Exam 2 review

1. A nurse is preparing to provide an educational seminar on stress to other nursing staff. Which of the following information should the nurse includes in the discussion? A. Excessive stressors cause the client to experience distress. B. The body's initial adaptive response to stress is denial. C. Absence of stressors results in homeostasis. D. Negative, rather than positive, stressors produce a biological response.

A

4. A nurse is caring for a client who has a new prescription for disulfiram (Antabuse) for the treatment of his alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting if he drinks alcohol. This form of treatment is an example of which of the following? a. Aversion therapy b. Flooding c. Biofeedback d. Dialectical behavior therapy

A

A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior? A. They are experiencing problems with termination, leading to feelings of abandonment. B. They did not think any new material would be covered at the last session. C. They were angry with the leader for not extending the length of the group. D. They were bored with the material covered in the group.

A

A middle-aged woman's father has passed away, and her mother requires physical and emotional help due to disabilities. The woman is married and raising two children, along with working full time. All of the factors described are a) Stressors b) Demands c) Illnesses d) Stimuli

A

A nurse is teaching a client about stress reduction techniques. Which of the following client statements indicates understanding of the teaching? A. "Cognitive reframing will help me change my irrational thoughts to something positive." B. "Progressive muscle relaxation uses a mechanical device to help me gain control over my pulse rate." C. "Biofeedback causes my body to release endorphins so that I feel less stress and anxiety." D. "Mindfulness allows me to prioritize the stressors that I have in my life so that I have less anxiety."

A

A nurse is trying to assess a client's stress type; however, the client is very depressed and quiet and does not reply to the nurse's questions. The nurse is unable to maintain her calm while repeating the questions. Where is the nurse going wrong in assessing the client? a) The nurse should demonstrate confidence and expertise. b) The nurse should take help from the senior physician. c) The nurse should not assess the client's stress type. d) The nurse should calm him first by giving him a sedative.

A

During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? A. Democratic B. Autocratic C. Laissez-faire D. Bureaucratic

A

During a group discussion, members freely interact with each other. Which member statement is an example of Yalom's curative group factor of imparting information? A. "I found a Web site explaining the different types of brain tumors and their treatment." B. "My brother also had a brain tumor and now is completely cured." C. "I understand your fear and will be by your side during this time." D. "My mother was also diagnosed with cancer of the brain."

A

During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style? A. Autocratic B. Democratic C. Laissez-faire D. Bureaucratic

A

During an inpatient educational group, a client shouts out, "This information is worthless. Nothing you have said can help me." These statements indicate to the nurse leader that the client is assuming which group role? A. The group role of aggressor B. The group role of initiator C. The group role of gatekeeper D. The group role of blocker

A

Which of the following nurses is most likely to experience the greatest amount of stress related to his or her position as a nurse? a) A graduate nurse working on a telemetry unit b) A nurse with 1 year of experience working on an oncology unit c) A nurse who is an editor of a nursing journal d) A nurse with 10 years of experience working as a nurse educator

A

A nurse is working in a community mental health facility. Which of the following services are appropriate for clients to receive? (Select all that apply.) A. Educational groups B. Medication dispensing programs C. Individual counseling programs D. Detoxification programs E. Crisis intervention

A B C

3. A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following are appropriate to include in the plan of care? (Select all that apply.) a. Priority restructuring b. Monitoring thoughts c. Diaphragmatic breathing d. Journal keeping e. Meditation

A,b,d

Which of the following observed client behaviors would lead a nurse to evaluate a member as assuming a maintenance group role? (Select all that apply.) A. A client decreases conflict within the group by encouraging compromise. B. A client offers recognition and acceptance of others. C. A client outlines the task at hand and proposes solutions. D. A client listens attentively to group interaction. E. A client uses the group to gain sympathy from others.

A,b,d,

A nurse is planning care for a client receiving surgical implantation of VNS device. Monitor for which adverse effects? a. voice changes b. seizure activity c. disorientation d. dysphagia e. neck pain

A,d,e

1. A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy? a. "Even if my anxiety improves, I will need to continue this therapy for 6 weeks." b. "The therapist will focus on my past relationships during our sessions." c. "Psychoanalysis will help me reduce my anxiety by changing my behaviors." d. "This therapy will address my conscious feelings about stressful experiences."

B

4. A nurse is caring for a group of clients. Which of the following clients should a nurse consider for referral to an assertive community treatment (ACT) group? A. A client in an acute care mental health facility who has fallen several times while running down a hallway. B. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia. C. A client in a day treatment program who says he is becoming more anxious during group therapy. D. A client in a weekly grief support group who says she still misses her deceased husband who has been dead for 3 months.

B

A charge nurse is discussing TMS with a new nurse. Which of the following indicates a need for further teaching? a. TMS is indicated for clients whose depression is not relieved by medication b. I will provide post anesthesia care following TMS c. TMS is usually performed as an outpatient procedure d. I will schedule the client for daily TMS treatments for the first several weeks

B

A client expresses to the nurse that she constantly feels irritated and loses her temper. During the course of the interview, the nurse finds that the client takes care of her mother who was confined to bed following a stroke. The client struggles to balance caring for her family and her mother. Which nursing diagnosis would the nurse most likely identify for this client? a) Compromised family adjustment b) Caregiver role strain c) Ineffective coping d) Anxiety

B

A client says she is experiencing increased stress because her significant other is "pressuring me and my kids to go live with him. I love him, but I'm not ready to do that." Which of the following recommendations should the nurse make to promote a change in the client's situation? A. Learn to practice mindfulness. B. Use assertiveness techniques. C. Exercise regularly. D. Rely on the support of a close friend.

B

A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, "I relapsed three times, but now have been sober for 15 years." Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Catharsis D. Universality

B

A nurse is caring for a client who is an investment banker. The client is stressed because of the sudden fall of share prices in the stock exchange. Which of the following stress-reduction techniques should the nurse use with this client? a) Discourage family from interacting with the client. b) Advocate on behalf of the client to others. c) Avoid referring the client to other organizations. d) Avoid discussing the client's condition with client's family.

B

An adolescent entering high school voices anxiety over changing schools. Stating anxiety is an act of a) Valuation b) Adaptation c) Evaluation d) Reaction

B

During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? A. "It's hard for me to tell my story when I'm not sure about the reactions of others." B. "I think Joe's Antabuse suggestion is a good one and might work for me." C. "My situation is very complex, and I need professional, not peer, advice." D. "I am really upset that you expect me to solve my own problems."

B

During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify? A. The task role of gatekeeper B. The individual role of recognition seeker C. The maintenance role of dominator D. The task role of elaborator

B

The nurse is caring for a client who is a doctor in a general hospital. He complains about the stressful condition of his job. Lately, he has become increasingly susceptible to colds, headaches, muscular tension, excessive tiredness, and many other symptoms. At what stage of stress is the client? a) Secondary stage b) Exhaustion stage c) Alarm stage d) Resistance stage

B

The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security? A. Socialization B. Support C. Empowerment D. Governance

B

Upon arrival to the emergency room, the mother of a patient involved in a motor vehicle accident becomes upset when she learns her son is unconscious and unstable. The mother begins to yell at the emergency room staff in unintelligible words, and she is trembling. She becomes short of breath and yells she can't breathe. What is the mother likely experiencing? a) Severe anxiety b) A panic attack c) Mild anxiety d) Moderate anxiety

B

When discussing his problem, a client tells the nurse that he is always doing small, petty jobs for everyone and he is not happy about it. Because of this, he is feeling stressed and has been getting into fights with his wife. What should the nurse suggest to help the client overcome this problem? a) Avoid doing petty jobs. b) Take control of the situation. c) Change jobs. d) Avoid people who dump tasks on him.

B

Which situation should a nurse identify as an example of an autocratic leadership style? A. The president of Sigma Theta Tau assigns members to committees to research problems. B. Without faculty input, the dean mandates that all course content be delivered via the Internet. C. During a community meeting, a nurse listens as clients generate solutions. D. The student nurses' association advertises for candidates for president.

B

Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? (Select all that apply.) A. Encouraging members to provide feedback to each other about individual progress B. Ensuring that group rules do not interfere with goal fulfillment C. Working with group members to establish rules that will govern the group D. Emphasizing the need for and importance of confidentiality within the group E. Helping the members to resolve conflicts and foster cohesiveness within the group

B,c,d

2. A nurse is discussing acute vs. prolonged stress with a client. Which of the following effects should the nurse identify as an acute stress response? (Select all that apply.) A. Chronic pain B. Depressed immune system C. Increased blood pressure D. Panic attacks E. Unhappiness

B,c,e

2. A nurse is caring for several clients who are attending community-based mental health programs. Which of the following clients should the nurse plan to visit first? A. A client who recently burned her arm while using a hot iron at home. B. A client who requests that her antipsychotic medication be changed due to some new side effects. C. A client who says he is hearing a voice that tells him he is not worthy of living anymore. D. A client who tells the nurse he experienced symptoms of severe anxiety before and during a job interview.

C

3. A nurse is working on promotion of healthy coping skills with older adult clients who had all previously been hospitalized for severe depression and are now in a residential care facility. The nurse should recognize that this an example of which of the following? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Mental status examination

C

5. A nurse in an acute mental health facility is caring for a client who has a severe mental illness and soon will be ready for discharge but still requires supervision much of the time. The client's wife works all day but is home by late afternoon. Which of the following should the nurse suggest as appropriate follow-up care? A. Receiving daily care from a home health aide. B. Having a weekly visit from a nurse case worker. C. Attending a partial hospitalization program. D. Visiting a community mental health center on a daily basis.

C

5. A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following is appropriate when implementing this form of therapy? a. Demonstrate riding in an elevator, and then ask the client to imitate the behavior. b. Advise the client to say "stop" out loud every time he begins to feel an anxiety response related to an elevator. c. Gradually expose the client to an elevator while practicing relaxation techniques. d. Stay with the client in an elevator until his anxiety response diminishes.

C

A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption? A. The group members manage conflict within the group. B. The group members use denial as part of the grief response. C. The group members compliment the leader and compete for the role of recorder. D. The group members initially trust one another and the leader.

C

A nurse is leading a peer group discussion about the indications for ECT. Which of the following is appropriate to include in the discussion? a. borderline personality disorder b. acute withdrawal r/t a substance use disorder c. bipolar with rapid cycling d. dysthymic disorder

C

A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary? A. "Psychodrama provides a safe setting in which to discuss painful issues." B. "In psychodrama, the client is the protagonist." C. "In psychodrama, the client observes actor interactions from the audience." D. "Psychodrama facilitates resolution of interpersonal conflicts."

C

An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead? A. A psychodrama group B. A psychotherapy group C. A parenting group D. A family therapy group

C

During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? A. The nurse mandates that all group members reveal an embarrassing personal situation. B. The nurse asks for a show of hands to determine group topic preference. C. The nurse sits silently as the group members stray from the assigned topic. D. The nurse shuffles through papers to determine the facility policy on length of group.

C

Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yalom's curative group factor of altruism? A. "I'll give you the name of a friend that rents inexpensive rooms." B. "The last time we helped a family, they got back on their feet and prospered." C. "I can give you all of my baby clothes for your little one." D. "I can appreciate your situation. I had to declare bankruptcy last year."

C

The children of a 60-year-old woman are distraught at her apparent lack of recovery following a stroke several weeks earlier. The patient's daughter has frequently directed harsh criticism toward the nurses, accusing them of a substandard effort in rehabilitating her mother despite their best efforts. What defense mechanism may the patient's daughter be exhibiting? a) Sublimation b) Regression c) Displacement d) Denial

C

The nurse would recognize that short-term pharmacological treatment may be appropriate if an anxious patient's nursing diagnoses includes which of the following? a) Social isolation b) Decisional conflict c) Disturbed sleep pattern d) Defensive coping

C

When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group? A. Open-ended membership; circle of chairs; group size of 5 to 10 members B. Open-ended membership; chairs around a table; group size of 10 to 15 members C. Closed membership; circle of chairs; group size of 5 to 10 members D. Closed membership; chairs around a table; group size of 10 to 15 members

C

You walk into your patients' room and find her sobbing uncontrollably. When you ask what the problem is your patient responds "I am so scared. I have never known anyone who goes into a hospital and comes out alive." On this patient's care plan, you note a nursing diagnosis of "Ineffective coping related to stress". What is the best outcome you can expect for this patient? a) Patient will avoid stressful situations. b) Patient will start anti-anxiety agent. c) Patient will adapt relaxation techniques to reduce stress. d) Patient will be stress free.

C

A nurse is assessing a client immediately following an ECT procedure. Which are expected findings? a. hypotension b. paralytic ileus c. memory loss d. nausea e. tachycardia

C,d,e

. A nurse is caring for a client who states, "I'm so stressed at work because of my coworker. He expects me to finish his work because he's too lazy!" When discussing effective communication, which of the following statements by the client to his coworker indicates client understanding? A. "You really should complete your own work. I don't think it's right to expect me to complete your responsibilities." B. "Why do you expect me to finish your work? You must realize that I have my own responsibilities." C. "It is not fair to expect me to complete your work. If you continue, then I will report your behavior to our supervisor." D. "When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities."

D

2. A nurse is discussing free association as a therapeutic tool with a client who has major depressive disorder. Which of the following client statements indicates understanding of this technique? a. "I will write down my dreams as soon as I wake up." b. "I may begin to associate my therapist with important people in my life." c. "I can learn to express myself in a nonaggressive manner." d. "I should say the first thing that comes to my mind."

D

A client who is a drug addict visits a health care facility for treatment. During counseling, he discloses that he took to drugs because it helped him deal with stressful situations. The nurse explains that he is not using the correct coping strategy to overcome his stress-related problems. What kind of strategy has the client used in this case? a) Stress-reduction strategy b) Therapeutic coping strategy c) Antidepressant strategy d) Non-therapeutic coping strategy

D

A high school student comes to the nurse's office to discuss her anxiety regarding an upcoming test. Her test-taking anxiety is a(an) a) Adjustment b) Concern c) Threat d) Stressor

D

A nurse is assessing an obese teenager who is unhappy and stressed out because she has not lost weight despite working out at the gym. The physician asks the nurse to try the modeling intervention for stress management for the client. Which of the following actions should the nurse perform when adhering to the modeling intervention? a) Ask the client to undergo liposuction surgery. b) Ask the client to change her exercise regimen. c) Ask the client to cut down on her food intake. d) Introduce the client to someone with a positive attitude.

D

A nurse is providing teaching who is scheduled for ECT. Which indicates an understanding of teaching? a. It is common to treat depression with ECT before trying meds b. I can have my depression cured if I receive a series of ECT treatments c. I will have seizures lasting 1.5-2 minutes during ECT d. I will receive a muscle relaxant to protect me from injury during ECT

D

A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? A. "There is little research to support AA's effectiveness." B. "Self-help groups used to be the treatment of choice, but their popularity is waning." C. "These groups have no external regulation, so clients need to be cautious." D. "Members themselves run the group, with leadership usually rotating among the members."

D

A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Altruism D. Universality

D

As an occupational health nurse at an oil refinery on the Gulf coast of Texas you are doing patient education with a man in his mid-forties. The patient is being seen after having been exposed to a chemical spill at the refinery. What type of stressor has this patient been exposed to? a) Psychiatric b) Psychosocial c) Physiologic d) Physical

D

During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? A. To referee the debate B. To adamantly oppose physical discipline measures C. To redirect the group to a less controversial topic D. To encourage the group to solve the problem collectively

D

The client is a 5-year-old child hospitalized for a surgical procedure. The client is bedwetting. The parents report this is a new behavior and their child is toilet trained. The nurse assesses the client is exhibiting the defense mechanism of a) displacement. b) reaction formation. c) compensation. d) regression.

D

The nurse is interviewing a client with complaints of chronic fatigue. The nurse understands that the client has a sedentary lifestyle and suggests that the client start low-intensity exercise. Which of the following exercises would be appropriate for the nurse to suggest the client engage in initially? a) Brisk walking b) Running c) Cycling d) Gardening

D

Which group leader activity should a nurse identify as being most effective in the final, or termination, phase of group development? A. The group leader establishes the rules that will govern the group after discharge. B. The group leader encourages members to rely on each other for problem solving. C. The group leader presents and discusses the concept of group termination. D. The group leader helps the members to process feelings of loss.

D

Which of the following is a physiological response experienced during the exhaustion stage of general adaptation syndrome? a) Increased mental alertness b) Vasoconstriction c) The initiation of neuroendocrine activity d) Decreased blood pressure

D

You are the nurse caring for a 72-year-old female who is recovering from abdominal surgery on the Medical Surgical unit. The surgery was very stressful and prolonged, and you note on the chart that her blood sugars are elevated yet she in not been diagnosed with diabetes. To what do you attribute this elevation in blood sugars? a) It is a result of antidiuretic hormone. b) She must have had diabetes prior to surgery. c) She has become a diabetic from the abdominal surgery. d) The blood sugars are probably a result of the "fight-or-flight" reaction.

D