Exam 2
Which characteristic fits the usual profile of an individual diagnosed with pedophilic disorder? a. Homosexual b. Ritualistic behaviors c. Seeks access to children d. Self-confident professional
ANS: C Persons with pedophilic disorder usually place themselves in jobs, activities, or relationships that provide easy access to children. They often become trusted by both parents and children. The other characteristics have no particular relationship to pedophilic disorder.
The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction? a. Renal b. Endocrine c. Integumentary d. Cardiovascular
ANS: D Refeeding resulting in too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused assessment is a necessity to ensure the patient's physiological integrity. The other body systems are not initially involved in the refeeding syndrome.
A parent who is very concerned about a 3-year-old son says, "He likes to play with girls' toys. Do you think he is homosexual or mentally ill?" Which response by the nurse most professionally describes the current understanding of gender identity? a. "A child's interest in the activities of the opposite gender is not unusual or related to sexuality. Most children do not carry cross-gender interests into adulthood." b. "It's difficult to say for sure because the research is incomplete so far, but chances are that he will grow up to be a normal adult." c. "The research is incomplete, but many boys play with girls' toys and turn out normal as adults." d. "I am sure that whatever happens, he will be a loving son, and you will be a proud parent."
a. "A child's interest in the activities of the opposite gender is not unusual or related to sexuality. Most children do not carry cross-gender interests into adulthood."
A patient experiencing primary insomnia asks the nurse, "I take a nap during the day. Doesn't that make up for a lost night's sleep?" Select the nurse's best reply. a. "Circadian drives give daytime naps a structure different from nighttime sleep." b. "The body clock operates on a 24-hour cycle, making nap effectiveness unpredictable." c. "It is a matter of habit and expectation. We expect to be more refreshed from a night's sleep." d. "Sleep restores homeostasis but works more efficiently when aided by melatonin secreted at night."
a. "Circadian drives give daytime naps a structure different from nighttime sleep."
A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and lost 25% of body weight. A nurse asks, "Describe what you think about your present weight and how you look." Which response by the patient is most consistent with the diagnosis? a. "I am fat and ugly." b. "What I think about myself is my business." c. "I'm grossly underweight, but that's what I want." d. "I'm a few pounds' overweight, but I can live with it."
a. "I am fat and ugly."
A man who regularly experiences premature ejaculation tells the nurse, "I feel like such a failure. It's so awful for both me and my partner." What is the nurse's most therapeutic response? a. "I sense you are feeling frustrated and upset." b. "Tell me more about feeling like a failure." c. "You are too hard on yourself." d. "What do you mean by awful?"
a. "I sense you are feeling frustrated and upset."
The nurse provides health education for an adult experiencing sleep deprivation. Which instruction has the highest priority? a. "It's important to limit your driving to short periods. Sleep deprivation increases your risks for serious accidents." b. "Sleep deprivation is usually self-limiting. See your health care provider if it lasts more than a year." c. "Turn the radio on with a soft volume as you prepare for bed each evening. It will help you relax." d. "Three glasses of wine each evening help many patients who suffer from sleep deprivation."
a. "It's important to limit your driving to short periods. Sleep deprivation increases your risks for serious accidents."
A nurse is anxious about assessing the sexual history of a client who is considerably older than the nurse is. Which statement would be most appropriate for obtaining information about the client's sexual practices? a. "Some people are not sexually active, others have a partner, and some have several partners. What has been your pattern?" b. "Sexual health can reflect a number of medical problems, so I'd like to ask if you have any sexual problems you think we should know about." c. "It's your own business, of course, but it might be helpful for us to have some information about your sexual history. Could you tell me about that, please?" d. "I would appreciate it if you could share your sexual history with me so I can share it with your health care provider. It might be helpful in planning your treatment."
a. "Some people are not sexually active, others have a partner, and some have several partners. What has been your pattern?"
One bed is available on the inpatient eating-disorder unit. Which patient should be admitted to this bed? The patient whose weight decreased from a. 150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9 C; pulse, 38 beats/min; blood pressure 60/40 mm Hg b. 120 to 90 pounds over a 3-month period. Vital signs are temperature, 36 C; pulse, 50 beats/min; blood pressure 70/50 mm Hg c. 110 to 70 pounds over a 4-month period. Vital signs are temperature 36.5 C; pulse, 60 beats/min; blood pressure 80/66 mm Hg d. 90 to 78 pounds over a 5-month period. Vital signs are temperature, 36.7 C; pulse, 62 beats/min; blood pressure 74/48 mm Hg
a. 150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9 C; pulse, 38 beats/min; blood pressure 60/40 mm Hg
Which scenario demonstrates a dissociative fugue? a. After being caught in an extramarital affair, a man disappeared but then reappeared months later with no memory of what occurred while he was missing. b. A man is extremely anxious about his problems and sometimes experiences dazed periods of several minutes passing without conscious awareness of them. c. A woman finds unfamiliar clothes in her closet, is recognized when she goes to new restaurants, and complains of "blackouts" despite not drinking. d. A woman reports that when she feels tired or stressed, it seems like her body is not real and is somehow growing smaller.
a. After being caught in an extramarital affair, a man disappeared but then reappeared months later with no memory of what occurred while he was missing.
Which person would be most likely to experience sleep fragmentation? a. An obese adult b. A toddler who attends day care c. A person diagnosed with mild osteoarthritis d. An adolescent diagnosed with anorexia nervosa
a. An obese adult
Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa? a. Assist the patient to identify triggers to binge eating. b. Provide corrective consequences for weight loss. c. Assess for signs of impulsive eating. d. Explore needs for health teaching.
a. Assist the patient to identify triggers to binge eating.
A nurse assesses a client diagnosed with a paraphilic disorder. Which findings are most likely? (Select all that apply.) a. Childhood history of attention deficit hyperactivity disorder (ADHD) b. A poorly managed endocrine disorder c. History of brain injury d. Cognitive distortions e. Grandiosity
a. Childhood history of attention deficit hyperactivity disorder (ADHD) c. History of brain injury d. Cognitive distortions
An adult experienced a myocardial infarction six months ago. At a follow-up visit, this adult says, "I haven't had much interest in sex since my heart attack. I finished my rehabilitation program but having sex strains my heart. I don't know if my heart is strong enough." Which nursing diagnosis applies to this client concern? a. Deficient knowledge related to faulty perception of health status b. Disturbed self-concept related to required lifestyle changes c. Disturbed body image related to treatment side effects d. Sexual dysfunction related to self-esteem disturbance
a. Deficient knowledge related to faulty perception of health status
A night shift worker reports, "I'm having trouble getting to sleep after a night's work. I have a hearty breakfast with coffee, read the paper, do my exercises, and then go to bed. However, I just lie awake until it is nearly time to get up to be with my family for dinner." What changes should the nurse suggest? Select all that apply. a. Drink juice with breakfast rather than coffee. b. Exercise after awakening rather than before. c. Turn on the television when going to bed. d. Do not read the paper. e. Eat a light breakfast.
a. Drink juice with breakfast rather than coffee. b. Exercise after awakening rather than before. e. Eat a light breakfast.
A 10-year-old boy is diagnosed with gender dysphoria. Which assessment finding would the nurse expect? a. Having tea parties with dolls b. A compromised sexual response cycle c. Identifying with boys who are athletic d. Intense urges to watch his parents have sex
a. Having tea parties with dolls
A patient reports, "The medicine prescribed to help me get to sleep worked well for about a month, but I don't have any more of those pills, and now my insomnia is worse than ever. I had nightmares the last 2 nights." Which type of medication did the health care provider most likely prescribe? a. Hypnotic b. Tricyclic antidepressant c. Conventional antipsychotic d. Central nervous system stimulant
a. Hypnotic
A man says, "I enjoy watching women when I am out in public. I like to go to places where I can observe women crossing their legs in hopes of seeing something good." Which statement about this behavior is most accurate? a. It is a sexual disorder. The behavior is socially atypical. It could disrupt relationships and could be insulting to others. b. It is not a sexual disorder. These events occur in public, where those he observes do not have a reasonable expectation of privacy. c. It is not a sexual disorder. Because it occurs in public areas, this behavior does not hurt others or involve intrusion into the personal space of those observed. d. An action is or is not a sexual disorder depending on applicable local laws, so whether this meets the definition of a sexual disorder depends on the location.
a. It is a sexual disorder. The behavior is socially atypical. It could disrupt relationships and could be insulting to others.
A patient referred to the eating disorders clinic has lost 35 pounds in 3 months. For which physical manifestations of anorexia nervosa should a nurse assess? (Select all that apply.) a. Peripheral edema b. Parotid swelling c. Constipation d. Hypotension e. Dental caries f. Lanugo
a. Peripheral edema b. Parotid swelling c. Constipation d. Hypotension f. Lanugo
A soldier in a combat zone tells the nurse, "I saw a child get blown up over a year ago, and I still keep seeing bits of flesh everywhere. I see something red, and the visions race back to my mind." Which phenomenon associated with posttraumatic stress disorder (PTSD) is the soldier describing? a. Reexperiencing b. Hyperarousal c. Avoidance d. Psychosis
a. Reexperiencing
A wife received news that her husband died of heart failure and called her family to come to the hospital. She angrily tells the nurse who cared for him, "He would still be alive if you had given him your undivided attention." Select the nurse's best intervention. a. Say to the wife, "I understand you are feeling upset. I will stay with you until your family comes." b. Say to the wife, "Your husband's heart was so severely damaged that it could no longer pump." c. Say to the wife, "I will call the health care provider to discuss this matter with you." d. Hold the wife's hand in silence until the family arrives.
a. Say to the wife, "I understand you are feeling upset. I will stay with you until your family comes."
A nurse is performing an assessment for a 59-year-old man with a long history of hypertension. What is the rationale for including questions about prescribed medications and their effects on sexual function in the assessment? a. Sexual dysfunction may result from use of prescription medications for management of hypertension. b. Such questions are an indirect way of learning about the client's medication adherence. c. These questions ease the transition to questions about sexual practices in general. d. Sexual dysfunction can cause stress and contribute to increased blood pressure.
a. Sexual dysfunction may result from use of prescription medications for management of hypertension.
Which season would be most associated with increased periods of wakefulness in the general population? a. Summer b. Winter c. Spring d. Fall
a. Summer
A 7-year-old child was diagnosed with pica. Which assessment finding would the nurse expect associated with this diagnosis? a. The child frequently eats newspapers and magazines. b. The child refuses to eat peanut butter and jelly sandwiches. c. The child often rechews and reswallows foods at mealtimes. d. The parents feed the child clay because of concerns about anemia.
a. The child frequently eats newspapers and magazines.
Normally, most people sleep at night. What is the physiological rationale? a. The master biological clock responds to darkness with sleep. b. Darkness stimulates histamine release, which promotes sleep. c. Cooler environmental temperatures stimulate retinal messages. d. Stimulation of the sympathetic nervous system promotes sleep.
a. The master biological clock responds to darkness with sleep.
A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed? a. The nurse interacts with the patient in a protective fashion. b. The nurse's comments to the patient are compassionate and nonjudgmental. c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. d. The nurse refers the patient to a self-help group for individuals with eating disorders.
a. The nurse interacts with the patient in a protective fashion.
The treatment team discusses adding a new prescription for lisdexamfetamine dimesylate to the plan of care for a patient diagnosed with binge eating disorder. Which finding from the nursing assessment is most important for the nurse to share with the team? a. The patient's history of poly-substance abuse b. The patient's preference for homeopathic remedies c. The patient's family history of autoimmune disorders d. The patient's comorbid diagnosis of a learning disability
a. The patient's history of poly-substance abuse
An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should a. assess lung sounds and extremities. b. suggest use of an aerobic exercise program. c. positively reinforce the patient for the weight gain. d. establish a higher goal for weight gain the next week.
a. assess lung sounds and extremities.
An adult seeks treatment for urges involving sexual contact with children. The adult has not acted on these urges but feels shame. Which finding concerning the adult's actions best indicates that this adult is making progress in treatment? a. consistently avoids schools and shops at malls only during school hours. b. indicates sexual drive and enjoyment from sex have decreased. c. reports an active and satisfying sex life with an adult partner. d. volunteers to become a scout troop leader.
a. consistently avoids schools and shops at malls only during school hours.
Physical assessment of a patient diagnosed with bulimia often reveals a. prominent parotid glands. b. peripheral edema. c. thin, brittle hair. d. 25% underweight.
a. prominent parotid glands.
The nurse who is counseling a patient with dissociative identity disorder should understand that the assessment of highest priority is: a. risk for self-harm. b. cognitive function. c. memory impairment. d. condition of self-esteem.
a. risk for self-harm.
A client approaches the nurse in the clinic waiting room and says, "I want to talk to you about a sexual matter." How can the nurse best facilitate the discussion? a. saying, "Let's go my office." b. responding, "I want to help. Go ahead; I'm listening." c. telling the client, "Let's schedule another appointment." d. offering to sit in a corner of the waiting room with the client.
a. saying, "Let's go my office."
A patient says, "I have trouble falling asleep at night and might lie awake until 3 or 4 AM before falling sleep." Which medication would the nurse expect a health care provider to prescribe for this patient? a. zolpidem (Ambien) b. flurazepam (Dalmane) c. risperidone (Risperdal) d. methylphenidate (Ritalin)
a. zolpidem (Ambien)
A new staff nurse tells the clinical nurse specialist, "I am unsure about my role when clients bring up sexual problems." The clinical nurse specialist should give clarification by making what statement? a. "All nurses qualify as sexual counselors. Nurses have knowledge about the biopsychosocial aspects of sexuality throughout the life cycle." b. "All nurses should be able to screen for sexual dysfunction and give basic information about sexual feelings, behaviors, and myths." c. "All nurses should defer questions about sex to other health care professionals because of their limited knowledge of sexuality." d. "All nurses who are interested in sexual dysfunction can provide sex therapy for individuals and couples."
b. "All nurses should be able to screen for sexual dysfunction and give basic information about sexual feelings, behaviors, and myths."
After the sudden death of his wife, a man says, "I can't live without her...she was my whole life." Select the nurse's most therapeutic reply. a. "Each day will get a little better." b. "Her death is a terrible loss for you." c. "It's important to recognize that she is no longer suffering." d. "Your friends will help you cope with this change in your life."
b. "Her death is a terrible loss for you."
A nurse who works night shift says, "I am exhausted most of the time. I sleep through my alarm. Sometimes my brain does not seem to work right. I am worried that I might make a practice error." Which question should the nursing supervisor ask first? a. "What stress are you experiencing in your life?" b. "How much sleep do you get in a 24-hour period?" c. "Would it help if you do some exercises just before going to bed?" d. "Have you considered using a hypnotic medication to help you sleep?"
b. "How much sleep do you get in a 24-hour period?"
A man who reports frequently experiencing premature ejaculation tells the nurse, "I feel like such a failure. It's so awful for both me and my partner. Can you help me?" Select the nurse's best response. a. "Have you discussed this problem with your partner?" b. "I can refer you to a practitioner who can help you with this problem." c. "Have you asked your health care provider for prescription medication?" d. "There are several techniques described in this pamphlet that might be helpful."
b. "I can refer you to a practitioner who can help you with this problem."
Which comment is most likely from a patient with chronic sleep deprivation? a. "I turn on the television every night to get to sleep. I set the timer so it goes off in 30 minutes." b. "I have diarrhea frequently and not much energy, so I stay at home most of the time." c. "I only sleep about 7 hours a night, but I know I should sleep 8 or 9 hours." d. "When my alarm clock goes off every morning, it seems like I am dreaming."
b. "I have diarrhea frequently and not much energy, so I stay at home most of the time."
A home care nurse assesses a very demanding patient with chronic obstructive pulmonary disease (COPD). Afterward, the nurse talks with the spouse who has provided this patient's care for 6 years. The spouse says, "I don't need much sleep anymore. I might need to help him during the night." Select the nurse's most therapeutic response. a. "It sounds like you are very devoted to your spouse." b. "I noticed you fell asleep while I was assessing your spouse. I'm concerned about you." c. "Your spouse is lucky to have you to provide care rather than being placed in a nursing home." d. "If you keep going like this, your health will be impaired also. Then who will take care of both of you?"
b. "I noticed you fell asleep while I was assessing your spouse. I'm concerned about you."
Two weeks ago, a soldier returned to the U.S. from active duty in a combat zone in Afghanistan. The soldier was diagnosed with posttraumatic stress disorder (PTSD). Which comment by the soldier requires the nurse's immediate attention? a. "It's good to be home. I missed my home, family, and friends." b. "I saw my best friend get killed by a roadside bomb. I don't understand why it wasn't me." c. "Sometimes I think I hear bombs exploding, but it's just the noise of traffic in my hometown." d. "I want to continue my education, but I'm not sure how I will fit in with other college students."
b. "I saw my best friend get killed by a roadside bomb. I don't understand why it wasn't me."
The unlicensed assistive personnel (UAP) says to the nurse, "That patient with amnesia looks fine, but when I talk to her, she seems vague. What should I be doing for her?" Select the nurse's best reply. a. "Spend as much time with her as you can and ask questions about her life." b. "Use short, simple sentences and keep the environment calm and protective." c. "Provide more information about her past to reduce the mysteries that are causing anxiety." d. "Structure her time with activities to keep her busy, stimulated, and regaining concentration."
b. "Use short, simple sentences and keep the environment calm and protective."
A nurse counsels a patient on ways to determine the person's total sleep requirement. Which instruction would produce the most accurate results? a. "For 1 full week, record what you remember about your dream content and related feelings as soon as you wake up. Bring the record to your next appointment." b. "While off work for 1 week, go to bed at your usual time and wake up without an alarm. Record how many hours you sleep and then average the findings." c. "For 2 full weeks, record how much time you sleep each night and rate your daytime alertness on a scale of 1 to 10. Calculate your average alertness score." d. "All adults need 7 or 8 hours of sleep to function properly. Let's design ways to help you reach that goal."
b. "While off work for 1 week, go to bed at your usual time and wake up without an alarm. Record how many hours you sleep and then average the findings."
A respected school coach was arrested after a student reported the coach attempted to have sexual contact. Which nursing action has priority in the period immediately following the coach's arrest? a. Determine the nature and extent of the coach's sexual disorder. b. Assess the coach's potential for suicide or other self-harm. c. Assess the coach's self-perception of problem and needs. d. Determine whether other children were harmed.
b. Assess the coach's potential for suicide or other self-harm.
A nurse cares for these four patients. Which patient has the highest risk for problems with sleep physiology? a. Retiree who volunteers twice a week at Habitat for Humanity b. Corporate accountant who travels frequently c. Parent with three teenagers d. Lawn care worker
b. Corporate accountant who travels frequently
A person says, "I often feel like I have been dreaming just before I awake in the morning." Which rationale correctly explains the comment? a. Sleep architecture changes during the sleep period, resulting in increased slow-wave sleep at the end of the cycle. b. Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods. c. Dreams occur more frequently when a person is experiencing unresolved conflicts or depression. d. Dream content relates directly to developmental tasks. The person is likely feeling autonomous.
b. Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods.
A patient needs diagnostic evaluation of sleep problems. Which test will evaluate the patient for possible sleep-related problems? a. Skull x-rays b. Electroencephalogram (EEG) c. Positron emission tomography (PET) d. Single-photon emission computed tomography (SPECT)
b. Electroencephalogram (EEG)
A patient diagnosed with depersonalization disorder tells the nurse, "It's starting again. I feel as though I'm going to float away." Which intervention would be most appropriate at this point? a. Notify the health care provider of this change in the patient's behavior. b. Engage the patient in a physical activity such as exercise. c. Isolate the patient until the sensation has diminished. d. Administer a PRN dose of anti-anxiety medication.
b. Engage the patient in a physical activity such as exercise.
A nurse works with a patient diagnosed with posttraumatic stress disorder who has frequent flashbacks as well as persistent symptoms of arousal. Which intervention should be included in the plan of care? a. Trigger flashbacks intentionally in order to help the patient learn to cope with them. b. Explain that the physical symptoms are related to the psychological state. c. Encourage repression of memories associated with the traumatic event. d. Support "numbing" as a temporary way to manage intolerable feelings.
b. Explain that the physical symptoms are related to the psychological state.
A woman consults the nurse practitioner because she has not achieved orgasm for 2 years, despite having been sexually active. This is an example of what sexual disorder? a. Paraphilic disorder. b. Female orgasmic disorder. c. Genito-pelvic pain/penetration disorder. d. Female sexual interest/arousal disorder.
b. Female orgasmic disorder.
A woman tells the nurse, "My partner is frustrated with me. I don't have any natural lubrication when we have sex." What type of sexual disorder is evident? a. Genito-pelvic pain/penetration disorder b. Female sexual interest/arousal disorder c. Hypoactive sexual desire disorder d. Female orgasmic disorder
b. Female sexual interest/arousal disorder
A soldier returned home from active duty in a combat zone in Afghanistan and was diagnosed with posttraumatic stress disorder (PTSD). The soldier says, "If there's a loud noise at night, I get under my bed because I think we're getting bombed." What type of experience has the soldier described? a. Illusion b. Flashback c. Nightmare d. Auditory hallucination
b. Flashback
The gas pedal on a person's car stuck on a busy interstate highway, causing the car to accelerate rapidly. For 20 minutes, the car was very difficult to control. Afterward, this person's cortisol regulation was compromised. Which assessment finding would the nurse expect associated with the dysregulation of cortisol? a. Weight gain b. Flashbacks c. Headache d. Diuresis
b. Flashbacks
A patient reports, "Nearly every night I awaken feeling frightened after a bad dream. The dream usually involves being hunted by people trying to hurt me. It usually happens between 4 and 5 AM." The nurse assesses this disorder as most consistent with criteria for which problem? a. Sleep deprivation b. Nightmare disorder c. Night terror disorder d. REM sleep behavior disorder
b. Nightmare disorder
Which neurotransmitters are most responsible for wakefulness? Select all that apply. a. Gamma-aminobutyric acid (GABA) b. Norepinephrine c. Acetylcholine d. Dopamine e. Galanin
b. Norepinephrine c. Acetylcholine d. Dopamine
Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to gain weight? a. Assess for depression and anxiety. b. Observe for adverse effects of refeeding. c. Communicate empathy for the patient's feelings. d. Help the patient balance energy expenditures with caloric intake.
b. Observe for adverse effects of refeeding.
A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain? a. Because severe anxiety concerning eating is expected, objective and subjective data may be unreliable. b. Patient involvement in decision making increases sense of control and promotes adherence to the plan of care. c. Because of increased risk of physical problems with refeeding, the patient's permission is needed. d. A team approach to planning the diet ensures that physical and emotional needs will be met.
b. Patient involvement in decision making increases sense of control and promotes adherence to the plan of care.
Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa? a. Carefree flexibility b. Rigidity, perfectionism c. Open displays of emotion d. High spirits and optimism
b. Rigidity, perfectionism
An adult consulted a nurse practitioner because of an inability to achieve orgasm for 2 years, despite having been sexually active. This adult was frustrated and expressed concerns about the relationship with the sexual partner. Which nursing diagnosis is most appropriate for this scenario? a. Defensive coping b. Sexual dysfunction c. Ineffective sexuality pattern d. Disturbed sensory perception, tactile
b. Sexual dysfunction
A person is prescribed lorazepam (Ativan) 2 mg po bid prn for anxiety. When the person takes this medication, which change in sleep is anticipated? The patient will: a. have fewer dreams. b. have less slow-wave sleep. c. experience extended sleep latency. d. enter sleep through rapid eye movement (REM) sleep.
b. have less slow-wave sleep.
An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient a. to eat a small meal after purging. b. not to skip meals or restrict food. c. to increase oral intake after 4 PM daily. d. the value of reading journal entries aloud to others.
b. not to skip meals or restrict food.
A new patient at the sleep disorders clinic tells the nurse, "I have not slept well in a year, so I never feel good. I do not expect things will ever improve or be any different." Interventions the nurse should consider include: (select all that apply) a. suggesting use of alcohol as a sedative. b. providing instruction in relaxation techniques. c. counseling the patient to address cognitive distortions. d. health teaching regarding factors that influence sleep. e. teaching fatigue-producing activities to become overtired. f. encouraging long daytime naps to compensate for sleep deprivation.
b. providing instruction in relaxation techniques. c. counseling the patient to address cognitive distortions. d. health teaching regarding factors that influence sleep.
An adult consulted a nurse practitioner because of an inability to achieve orgasm for 2 years, despite having been sexually active. This adult was frustrated and expressed concerns about the relationship with the sexual partner. Which documentation best indicates the treatment was successful? a. "No complaints related to sexual function; to return next week." b. "Client reports achieving orgasm last week; seems very happy." c. "Reports satisfaction with sexual encounters; feels partner is supportive." d. "Reports achieving orgasm occasionally; relationship with partner is adequate."
c. "Reports satisfaction with sexual encounters; feels partner is supportive."
A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient: a. "Do you often feel fat?" b. "Who plans the family meals?" c. "What do you eat in a typical day?" d. "What do you think about your present weight?"
c. "What do you eat in a typical day?"
A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? (Select all that apply.) a. Flexible mealtimes b. Unscheduled weight checks c. Adherence to a selected menu d. Observation during and after meals e. Monitoring during bathroom trips f. Privileges correlated with emotional expression
c. Adherence to a selected menu d. Observation during and after meals e. Monitoring during bathroom trips
A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, "If you had given him your undivided attention, he would still be alive." How should the nurse analyze this behavior? a. The comment suggests potential allegations of malpractice. b. In some cultures, grief is expressed solely through anger. c. Anger is an expected emotion in an adjustment disorder. d. The patient had ambivalent feelings about her husband.
c. Anger is an expected emotion in an adjustment disorder.
Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely? a. Binge eating b. Bulimia nervosa c. Anorexia nervosa d. Eating disorder not otherwise specified
c. Anorexia nervosa
A patient states, "I feel detached and weird all the time. It is as though I am looking at life through a cloudy window. Everything seems unreal. It really messes up things at work and school." This scenario is most suggestive of which health problem? a. Acute stress disorder b. Dissociative amnesia c. Depersonalization disorder d. Disinhibited social engagement disorder
c. Depersonalization disorder
As a patient admitted to the eating-disorder unit undresses, a nurse observes that the patient's body is covered by fine, downy hair. The patient weighs 70 pounds and is 5'4" tall. Which term should be documented? a. Amenorrhea b. Alopecia c. Lanugo d. Stupor
c. Lanugo
A person runs from a crowded nightclub after a pyrotechnics show causes the building to catch fire. Which division of the autonomic nervous system will be stimulated in response to this experience? a. Limbic system b. Peripheral nervous system c. Sympathetic nervous system d. Parasympathetic nervous system
c. Sympathetic nervous system
A client's medical record documents sexual masochism. This client derives sexual pleasure from what source? a. from inanimate objects. b. by inflicting pain on a partner. c. being sexually humiliated by a partner. d. touching a nonconsenting person.
c. being sexually humiliated by a partner.
A soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with posttraumatic stress disorder (PTSD). The nurse's highest priority is to screen this soldier for: a. bipolar disorder. b. schizophrenia. c. depression. d. dementia.
c. depression.
A nurse provides health education for an adult with sleep deprivation. It is most important for the nurse to encourage caution when the patient engages in: a. using a vacuum cleaner. b. cooking a meal. c. driving a car. d. bathing.
c. driving a car.
A nurse provides health teaching for a patient diagnosed with bulimia nervosa. Priority information the nurse should provide relates to a. self-monitoring of daily food and fluid intake. b. establishing the desired daily weight gain. c. how to recognize hypokalemia. d. self-esteem maintenance.
c. how to recognize hypokalemia.
A nurse conducting group therapy on the eating-disorder unit schedules the sessions immediately after meals for the primary purpose of a. maintaining patients' concentration and attention. b. shifting the patients' focus from food to psychotherapy. c. promoting processing of anxiety associated with eating. d. focusing on weight control mechanisms and food preparation.
c. promoting processing of anxiety associated with eating.
A patient says, "It takes me about 15 minutes to go to sleep each night." This comment describes: a. delta sleep. b. parasomnia. c. sleep latency. d. rapid eye movement sleep.
c. sleep latency.
A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Which response by the nurse is appropriate? a. "You and I will have to sit down and discuss this problem." b. "It bothers me to see you exercising. I am afraid you will lose more weight." c. "Let's discuss the relationship between exercise, weight loss, and the effects on your body." d. "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."
d. "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."
A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy? a. "What are your feelings about not eating foods that you prepare?" b. "You seem to feel much better about yourself when you eat something." c. "It must be difficult to talk about private matters to someone you just met." d. "Being thin doesn't seem to solve your problems. You are thin now but still unhappy."
d. "Being thin doesn't seem to solve your problems. You are thin now but still unhappy."
A patient with rheumatoid arthritis reports, "For the past month I've been having a lot of trouble falling asleep. When I finally get to sleep, I wake up several times during the night." Which information should the nurse seek initially? a. "What have you done to try to improve your sleep?" b. "What would be a good sleep pattern for you?" c. "How much exercise are you getting?" d. "Do you have pain at night?"
d. "Do you have pain at night?"
A young adult says to the nurse, "I go to sleep without any problem, but I often wake up during the night because it feels like there are rubber bands in my legs." Which assessment question should the nurse ask to assess for restless legs syndrome (RLS)? a. "What type of birth control do you use?" b. "How much caffeine do you use every day?" c. "How much exercise do you get in a typical day?" d. "Does anyone else in your family have this problem?"
d. "Does anyone else in your family have this problem?"
A patient tells the nurse, "Everyone says we should sleep 8 hours a night. I can only sleep 6 hours, no matter how hard I try. Am I doing harm to my body?" Select the nurse's best response. a. "Tell me about strategies you have tried to increase your total sleep hours." b. "Lack of sleep acts as a stressor on the body and can cause physical changes." c. "If you have really tried to sleep more, maybe you should consult your health care provider." d. "If you function well with 6 hours of sleep, you are a short sleeper. That's normal for some people."
d. "If you function well with 6 hours of sleep, you are a short sleeper. That's normal for some people."
A store clerk was killed during a robbery 2 weeks ago. His widow, who has a long history of schizoaffective disorder, cries spontaneously when talking about his death. Select the nurse's most therapeutic response. a. "Are you taking your medications the way they are prescribed?" b. "This loss is harder to accept because of your mental illness. Do you think you should be hospitalized?" c. "I'm worried about how much you are crying. Your grief over your husband's death has gone on too long." d. "The unexpected death of your husband is very painful. I'm glad you are able to talk about your feelings."
d. "The unexpected death of your husband is very painful. I'm glad you are able to talk about your feelings."
Which statement about paraphilic disorders is accurate? a. Paraphilic behavior is controllable by willpower, but most persons with these disorders fail to do so. b. Persons with paraphilic disorders rarely experience shame and are not distressed by their acts. c. Persons with paraphilic disorders prey primarily on female children between the ages of 12 and 15 years. d. Acts of paraphilia are common because persons with the disorders commit the acts repeatedly, but paraphilic disorders are uncommon.
d. Acts of paraphilia are common because persons with the disorders commit the acts repeatedly, but paraphilic disorders are uncommon.
Which nursing action should occur first regarding a client who has a problem of sexual dysfunction or sexual disorder? a. Developing an understanding of human sexual response. b. Assessing the client's sexual functioning and needs. c. Acquiring knowledge of the client's sexual roles. d. Clarifying own personal values about sexuality.
d. Clarifying own personal values about sexuality.
A soldier returned 3 months ago from Afghanistan and was diagnosed with posttraumatic stress disorder (PTSD). Which social event would be most disturbing for this soldier? a. Halloween festival with neighborhood children b. Singing carols around a Christmas tree c. A family outing to the seashore d. Fireworks display on July 4th
d. Fireworks display on July 4th
A man with hypospadias tells the nurse, "Intercourse with my new bride is painful." Which term applies to the client's report? a. Delayed ejaculation b. Erectile dysfunction c. Premature ejaculation d. Genito-pelvic pain/penetration disorder
d. Genito-pelvic pain/penetration disorder
While performing an assessment, the nurse says to a client, "While growing up, most of us heard some half-truths about sexual matters that continue to puzzle us as adults. Do any come to your mind now?" The purpose of this question is to achieve what? a. Identify areas of sexual dysfunction for treatment. b. Determine possible homosexual urges. c. Introduce the topic of masturbation. d. Identify sexual misinformation.
d. Identify sexual misinformation.
Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges? a. Powerlessness b. Ineffective coping c. Disturbed body image d. Imbalanced nutrition: less than body requirements
d. Imbalanced nutrition: less than body requirements
A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies? a. Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss b. Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia c. Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia d. Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia
d. Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia
A patient being admitted to the eating-disorder unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 70 pounds; height is 5'4". The patient says, "I won't eat until I look thin." Select the priority initial nursing diagnosis. a. Anxiety related to fear of weight gain b. Disturbed body image related to weight loss c. Ineffective coping related to lack of conflict resolution skills d. Imbalanced nutrition: less than body requirements related to self-starvation
d. Imbalanced nutrition: less than body requirements related to self-starvation
Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor? a. Weight, muscle, and fat congruence with height, frame, age, and sex b. Calorie intake is within required parameters of treatment plan c. Weight reaches established normal range for the patient d. Patient expresses satisfaction with body appearance
d. Patient expresses satisfaction with body appearance
A 76-year-old man tells the nurse at the sleep disorder clinic, "I awaken almost nightly in the midst of violent dreams in which I am defending myself against multiple attackers. Then I realize I have been hitting and kicking my wife. She has bruises." Which health problem is most likely? a. Sleep Paralysis b. Night Terror Disorder c. Sleep-Related Bruxism d. Rapid Eye Movement (REM) Sleep Behavior Disorder
d. Rapid Eye Movement (REM) Sleep Behavior Disorder
A soldier served in combat zones in Iraq during 2010 and was deployed to Afghanistan in 2013. When is it most important for the nurse to screen for signs and symptoms of posttraumatic stress disorder (PTSD)? a. Immediately upon return to the U.S. from Afghanistan b. Before departing Afghanistan to return to the U.S. c. One year after returning from Afghanistan d. Screening should be on-going
d. Screening should be on-going
Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization? a. Urine output 40 mL/hour b. Pulse rate 58 beats/min c. Serum potassium 3.4 mEq/L d. Systolic blood pressure 62 mm Hg
d. Systolic blood pressure 62 mm Hg
Four teenagers died in an automobile accident. One week later, which behavior by the parents of these teenagers most clearly demonstrates resilience? The parents who: a. visit their teenager's grave daily. b. return immediately to employment. c. discuss the accident within the family only. d. create a scholarship fund at their child's high school.
d. create a scholarship fund at their child's high school.
A client tells the nurse that his sexual functioning is normal when his wife wears short, red camisole-style nightgowns. He states, "Without the red teddies, I am not interested in sex." The nurse can assess this as consistent with what sexual disorder? a. exhibitionism. b. voyeurism. c. frotteurism. d. fetishism.
d. fetishism.
Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired outcome related to the nursing diagnosis Imbalanced nutrition: less than body requirements. Within 1 week, the patient will a. weigh self accurately using balanced scales. b. limit exercise to less than 2 hours daily. c. select clothing that fits properly. d. gain 1 to 2 pounds.
d. gain 1 to 2 pounds.
A nursing diagnosis for a patient diagnosed with bulimia nervosa is Ineffective coping related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is that within 2 weeks the patient will a. appropriately express angry feelings. b. verbalize two positive things about self. c. verbalize the importance of eating a balanced diet. d. identify two alternative methods of coping with loneliness.
d. identify two alternative methods of coping with loneliness.
person is prescribed sertraline (Zoloft) 100 mg PO daily. Which change in sleep is likely secondary to this medication? The patient will have: a. more dreams. b. excessive sleepiness. c. less slow-wave sleep. d. less rapid eye movement (REM) sleep.
d. less rapid eye movement (REM) sleep.
A child drowned while swimming in a local lake 2 years ago. Which behavior indicates the child's parents have adapted to their loss? The parents: a. visit their child's grave daily. b. maintain their child's room as the child left it 2 years ago. c. keep a place set for the dead child at the family dinner table. d. throw flowers on the lake at each anniversary date of the accident.
d. throw flowers on the lake at each anniversary date of the accident.
The male manager of a health club placed a hidden video camera in the women's locker room and recorded several women as they showered and dressed. What is the disorder most likely represented by this behavior? a. homosexuality. b. exhibitionism. c. pedophilia. d. voyeurism.
d. voyeurism.
