345 Mental Health Final
6. Ophelia, a 69-year-old retired nurse, attends a reunion of her former coworkers. Ophelia is concerned because she usually knows everyone, and she cannot recognize faces today. A registered nurse colleague recognizes Ophelia's distress and "introduces" Ophelia to those attending. The nurse practitioner recognizes that Ophelia seems to have a deficit in: a. Lower-level cognitive domain b. Delirium threshold c. Executive function d. Social cognition
d
Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? SATA: A. Limited language skills B. Level of cognitive development C. Level of emotional development D. Parental denial that a problem exists E. Severity of the typical mental illnesses observed in young children
A, B, C
Which activity is most appropriate for a child with ADHD? A. Reading an adventure novel B. Monopoly C. Checkers D. Tennis
D
Nursing assessment of an alcohol-dependent client 6 to 8 hours after the last drink would most likely reveal the presence of which early sign of alcohol withdrawal? a. Tremors b. Seizures c. Blackouts d. Hallucinations
a
2. When assessing a patient diagnosed with a borderline personality disorder, which statement by the patient warrants immediate attention? a. "My mother died ten years ago." b. "I haven't needed medication in weeks." c. "My dad never loved me." d. "I'd really like to hurt her for hurting me."
d
1. Which statement made by the psychiatric nurse demonstrates an accurate understanding of the factors that affect an individual's personality? a. "Therapy will help her identify that her problems are personality related." b. "I'll need to learn more about this patient's cultural beliefs." c. "It's encouraging to know that personality disorders respond well to treatment." d. "A person's personality is fluid and adjusts to current social situations."
b
3. When considering the pathophysiology responsible for both delirium and dementia, which intervention is appropriate for delirium specifically? a. Assist with needs related to nutrition, elimination, hydration, and personal hygiene. b. Monitor neurological status on an ongoing basis. c. Place identification bracelet on patient. d. Give one simple direction at a time in a respectful tone of voice.
b
6. Personality disorders often co-occur with mood and eating disorders. A young woman is undergoing treatment at an eating disorders clinic and her nurse suspects the patient may also have a Cluster B personality disorder due to the young woman's: a. Desire to avoid eating b. Dramatic response to frustration c. Excessive exercise routine d. Morose personality traits
b
A 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for this client's treatment plan while in the hospital? a. Client will return to a predrug level of functioning within 1 week. b. Client will be medically stabilized while in the hospital. c. Client will state within 3 days that they will totally abstain from drugs and alcohol. d. Client will take a leave of absence from college to alleviate stress.
b
A patient diagnosed with opioid use disorder has expressed a desire to enter into a rehabilitation program. What initial nursing intervention during the early days after admission will help ensure the patient's success? a. Restrict visitors to family members only. b. Manage the patient's withdrawal symptoms well. c. Provide the patient a low stimulus environment. d. Advocate for at least 3 months of treatment.
b
Cocaine exerts which of the following effects on a client? a. Stimulation after 15 to 20 minutes b. Stimulation and euphoria c. Immediate imbalance of emotions d. Paranoia
b
7. Larry is from a small town and began displaying aggressive and manipulative traits while still a teenager. Now at 40 years old, Larry is serving a life sentence for the murders of his wife and her brother. John, the prison psychiatric nurse practitioner, recognizes that Larry's treatment will most likely: a. Transform Larry to a model prisoner b. Not improve Larry's coping skills c. Reaffirm Larry's high-risk behaviors d. Manifest as small incremental changes
d
8. Darnell is an 84-year-old widower who has lived alone since his wife died 6 years ago. A neighbor called Darnell's son to tell him that Darnell was trying to start his car from the passenger's side. He became angry and aggressive when the car would not start. After a medical assessment, Darnell was diagnosed with a major neurocognitive disorder. The nurse realized additional family teaching is necessary when Darnell's son states: a. "My father's diagnosis is interfering with his daily functioning." b. "This neurocognitive disorder will probably progress." c. "Advancing age is a risk factor in my father's diagnosis." d. "With person-centered care, my father will be able to remain in his home."
d
What is an appropriate long-term client-centered goal/outcome for a recovering substance abuser. a. Ability to discuss the addiction with significant others. b. State an intention to stop using illegal substances. c. Abstain from the use of mood-altering substances. d. Substitute a less addicting drug for the present drug.
c
In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: SATA: A. Children of color and poor economic conditions being underserved B. Increased stress in the family unit C. Markedly increased funding D. Premature termination of services
A, B, D
What assessment question should the nurse ask when attempting to determine a teenager's mental health resilience? SATA: A. How did you cope when your father deployed with the Army for a year in Iraq? B. Who did you to to for advice while your father was away for a year in Iraq? C. How do you feel about talking to a mental health counselor? D. Where do you see yourself in 10 years? E. Do you like the school you go to?
A, B, D
Which statement is true regarding substance addiction and medical comorbidity? a. Most substance abusers do not have medical comorbidities. b. There has been little research done regarding substance addiction disorders and medical comorbidity. c. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. d. Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier.
c
Which statement is descriptive of clients with a personality disorder? A. They are resistant to behavioral change. B. They have an ability to tolerate frustration and pain. C. They usually seek help to change maladaptive behaviors. D. They have little difficulty with cognitive functioning.
A Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change. Change proceeds very slowly. None of the other options are generally associated with this disorder.
Which factor can reduce the vulnerability of a child to etiological influences predisposing to the development of psychopathology? A. Resilience B. Malnutrition C. Child abuse D. Having a depressed parent
A Resilience refers to developing and using certain characteristics that help a child to handle the stresses of a difficult childhood without developing mental problems. Resilient children can adapt to changes in the environment, form nurturing relationships with adults other than their parents, distance themselves from the emotional chaos of the family, and have social intelligence and the ability to use problem-solving skills.
A 5-year-old who consistently omits the sound for 'r' and 's' when speaking is demonstrating which type of disorder? A. Speech B. Language C. Social communication D. Specific learning
A Speech disorders are marked by problems in making sounds. Children may have trouble making certain sounds, or they may distort, add, or omit sounds. Such patterns are not associated with any of the other options.
The physician mentions to the nurse that a client who is about to be admitted has "sundowning." The nurse can expect to assess for which nightly behavior? A. Agitation B. Lethargy C. Depression D. Mania
A Sundowning involves increased disorientation and agitation occurring at night. None of the other options are associated with sundowning.
When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing characteristic? A. Temperament B. Resilience C. Vulnerability D. Cultural assimilation
A Temperament is the behavior the child habitually uses to cope with the environment. It is a constitutional factor thought to be genetically determined. It may be modified by the parent-child relationship. None of the other options would reflect this characteristic.
A child diagnosed with attention deficit hyperactivity disorder (ADHD) is reprimanded for taking the nurse's pen without asking first. He responds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding with which statement? A. "I do like you, but I don't like it when you grab my pen." B. "Liking you has nothing to do with whether I will loan you my pen." C. "It sounds as though you are feeling helpless and insecure." D. "You must ask for permission before taking someone else's things."
A This reply shows positive regard for the child while describing the behavior as undesirable. Feedback such as this helps the child feel accepted while making her aware of the effect her behavior has on others. None of the other options provide the necessary degree of positive regard.
A client diagnosed with delirium strikes out at a staff member. The nurse can most correctly hypothesize that this behavior is related to which characteristic symptom of delirium? A. Anger B. Fear C. Unmet physical need D. Unmet social interaction
B Clients with delirium often misinterpret reality, perceiving threat where none actually exists. Delirious clients who are fearful may strike out at others, seemingly without provocation. Anger may develop but it is triggered by fear. Neither of the remaining options are generally associated with the behavior described.
An 8-year-old patient is newly diagnosed with attention deficit hyperactivity disorder (ADHD). It is important that the parents be educated to the fact that symptoms will take which form? (Select all that apply). of, inattention, and impulsivity have to be apparent: SATA: A. Low frustration tolerance B. Poor school performance C. Impulsive behaviors D. Easily intimidated E. Mood swings
A, B, C, E Individuals with ADHD show an inappropriate degree of inattention, impulsiveness, and hyperactivity. Attention problems and hyperactivity contribute to low frustration tolerance, temper outbursts, labile moods, poor school performance, peer rejection, and low self-esteem. ADHD is not generally characterized by meekness or by being easily intimidated.
Which statement demonstrates a well-structured attempt at limit setting? A. Hitting me when you are angry is unacceptable. B. I expect you to behave yourself during dinner. C. Come here, right now! D. Good boys don't bite.
A
Which characteristics will the nurse assess in the client diagnosed with antisocial personality? A. Deceitfulness, impulsiveness, and lack of empathy B. Perfectionism, preoccupation with detail, and verbosity C. Avoidance of interpersonal contact and preoccupation with being criticized D. A need for others to assume responsibility for decision making and seeking nurture
A Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others. Characteristics presented in the other options are not associated with this disorder.
The family members of a client with early-stage Alzheimer's disease cannot provide adequate supervision for the client. What would be a reasonable alternative for the nurse to explore with them to meet their current needs? A. Day care B. Acute care hospitalization C. Long-term institutionalization D. Group home residency
A Day care is a good option for clients with early-stage Alzheimer's disease. It provides supervision, a protected environment, and supportive interactions. The other options may be considered as the client moves into the advances stages of the disease disorder.
A family member reports that the client had been oriented and able to carry on a logical conversation last evening, but this morning is confused and disoriented. The nurse can suspect that the client is displaying symptoms associated with which cognitive disorder? A. Delirium B. Dementia C. Amnesic disorder D. Selective inattention
A Delirium is characterized by a disturbance of consciousness, a change in cognition (such as impaired attention span), and a fluctuating level of consciousness that develop over a short period of time. None of the other options share these characteristics.
The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character for the client who truly has early stage Alzheimer's disease? Select all that apply. A. Easily frustrated by cognitive losses B. Charming behavior designed to hide memory deficit C. Confabulation to compensate for forgotten information D. Avoidance of questions by subject changing
A Frustration and anger are characteristics of the middle stage of Alzheimer's. During early-stage Alzheimer's disease the client is aware of memory impairment and may attempt to disguise it or cover it by being evasive or using confabulation. The remaining options are associated with the early stage of Alzheimer's disease.
What initial intervention should the nurse suggest to the family members of a client diagnosed with Alzheimer's disease who has become incontinence of urine? A. Label the bathroom door with a picture. B. Provide toileting on an as-needed basis. C. Apply disposable diapers. D. Encourage hourly toileting.
A Labeling doors and various items with pictures can be helpful for a client who has forgotten where things are and what certain items are. The remaining options may need to be implemented eventually when such prompting is no longer effective.
A nursing diagnosis appropriate for a client with Alzheimer's disease, regardless of the stage, would be A. risk for injury. B. acute confusion. C. imbalanced nutrition. D. impaired environmental interpretation syndrome.
A Memory loss, agnosia, poor judgment, and the other symptoms of Alzheimer's disease contribute to placing the client at risk for injuries such as burns and falling down stairs. Risk for injury is always present for the client diagnosed with dementia. The remaining options suggest diagnoses that are associated with certain stages and degrees of cognitive impairment.
The term "perceptual disturbance" refers to difficulty in which area of function? A. Processing information about one's internal and external environment B. Can be one's way of thinking to accommodate new information C. Performing purposeful motor movements D. Formulating words appropriately
A Perceptual distortion refers to impaired ability to process intellectual, sensory, and emotional data in a logical, meaningful way. None of the other options are associated with this inability.
The family of a child diagnosed with attention deficit hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What is the focus of child's evaluation? SATA: A. Academic performance B. Activities of daily living C. Physical growth D. Social relationships E. Personal perception
A, B, D, E For the family and child with ADHD, evaluation will focus on the symptom patterns and severity. For those with ADHD, inattentive type, the focus of evaluation will be academic performance, activities of daily living, social relationships, and personal perception. For those with ADHD, hyperactive-impulsive type or combined type, the focus will be on both academic and behavioral responses.
A 9-year-old patient has been diagnosed with an intellectual development disorder (IDD). Which assessment findings support this diagnosis? SATA: A. Unable to explain the phrase, "Raining cats and dogs" B. Reads below age level C. Is capable of providing effective oral self care D. Enjoy interacting with developmentally similar peers E. Physically lashes out when frustrated
A, B, E IDD is characterized by severe deficits in three major areas of functioning: intellectual, social, and managing daily life. These children demonstrate difficulty with self care and with almost any social interactions.
When preparing educational materials for the family of a client diagnosed with progressive dementia, the nurse should include information related to which local resourses? Select all that apply. A. Day care centers B. Legal professionals C. Home health services D. Family support groups E. Professional counseling
A, C, D, E Most importantly, families need to know where to get help. Help includes professional counseling and education regarding the process and progression of the disease. Families especially need to know about and be referred to community-based groups that can help shoulder this tremendous burden (e.g., day care centers, senior citizen groups, organizations providing home visits and respite care, and family support groups). While legal professionals may be of interest to the family, client and family education does not include such services.
Pam, the nurse educator, is teaching a new nurse about seclusion and restraint. Order the following interventions from least (1) to most (5) restrictive: A. With the patient identify the behaviors that are unacceptable and consequences associated with harmful behaviors B. Placing the pt in physical restraints C. Allowing the pt to take a time-out and sit in his or her room D. Offering a PRN medication by mouth E. Placing the pt in a locked seclusion room
A, D, C, E, B
Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to: A. Limited executive function B. Cerebellum maturation C. Cerebral stasis and hormonal changes D. A slight reduction in brain volume
B
April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April's mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that: A. Time-out is an important part of April's baseline discipline B. Time-out is no longer an effective therapeutic measure C. April enjoys time-out, and acts out to get some alone time. D. Time-out will need to be replaced with seclusion and restraint
B
Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner: A. I was so mad I wanted to hit my mother. B. I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd. C. I forgot that you told me to breathe when I become angry. D. I scream as loud as I can when the train goes by the house.
B
A client diagnosed with Alzheimer's disease looks confused and cannot recall many common household objects by name, such as a pencil or glass. The nurse should document this loss of function using which term? A. Apraxia B. Agnosia C. Aphasia D. Anhedonia
B Agnosia is a loss of the ability to recognize familiar objects. The loss is not associated with any of the other options
A 78-year-old patient diagnosed with Alzheimer's disease picks up a glass from the bedside table but does not recognize the purpose of the object. This inability is associated with which characteristic of the disorder? A. Apraxia B. Agnosia C. Aphasia D. Agraphia
B Agnosia is the loss of sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write.
A child diagnosed with autism will demonstrate impaired development in which area? A. Adhering to routines B. playing with other children C. swallowing and chewing D. eye-hand coordination
B Autism affects the normal development of the brain in social interaction and communication skills. Symptoms associated with autism spectrum disorders include significant deficits in social relatedness, including communication, nonverbal behavior, and age-appropriate interaction. Other behaviors include stereotypical repetitive speech, obsessive focus on specific objects, over adherence to routines or rituals, hyper- or hypo-reactivity to sensory input, and extreme resistance to change. None of the other options are characteristically associated with autism.
Based on the current research, which patient is most likely to develop dementia? A. An office manager in a high-stress environment B. A former boxer and is now a trainer C. A worker in a factory where asbestos is found D. A bartender in a dark underground club/bar
B Brain injury and trauma are associated with a greater risk of developing Alzheimer's disease and other dementias. People who suffer repeated head trauma, such as boxers and football players, may be at greater risk. The other options do not specifically represent known risk.
Which social behavior is often a result of a child having been exposed to some form of abuse? A. Speech disorders B. Bullying others C. Eating disorders D. Delayed motor skills
B Children who have experienced abuse are at risk for identifying with their aggressor and may act out, bully others, become abusers, or develop dysfunctional interpersonal relationships in adulthood. None of the remaining options are as directly associated with abuse as bullying.
Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his "nice" mom, that he loves school, and gets above average grades. The strongest explanation of this response is: A. Temperament B. Genetic Factors C. Resilience D. Paradoxical effects of neglect
C
The mother of a 3-year-old boy just diagnosed with autism spectrum is tearful and states, "The doctor said we need to start therapy right away. I just don't understand how helpful it will be—he's only 3 years old!" What response should the nurse provide to the mother's statement? A. "You are right, 3 years old is very young to start therapy, but it will make you feel better to be doing something." B. "Starting him on treatment now gives Taylor a much greater chance for a productive life." C. "If your child starts therapy now, he will be able to stop therapy sooner." D. "If you have questions, its best to ask the doctor."
B Early intervention for children with autism can greatly enhance their potential for a full, productive life. 3 years old is not too young to start therapy since the sooner therapy is started, the better the outcome. The patient will most likely not be able to stop therapy as interventions will continue indefinitely. Telling the mother to ask her provider abdicates the nurse's responsibility to provide education to patients and families.
When a delirious client insists that a vacuum hose is a large, poisonous snake, the nurse recognizes that this client is experiencing what characteristic symptom? A. Hallucinations B. Illusion C. Hypervigilant D. Agnosia
B Illusions are errors in the perception of a sensory stimulus. None of the other options are associated with this form of misperception.
Research has indicated that the antisocial personality may be characterized by what behavior? A. Social isolation B. Lack of remorse C. Learning difficulties D. Difficulty with reality testing
B Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others. This disorder is not associated with any other behaviors suggested by the remaining options.
Playing one staff member against another is an example of what defense mechanism? A. Devaluation B. Splitting C. Impulsiveness D. Social ineptitude
B Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client. The client can enjoy the spectacle and do as he or she pleases. The example provided does not effectively describe any of the other options.
Which nursing diagnosis should be considered for a child with attention deficit hyperactivity disorder ADHD? A. Anxiety B. risk for injury C. defensive coping D. impaired verbal communication
B The child's marked hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, and so forth.
A 7-year-old, who is described as impulsive and hyperactive, tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with which diagnosis? A. Attention deficit disorder B. Attention deficit hyperactivity disorder C. Autism D. Conduct disorder
B The data are most consistent with attention deficit hyperactivity disorder (ADHD) as described in the DSM-5. The other options present with characteristics and behaviors that differ from those in the scenario.
A 12-year-old male patient diagnosed with Tourette's disorder is visiting his provider. The nurse will prepare medication teaching on which class of medication to help manage the tics associated with this disorder? SATA: A. Mood stabilizers B. Antianxiety agents C. Anticholinesterase inhibitors D. First-generation antipsychotics E. Second-generation antipsychotics
B, D, E Drugs with Food and Drug Administration (FDA) approval for treating tics are the first-generation antipsychotics haloperidol and pimozide, and the second-generation antipsychotic aripiprazole.Clonidine hydrochloride, an alpha 2-adrenergic agonist, used to treat hypertension, is also prescribed for tics. While less effective and far slower acting than the antipsychotics, it has fewer side effects. The antianxiety drug clonazepam (Klonopin) is used as a supplement to other medications. It may work by reducing anxiety and resultant tics. The other options are not used or approved for the treatment of Tourette's disorder.
When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her." The nurse should plan to provide which intervention? A. Suggest that the child's father become her primary caregiver. B. Encourage the mother to consider attending parenting classes. C. Counsel the mother regarding ways to better bond with her child. D. Educate the father regarding signs that the child is being physically abused.
C All people have temperaments, and the fit between the child and parent's temperament is critical to the child's development. The caregiver's role in shaping that relationship is of primary importance, and the nurse can intervene to teach parents ways to modify their behaviors to improve the interaction.
The client, diagnosed with which personality disorder, will most likely require admission to a psychiatric unit? A. Paranoid personality disorder B. Narcissistic personality disorder C. Borderline personality disorder D. Dependent personality disorder
C Clients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times. Psychosis is not generally associated with the other options.
A 72-year-old patient is hospitalized diagnosed with pneumonia and experiencing delirium. When the client points to the IV pole and screams, "Get him out of here! He's going to hurt me!", the nurse recognizes the response as a(n) A. hallucination. B. delusion. C. illusion. D. confabulation.
C Illusions are errors in perception of sensory stimuli. The stimulus is a real object in the environment; however, it is misinterpreted and often becomes the object of the patient's projected fear. Hallucinations are false sensory stimuli. For example, individuals experiencing delirium may become terrified when they "see" giant spiders crawling over the bedclothes or "feel" bugs crawling on or under their bodies. A delusion is described as thinking or believing something that is not true and is seen more often in schizophrenia. For example, a patient may firmly believe that government agencies can read and are monitoring his or her thoughts or that neighbors can see him or her through walls. Confabulation is the creation of stories or answers in place of actual memories to maintain self-esteem.
Which behavior is most indicative of a 4-year-old child diagnosed with Tourette's syndrome? A. Difficulty in social relationships B. Humming while performing activities that require concentration C. Frequent eye blinking D. Difficulty in completing tasks on time
C Persistent motor or vocal ticking is characteristic of Tourette's syndrome. Dysfunctional social relationship is an inconclusive symptom, especially for a 4-year-old. Humming can be a normal response of a child at play. Ineffective time management is usually associated with a child who demonstrates ADHD, not Tourette's syndrome.
Splitting is a process in which the client demonstrates what behavior? A. Unconsciously represses undesirable aspects of self B. Places responsibility for his or her behavior outside the self C. Sees things as divided into "all good" or "all bad" D. Evidences lack of personal boundaries
C Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad. This behavior does not relate to any of the other options.
What are the foundational concerns regarding the use of restraint and seclusion when providing care to children? SATA: A. Parents may initiate a lawsuit if injury occurs. B. Staff have conflicted feelings leading to ineffectiveness. C. Research suggests both are psychologically and physically harmful. D. Staff tends to be undertrained in use of restraints in children. E. The principle of least restrictive intervention is a primary concern.
C, E Restraint and seclusion have been shown to be psychologically harmful and may also be physically harmful and result in injury or death. To ensure that the civil and legal rights of individuals are maintained, techniques are selected according to the principle of least restrictive intervention. This principle requires that you use more-restrictive interventions only after attempting less restrictive interventions to manage the behavior that have been unsuccessful. The other options are not correct reasons why restraint and seclusion are controversial in children.
A 62-year-old patient who is recovering from a urinary tract infection that has required hospitalized for delirium. Based on research regarding possible postdelirium complications, what are important areas for the provider to assess regularly after discharge? A. Sleeping habits B. Sexual functioning C. Symptoms of posttraumatic stress D. Depression and level of cognition
D Although delirium is usually a short-term condition, it may have long-term consequences. In patients with preexisting cognitive impairment, there is an acceleration of cognitive decline. Although there are reports of long-term cognitive impairment (in the absence of preexisting cognitive impairment) and functional decline following delirium, results of studies have been inconsistent. An association also exists with depression after delirium. Although a holistic examination would assess sleep, this is not the area that research has found to be problematic. A holistic examination would include sexual functioning, but it is not the priority at this time. Posttraumatic stress symptoms have been seen in younger patients who experienced delirium while hospitalized.
A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. When the client is admitted, the daughter states, "I'll take her glasses and hearing aid home, so they don't get lost." The best reply for the nurse would be: A. "That will be fine. I'll have you sign our hospital release form." B. "Because we do not have a copy of durable power of attorney, we cannot release them to you." C. "Don't worry. You can leave them at her bedside. We are insured for losses of this sort." D. "I would like to have your mother wear them. It will help her to be less confused or retain more of her orientation."
D Clients with cognitive disorders usually profit from being able to see and hear clearly. Confusion is reduced through the use of glasses and hearing aids. None of the other options support this client need.
Which type of dementia has a clear genetic link? A. Alcohol-induced dementia B. Multi-infarct dementia C. Creutzfeldt-Jakob disease D. Alzheimer's disease
D Family members of people with Alzheimer's disease have a higher risk of developing the disease than does the general population. Research does not support such a claim for any of the other options.
Which event would an older client diagnosed with early stage Alzheimer's disease have greatest difficulty remembering? A. His or her high school graduation B. The births of his or her children C. The story of a teenage escapade D. What he or she ate for breakfast
D Initially, recent memory is impaired, and remote memory remains intact.
The nurse caring for a client diagnosed with Alzheimer's disease can anticipate that the family will need information about which medication therapy? A. Antihypertensives B. Benzodiazepines C. Immunosuppressants D. Acetylcholinesterase inhibitors
D Memory deficit is thought to be related to a lack of acetylcholine at the synaptic level. Acetylcholinesterase inhibitor drugs prevent the chemical that destroys acetylcholine from acting, thus leaving more available acetylcholine.
A student nurse is working with an 82-year-old patient diagnosed with dementia. The student is frustrated at times by not knowing how best to care for or communicate with the client. Which of the statement by the student best illustrates best care practice? A. Lighthearted banter: "Carl, you look great today in your new sweater, you handsome devil!" B. Limit setting: "Carl, you cannot yell out in your room. You are upsetting other patients." C. Firm direction: "You will take a shower this morning; there is no debating about it so don't try to argue." D. Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day."
D Positive regard implies respect. It is the ability to view another person as being worthy of caring about and as someone who has strengths. The attitude of unconditional positive regard is the nurse's single most effective tool in caring for people with dementia. It induces people to cooperate with care and increases family members' satisfaction with care. Although the patient may not be able to verbalize plans for his day, this response conveys belief that the patient has something to offer and treats him with respect. It also shows that the nurse wants to care for the patient and conveys commitment to the relationship. Limit-setting may be necessary at times; however, it is not the most effective care tool. The other responses are nontherapeutic.
A 10-year-old who is frequently disruptive in the classroom begins to fidget and then moves on to disruptive behavior. What is the most appropriate initial technique for managing this sort of disruptive behavior? A. Therapeutic holding B. Seclusion C. Quiet room D. Touch control
D The appropriate adult can move closer to the child and place a hand on his/her arm or an arm around his/her shoulder for a calming effect when the fidgeting is first noted. The closeness signals the child to use self-control. It is the least restrictive treatment approach and should be tried initially; before any of the other options.
2. Which statement made by a family member tends to support a diagnosis of delirium rather than dementia? a. "She was fine last night but this morning she was confused." b. "Dad doesn't seem to recognize us anymore." c. "She's convinced that snakes come into her room at night." d. "He can't remember when to take his pills or whether he's bathed."
a
3. What is the current accepted professional view of the effect of culture on the development of a personality disorder? a. There aren't sufficient studies to confirm the role that ethnicity and race have on the prevalence of personality disorders. b. The North American and Australian cultures produce higher incidences of personality disorders among their populations. c. Neither culture nor ethnic background is generally considered in the development of personality disorders. d. Personality disorders have been found to be primarily the products of genetic factors, not cultural factors.
a
5. What is the rationale for providing a patient diagnosed with dementia easily accessible finger foods thorough the day? a. Increases input throughout the day b. The person may be anorexic c. Assists with monitoring food intake d. Helps prevent constipation
a
8. Connor is a 28-year-old student, referred by his university for a psychiatric evaluation. He reports that he has no friends at the university and people call him a loner. Recently, Connor has been giving lectures to pigeons at the university fountains. Connor is diagnosed as schizotypal, which differs from schizophrenia in that persons diagnosed as schizotypal: a. Can be made aware of their delusions b. Are far more delusional than schizophrenics c. Have a greater need for socialization d. Do not usually respond to antipsychotic medications
a
A client who is dependent on alcohol tells the nurse, "Alcohol is no problem for me. I can quit anytime I want to." The nurse can assess this statement as indicating which defense mechanism? a. Denial b. Projection c. Rationalization d. Reaction formation
a
The treatment team meets to discuss a client's plan of care. Which of the following factors will be priorities when planning interventions? a. Readiness to change and support system b. Current college performance c. Financial ability d. Availability of immediate family to come to meetings
a
Which signs and symptoms are associated with opioid withdrawal? a. Lacrimation, rhinorrhea, dilated pupils, and muscle aches. b. Illusions, disorientation, tachycardia, and tremors. c. Fatigue, lethargy, sleepiness, and convulsions. d. Synesthesia, depersonalization, and hallucinations.
a Symptoms of opioid withdrawal resemble the "flu"; they include runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever.
4. Which personality disorders are generally associated with behaviors described as "odd or eccentric"? Select all that apply. a. Paranoid b. Schizoid c. Histrionic d. Obsessive-compulsive e. Avoidant
a, b
A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested what substance? Select all that apply. a. Rohypnol b. Gamma-hydroxybutyrate (GHB) c. ReVia d. Clonidine e. Ayahuasca
a, b The drugs most frequently used to facilitate a sexual assault (rape) are flunitrazepam (Rohypnol, "roofies"), a fast-acting benzodiazepine, and gamma-hydroxybutyrate (GHB) and its congeners. These drugs are odorless, tasteless, and colorless; mix easily with drinks; and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur.
5. Which behaviors are examples of a primitive defense mechanism often relied upon by those diagnosed with a personality disorder? Select all that apply. a. Regularly attempts to split the staff b. Attempts to undo feelings of anger by offering to do favors c. Regresses to rocking and humming to sooth themselves when fearful d. Lashes out verbally when confronted with criticism e. Destroys another person's belongings when angry
a, b, c
A patient with a history of alcohol use disorder has been prescribed disulfiram (Antabuse). Which physical effects support the suspicion that the patient has relapsed? Select all that apply. a. Intense nausea b. Diaphoresis c. Acute paranoia d. Confusion e. Dyspnea
a, b, d, e
10. Nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels. Specialized skills training and continuing education are helpful to diffuse nursing stress, as well as: Select all that apply. a. Expressing emotions by journaling b. Describing stressful events on Facebook c. Engage in exercise and relaxation activities d. Having realistic patient expectations e. Happy hour after work to blow off steam
a, c, d
4. What side effects should the nurse monitor for when caring for a patient prescribed donepezil (Aricept)? Select all that apply. a. Insomnia b. Constipation c. Bradycardia d. Signs of dizziness e. Reports of headache
a, c, d, e
Which assessment data confirm the suspicion that a patient is experiencing opioid withdrawal? Select all that apply. a. Pupils are dilated b. Pulse rate is 62 beats/min c. Slow movements d. Extreme anxiety e. Sleepy
a, d
Donald, a 49-year-old male, is admitted for inpatient alcohol detoxification. He is cachexic, has multiple scabs on his arms and legs, and has lower extremity edema. An appropriate nursing diagnosis for Donald along with an expected outcome is: a. Risk for injury/Remains free from injury b. Ineffective denial/Accepts responsibility for behavior c. Nutrition: Less than body requirements/Maintains nutrient intake for metabolic needs d. Risk for suicide/Expresses feelings, plans for the future
c
Josie, a 27-year-old patient, complains that most of the staff do not like her. She says she can tell that you are a caring person. Josie is unsure of what she wants to do with her life and her "mixedup feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it "makes the numbness stop." Given this presentation, which personality disorder would you suspect? a. Obsessive-compulsive b. Borderline c. Antisocial d. Schizotypal
b
Lester and Eileen have always enjoyed gambling. Lately, Eileen has discovered that their savings account is down by $50,000. Eileen insists that Lester undergo therapy for his gambling behavior. The nurse recognizes that Lester is making progress when he states: a. "I understand that I am a bad person for depleting our savings." b. "Gambling activates the reward pathways in my brain." c. "Gambling is the only thing that makes me feel alive." d. "We have always enjoyed gaming. I do not know why Eileen is so upset."
b
Maxwell is a 30-year-old male who arrives at the emergency department stating, "I feel like I am having a stroke." During the intake assessment, the nurse discovers that Maxwell has been working for 36 hours straight without eating and has consumed eight double espresso drinks and 12 caffeinated sodas. The nurse suspects: a. Fluid overload b. Dehydration and caffeine overdose c. Benzodiazepine overdose d. Sleep deprivation syndrome
b
A 26-year-old patient who abuses heroin states to you, "I've been using more heroin lately because I've begun to need more to feel the effect I want." What effect does this statement describe? a. Intoxication b. Tolerance c. Withdrawal d. Addiction
b Tolerance is described as needing increasing greater amounts of a substance to receive the desired result to become intoxicated or finding that using the same amount over time results in a much-diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships.
The nursing diagnosis ineffective denial is especially useful when working with substance use disorders and gambling. Which statements describe this diagnosis? Select all that apply. a. Reports inability to cope b. Does not perceive danger of substance use or gambling c. Minimizes symptoms d. Refuses healthcare attention e. Unable to admit impact of disease on life pattern
b, c, d, e
A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive. What nursing intervention should be implemented to best assure the safety of the client and the milieu? Select all that apply. a. Taking him to the gym on the psychiatric unit b. Obtaining an order for seclusion and close observation c. Assigning a psychiatric technician to "talk him down" d. Administering naltrexone as needed per hospital protocol e. Obtaining a prescription for a benzodiazepine
b, e Aggressive, violent behavior is often seen with PCP ingestion. The client will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off as well as the calming effect of a benzodiazepine. Talking down is never advised because of the client's unpredictable violent potential.
1. Which statement made by the primary caregiver of a patient diagnosed with dementia demonstrates accurate understanding of providing the patient with a safe environment? a. "The local police know that he has wandered off before." b. "I keep the noise level low in the house." c. "We've installed locks on all the outside doors." d. "Our telephone number is always attached to the inside of his shirt pocket."
c
7. Nancy is a nurse. After talking with her mother, she became concerned enough to drive over and check on her. Her mother's appearance is disheveled, words are nonsensical, smells strongly of urine, and there is a stain on her dressing gown. Nancy recognizes that her mother's condition is likely temporary due to: a. Early onset dementia b. A mild cognitive disorder c. A urinary tract infection d. Skipping breakfast
c
9. Garret's wife of 8 years is divorcing him because the marriage never developed a warm or loving atmosphere. Garrett states in therapy, "I have always been a loner," and was never concerned about what others think. The nurse practitioner suggests that Garrett try a trial of bupropion (Wellbutrin) to: a. Improve his flat emotions b. Assist in getting a good night's sleep c. Increase the pleasure of living d. Prepare Garrett for group therapy
c
A teaching need is revealed when a client taking disulfiram (Antabuse) states: a. "I usually treat heartburn with antacids." b. "I take ibuprofen or acetaminophen for headache." c. "Most over-the-counter cough syrups are safe for me to use." d. "I have had to give up using aftershave lotion."
c
Opioid use disorder is characterized by: a. Lack of withdrawal symptoms b. Intoxication symptoms of pupillary dilation, agitation, and insomnia c. Tolerance d. Requiring smaller amounts of the drug to achieve a high over time
c
9. In the 2 months after his wife's death, Aaron, aged 90 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate? a. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him. b. Meet with family and support them to accept, anticipate, and prepare for the progression of his stage 2 dementia. c. Avoid touch and proximity; these are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented. d. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression.
d
A client being prepared for discharge tells the nurse, "Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?" Which response is appropriate teaching regarding naltrexone? a. "It helps your mood so that you don't feel the need to do drugs." b. "It will keep you from experiencing flashbacks." c. "It is a sedative that will help you sleep at night so you are more alert and able to make good decisions." d. "It helps prevent relapse by reducing drug cravings."
d
A client has a 4 year history of using cocaine intranasally. When brought to the hospital in an unconscious state, what nursing measure should be included in the client's plan of care? a. Induction of vomiting b. Administration of ammonium chloride c. Monitoring of opiate withdrawal symptoms d. Observation for tachycardia and seizures
d
A syndrome that occurs after stopping the long-term use of a drug is called a. amnesia. b. tolerance. c. enabling. d. withdrawal.
d
Benzodiazepines are useful for treating alcohol withdrawal because they are associated with which action? a. Blocking cortisol secretion b. Increasing dopamine release c. Decreasing serotonin availability d. Exerting a calming effect
d
Terry is a young male in a chemical dependency program. Recently he has become increasingly distracted and disengaged. The nurse concludes that Terry is: a. Bored b. Depressed c. Bipolar d. Not ready to change
d
The term tolerance, as it relates to substance abuse, refers to which situation? a. The use of a substance beyond acceptable societal norms b. The additive effects achieved by taking two drugs with similar actions c. The signs and symptoms that occur when an addictive substance is withheld d. The need to take larger amounts of a substance to achieve the same effects
d
What action should you take when a female staff member is demonstrating behaviors associated with a substance use disorder? a. Accompany the staff member when she is giving patient care. b. Offer to attend rehabilitation counseling with her. c. Refer her to a peer assistance program. d. Confront her about your concerns and/or report your concerns to a supervisor immediately.
d
