurse would expect to assess which of the following? A) Difficulty with coordination B) Stupor C) Emotional lability D) Ataxia

Ans: A Feedback: A BAL of 0.10 mg% would be manifested by difficulty driving and coordinating movements. Ataxia and emotional lability would be associated with a BAL of 0.20 mg %. Stupor would be associated with a BAL of 0.30 mg%.

Origin: Chapter 25, 11 11. A client is receiving methadone maintenance therapy. After teaching the client about this treatment, the nurse determines that the education was successful when the client states which of the following? 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."

Ans: B Feedback: 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.

Origin: Chapter 30, 13 13. A nurse is assessing a client who is a survivor of abuse. Which of the following would be most appropriate to use when conducting a lethality assessment? A) Danger Assessment Screen B) Abuse Assessment Screen C) Burgess-Partner Abuse Scale D) Beck Depression Inventory

Ans: A Feedback: The Danger Assessment Screen, developed by Jacquelyn Campbell and colleagues, is a useful tool for assessing the risk that either an adult survivor or perpetrator will commit homicide. It would be appropriate to use when conducting a lethality assessment. The Abuse Assessment Screen and Burgess-Partner Abuse Scale are appropriate tools to use to screen for violence and abuse. The Beck Depression Inventory is used to screen for depression

Origin: Chapter 29, 23 23. After educating a group of nursing students on Alzheimer's disease and appropriate nursing care, the instructor determines that the education was successful when the students identify which of the following as the foundation for providing care to the client and family? A) Therapeutic relationship B) Medication therapy C) Injury prevention D) Functional independence

Ans: A Feedback: A therapeutic relationship is the basis for interventions for clients with dementia and their families. Care of the client entails a long-term relationship needing much support and expert nursing care. Interventions should be delivered within the relationship context. Medication therapy, injury prevention, and promoting independent functioning within the limits of the disorder are important components of care, but the therapeutic relationship is critical.

Origin: Chapter 27, 5 5. A nurse is preparing for a client an education plan about the sexual response cycle, integrating the theoretical model described by Masters and Johnson. Which of the following would the nurse describe as occurring first? A) Erotic feelings B) Penile erection C) Vaginal lubrication D) Increased muscle tension

Ans: A Feedback: According to Masters and Johnson, the first phase of the sexual response cycle is excitement. During this phase, erotic feelings occur in both genders, which lead to penile erection in the man and vaginal lubrication in the woman. Sexual pleasures and increased muscle tension occur in the second phase, the plateau phase

Origin: Chapter 28, 8 8. After educating a group of nursing students about intellectual disability and adaptive behavior, the instructor determines that additional education is needed when the group identifies which of the following as a type of skill involved with adaptive behavior? A) Intellectual skill B) Conceptual skill C) Social skill D) Practical skill

Ans: A Feedback: Adaptive behavior comprises three skill types: conceptual skills (language and literacy, money, time, number concepts, and self-direction); social skills (interpersonal skills, social responsibility, self-esteem, gullibility, social problem solving, and the ability to follow rules and obey laws and to avoid being victimized); and practical skills (activities of daily living, occupational skills, health care, travel and transportation, schedules and routines, safety, use of money, use of telephone)

Origin: Chapter 30, 2 2. A nurse is caring for a young adult in the mental health clinic. The client tells the nurse that he was physically neglected as a child. The nurse should assess the client for symptoms of which of the following? A) Major depression B) Schizophrenia C) Narcissistic personality disorder D) Panic disorder

Ans: A Feedback: An important outcome of nursing intervention with survivors is appropriate treatment of any disorder resulting from abuse, such as acute stress disorder, posttraumatic stress disorder, anxiety disorders, dissociative identity disorder, major depression, or substance abuse

Origin: Chapter 29, 12 12. A daughter brings her mother, who has Alzheimer's disease, to the clinic. The client has been taking a cholinesterase inhibitor medication for 1 month. When assessing the client, the nurse would be alert for the possibility of which side effect? A) Gastrointestinal distress B) Mild headache C) Muscle tics D) Blurred vision

Ans: A Feedback: The most frequent side effects from cholinesterase inhibitors include gastrointestinal distress, such as nausea, vomiting, and diarrhea. Other side effects include constipation, ataxia, insomnia, and skin rashes. Mild headache, muscle tics, and blurred vision are not side effects of cholinesterase inhibitors.

Origin: Chapter 27, 2 2. When describing the events associated with determining the sex of a fetus, which of the following would the nurse most likely include in the discussion? A) Genes on the Y chromosome B) Formation of ovaries C) Increasing testosterone levels D) Neurochemical inhibition

Ans: A Feedback: As a result of the sex-determining genes on the Y chromosome, testosterone is present in male fetuses and, by weeks 6 to 12, is responsible for the formation of the penis, prostate, and scrotum. The formation of ovaries in the female depends on the absence of this male hormone. After the male sex organs are formed, testosterone levels temporarily rise, causing a permanent sexual organization of the brain that is different than that in females. Testosterone is also elevated during the first 3 months after birth, causing the brain structures and circuits to be fixed for the rest of a boy's life. These structural differences are thought to be the basis of sex differences that are reflected in behavior from birth.

Origin: Chapter 29, 10 10. A nurse is caring for a client diagnosed with delirium who has been brought for treatment by his son. While taking the client's history, which question would be most appropriate for the nurse to ask the client's son? A) "Has your father taken any medications recently?" B) "Are you aware of your father falling or injuring his head in any way?" C) "Has your father had a recent stroke?" D) "Has your father experienced any major losses recently?"

Ans: A Feedback: Delirium is typically caused by medications, urinary or upper respiratory tract infections, fluid and electrolyte imbalances, and metabolic disturbances. Therefore, questioning the son about the client's medication use would be most appropriate. Head injury or stroke may lead to changes in consciousness but not delirium. Although acute or chronic stress may be a risk factor for the development of delirium, this would not be the most appropriate question to ask at time.

Origin: Chapter 29, 15 15. While a nurse is caring for a hospitalized client in the advanced stages of Alzheimer's disease, the client begins to have a catastrophic reaction to feeding himself. Which of the following should the nurse do first? A) Remain calm and reassuring B) Restrain the client temporarily C) Draw the curtains to darken the room D) Offer to feed the client

Ans: A Feedback: During a catastrophic reaction, the nurse should remain calm, minimize environmental distractions (quiet the environment), get the client's attention, and softly assure the client that he or she is safe. Give information slowly, clearly, and simply, one step at a time, letting the client know that the nurse understands the fear or other emotional response, such as anger or anxiety.

Origin: Chapter 27, 15 15. During the health history, a client reports that she experiences pain during sexual intercourse. The nurse documents this as which of the following? A) Dyspareunia B) Anorgasmia C) Vaginismus D) Paraphilia

Ans: A Feedback: Dyspareunia is a term used to describe the genital pain associated with sexual intercourse. Anorgasmia refers to the inability to achieve an orgasm. Vaginismus refers to the spastic, involuntary constriction of the perineal and outer vaginal muscles. Paraphilias are characterized by recurrent, intense sexual urges, fantasies, or behaviors involving unusual objects, activities, or situation.

Origin: Chapter 30, 1 1. A nurse is talking to a female client who is a survivor of intimate partner violence. The woman relates that her husband has been told that he has the characteristics of an antisocial personality disorder. The woman also informs the nurse that her husband has an extensive criminal record. The nurse interprets this information and suspects that the woman's husband would most likely demonstrate which A) A risk for aggressive and assaultive violence toward people within and outside of his family B) Intermittent remorse for the violence and abuse that he commits C) Symptoms of depression along with harboring feelings of inadequacy D) Purposefully remaining socially isolated from people other than those in his family

Ans: A Feedback: Evidence suggests that when people with borderline personality disorder are distressed, they are predisposed to interpret social situations as threatening and to respond with emotional dysregulation, verbal attacks, and physical violence. People who meet the diagnostic criteria of antisocial personality disorder, have an extensive history of criminal behavior, and who are generally violent are also more likely to be both aggressive and assaultive. These perpetrators have a heightened sensitivity to emotional displays that predispose them to interpret social situations as threatening and to respond with emotional dysregulation, verbal attacks, and physical violence

Origin: Chapter 27, 12 12. After educating a group of students on sexual disorders in women, the instructor determines that the education was successful when the students identify which of the following as most common? A) Female orgasmic disorder B) Sexual interest/arousal disorder C) Genito-pelvic pain/penetration disorder D) Paraphilia

Ans: A Feedback: Female orgasmic disorder is among the most commonly occurring sexual disorders in women. The other disorders occur, but are less common.

Origin: Chapter 25, 7 7. A nurse is working with a client who is addicted to heroin. The nurse engages in harm reduction by educating the client about which of the following? A) Needle exchange programs B) Problem solving C) Healthy coping skills D) Proper use of naltrexone

Ans: A Feedback: Harm reduction initiatives range from widely accepted designated driver campaigns to controversial initiatives such as provision of condoms in schools, safe injection rooms, needle exchange programs, and heroin maintenance programs. Problem solving, coping skills, and naltrexone would not be considered harm-reduction interventions

Origin: Chapter 28, 10 10. A child with autism spectrum disorder engages in a repetitive rocking behavior that does not pose a threat to the child's safety. When educating the child's family on managing this behavior, which of the following would be appropriate for the nurse to suggest? A) Ignore it B) Redirect the child C) Use positive reinforcement D) Pad the area around the child

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

Origin: Chapter 29, 5 5. Assessment of an older adult diagnosed with dementia with Lewy bodies reveals that the client is receiving psychiatric medications. The client states, "I get dizzy periodically and have trouble walking." Which of the following should the nurse do first? A) Assess for development of orthostatic hypotension. B) Instruct the client to stop taking the psychiatric medications. C) Interview the client's family about the client's coping skills and current stress level. D) Suggest the client periodically use an alcohol-based mouthwash several times a day.

Ans: A Feedback: Many psychiatric medications affect blood pressure. Generally, these medications may cause orthostatic hypotension, which can lead to dizziness, an unsteady gait, and falls. A baseline blood pressure is needed to effectively monitor medication side effects. Telling the client to stop taking the medications is inappropriate. Asking family members about the client's coping skills and stress level would provide no information about the client's complaints. Using a non-alcohol-based mouthwash would be appropriate for combating dry mouth.

Origin: Chapter 29, 14 14. A client is admitted to the hospital with dementia-related to Parkinson's disease. The client is being treated for a fractured tibia from a recent fall. The nurse should assess the client's history for use of which type of medication? A) Anticholinergics B) Dopamine agonists C) Anxiolytics D) Benzodiazepines

Ans: A Feedback: Medical treatment of people with Parkinson's disease typically involves anticholinergics and dopamine agonists. In clients with dementia caused by Parkinson's disease, anticholinergic medications are likely to increase cognitive impairment.

Origin: Chapter 24, 1 1. While caring for a client with anorexia nervosa, a nurse anticipates that the client would have difficulty making which of the following comments? A) "I'm mad at you because you won't let me go on a pass unless I gain weight!" B) "I need to have everything in its place and perfect." C) "If I gain a pound, I'll just keep gaining weight." D) "I am very involved in preparing my food and counting calories."

Ans: A Feedback: Most clients with anorexia nervosa avoid conflict and have difficulty expressing negative emotions, such as anger. Perfectionism and a drive for thinness are key for a client with anorexia. The behavior of clients with anorexia becomes organized around food-related activities such as preparing food, counting calories, and read cookbooks.

Origin: Chapter 25, 8 8. A man 20 years of age arrives at the emergency department by ambulance. He is unconscious, with slow respirations and pinpoint pupils. There are "tracks" visible on his arms. The friend who came with him reports that the client had just "shot up" heroin when he became unconscious. Which medication would the nurse most likely expect to administer? A) Naloxone B) Naltrexone C) Bupropion D) Varenicline

Ans: A Feedback: 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.

Origin: Chapter 26, 2 2. A student nurse is preparing a nursing care plan for a client who has insomnia and is experiencing sleep deprivation. Which nursing diagnosis would the nurse most likely identify as reflecting a priority care issue? A) Risk for Injury B) Ineffective Coping C) Deficient Knowledge D) Anxiety

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

Origin: Chapter 27, 16 16. After educating a group of students on sexual maturation, the instructor determines that the education was successful when the students identify which of the following as referring to the anatomic and physiologic state of being male or female? A) Biosexual identity B) Gender identity C) Sex role identity D) Sexual orientation

Ans: A Feedback: Sexual maturation encompasses four areas: biosexual identity, gender identity, sex role identity, and sexual orientation. Whereas biosexual identity refers to the anatomic and physiologic state of being male or female, gender identity is the conviction of belonging to a male or female gender. Both biosexual and gender identities result from genetic and intrauterine hormonal influences, not learned behavior. Sex role identity (or gender role) is the outward expression of gender, including behaviors, feelings, and attitudes. Sexual orientation refers to a person's sexual attraction to those of the opposite sex (heterosexual), same sex (homosexual), or both sexes (bisexual).

Origin: Chapter 26, 15 15. A nurse is interviewing a client about his sleep patterns. He tells the nurse that he goes to bed about 11 p.m. and usually falls asleep by 11:15 p.m. The nurse identifies this time period as which of the following? A) Sleep latency B) Sleep architecture C) Sleep efficiency D) Slow-wave sleep

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

Origin: Chapter 25, 3 3. A client tells a nurse that he is committed to trying to quit smoking. When educating the client on smoking cessation, which of the following would the nurse include? A) Success usually involves more than one type of intervention. B) Relapse is fairly rare within the first year of quitting. C) Ear acupressure is a highly proven method for quitting. D) The drug varenicline is widely used among patients with psychiatric disorders

Ans: A Feedback: Successful smoking cessation usually requires more than one type of intervention, including social support and education. Recent research has shown that nicotine addiction is extremely powerful and is at least as strong as addictions to other drugs, such as heroin and cocaine; 70% of those who quit relapse within 1 year. Auricular therapy, or ear acupressure, is being studied as a potential adjunctive treatment for nicotine addiction. Varenicline tartrate reduces the craving and rewarding effects of nicotine by preventing nicotine from accessing one of the acetylcholine receptor sites involved with nicotine dependence, but it can cause depression and related psychiatric symptoms in some people. This side effect limits its usefulness for people with psychiatric disorders.

Origin: Chapter 26, 7 7. A client has been admitted to the psychiatric unit with a diagnosis of narcolepsy. Which client statement would the nurse interpret as reflecting this condition? A) "Sometimes I fall asleep when I'm driving my car home from work." B) "I often have brief periods of intense excitement when going to sleep, and my legs won't hold still." C) "I lie there and worry all night, and it keeps me awake. I just can't relax." D) "I think my sleep pattern is messed up because I took sleeping pills when I was younger."

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

Origin: Chapter 29, 25 25. A client with Alzheimer's disease is admitted to an acute care facility for treatment of an infection. Assessment reveals that the client is anxious. When developing the client's plan of care, which of the following would be least appropriate for a nurse to include? A) Frequently provide reality orientation B) Simplify the client's routines C) Limit the number of choices to be made D) Establish predictable routines

Ans: A Feedback: The threshold for stress is progressively lowered in people with Alzheimer's disease and other progressive dementias. A healthy person frequently uses cognitive coping strategies when under stress, but a person with dementia can no longer use many of these strategies. Commonly used therapeutic approaches may exacerbate anxiety in a client with dementia. For example, reality orientation is usually an effective intervention for acutely confused clients. Reality orientation is contraindicated in those with dementia because it is possible that the client's disoriented behavior or language has inherent meaning. If the disoriented behavior or language is continuously neglected or corrected, the client's sense of isolation and anxiety may increase. Effective nursing interventions include simplifying routines, making routines as consistent and predictable as possible, reducing the number of choices the client must make, identifying areas in which control can be maintained, and creating an environment in which the client feels safe.

Origin: Chapter 28, 15 15. A child with a tic disorder is prescribed an antipsychotic agent as part of his treatment plan. Which of the following would the nurse expect to be prescribed? A) Aripiprazole B) Haloperidol C) Clonidine D) Guanfacine

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

Origin: Chapter 29, 17 17. A group of nursing students is reviewing information about delirium and dementia. The students demonstrate a need for additional review when they identify which of the following as a characteristic of dementia? A) Fluctuating changes within a 24-hour period B) Possible hallucinations C) Normal psychomotor activity D) Globally impaired cognition

Ans: A Feedback: With dementia, a client's cognition is stable throughout a 24-hour period, but with delirium, a client's cognition fluctuates. Hallucinations are possible with dementia. Psychomotor activity is normal, and cognition is globally impaired with dementia.

Origin: Chapter 26, 11 11. A client with insomnia is prescribed zolpidem. When describing the action of this medication to the client, the nurse would incorporate information related to the medication's effect on which of the following? A) Gamma-aminobutyric acid (GABA) B) Serotonin C) Dopamine D) Norepinephrine

Ans: A Feedback: Zolpidem is a benzodiazepine receptor agonist that exerts its effects by facilitating GABA effects. Serotonin, dopamine, and norepinephrine are not involved.

Origin: Chapter 29, 1 1. A nurse is caring for a client age 78 years who is taking an anticholinergic medication and complains of dry mouth. Which of the following would be most appropriate for the nurse to suggest? Select all that apply. A) Chew hard candies. B) Rinse the mouth with a glycerol mouthwash. C) Use more seasonings on food. D) Drink decaffeinated beverages often.

Ans: A, B Feedback: Xerostomia, or dry mouth, which is common in older adults, also may impair eating. For patients with xerostomia, hard candy or chewing gum may stimulate salivary flow. Glycerol mouthwash can provide as much relief from xerostomia, acting as artificial saliva. The nurse should pay particular attention to those who are currently receiving treatment for mental illnesses, particularly with medications that have anticholinergic properties; modification of the drug regimen may be necessary. Dry mouth is also a side effect of many other anticholinergic medications, such as cimetidine, digoxin, and furosemide. Increasing seasonings or use of decaffeinated beverages would have no effect on dry mouth.

Origin: Chapter 29, 9 9. As part of a follow-up home visit to an client age 80 years who has had surgery, a nurse discusses the client's risk for delirium with his family members. Which of the following would the nurse include as placing the client at increased risk? Select all that apply. A) Urinary tract infection B) Hypertension C) Acute stress D) Bone fractures E) Dehydration F) Electrolyte balance

Ans: A, C, D, E Feedback: Risk factors associated with delirium include infection, advanced age, hypotension, acute or chronic stress, bone fractures, and electrolyte or metabolic imbalances, such as dehydration and hyponatremia.

Origin: Chapter 29, 18 18. A client is brought to the emergency department by his wife. The wife states that over the past few hours, the client has become disoriented and confused. "He didn't know where he was and didn't seem to recognize me or be able to carry on a coherent conversation." The nurse suspects delirium. When reviewing the client's medication history with the wife, which of the following medications would alert the nurse to a potential cause? Select all that apply. A) Propranolol B) Acetaminophen C) Diphenhydramine D) Verapamil E) Quinidine

Ans: A, C, E Feedback: Drugs associated with delirium include propranolol, diphenhydramine, and quinidine. Special attention should be given to combinations of these medications because drug interactions can cause delirium. Acetaminophen and verapamil are not typically associated with delirium.

Origin: Chapter 28, 4 4. The history of a child newly diagnosed with attention deficit hyperactivity disorder reveals that the child is experiencing sleeping difficulties. Which agent would the nurse most likely use? A) Methylphenidate B) Atomoxetine C) Bupropion D) Clonidine

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

Origin: Chapter 29, 20 20. A nursing instructor is preparing a presentation on the etiology of Alzheimer's disease (AD). When discussing the role of neurotransmitters in the course of the disease, which of the following would the instructor most likely emphasize? A) Serotonin B) Acetylcholine C) Dopamine D) Norepinephrine

Ans: B Feedback: Acetylcholine is a major neurotransmitter involved with AD. Cell loss in the nucleus basalis leads to deficits in the synthesis of cortical acetylcholine (ACh), but the number of ACh receptors is relatively unchanged. The reduced ACh is related to a decrease in choline acetyltransferase (a critical enzyme in the synthesis of ACh), especially in the forebrain. That is, there are fewer enzymes available to synthesize ACh, which leads to a reduction in cholinergic activity. Other neurotransmitters that are affected include norepinephrine and serotonin. Deficiencies in norepinephrine are associated with a loss of cells in the locus ceruleus, and neuronal loss in the raphe nuclei leads to a loss of serotonergic activity. Dopamine is not involved with AD.

Origin: Chapter 28, 5 5. A nurse is preparing to initiate a behavioral treatment program for a child with encopresis. Which of the following would the nurse most likely implement first? A) Administration of mineral oil B) Bowel cleansing C) Low-fiber diet D) Sitting on the toilet after each meal

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

Origin: Chapter 24, 2 2. A nurse is performing an admission assessment for an adolescent girl with an eating disorder who is being admitted to the psychiatric unit. Which statement would the nurse interpret as most likely supporting the client's diagnosis? A) "My father was always very thin." B) "I've never really liked myself." C) "I have a lot of confidence in myself." D) "I feel really close to my parents and my brother."

Ans: B Feedback: Body dissatisfaction is strongly related to low self-esteem and is a key characteristic of anorexia nervosa. Results of numerous studies have shown that low self-esteem, body dissatisfaction, and feelings of ineffectiveness and inadequacy put individuals at risk for an eating disorder. A father's body type has little impact on the development of this disorder. Families of individuals with anorexia are often labeled as overprotective, enmeshed, unable to resolve conflicts, and rigid related to boundaries. Thus, a close relationship would not be associated with this disorder.

Origin: Chapter 25, 16 16. A nurse is implementing a brief intervention with a client who is abusing alcohol. The nurse most likely would be involved with which of the following? A) Asking the client questions about alcohol use B) Negotiating a conversation with the client to reduce use C) Pointing out the inconsistencies in thoughts, feelings, and actions D) Helping the client change the way he thinks about a situation

Ans: B Feedback: 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.

Origin: Chapter 29, 4 4. A nurse is providing an in-service educational program for beginning nurses regarding mental health assessment needs of older adults. One of the topics addressed is the importance of interviewing family members in addition to the older adult client. The nurse tells the audience that family members are sometimes able to give a more accurate history than the client himself if the client has memory impairment. The nurse also emphasizes that interviewing family members provides which of the following? A) A more accurate picture of the social support resources available B) Evaluation of the family's ability to effectively care for the older client C) Determination of the extent of the client's memory impairment D) A much-needed period of respite and support for the family members

Ans: B Feedback: By interviewing family members, the nurse expands the scope of the client assessment. Moreover, the nurse has an opportunity to evaluate the caregivers themselves to determine whether they can adequately care for the client and how they are coping with the situation.

Origin: Chapter 28, 6 6. A nurse is assessing a girl age 8 years with a mood disorder. Which of the following would the nurse most likely expect to assess? A) Statement from the child that she feels sad B) Behavioral problems C) Recurrent obsessions D) Ritualistic behavior

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

Origin: Chapter 25, 12 12. A client with a history of alcohol abuse is participating in a 12-step Alcoholics Anonymous (AA) program. The nurse determines that the client is at step 2 when he states which of the following? A) "I've admitted to myself and others the wrongdoings I've done." B) "I realize that there is a higher power that can help me." C) "I know now that I am powerless over alcohol." D) "I am making amends to all those that I've harmed."

Ans: B Feedback: Coming to believe that a power greater than oneself could help restore sanity reflects the second step of AA. Admitting to one's self and others about wrongdoings reflects step 5 of AA. Admitting powerlessness over alcohol is step 1. Making amends is part of step 9.

Origin: Chapter 25, 19 19. A client is prescribed disulfiram as part of his alcohol treatment program to prevent relapse. The client asks a nurse, "How will this drug help me?" Which response by the nurse would be most appropriate? A) "It will help to cure your alcoholism." B) "It can help to prevent you from drinking." C) "It makes the withdrawal symptoms less troublesome." D) "It helps to clear the alcohol out of your body."

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

Origin: Chapter 28, 2 2. A nurse is counseling a parent whose child has a communication disorder. Which of the following would the nurse emphasize when educating the parent on this disorder? A) Providing the child with nonverbal activities B) Initiating conversations with the child frequently C) Stopping the child's conversation if stuttering begins D) Asking the physician for medication to improve the Childs speech

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

Origin: Chapter 27, 11 11. A nursing instructor is preparing a class discussion about sexual disorders. Which of the following would the instructor include when describing gender dysphoria? A) It typically involves same-sex identification. B) The individual experiences a strong desire to be of the opposite gender. C) Recurrent, intense sexual urges lead to significant distress. D) Changes in sexual desire and response are key characteristics

Ans: B Feedback: Gender dysphoria is the term used to describe an incongruence between an individual's experienced/expressed gender and assigned gender. These individuals have a strong desire to be of the other gender. In boys (assigned gender), there is a strong preference for cross-dressing or simulating female attire. In girls (assigned gender), there is a strong preference for wearing typical masculine clothing and a strong resistance to wearing typical female clothing. Paraphilias involve recurrent, intense sexual urges, fantasies, or behaviors involving unusual objects, activities, or situations. Sexual dysfunctions are characterized by alterations in sexual desire and response, and by emotional and interpersonal distress.

Origin: Chapter 29, 7 7. A group of nursing students is reviewing information about age-related changes occurring in cognition and intellectual performance. The students demonstrate understanding of the concepts when they identify which of the following as a cognitive change for a patient diagnosed with delirium? A) Orientation to time B) Inability to recognize familiar objects C) Diminished executive functioning D) Restricted judgment

Ans: B Feedback: Impaired consciousness is the key diagnostic criterion for delirium. The patient becomes less aware of his or her environment and loses the ability to focus, sustain, and shift attention. Cognitive changes include problems with memory, orientation, and language. The patient may not know where he or she is, may not recognize familiar objects, or may be unable to carry on a conversation.

Origin: Chapter 27, 8 8. A nurse identifies the nursing diagnosis of Ineffective Sexuality Patterns based on which of the following? A) The sexual problem is causing dissatisfaction for the client. B) The client has experienced a change in sexual functioning. C) The client is feeling inadequacy related to the sexual problem. D) The client believes that sexual activity is unrewarding

Ans: B Feedback: Ineffective Sexuality Patterns is used as the nursing diagnosis if the person is at risk for, or has already experienced, a change in sexual functioning. Sexual dysfunction refers to problematic sexual function that the individual perceives as unsatisfying, unrewarding, or inadequate, and for which nursing can intervene.

Origin: Chapter 26, 1 1. A nurse is assessing the sleep patterns of a female client age 70 years with a mental disorder. Based on the knowledge of circadian rhythms and the influence of age, which of the following would the nurse anticipate that the client would report about her sleep pattern? A) "When I was younger, I didn't notice any differences in how I felt in the morning or evening." B) "Now it seems like I have difficulty falling asleep or staying asleep even when circumstances are adequate for sleep." C) "When I worked days, I'd always have trouble feeling sleepy in the morning." D) "When I was younger, the amount of sleep I got didn't seems to matter."

Ans: B Feedback: Insomnia has a greater prevalence among older people and among divorced, separated, and widowed adults. Increasing age, female sex, and comorbid disorders (e.g., medical, mental disorders, and substance use) are all risks for developing insomnia disorder.

Origin: Chapter 30, 10 10. A group of nursing students is reviewing information about intimate partner violence (IPV). The group demonstrates understanding of this topic when they identify which of the following? A) Men are more likely to be seriously injured even though more women are typically victims. B) Men may not consider behaviors such as slapping or shoving as abuse. C) IPV in same-sex couples occurs less frequently than in heterosexual relationships. D) The reactions to IPV are similar in male and female victims.

Ans: B Feedback: Men are sometimes hesitant to report victimization or may not consider behaviors such as shoving or slapping "abuse." Nearly one in four women and one in nine men are victims of IPV at some point in their lives. Women are much more likely than men to be seriously injured as a result of IPV and to require medical treatment. IPV in same-sex couples occurs with at least the same frequency as in heterosexual relationships, but individuals with same-sex partners may not be afforded the same support. The reaction to IPV may differ by gender.

Origin: Chapter 28, 7 7. A group of nurses is reviewing medications used to treat attention deficit hyperactivity disorder. The students demonstrate understanding of the information when they identify methylphenidate as which of the following? A) Selective serotonin reuptake inhibitor B) Psychostimulant C) Noradrenergic reuptake inhibitor D) Alpha agonist

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

Origin: Chapter 30, 8 8. A school nurse is aware that a student has requested aspirin three times during the past week because his "back hurts." The nurse has noticed that he often wears long-sleeved sweaters and sweatshirts even in warm weather. The nurse suspects that the student may be the victim of physical abuse. The nurse is preparing to ask the child about his ongoing backache. Which of the following would the nurse anticipate being reported by the child if he was being abused? A) His father is beating him on a regular basis B) Be reluctant to report abuse because of shame or fear of retaliation C) Give the same reason his sister would give were she asked to explain his injuries D) Carefully explain that his mother disciplines him because she loves him

Ans: B Feedback: Most survivors do not report violence to health care providers without specifically being asked about it. Survivors may be reluctant to report abuse because of shame and fear of retaliation, especially if the victim depends on the abuser as a caregiver. In addition, children may fear they will not be believed.

Origin: Chapter 26, 8 8. A nurse is working with a client diagnosed with insomnia. When developing an education plan for the client, which sleep promotion intervention would the nurse implement first? A) Encouraging the client to stop smoking B) Instructing the client to keep regular bedtimes and rising times C) Encouraging the client to take frequent naps D) Administering prescribed sleep medications

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

Origin: Chapter 30, 15 15. A nurse is working on developing a safety plan with a client who is a survivor of violence. Which of the following would the nurse address first? A) Devising an escape route B) Recognizing the signs of danger C) Identifying a safe place to hide D) Identifying a signal to indicate it is safe to leave

Ans: B Feedback: One of the most important teaching goals is to help survivors develop a safety plan. The first step in developing such a plan is helping the survivor recognize the signs of danger. Changes in tone of voice, use of alcohol and other drugs, and increased criticism may indicate that the perpetrator is losing control. Detecting early warning signs helps survivors to escape before battering begins. The next step is to devise an escape route. This involves mapping the house and identifying where the battering usually occurs and what exits are available. The survivor needs to have a bag packed and hidden, but readily accessible, containing what is needed to get away. If children are involved, the adult survivor should make arrangements to get them out safely. That might include arranging a signal to indicate when it is safe for them to leave the house and to meet at a prearranged place. A safety plan for a child or dependent older adult might include safe places to hide and important telephone numbers, including 911, police and fire departments, and other family members and friends.

Origin: Chapter 27, 10 10. A group of students is reviewing medications used to treat erectile dysfunction. The students demonstrate understanding of the information when they identify which of the following as being administered by injection? A) Tadalafil B) Papaverine C) Alprostadil D) Vardenafil

Ans: B Feedback: Papaverine is injected directly into the corpus cavernosum to increase arterial flow of blood. Tadalafil and vardenafil are PDE5 inhibitors that are taken orally. Alprostadil is used in a microsuppository form inserted into the urethra with a special applicator.

Origin: Chapter 27, 13 13. A client diagnosed with an ejaculatory disorder is receiving treatment using sensate focus. The nurse understands that this treatment focuses on which of the following? A) Learning new ejaculatory control responses B) Partners learn what each finds arousing and to communicate those preferences C) Resolving underlying issues D) Gaining knowledge about the arousal-orgasm mechanism

Ans: B Feedback: Sensate focus is a method for partners to learn what each finds arousing and to learn to communicate those preferences. It begins with nongenital contact and gradually includes genital touching and sexual intercourse. The squeeze technique is used to help the person learn new ejaculatory control responses. Counseling or psychotherapy focuses on helping the individual become aware of and resolve personal, sexual, and relationship issues. Education focuses on increasing the person's knowledge of the arousal-orgasm mechanism

Origin: Chapter 30, 12 12. A group of nursing students is reviewing information about the types of abuse. The students demonstrate understanding of the information when they identify stalking as a crime of which of the following? A) Violence B) Intimidation C) Jealousy D) Fear

Ans: B Feedback: Stalking is a crime of intimidation in which stalkers harass and terrorize their victims through behavior that causes fear or substantial emotional distress. Rape is a crime of violence.

Origin: Chapter 25, 13 13. A nurse is preparing an in-service program about substance abuse and its etiology. Which of the following would the nurse most likely include in the presentation when discussing possible etiologies? A) Mixed self-esteem B) Genetic predisposition C) Dysfunctional family D) Peer influence

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

Origin: Chapter 30, 6 6. A nurse is working with a female client who is anticipating the possibility of leaving an abusive relationship. In helping the client make the decision to leave or to stay in the abusive situation, which of the following would be most important for the nurse to do? A) Ensure that the client can effectively describe the behaviors inherent in each phase of the cycle of domestic violence. B) Inform the client that if she leaves the abusive situation, there is a possibility her partner will attempt to murder her. C) Assist the client in finding a new apartment and a new job so she will be safe after she leaves her current situation. D) Suggest that the client legally change her name and move out of state so she will be safe from future harm

Ans: B Feedback: Survivors must understand the cycle of violence and the danger of homicide that increases as violence escalates or when the survivor attempts to leave the relationship. Although survivors also need information about resources (e.g., shelters for battered women), legal services, government benefits, and support networks, the nurse first needs to discuss the possibility of the perpetrator's reaction and the possibility of extreme violence leading to death.

Origin: Chapter 26, 5 5. A nurse is working with a psychiatric client who was admitted to the inpatient facility and is being discharged. The client asks the nurse what he should do when he goes home to promote getting adequate sleep. Which response by the nurse would be most appropriate? A) "Go to bed at the same time every night and watch a television show that relaxes you." B) "Save your bedroom for sleeping; that means no work and no TV in the bedroom." C) "Why don't you ask your psychiatrist for a prescription for a sleeping pill?" D) "Make sure to keep the bedroom warm and toasty."

Ans: B Feedback: The nurse can help the client develop bedtime rituals and good sleep hygiene. Bedtime should be at a regular hour, and the bedroom should be conducive to sleep. Preferably, the bedroom should not be a place where the individual watches television or does work-related activities. The bedroom should be viewed as a room for sleeping and sex, and the environment should be cool, with minimal lighting.

Origin: Chapter 30, 9 9. A nurse is presenting to a church group a program about domestic violence. During the presentation, a member of the audience asks the nurse to explain what "intergenerational transmission of violence" means because he has seen that phrase used in the media. Which of the following responses by the nurse would be most appropriate? A) "People who are violent are that way because of the various neurochemical imbalances in their brains." B) "People who grow up in violent home situations tend to be involved in domestic violence situations as an adult." C) "Recent research has identified a gene that is responsible for transmission of a risk for violent behavior that is passed on from generation to generation." D) "Domestic violence seems to skip every other generation when it is traced in families."

Ans: B Feedback: Violent families create an atmosphere of tension, fear, intimidation, and tremendous confusion about intimate relationships. Children in violent homes often learn violent behavior as an approved and legitimate way to solve problems, especially within intimate relationships. The social learning or intergenerational transmission of violence theory posits that children who witness violence in their homes often perpetuate violent behavior in their own families as adults. Moreover, children who grow up in violent homes learn to accept violence and expect it in their own adult relationships. Neurochemical imbalances, genetics, or skipping generations are unrelated to this theory.

Origin: Chapter 28, 16 16. A child diagnosed with autism spectrum disorder is hospitalized in an inpatient mental health unit. When developing the plan of care for this child, which of the following would be most important for the nurse to include? A) Ensuring that a variety of caregivers are available for the child B) Providing a consistent, structured environment with predictable routines C) Allowing the child frequent visits off the unit to provide stimulation D) Sending the child to the "time out" area if the child continually repeats phrases

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

Origin: Chapter 27, 9 9. A client has been admitted to the inpatient psychiatric facility as part of a court-ordered program. The client was arrested numerous times over the past several months for exposing his genitals and masturbating in public in front of an elementary school. The nurse interprets this behavior as reflecting which of the following? A) Frotteurism B) Exhibitionism C) Sexual masochism D) Voyeurism

Ans: B Feedback: With exhibitionism, the behavior involves exposing one's genitals to strangers, with occasional masturbation. Frotteurism involves sexually arousing urges, fantasies, and behaviors that occur when touching or rubbing one's genitals against the breasts, genitals, or thighs of a nonconsenting person. Sexual masochism involves the act of being humiliated, beaten, bound, or made to suffer. Voyeurism behavior involves "peeping" at unsuspecting people who are nude, undressing, or engaged in sexual activity for the purpose of sexual excitement.

Origin: Chapter 29, 19 19. A nurse is assessing a client diagnosed with Alzheimer's disease. As part of the assessment, the nurse asks the client to identify common objects. The nurse is assessing for which of the following? A) Aphasia B) Apraxia C) Agnosia D) Executive functioning

Ans: C Feedback: Agnosia is the failure to recognize or identify objects despite intact sensory function. Aphasia is alterations in language ability. Apraxia is the impaired ability to execute motor activities despite intact motor functioning. Executive functioning is the ability to think abstractly and plan, initiate, sequence, monitor, and stop complex behavior.

Origin: Chapter 29, 11 11. A nurse makes a home visit to a family caring for a client with Alzheimer's disease. The client's wife tells the nurse that she hasn't been out of the house for more than 2 weeks because her sister has been unable to help care for the client. Which nursing diagnosis would the nurse identify as the priority? A) Ineffective Family Coping related to care of a client with Alzheimer's disease B) Risk for Activity Intolerance related to Alzheimer's disease C) Caregiver Role Strain related to social isolation D) Powerlessness related to seclusion and long-term care of client

Ans: C Feedback: Although family coping, activity intolerance, and powerlessness may be issues, the priority nursing diagnosis is Caregiver Role Strain related to social isolation, as evidenced by the wife's statement of not being out of the house for 2 weeks. The nurse should assist the client's wife in obtaining respite care if it is available.

Origin: Chapter 27, 14 14. Which of the following is considered the treatment of choice for erectile dysfunction? A) Microsuppository alprostadil B) Intracavernosal pharmacotherapy C) PDE5 inhibitors D) Penile prosthesis

Ans: C Feedback: Although intracavernosal pharmacotherapy, alprostadil in microsuppository form, and penile prosthesis can be used to treat erectile dysfunction, the treatment of choice is the use of PDE5 inhibitors.

Origin: Chapter 26, 9 9. The sleep history of a client experiencing sleep problems reveals that the client ingests a significant amount of caffeine each day. When reviewing with the client the effect of caffeine on sleep, which of the following would the nurse incorporate into the discussion as a caffeine effect? A) Decreased sleep latency B) Increased total sleep time C) Decreased REM sleep D) Increased slow-wave sleep

Ans: C Feedback: Caffeine causes increased sleep latency, decreased total sleep time, and decreased REM sleep. It does not affect slow-wave sleep.

Origin: Chapter 29, 6 6. A nurse is preparing a presentation for a group of colleagues about suicide and the older adult population. Which of the following would the nurse include in this presentation? A) Suicide is less of a risk in this population compared with middle-aged adults. B) Married African American men are at the greatest risk for suicide in this group. C) Depression is greatest risk factor for suicide in this population group. D) White women account for the highest number of suicide deaths in this age group.

Ans: C Feedback: Depression is the greatest risk factor for suicide. Individuals who are suicidal often believe that they are a burden to their family, which would be better off without them. In addition, suicide assessment is a priority for older adults experiencing mental health problems. It is important to carefully assess recent behavior changes and loss of support. Suicide is a major mental health risk for older adults. Suicide rates increase with age; the rate among older white men is six times higher than that of the general population. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have a significantly increased risk of committing suicide. White men account for more than 80% of suicide deaths in this older age group. Older white men are at the highest risk for suicide, with a rate of approximately 31.1 suicides per 100,000 persons each year.

Origin: Chapter 26, 6 6. A client with a mental disorder is being discharged from an inpatient unit. During the hospital stay, the client eventually was able to get an adequate night's sleep even though he had experienced chronic insomnia over the years. The client's spouse asks the nurse what the family can do in the home environment to promote healthy sleep. Which response by the nurse would be most appropriate? A) "It is basically up to your husband to focus on promoting his own sleep." B) "You might consider a glass of wine about 30 minutes before he is ready to go to bed." C) "Remember to keep stimulating activities at a minimum before he goes to bed." D) "Give him a spicy snack with a warm cup of tea at night before bedtime."

Ans: C Feedback: Family and friends should be encouraged to support the new habits that the client is trying to establish. Avoiding stimulating activities and engaging in relaxing activities before bedtime are crucial, and family and friends can help create an environment conducive to sleep. Alcohol, spicy foods, and caffeine should be avoided.

Origin: Chapter 27, 4 4. A woman comes to the clinic for a routine visit. While a nurse is interviewing the client and obtaining a sexual history, the client states, "I've always wondered what is happening in my body when I become sexually aroused." The nurse would incorporate an understanding of which of the following as the control mechanism? A) Sympathetic nervous system B) Endocrine system C) Parasympathetic nervous system D) Central nervous system

Ans: C Feedback: In healthy adults, the sex drive is integrated through the central nervous system, with the autonomic nervous system governing extragenital changes (increased respiration and heart rate). The parasympathetic nervous system largely controls arousal, and the sympathetic nervous system controls orgasmic discharge. Sexual stimulation brings about a total-body response, with dramatic changes seen in the genitals and breasts. Sex hormones, particularly androgen, influence desire in both genders, but less is known about hormonal influence in women. That the higher centers of the brain apparently mediate the lower reflex response centers supports the relationship between cognitive and affective states and sexual function.

Origin: Chapter 25, 5 5. A nurse is talking with a client 57 years of age who has been a heavy drinker for many years. The client is being treated for alcoholism, and this is her second week as an inpatient on the psychiatric unit. It is 5 a.m. and the client has been having difficulty sleeping. The client is an orthopedic nurse, and although she is clothed in a hospital-issued gown and robe, she is wearing a stethoscope around her neck that the nurse recognizes as belonging to one of the staff nurses. When the nurse asks her why she is wearing the stethoscope and where she got it, the client gives her a long and involved reply that describes how her nursing supervisor came to visit and gave it to her to wear "so she'd remember to get well." The nurse suspects that the client may be experiencing which of the following? A) Wernicke's syndrome B) Delirium tremens C) Korsakoff's amnesic syndrome D) Malignant hyperthermia

Ans: C Feedback: Korsakoff's amnesic syndrome, also known as psychosis, is associated with alcoholism and involves the heart and the vascular and nervous systems, but the primary problem is acquiring new information and retrieving memories. Symptoms include amnesia, confabulation, (i.e., telling a plausible but imagined scenario to compensate for memory loss), attention deficit, disorientation, and vision impairment. Wernicke's encephalopathy, a degenerative brain disorder caused by thiamine deficiency, is characterized by vision impairment, ataxia, hypotension, confusion, and coma. Delirium tremens is an acute withdrawal syndrome characterized by autonomic hyperarousal, disorientation, hallucinations, and tremors. Malignant hyperthermia is characterized by a sharp increase in body temperature leading to muscle breakdown, kidney and cardiovascular failure, and death

Origin: Chapter 29, 16 16. While reviewing the medical record of a client with moderate dementia of the Alzheimer type, a nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type? A) Atypical antipsychotic B) Cholinesterase inhibitor C) NMDA receptor antagonist D) Benzodiazepine

Ans: C Feedback: Memantine is classified as an NMDA receptor antagonist that has been shown to improve cognition and activities of daily living in clients with moderate to severe symptoms of dementia. Risperidone, olanzapine, and quetiapine are examples of atypical antipsychotics. Galantamine, donepezil, rivastigmine, and tacrine are cholinesterase inhibitors. Clonazepam, alprazolam, and lorazepam are examples of benzodiazepines.

Origin: Chapter 25, 1 1. A client has been prescribed naltrexone for treatment of alcohol dependence. The nurse has explained the drug's purpose to the client. The nurse determines that the client has understood the instructions when the client identifies which of the following about the drug? 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

Ans: C Feedback: 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.

Origin: Chapter 30, 5 5. A nurse is caring for a family in which the elderly mother has been a victim of abuse and neglect by her son, 48 years of age. Which of the following would be most important for the nurse to keep in mind before interviewing the family? A) A top nursing priority would be to legally remove the son from the home. B) The main focus of the nurse's actions should be on improving the elderly mother's self-esteem. C) The nurse must allow the older adult mother to decide whether she wants to leave the situation. D) Placement for the older adult woman in a nursing home within the community is crucial

Ans: C Feedback: Removing children and older adults from their families or caregivers often is necessary to ensure immediate safety. If the home of an abused or neglected child or older adult cannot be made safe, the nurse must facilitate the involvement of other professionals in placing the child or older adult in a foster home or nursing home. Still, intervening in cases of elder abuse is not a clear-cut issue. When an older adult's decision making is not impaired (competence is the legal term), he or she must be allowed an appropriate degree of autonomy in deciding how to manage the problem, even if the choice is to remain in the abusive situation. Forcing someone to do something against his or her wishes is in itself a form of victimization and denies autonomous decision making.

Origin: Chapter 27, 6 6. A female client is diagnosed with female orgasmic disorder and is receiving treatment by a qualified sex therapist. The client and her partner are being taught sensate focus. Which of the following would the couple be required to do first? A) Have sexual intercourse B) Engage in genital touching C) Participate in nongenital contact D) Use masturbation

Ans: C Feedback: Sensate focus is a method for partners to learn what each finds arousing and to learn to communicate those preferences. It begins with nongenital contact and gradually includes genital touch and sexual intercourse.

Origin: Chapter 29, 22 22. A nurse is talking with the husband of a female client diagnosed with Alzheimer's disease. During the conversation, the husband tells the nurse that "she often begins to scream and curse for no apparent reason." The nurse interprets this as which of the following? A) Hypersexuality B) Disinhibition C) Hypervocalization D) Apathy

Ans: C Feedback: The husband is describing hypervocalization, which involves screams, cursing, moaning, groaning, and verbal repetitiveness, which reflect aberrant motor behavior. Hypersexuality is manifested by inappropriate and socially unacceptable sexual behavior, in which the client begins talking and behaving in ways that are uncharacteristic of premorbid behavior. Disinhibition is acting on thoughts and feelings without exercising appropriate social judgment, such as removing clothes in public or walking into a room naked because the client was unable to find clothes. Apathy is the inability or unwillingness to become involved with one's environment, which leads to withdrawal from the environment and a gradual loss of empathy for others.

Origin: Chapter 29, 8 8. A nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate? A) "Basically, this diagnosis is based on the client's inability to talk normally." B) "Your report of gradually developing confusion over time was the basis for the diagnosis." C) "His diagnosis is primarily based on the rapid onset of his change in consciousness." D) "The client's exposure to an infectious agent led us to determine the diagnosis.

Ans: C Feedback: The key diagnostic indicator for delirium is impaired consciousness, which is usually sudden in onset. Although infection may be an underlying cause, and other cognitive changes may occur, such as problems with memory, orientation, and language, impaired consciousness developing over a short period is key.

Origin: Chapter 28, 12 12. A nurse is counseling a family whose child, age 4 years, has mild intellectual disability. The nurse is working with the family on realistic long-term goals. Which of the following would be most appropriate? A) Locating suitable residential placement for the child B) Finding a foster home for the child C) Having the child function independently as an adult D) Preventing the onset of psychiatric disorders in the child

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

Origin: Chapter 30, 3 3. An emergency department nurse is assessing a female client with traumatic injuries. To assess whether the client's injuries have resulted from abuse, which question would be most appropriate for the nurse to ask the client? A) "Is your partner being mean to you?" B) "Why do you think your husband has beaten you?" Page 1 C) "It looks like someone has hurt you. Tell me about it." D) "Can you describe the person who did this to you?"

Ans: C Feedback: The nurse should say to the client, "It looks like someone has hurt you. Tell me about it." This is an open-ended statement and allows the client to verbalize her thoughts and feelings. Asking whether the partner is being mean or asking why the client thinks the husband has beaten her already assumes that the client has been abused. Asking about the person who did this would be ineffective because survivors of violence are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Additionally, this question is a closed question that does not allow the client to verbalize her thoughts and feelings openly

Origin: Chapter 30, 11 11. A nurse is assessing a survivor of intimate partner violence. During the interview, the nurse determines that the survivor's partner is using power and control over the client through coercion and threats. Which client statement would lead the nurse to suspect this? A) "He always tells me that the abuse never happened." B) "He tells me who I can and cannot see." C) "He tells me that he'll tell Child Services I'm a bad mother." D) "He acts like he's the master of his castle and I'm his servant."

Ans: C Feedback: The statement about telling child services that the client is a bad mother reflects coercion and threats. The statement about the abuse never happening reflects power and control through minimizing, denying, and blaming. The statement about whom the client can and cannot see reflects power and control through the use of isolation. The statement about the partner being the master of his castle reflects power and control through the use of the male privilege.

Origin: Chapter 25, 15 15. A client with a history of opioid abuse is exhibiting manifestations of moderate withdrawal. Which of the following would the nurse expect to assess? A) Rhinorrhea B) Lacrimation C) Dilated pupils D) Dysphoria

Ans: C Feedback: With moderate opioid withdrawal, pupils are dilated. Rhinorrhea, lacrimation, and dysphoria are noted with mild withdrawal.

Origin: Chapter 28, 9 9. The mother of a child with autism spectrum disorder tells the nurse that her child has few playmates. She states, "He has real trouble interacting with other children and when there is a change in his routine, he throws a tantrum." Based on this information, the nurse identifies which nursing diagnosis as the priority? A) Self-Care Deficits related to repeated tantrums B) Risk for Injury related to autism spectrum disorder C) Compromised Family Coping related to having a child with autism spectrum disorder D) Social Isolation related to poor social skills

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

Origin: Chapter 29, 13 13. A son brings his mother to the clinic for an evaluation. The son's mother has moderate Alzheimer's disease without delirium. The nurse assesses the client for which of the following as the priority? A) Hearing deficits B) Mania C) Strange verbalizations D) Catastrophic reactions

Ans: D Feedback: Catastrophic reactions are overreactions, or extreme anxiety reactions, to everyday situations. As Alzheimer's disease progresses, the client may exhibit catastrophic responses such as night awakening, wandering, agitation, and panic.

Origin: Chapter 29, 2 2. While caring for a client age 88 years suspected of having dementia, the nurse assesses the client for a common delusional thought. Which of the following would the nurse interpret as a common delusion? A) "I am the king of the universe." B) "Creatures are living in my closet." C) "The government has people following me." D) "My roommate keeps stealing my clothes."

Ans: D Feedback: Common delusional or suspicious thoughts for clients with dementia include "People are stealing my things," "This is not my house," and "My relative is an imposter."

Origin: Chapter 30, 14 14. A nurse is interviewing a client who is a survivor of abuse. The client is telling the nurse about how the violence occurred. Which statement would the nurse interpret as reflecting phase 3 of the cycle of violence? A) "He threw me against the wall and started punching my face." B) "He yells at me for not having dinner waiting for him when he comes home." C) "He calls me stupid and incompetent, asking himself why he ever married me." D) "He tells me that he is sorry and that he will never hit me again."

Ans: D Feedback: During phase 3 of the cycle, the perpetrator becomes kind, contrite, and loving, begging for forgiveness and promising never to inflict abuse again. The actual violence occurs in phase 2. Yelling at the client for not having dinner ready and calling her stupid and incompetent reflect phase 1, or tension building.

Origin: Chapter 28, 3 3. A nurse is assessing a child who is suspected of having attention deficit hyperactivity disorder. Which of the following would the nurse identify as reflecting impulsiveness in the child? A) Inability to wait his turn B) Restlessness C) Difficulty completing a task D) Risk-taking behavior

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

Origin: Chapter 29, 3 3. A nurse is assessing a client age 78 years who lives alone in his own home. To assess the client's instrumental activities of daily living, which question would be most appropriate to ask? A) "How often do you bathe or shower?" B) "How many times do you change clothes during the day?" C) "How often do you cook meals for yourself?" D) "How often do you go to the store to buy groceries?"

Ans: D Feedback: Instrumental activities of daily living are part of the functional status assessment of older adults. These activities include shopping, talking on the telephone, and driving or using other transportation. Bathing, showering, dressing, and cooking are examples of activities of daily living.

Origin: Chapter 26, 3 3. A female client who is receiving counseling at a community health center has complained during the last three weekly sessions about being unable to sleep. A nurse interviews the family members to determine the effect of the client's problem on them. Which response would the nurse most likely expect to hear? A) "It really hasn't seemed to be a problem for us." B) "There's been little change in how she gets along with other family members." C) "The not sleeping has really had a positive effect on her and us." D) "It's been exhausting living with her these past few weeks."

Ans: D Feedback: Living with a family member with insomnia is challenging. Irritability, complaints of sleeplessness, and chronic fatigue interfere with quality interpersonal relationships. It would be highly unlikely that things are not problematic or that the effects of the insomnia would be positive.

Origin: Chapter 25, 2 2. An adolescent client tells a nurse that he or she occasionally "sniffs airplane glue." When discussing the effects of long-term use of inhalants, which of the following would the nurse most likely include? A) Tremors and central nervous system arousal B) Enhanced normal heart rhythms C) Enhanced attention on focus and memory D) Brain damage and cognitive abnormalities

Ans: D Feedback: Long-term inhalant use is linked to widespread brain damage and cognitive abnormalities that can range from mild impairment to severe dementia. Tremors, central nervous system arousal, and cardiac changes are not associated with long-term inhalant use. Intoxication can lead to cardiac arrest.

Origin: Chapter 24, 3 3. A client with bulimia nervosa is being treated at an outpatient clinic and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which of the following would the nurse include when teaching the client about the prescribed medication? A) Closely monitor your fluid intake while taking this medication. B) Stop taking this medication if it causes weight gain. C) Expect menstrual irregularities, particularly if they've occurred previously. D) Report any weight changes that occur during the first few weeks this medication is taken.

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

Origin: Chapter 30, 7 7. A nurse is conducting a public information seminar on the topic of rape and sexual assault at a local community center. Which of the following would the nurse include when describing power rapists? A) Committed by sadistic perpetrators who plan the rape before committing it to experience erotic enjoyment in response to the victim's suffering B) Target very young or elderly victims, may involve extreme force, and often results in victim injury C) Are not planned ahead of time and result from the perpetrator being obsessed with uncontrollable sexual urges D) Target victims near the age of the perpetrators and involve minimal physical force and intimidation in controlling their victims

Ans: D Feedback: Power rapists commit 55% of sexual assaults. They often attack people their own age and use intimidation and minimal physical force to control their victims. Their assaults are generally premeditated. Anger rapists commit 40% of sexual assaults. These rapists tend to target either very young or older adult victims. They may use extreme force and restraint that results in physical injury to the victim. Sadistic rapists commit 5% of sexual assaults; however, they are the most dangerous. Their crimes are premeditated, and they often torture and kill their victims. Sadistic rapists derive erotic gratification from their victims' suffering.

Origin: Chapter 26, 12 12. A group of nursing students is reviewing the various agents used to treat insomnia. The students demonstrate an understanding of the information when they identify which agent as a melatonin receptor agonist? A) Trazodone B) Estazolam C) Mirtazapine D) Ramelteon

Ans: D Feedback: Ramelteon is a melatonin receptor agonist. Trazodone and mirtazapine are sedating antidepressants. Estazolam is a benzodiazepine classified as a benzodiazepine receptor agonist.

Origin: Chapter 26, 4 4. A nurse is discussing strategies to enhance sleep with a client who is experiencing insomnia. Which of the following would be most appropriate for the nurse to suggest? A) "Eat right before you go to bed, as long as it is something rich that will make you sleepy." B) "Try exercising a bit right before your bedtime so you will feel tired and sleepy." C) "Drinking a warm cup of tea right before bedtime will help to relax you." D) "Establish a regular time for going to bed and getting up in the morning."

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

Origin: Chapter 26, 10 10. A client with insomnia is taught to avoid watching television, eating, and doing work in the bedroom. Which technique is being used? A) Sleep restriction B) Relaxation training C) Cognitive-behavioral therapy D) Stimulus control

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

Origin: Chapter 29, 24 24. A nurse is providing care to a client with Alzheimer's disease who is exhibiting suspiciousness and delusional thinking. Which of the following would be most important for the nurse to do with this client? A) Tell the client that he is experiencing delusions. B) Confront the client about his distorted thinking. C) Correct the client's interpretation of the situation. D) Determine the trigger for distorted thinking.

Ans: D Feedback: Suspiciousness and delusional thinking must be addressed to be certain that they do not endanger the client or others. Often, delusions are verbalized when clients are placed in situations they cannot master cognitively. The principle of nonconfrontation is most important in dealing with suspiciousness and delusion formation. No efforts should be made to ease the client's suspicions directly, or to correct delusions. Rather, efforts should be directed at determining the circumstances that trigger suspicion or delusion formation, and creating a means of avoiding these situations.

Origin: Chapter 25, 6 6. A nurse is using motivational therapy with a female client suffering from alcoholism. The client, who is unwilling to consider changing her drinking behavior, emphatically states, "I am not an alcoholic; you can't make me stop drinking." Which response by the nurse would be most appropriate? A) "You have to stop drinking and driving. You could kill someone." B) "You're right. You are not an alcoholic." C) "You should consider what you are doing to your marital relationship." D) "You're the only one who can make yourself stop drinking."

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

Origin: Chapter 30, 4 4. A female client has been admitted to an inpatient psychiatric facility with a diagnosis of posttraumatic stress disorder after a history of violence by her boyfriend. During the initial assessment interview, which assessment would be the priority? A) Nutritional status B) Hydration status C) Sleep patterns D) Suicide risks

Ans: D Feedback: The first, and most important, assessment conducted is a lethality assessment that determines whether the survivor's life is in danger, either from homicide or suicide, and, if children are in the home, whether they are in danger. Then the physiologic areas such as nutrition, hydration, and sleep can be assessed.

Origin: Chapter 28, 11 11. A nurse is caring for a family with a child who has autism spectrum disorder. When developing an education plan for the parents, which of the following would the nurse most likely emphasize? A) The child is at higher risk for seizure disorder. B) The child's IQ will typically be higher than that of other children. C) Dyslexia also may be a comorbid condition. D) A structured physical environment is important for the child

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

Origin: Chapter 28, 1 1. A school nurse is caring for a child age 7 years who has demonstrated a significantly lower-than-average score for mental age on standardized tests in reading. However, the child's IQ scores were within the average range. The nurse interprets this information as suggesting which of the following? A) Communication disorder B) Attention deficit hyperactivity disorder C) Asperger syndrome D) Dyslexia

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

Origin: Chapter 27, 17 17. A nurse is preparing for a group of parents a class about sexuality and sexual behaviors in children. Which of the following would the nurse include as typical behavior of children between the ages of 10 and 12 years? A) Touching one's genitals at home B) Standing extremely close to others C) Trying to look at persons when nude D) Looking at nudity on television or the Internet

Ans: D Feedback: Typically, boys and girls ages 6 to 9 years often touch genitals at home, stand too close to others, and try to look at persons when they are nude. by contrast, children age 10 to 12 years, who are actually more interested in (and know more about) sex, limit their behavior to looking at nudity in magazines, television, and on the internet.

Origin: Chapter 27, 1 1. A group of nursing students is reviewing information about sexual development. The students demonstrate understanding of the information when they describe biosexual identity as which of the following? A) Conviction of belonging to the male or female gender B) Outward expression of gender C) Sexual attraction to opposite, same, or both sexes D) Anatomic and physiologic state of being male or female

Ans: D Feedback: Whereas biosexual identity refers to the anatomic and physiologic state of being male or female, gender identity is the conviction of belonging to the male or female gender. Both biosexual and gender identities result from genetic and intrauterine hormonal influences, not learned behavior. Sex role identity (or gender role) is the outward expression of gender, including behaviors, feelings, and attitudes. Sexual orientation is a person's sexual attraction to those of the opposite sex (heterosexual), same sex (homosexual), or both sexes (bisexual)