Psych CH25, 26, 27

27 During a group session a nurse mimics the disruptive behavior of a patient to demonstrate its affect on group work. The teaching strategy the nurse is implementing is: a. shaping. b. modeling. c. role playing. d. positive reinforcement.

ANS: C Role playing is defined as the process by which patients rehearse problematic issues and obtain feedback about their behavior. In this situation, the patient switches roles with the nurse and is given an opportunity to see issues from another individual's viewpoint. DIF: Cognitive Level: Comprehension REF: Text Page: 568 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26 Which assessment data would indicate to the nurse that the patient who is prescribed a benzodiazepine is experiencing a medication side effect? a. Dizziness b. Reduced irritability c. Reduced nervousness d. Physiological dependency

ANS: A A common side effect of benzodiazepine therapy is dizziness. Two options indicate that the patient is actually obtaining relief from the benzodiazepine, and physiological dependency is unlikely, whereas psychological dependency can occur if the patient is not taught effective ways to manage anxiety aside from taking a pill. DIF: Cognitive Level: Comprehension REF: Text Pages: 532-533 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25 What is the rationale for seeking information about the effects of prescribed medications on a patient's sexual function? a. Sexual dysfunction may result from use of prescription medications. b. The question eases the transition to questioning about sexual practices. c. Patients are more comfortable talking about medications than about sex. d. The question provides an opening to question about nonprescription drug use.

ANS: A A nursing history should include questions about sexual health. The side effects of several groups of drugs include impotence or delayed ejaculation in men and diminished responsiveness in women. DIF: Cognitive Level: Comprehension REF: Text Page: 505 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25 A person states, "I feel as though I'm really a woman trapped in this male body." This type of statement is characteristically expressed by someone who is a: a. transsexual. b. transvestite. c. pedophile. d. homosexual.

ANS: A A transsexual is a person who is anatomically a male or female but who expresses strong conviction that he or she has the mind and feelings of the opposite gender. DIF: Cognitive Level: Comprehension REF: Text Page: 503 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

26 Which statement represents the most appropriate instructions for a patient with a past suicide attempt who is prescribed amitriptyline (Elavil), 150 mg PO at bedtime? a. "You will need to pick up your 7-day supply of medication at the pharmacy each week." b. "Your prescription will provide you with a 6-month supply to save you money and time." c. "I'm going to strongly suggest that your spouse dispense this medication to you each evening." d. "Stop by the clinic each evening for your medication so your emotional state of mind can be assessed."

ANS: A Amitriptyline (Elavil) is a tricyclic antidepressant (TCA) medication (tertiary amine). The TCAs are very toxic when ingested at levels of 1000 to 3000 mg, and overdosage and suicide attempts with this medication are extremely dangerous and often require emergency medical attention. Because an overdose often requires only a 1-week supply of medication, it is the nurse's responsibility to suggest that the prescription be dispensed in weekly doses. In the above situation, the patient has a history of self-directed lethality, and prudence is the best approach. By asking the patient to help the nurse determine the easiest method of dispensing medication, the nurse allows the patient control and offers respect and mutuality. DIF: Cognitive Level: Analysis REF: Text Page: 544 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care

26 A patient who is prescribed an antidepressant medication says, "I've been getting dizzy in the morning when I wake up ever since I started this drug. Do you think I should stop taking it?" Which communication would reflect the most therapeutic nursing intervention on the basis of the patient's problem? a. "It's important to change positions slowly and dangle your feet at the side of the bed before getting up." b. "You'll have to stop driving your car while you're taking your medicine, and napping during the day should help." c. "This medication does not usually cause dizziness unless it's being taken along with alcohol, wine, or beer." d. "This should not be happening. Stop taking this medicine, and I'll notify your doctor to prescribe something else."

ANS: A Antidepressant medications can cause orthostatic or postural hypotension, and the nurse will teach the patient the following: lie down, rest as able, and change positions slowly. Dangle at the side of the bed for 30 seconds or so. Operate heavy equipment and drive a car only with caution. Check and record your blood pressure, both sitting and standing, twice each day. DIF: Cognitive Level: Application REF: Text Page: 542 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

26 A patient who is taking psychotropic medication is experiencing constipation. Which intervention would the nurse plan for the patient? a. Drinking six to eight glasses of water daily and eating green vegetables and bran b. Drinking 10 to 12 glasses of water daily and eating a serving of beef liver weekly c. Taking a laxative and stool softener daily in addition to eating prunes and dates d. Using a retention enema weekly and adding bran and vegetables in the daily diet

ANS: A Constipation, an anticholinergic side effect, is alleviated by drinking six to eight glasses of water and eating bran and green vegetables daily. Prunes and raisins are especially helpful. If the side effect continues, the patient should notify the health care provider and use a laxative only when medically advised to do so. DIF: Cognitive Level: Application REF: Text Page: 542 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

27 A patient says, "There aren't many things in life that I'm really afraid of, but I'm so afraid that I'll have another panic attack when I least expect it." Which question indicates the nurse is using decatastrophizing? a. "Okay, let's talk about the worst case scenario. What if you're driving in a snow storm with your children in the car and you have an attack?" b. "I can understand your concern. But keep telling yourself not to worry because panic attacks go away as quickly as they appear." c. "I can understand that your anxiety over the possibility of experiencing another panic attack could paralyze you with fear." d. "Let me understand this. You're not afraid of much, but these attacks cause you to be fearful?"

ANS: A Decatastrophizing is also called the "what-if" technique. The goal of this technique is to help the patient see that the consequences of life's actions are generally not catastrophic. DIF: Cognitive Level: Application REF: Text Pages: 566-567 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25 What factor is most important during evaluation of effectiveness of sexual counseling or intervention? a. Patient satisfaction with treatment b. Patient reduction in use of fantasy c. Nursing involvement in forming the sex education plan d. Patient agreement with the moral norms of the community

ANS: A Evaluation factors include patient sense of well-being, functioning ability, and satisfaction with treatment. DIF: Cognitive Level: Comprehension REF: Text Pages: 517-518 TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

27 A nurse explains the technique of extinction to parents who are seeking to reduce the frequency of unwanted behaviors in their children. What is an example of this type of strategy? a. Ignoring a temper tantrum b. Taking away an allowance for not keeping a clean room c. Sending children to their rooms after fighting with each other d. Not allowing children to play with friends because homework is not completed

ANS: A Extinction is the process of eliminating a behavior by ignoring it or not rewarding it. DIF: Cognitive Level: Application REF: Text Page: 565 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25 Parents are upset after learning that their child is homosexual. They ask the nurse, "What causes homosexuality; was it something we did?" The nurse responds best when stating: a. "The cause of homosexuality has not been determined as of yet." b. "It's thought that homosexuality is transmitted via the X chromosome." c. "Many people consider homosexuality to be an expression of normal sexual behavior." d. "You sound as though you are expressing concern about both your child and yourself."

ANS: A Giving a direct answer is appropriate because the patient is seeking information. To mention a possible genetic origin may cause the parent to needlessly feel responsible. Saying that homosexuality is a normal expression of sexual behavior denies the parent's right to be distressed. Suggesting that the patient is concerned for self may be considered challenging. DIF: Cognitive Level: Application REF: Text Page: 502 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25 A patient with a sexual response disorder reports hypersexuality. During the interview, a nurse should inquire about a history of which psychiatric disorder? a. Mania b. Depression c. Personality disorder d. Obsessive-compulsive disorder

ANS: A Hypersexuality may be the first symptom of a manic episode. In depression, sexuality responses tend to be decreased. There are no specific patterns of altered sexuality associated with personality disorders or obsessive-compulsive disorder. DIF: Cognitive Level: Application REF: Text Page: 505 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

26 In order to effectively provide appropriate patient teaching regarding the effects of psychotropic medications, the nurse is required to have a thorough understanding of which drug-related topic? a. Clinical indicators b. Pharmacology algorithms c. Monotherapeutic symptoms d. Doses of all atypical psychotropic drugs

ANS: A In 2003, the National Organization of Nurse Practitioner Faculties (NONPF) published a comprehensive set of competencies defining the scope and practice of psychiatric mental health nurse practitioners (PMHNPs). An example of a competency specific to medication prescribing for PMHNPs states that the PMHNP "prescribes psychotropic and related medications based on clinical indicators of a patient's status, including results of diagnostic and lab tests as appropriate, to treat symptoms of psychiatric disorders and improve functional health status." Knowledge of pharmacology algorithms or of monotherapeutic symptoms is not applicable since they are not required needs. A knowledge of the doses of all "atypical" psychotropic drugs is too specific to one class of psychotropic medications. Nurses need to know information about all psychotropic medications. DIF: Cognitive Level: Application REF: Text Page: 556 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

26 A patient who is taking lithium shares with the nurse, "I'm planning to breast-feed my baby who is due to be born in 2 months." Which statement shows the best understanding of the effect of lithium on breast-feeding? a. "Your medication would be excreted in your breast milk, so let's discuss a safer option for your baby." b. "Your medication will cause the breast milk to have an unpleasant taste and will likely cause your infant to be gassy." c. "This medication will likely affect your ability to lactate, resulting in a marked decrease in breast milk production." d. "This medication can cause extreme mood fluctuations, which can have a negative effect on your ability to produce breast milk."

ANS: A Lithium crosses the placental barrier and is excreted in the breast milk, so breast-feeding is not an option. Lithium should only be taken by pregnant women when it is an absolute necessity. DIF: Cognitive Level: Application REF: Text Pages: 545-546 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25 A couple reports having rare-to-occasional variations in their sexual response patterns. The nurse should conclude that this couple has: a. no medically diagnosed health problem. b. behaviors in accordance with sexual dysfunction. c. engaged in sexual perversion or deviations regularly. d. at least one partner who experiences a gender identity disorder.

ANS: A Many people who have transient variations in sexual response do not have a medically diagnosed health problem. Those with more severe or persistent problems are classified as having one of the disorders outlined in the remaining options. DIF: Cognitive Level: Comprehension REF: Text Page: 507 TOP: Nursing Process: Diagnosis|Nursing Process: Analysis MSC: NCLEX: Psychosocial Integrity

26 A patient who has been taking an antidepressant for 2 months shares with the nurse, "Since my depression is over, I've stopped the Prozac and I won't need to see you any longer." Which response by a nurse would be most therapeutic? a. "Do you recall that we discussed the need for you to take the medication for up to 1 year before trying to taper off the drug? Let's discuss why it's not advisable to stop your medication abruptly." b. "It is not recommended that you stop the antidepressants abruptly. I strongly suggest that you continue seeing me regularly to ensure that any change in your condition will be treated immediately." c. "You should not discontinue your medication without consulting your psychiatrist. You will very likely experience withdrawal symptoms and become more depressed than you were before." d. "Although it isn't wise to stop the medication as you have, you seem to be handling things very well. Call me if you have any questions and follow-up with your psychiatrist in a year."

ANS: A Most patients who respond initially to antidepressant therapy require at least 1 year of therapy and may take medication on a lifetime basis. This is similar to patients who take antihypertensives or insulin. The patient's statement alerts the nurse to set clear therapy goals that extend beyond medication assessment. Prozac takes 2 to 4 weeks to reach a steady state and is maintained in the body for several weeks after it is discontinued, but the nurse's suggestion of tapering off the medication is a wise intervention for this patient, who seems impulsive about medication adherence. A patient with a knowledge deficit and nonadherence potential requires communication that recalls prior teaching and that builds on the knowledge he or she already has. Reminding the patient of the time it takes to become depressed provides anticipatory guidance about the possibility of needing medication on a lifetime basis. Sarcastic humor is usually a poor response that demeans the patient and may reflect the nurse's impatience and a judgmental attitude toward the patient, and a laissez-faire response does not reflect a caring attitude. Withdrawal usually is not a problem for medications with a long half-life. DIF: Cognitive Level: Analysis REF: Text Pages: 536-537 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

26 During a home visit with a patient diagnosed with schizophrenia the patient tells the nurse, "I'm going to stop going to the clinic for my fluphenazine decanoate (Prolixin) shots because I think I'm okay now." Which statement represents the best understanding of the effect of the patient's decision on the prognosis? a. "So you think you're better now. Let's discuss why you've decided to stop taking your medication." b. "Your doctor knows what's best for you. Just look at how well you're feeling now so don't stop taking the medication." c. "Our philosophy is to use the least amount of medicine that is needed to treat a problem. Tell me why you think that you are okay now." d. "I'm afraid that you'll be sick again very soon if you aren't taking your medication, but you are an adult and entitled to make your own decisions."

ANS: A Nonadherence or noncompliance with medication is usually lessened with the decanoate preparation of the antipsychotic medication. The most therapeutic communication is usually the one that helps the patient to share thoughts and feelings. By restating and seeking clarification, the nurse can assist the patient in looking at what he or she is saying. If the nurse focuses, the patient will be able to help with the thinking-through process, which is to communicate that the Prolixin injections are received only 12 to 14 times annually and that they will keep the patient's thoughts clear. DIF: Cognitive Level: Analysis REF: Text Page: 551 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25 A patient with gender identity disorder (gender dysphoria) tells a nurse about a wish to undergo a "sex change operation." Which statement correctly reflects one prerequisite for sexual reassignment surgery? a. The patient must be of legal age. b. At least three clinicians must agree that the reassignment is appropriate. c. The patient must live in the role of the preferred gender for at least 6 months. d. The patient must undergo approximately 5 years of psychotherapy after surgery.

ANS: A Patients who believe they are transsexual and request surgical reassignment must be of legal age, have two therapists agree that the surgery is indicated, and live in the preferred gender identity role for at least 1 year. Although follow-up care also is generally recommended, there is no specific time requirement. DIF: Cognitive Level: Comprehension REF: Text Page: 515 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25 Which nursing diagnosis could be applied to both a patient who is upset that she has developed vaginismus associated with fear of pregnancy as well as a patient with diabetes who is concerned that he cannot attain an erection? a. Sexual dysfunction b. Sexual arousal disorder c. Sexual aversion disorder d. Ineffective sexuality pattern

ANS: A Sexual dysfunction is a state in which an individual expresses concern about his or her sexuality. This diagnosis would be equally applicable to either of the patients described above. DIF: Cognitive Level: Application REF: Text Page: 503 TOP: Nursing Process: Diagnosis|Nursing Process: Application MSC: NCLEX: Psychosocial Integrity

27 A patient frequently experiences angry outbursts and asks, "Is there anything I can do to stop being rude every time I get angry?" The nurse responds: a. "A social skills training program would be helpful." b. "Do you really want to stop being rude when you become angry?" c. "Patients who have trouble controlling their tempers are often helped by talking with a counselor." d. "I could recommend for you to enter into therapy with a psychiatrist who is an expert in communications theory."

ANS: A Social skills training is often helpful for patients who have trouble with assertiveness and with managing their anger. DIF: Cognitive Level: Analysis REF: Text Page: 568 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26 A nurse is assessing a patient who was recently prescribed an antipsychotic medication. Which side effects could the nurse expect to observe? a. Constipation, decreased sweating, and increased sensitivity to heat b. Increased moisture around the eyes, vomiting, and frontal headache c. Slurred speech, hand tremors, and severe occipital headache d. Sleeplessness, irritability, and muscle weakness

ANS: A The most common side effects of antipsychotic medications include the following: dry mouth, blurred vision, nasal stuffiness, weight gain, difficulty urinating, infection, decreased sweating, increased sensitivity to sunlight, yellowing of the eyes (especially the whites of the eyes), breast enlargement/lactation, skin rash, anhedonia, itchy skin, and constipation. DIF: Cognitive Level: Comprehension REF: Text Page: 541 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25 Which statement made by a patient shows a correct understanding of human sexuality? a. "Oral intercourse is dangerous." b. "Sex during menstruation should be avoided." c. "Advanced age is not by itself a deterrent to sexual function." d. "Alcohol ingestion enhances sexual pleasure and performance."

ANS: C Sexually, men and women in good health can function effectively throughout the life span. The other answers are sexual myths that the nurse should address. DIF: Cognitive Level: Comprehension REF: Text Page: 510 TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

27 A patient says, "When I lost weight, everyone was so nice to me. Now that I've regained the weight, people don't want anything to do with me. They think I'm just a fat pig." The nurse's initial response should be: a. "It sounds as if your interpersonal relationships improved when you lost weight and now that you have regained the weight, you feel people don't want to be with you." b. "Yes, there is a stigma about obesity. People are judged harshly for their weight." c. "So, if you lose all the weight again do you think your relationships will improve?" d. "Do you really believe that your friends think that you are a 'fat pig'?"

ANS: A The patient is cognitively distorting by externalizing self-worth. The most therapeutic communication is the one that summarizes the patient's viewpoint and reflects it back for the patient to hear in a nonjudgmental way. DIF: Cognitive Level: Analysis REF: Text Page: 564 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27 A patient tells a nurse, "I want my own private room because my roommate is always watching football on television. He probably thinks I'm gay because I don't like football." Which communication best reflects a cognitive behavioral assessment by the nurse? a. "You feel your roommate thinks you're gay because you don't like football and he spends his time watching football? How will getting a private room change things?" b. "It's hard to feel excluded, but isolating yourself is not the answer. Perhaps you might try watching football with him." c. "Don't you think your roommate will be more likely to think you're gay if you get a private room?" d. "Well, you must realize that most men like football, but that doesn't mean he will think you are gay."

ANS: A The patient is demonstrating personalization and engaging in ineffective problem solving. The most therapeutic communication is the one in which the nurse identifies the problem from the patient's perspective and asks how the ineffective problem solving will change things. DIF: Cognitive Level: Application REF: Text Page: 564 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26 What will a health care provider include in medication teaching for a patient who will be starting a monoamine oxidase inhibitor (MAOI) medication after ending treatment with sertraline hydrochloride (Zoloft)? a. "Here is some information concerning the foods you must avoid when you are taking your new medication. In 2 weeks, after your last dose of Zoloft, we will meet and I will give you a prescription for your MAOI and answer any questions you may have." b. "After you have been off Zoloft for 1 week, come see me. I will order the new medication for you. This list includes all the foods you will not be able to eat while taking your new medicine. We'll review your diet and medication when we meet, and we will get a blood sample as well." c. "After 4 weeks off Zoloft, come see me. The prescription for your new medication will be ready along with a list of foods you will need to avoid once you start taking the medication. I'll order some blood work at that time as well." d. "After 2 days off Zoloft, come in to see me before going to work. I'll give you a prescription for the new medication, and we can review the foods you will need to avoid while taking the new medication."

ANS: A The psychiatrist or advanced practice nurse (psychiatric clinical specialist) will wait 2 weeks before changing from a selective serotonin reuptake inhibitor (SSRI) to a monoamine oxidase inhibitor (MAOI). The SSRI should not be administered concomitantly with an MAOI. Foods that contain tyramine (e.g., Chianti, nuts, figs, cheese), a pressor amine, are avoided to prevent hypertensive crisis. DIF: Cognitive Level: Application REF: Text Page: 537 | Text Pages: 544-545 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

26 A patient being treated for depression reports experiencing nausea, palpitations, and "a terrible headache." When the physical examination determines the patient is diaphoresic and hypertensive, the nurse should ask: a. "When did you last take your phenelzine (Nardil)?" b. "Did you take your amitriptyline (Elavil) on schedule?" c. "What natural foods have you had in the last 24 hours?" d. "Have you had any alcohol to drink within the last 24 hours?"

ANS: A This question requires analytical decision making to identify hypertensive crises and data for the evaluation process. Knowing when the last dose of the monoamine oxidase inhibitor (MAOI) was taken helps determine immediate treatment. Although the ingestion of alcohol is pertinent to determining what tyramine-containing foods the patient may have had, it is not as crucial as knowing when the last dose of MAOI was consumed. Although natural foods may produce similar bioactivity and other antidepressants should not be taken along with an MAOI, these answers do not reflect medication assessment and evaluation. The patient is experiencing the clinical manifestation of hypertensive crisis. The classic symptoms of this condition are severe occipital headache, dilated pupils, hypertension, and palpitations or arrhythmias. This syndrome can be caused when the patient who is taking an MAOI ingests food containing tyramine, an amino acid released from foods that undergo hydrolysis (e.g., fermentation, aging, pickling, smoking, spoilage). This inhibits the monoamine oxidase and allows tyramine to reach the adrenergic nerve endings and cause the release of excess norepinephrine, which causes hypertensive crisis. To confirm the physical syndrome, first determine whether the patient is taking an MAOI. Knowing when the last dose was ingested provides a window for the duration of hypertension and therapeutic nursing interventions. DIF: Cognitive Level: Analysis REF: Text Page: 545 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25 A nurse assesses a patient who reports that she is unable to have intercourse because of involuntary contractions at the vaginal opening. The nurse can correctly assess this as: a. vaginismus. b. dyspareunia. c. arousal disorder. d. orgasmic dysfunction.

ANS: A Vaginismus is defined as recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with coitus. DIF: Cognitive Level: Comprehension REF: Text Page: 503 | Text Page: 509 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

27 A nurse determines that a patient with a fear of insects has mastered the first step in a systematic desensitization process when the patient is able to: a. relax the muscles of the body. b. look at a picture of an insect in a book. c. rate anxiety produced by various insects. d. touch a clear glass bottle containing an insect.

ANS: A With systematic desensitization, the patient must first be able to relax the muscles. Next, the patient constructs a hierarchy of the anxiety-producing situation (insects) by ranking them from 1 to 10. The patient then proceeds to work through the hierarchy, using muscle relaxation to maintain a relaxation response in the face of fearful stimuli. DIF: Cognitive Level: Application REF: Text Page: 563 TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

27 A nurse would implement social skills training for a patient with which problem? a. Anxiety b. Binge eating c. Poor impulse control d. Obsessive-compulsive disorder

ANS: C Social skills training is most often used with patients who lack social skills, assertiveness (assertiveness training), or impulse control (anger management) and those with antisocial behavior. DIF: Cognitive Level: Analysis REF: Text Page: 568 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

26 A nurse is caring for a female diagnosed with a mental disorder who has been prescribed medication. Which fact will most impact the nurse's assessment for possible side effects? a. Women are at higher risk for tardive dyskinesia while taking conventional antipsychotic medications. b. Women experience more severe side effects than men while taking atypical antidepressants. c. Women are more susceptible to developing a dependence on most psychiatric medications than are men. d. Women are less susceptible to developing the common side effects of antipsychotic medications than are men.

ANS: A Women are at higher risk for tardive dyskinesia from conventional antipsychotics and for activating side effects caused by antidepressants. All other answers are incorrect. DIF: Cognitive Level: Comprehension REF: Text Pages: 551-552 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25 Which classification of drugs has the greatest potential for causing sexual dysfunction? a. Diuretics b. Antihypertensives c. Appetite suppressants d. Gastrointestinal (GI) antiinflammatory agents

ANS: B Antihypertensive medications, antihistamines, anticholinergics, chemotherapeutic agents, and antiseizure drugs can cause reduced sexual desire and/or orgasmic disorders in both men and women. The other drug classes listed are not known for these types of effects. DIF: Cognitive Level: Comprehension REF: Text Page: 505 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

26 Which instructions will the nurse include in the teaching plan of a patient who is prescribed fluphenazine (Prolixin) and has developed a thickly white-coated tongue? (Select all that apply.) a. Avoid foods high in sugar. b. Brush teeth and tongue frequently. c. Continue taking your medication; the coating will subside in about 3 weeks. d. Nasal inhalants should be avoided since they can interact with your medication and cause this problem. e. Smoking cigarettes can make the white coating on your tongue worse and more difficult to treat effectively.

ANS: A, B, E Fluphenazine (Prolixin) may cause the side effect of infection, because this medication can reduce the normal bacteria in the patient's mouth and increase sensitivity to infection. A thick white coating on the tongue indicates infection and must be treated. Brushing the tongue and teeth is a good preventive measure. Smoking and a high sugar diet will exacerbate the problem. The measures the nurse is offering will prevent recurrence if paired with adequate hydration. DIF: Cognitive Level: Application REF: Text Page: 541 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

27 Which clinical manifestation would indicate to a nurse that a patient has been employing relaxation training successfully? (Select all that apply.) a. Decreased blood pressure b. Decreased bowel sounds c. Decreased respirations d. Decreased apical pulse e. Decreased pupil size

ANS: A, C, D, E The manifestations of relaxation include reduced blood pressure, pulse, peripheral temperature, and respirations; peripheral vasoconstriction; and constricted pupils. Bowel sounds would not necessarily be affected. DIF: Cognitive Level: Application REF: Text Page: 563 TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

27 When describing cognitive behavioral therapy, it would be stressed that nursing is responsible for: (Select all that apply.) a. providing direct patient care. b. assisting in actual psychotherapy sessions. c. participating in planning the treatment program. d. teaching family members how to use cognitive behavioral techniques. e. reinforcing the expectations of the planned interventions of the treatment plan.

ANS: A, C, D, E Three basic roles for nurses involved in cognitive behavioral therapy at all levels of practice (novice through generalist and specialist) are as follows: providing patient care, planning treatment programs, and teaching others the use of cognitive behavioral strategies. DIF: Cognitive Level: Comprehension REF: Text Pages: 568-569 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26 A patient who has been treated with clozapine (Clozaril) for 9 months calls to cancel a clinic appointment because of flulike symptoms, including a sore throat, fever, and tiredness. The nurse demonstrates the best understanding on the management of these symptoms when responding: a. "I think you need to drink lots of juices and water and go to bed. Call me at the end of the week to reschedule your appointment." b. "I want you to please keep the appointment, and I will arrange for some blood work to be done while you are here." c. "It's flu season all right. Get better soon, and call me to reschedule when you're feeling better." d. "This may be something much more serious than the flu. Go to the hospital at once."

ANS: B Although agranulocytosis occurs in only about 1% to 2% of patients, this is a risk 10 to 20 times greater than the risk with standard antipsychotic agents. In addition, even though the risk for this adverse effect decreases substantially after 5 months of taking these drugs, the risk always remains and requires vigilant monitoring. After the first 6 months, blood counts are drawn biweekly, so the nurse in the above situation would want to obtain one today to determine whether the patient is experiencing agranulocytosis or flu. Although this is a serious adverse effect, the nurse will provide specific instructions but endeavor not to alarm the patient. In addition, the fact that this patient is female and of an older age places her at increased risk for agranulocytosis. DIF: Cognitive Level: Analysis REF: Text Page: 548 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

27 An important characteristic of cognitive behavioral therapy is its focus on the: a. authoritarian role assumed by the therapist. b. consistent collaboration with the patient. c. subjective experiences of the patient. d. approach to treatment.

ANS: B An important characteristic of cognitive behavioral therapy is the mutuality between the therapist and patient (i.e., the collaboration in defining the problem, identifying goals, formulating treatment strategies, and evaluating progress). Other characteristics include an emphasis on an objective assessment process, a supportive rather than curative focus, and a facilitative role of the therapist. DIF: Cognitive Level: Comprehension REF: Text Pages: 564-565 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26 A patient taking medication for depression states, "I need to stop taking my medication because it blurs my vision, and I'm making mistakes when I paint jewelry by hand." Which response by a nurse would be most therapeutic? a. "If you cannot take medication, would you consider a course of 6 to 10 electroconvulsive therapy (ECT) treatments offered on an outpatient basis? ECT treatments usually work immediately." b. "Do you recall the two of us discussing that blurred vision may occur but that it will resolve shortly? In the meantime, let's discuss how to best avoid getting injured until your vision clears up." c. "I understand your concern considering that you need to work to receive health insurance. Would you like me to ask the psychiatrist to change your medication?" d. "You may need to apply for a sick leave for 6 months until your depression improves enough to lessen the medication dosage."

ANS: B Blurred vision, an anticholinergic side effect of antidepressant and antipsychotic medications, will usually resolve within 1 to 2 weeks. The most therapeutic intervention is the one that assesses the patient's recall of medication teaching. Moreover, it offers a strategy to assist the patient to cope during work time. The nurse must apply knowledge of the anticholinergic side effects of antidepressants and antipsychotics to select the appropriate nursing intervention for the patient's problem. Although ECT may be offered when patients are unable to take medication, it is premature to suggest ECT or other medications, and these suggestions reflect a knowledge deficit. It is considered best to encourage patients to maintain activities of daily living and work, if possible. DIF: Cognitive Level: Application REF: Text Page: 542 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27 A patient states, "When I married my husband I thought he was perfect, but now I know that he is certainly far from perfect." The nurse reframes the statement by responding: a. "I think you might want to change your thinking since no one is perfect." b. "It seems as if you think of people as being either all good or all bad." c. "So, when did you start seeing your husband as a very bad person?" d. "It is good to be able to both externalize and objectify your anger."

ANS: B Dichotomous thinking is a cognitive distortion that involves thinking in extremes (i.e., things are either all good or all bad). Reframing involves focusing on other aspects of the problem or encouraging the patient to see the issue from a different perspective. The nurse should avoid judgmental statements. The remaining options do not reframe or restate the patient's original statement. DIF: Cognitive Level: Application REF: Text Page: 564 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27 The most appropriate nursing intervention for a patient in the third stage of change is: a. helping the patient see the benefit of changing the problematic behavior. b. assisting the patient with the development of realistic treatment goals. c. developing relapse prevention plans in anticipation of potential failures. d. providing nurse-patient interactions that discuss change in a relaxed environment.

ANS: B During the third stage of change (preparation) the patient has made a decision to change and is assessing how that decision feels. Patients can be helped to select realistic treatment goals and different ways to reach those goals. They need to be actively involved in designing their own strategies for change. DIF: Cognitive Level: Analysis REF: Text Page: 561 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

26 When assessing a patient who has been prescribed an antipsychotic medication, which statement would indicate a need for further patient education? a. "I'm already too thin; I'm concerned that I'm going to get even thinner on this new type of medication." b. "I'm a warm weather person, I follow the sun—I live in Florida in the winter and Maine in the summer." c. "I just got married, and my wife and I are so excited about starting a family as soon as we can." d. "My parents said that as soon as I am off the medication, they'll give me the money for a car."

ANS: B Increased sensitivity to sunlight is one of the most common side effects of antipsychotic agents. The patient will need to be instructed about the importance of using a sunscreen at all times when in the sun. DIF: Cognitive Level: Analysis REF: Text Page: 534 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

26 A nurse who administers an antipsychotic medication explains to the client patient how the medication helps manage the symptoms by affecting: a. dopamine and GABA. b. serotonin and dopamine. c. synaptic neurovesicles and neurodendrites. d. monoamine oxidase inhibitors and serotonin.

ANS: B Many psychiatric disorders are thought to be caused by a dysregulation (imbalance) in the complex process of brain structures communicating with each other through neurotransmission. It is currently thought that excessive dopamine and serotonin contribute to dysregulation. DIF: Cognitive Level: Comprehension REF: Text Page: 531 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25 A couple come to the clinic for treatment of sexual dysfunction. A therapist obtains a detailed sexual history and decides to employ the Masters and Johnson model of therapy. The nurse expects that treatment planning will include: a. examination of performance failures. b. enhancing mutual feelings of warmth. c. exploring the couple's early sexual experiences. d. delving into the early growth and development of each person.

ANS: B Masters and Johnson believe that attitudes and ignorance are responsible for most sexual dysfunction. Their therapeutic model emphasizes education about sexual function, alleviation of performance anxiety, and an increase in warm, comfortable feelings between partners. There is no attempt to employ the uncovering used in psychoanalytical treatment. DIF: Cognitive Level: Comprehension REF: Text Page: 516 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

27 What is the correct order for performing progressive muscle relaxation (PMR)? a. Tensing and relaxing muscle groups from the middle of the body outward to the extremities b. Relaxing and tensing muscle groups from the middle of the body outward to the extremities c. Tensing and releasing muscle groups from the facial muscles and moving down to the muscles in the feet d. Relaxing and tightening muscle groups from the facial muscles and moving down to the muscles in the feet

ANS: C PMR uses a process of tensing and releasing muscle groups, starting from facial muscles and moving down the body to the muscles in the feet. Patients are taught to perform the technique systematically to gain control over anxiety-provoking thoughts and muscle tension. DIF: Cognitive Level: Comprehension REF: Text Page: 563 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26 Which set of instructions is most appropriate when preparing the patient for collection of a 24-hour creatinine clearance for a prelithium workup? a. "Collect all urine when you wake up and for 12 hours thereafter, and then discard all collected urine, noting the time. Begin again to collect all urine, and refrigerate it for the next 12 hours after your blood is drawn." b. "Discard your first morning urine on awakening, and then begin to time and collect your urine. Keep it refrigerated in a clean 3-L plastic container. Your blood may be drawn at any time during the collection." c. "Sign this consent form; then collect your urine for the next 24 hours after discarding the first urine of the morning and then refrigerate the clean 3-L container between voidings." d. "Sign this consent form, and then begin to collect your urine in a clean 3-L plastic container for 24 hours. You may refrigerate the urine collection if you wish."

ANS: B No consent form is required for this 24-hour urine and serum collection. Blood may be drawn at any time during the collection. In the morning the first voiding is discarded, and then the collection is timed and urine is collected for 24 hours. All urine is stored in a clean, 3-L plastic container that is refrigerated when not in use and then delivered to the lab. Teaching the patient the procedure for a 24-hour creatinine clearance as part of a prelithium workup (urinalysis, BUN, TSH, T3 and T4, FBS, and a complete physical examination with history and workup for family history of renal disease, diabetes mellitus, hypertension, diuretic use, and analgesic abuse) is required. DIF: Cognitive Level: Application REF: Text Page: 547 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

26 A patient taking a benzodiazepine says to the nurse, "I really like this pill because if I just take an extra one when I get very anxious, I always feel a lot better." What is the nurse's best response? a. "That isn't the way the medication is to be taken. I think you need to talk to your doctor so something more effective can be prescribed for you." b. "Let's review the way you use this medication. Remember to try the coping measures that we discussed to help manage your nervousness." c. "You are not taking the medication as the doctor ordered. I think the doctor will be very concerned that you are abusing your medication." d. "You really shouldn't be adjusting your medication dosage like that. You need to take the medication only as it was originally prescribed by your physician."

ANS: B The patient seems to be using the medication first rather than trying more holistic ways of controlling the anxiety. It is the nurse's responsibility to teach complementary and alternative ways to cope with anxiety and stress as a lifetime measure rather than simply using a pill every time the patient identifies anxiety. Mild anxiety may help the individual adapt. DIF: Cognitive Level: Application REF: Text Page: 524 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25 A patient is hospitalized for an acute episode of schizophrenia. A nurse finds the patient in the lounge nude and telling everyone, "I am the body beautiful." The most appropriate intervention for the nurse would be to: a. tell the patient to put on clothes immediately and to not undress in public again. b. take the patient back to the assigned room and then assist the patient with getting appropriately dressed. c. ignore the behavior and share with the other patients that the patient has no control over it. d. seclude the patient until control can be regained and clearly define why the behavior is unacceptable.

ANS: B The sexual expression of patients with psychiatric illness may be inappropriate and, at times, intrusive. The patient may not be able to understand or control sexual thoughts or impulses. Nursing intervention should protect the patient from the consequences of poor judgment whenever possible and should be achieved in a neutral, nonjudgmental manner. DIF: Cognitive Level: Application REF: Text Page: 505 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26 A patient will be starting on fluoxetine hydrochloride (Prozac) therapy and taking 20 mg PO every morning. Which information should the nurse provide to the patient? a. "Make sure that you take your pulse before getting out of bed in the morning." b. "Try taking your medication with breakfast if you begin experiencing nausea." c. "You may need to reduce your fluids at night because of nocturnal urination." d. "Remember to avoid red wine, nuts, and any cheese except cottage and cream."

ANS: B This question requires the application of knowledge about selective serotonin reuptake inhibitors (SSRIs) to a specific plan for medication education. To reduce nausea, the patient should be advised to take the medicine with meals. When teaching patients who are taking tricyclic antidepressants (TCAs), one must emphasize that patients should dangle their legs over the bed and change positions slowly to prevent postural hypotension. It is also advisable for patients to increase fluids, exercise, and roughage intake to prevent the anticholinergic effects of antidepressants. Foods that contain tyramine (e.g., Chianti, nuts, cheese) are prohibited when patients are taking monoamine oxidase inhibitors (MAOIs). The primary synaptic activity for SSRIs is to inhibit the reuptake of 5-HT. The possible clinical effects of 5-HT include the following: gastrointestinal (GI) disturbances and sexual dysfunction. Fluoxetine hydrochloride (Prozac), an SSRI that is usually administered in the morning to reduce the potential of a side-effect profile that is 2+ for insomnia/agitation, also demonstrates a 3+ for GI disturbances. DIF: Cognitive Level: Application REF: Text Page: 539 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

27 A nurse explains the technique of response cost to parents who are seeking to reduce the frequency of unwanted behaviors in their children. What is an example of this type of strategy? a. Ignoring a temper tantrum b. Taking away the privilege to watch television until homework is finished c. Grounding a child for a month after a very poor report card is received d. Making a young child sit in a corner after fighting with a younger sibling

ANS: B With response cost, the frequency of a behavior is likely to decrease because of a loss or penalty following a behavior. Extinction is the process of eliminating a behavior by ignoring it. Punishment is an aversive stimulus that occurs after the behavior and reduces its future occurrence. DIF: Cognitive Level: Comprehension REF: Text Page: 565 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26 In order to accurately predict how the body absorbs, distributes, metabolizes, and eliminates psychotropic medications the nurse must be familiar with a medication's: a. half-life. b. side effects. c. pharmacokinetics. d. therapeutic dosage range.

ANS: C Pharmacokinetics is the study of how the body affects a drug. It answers the question: how does the body get drugs to and from their intended target? Body functions such as absorption, distribution, metabolism, and elimination all are pharmacokinetics. DIF: Cognitive Level: Comprehension REF: Text Pages: 525-526 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

27 A nurse teaches a group of parents about positive and negative reinforcement in shaping behavior. Which is an example of a positive reinforcer? a. A parent who kisses a child who is crying to make the crying stop b. An adolescent who runs away from home because of trouble in school c. A parent who praises a child for putting toys away after playtime d. An adolescent who drives within the speed limit to avoid getting a ticket

ANS: C A positive reinforcement is a rewarding stimulus, such as praise. A negative reinforcement also increases the frequency of the appropriate behavior by reinforcing the power of the behavior to control an aversive, rather than rewarding, stimulus. The remaining options are all negative reinforcements. DIF: Cognitive Level: Application REF: Text Pages: 567-568 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27 Which strategy for assisting patients to learn new behavior is considered by some to be questionable? a. Shaping b. Token economy c. Aversion therapy d. Contingency training

ANS: C Aversion therapy applies an aversive or noxious stimulus when a maladaptive behavior occurs. Aversion therapy has sometimes been criticized as unethical and detrimental to patients' well-being since it subjects the patient to physically and emotionally unpleasant or even harmful experiences. DIF: Cognitive Level: Comprehension REF: Text Page: 568 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

26 Which medication would the nurse expect to administer when observing that a patient being treated for schizophrenia is fidgety, demonstrates motor restlessness, and jiggles both legs when asked to sit down? a. Olanzapine (Zyprexa) b. Molindone (Moban) c. Biperiden (Akineton) d. Thioridazine (Mellaril)

ANS: C By blocking dopamine, antipsychotic medications produce extrapyramidal side effects. Akathisia is internal or external restless fidgeting or pacing. Patients with akathisia demonstrate motoric restlessness and complain of feeling their muscles quiver. When this condition has advanced, the patient will say that he or she is not able to sit still or lie down quietly. The nurse will want to observe whether the patient's legs are shaking. If the patient's feet are not shaking, the nurse will observe that his or her arms will start to shake. The therapeutic treatment is the administration of anticholinergic agents, such as benztropine (Cogentin), trihexyphenidyl (Artane), or procyclidine (Kemadrin). Diphenhydramine (Benadryl), an antihistamine, also may be administered. The other three medication selections are antipsychotic agents: Zyprexa, an atypical antipsychotic; Moban, an antipsychotic (dihydroindolone); and Mellaril (phenothiazine), a typical antipsychotic. DIF: Cognitive Level: Application REF: Text Page: 553 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25 A patient with a new colostomy tells a nurse, "This surgery is the end of my sex life." This statement should lead the nurse to take the initial step of: a. making a referral to an ostomy self-help group. b. bringing the patient's partner into the discussion. c. helping the patient fully express fears and feelings. d. reframing the effect of illness on the patient's sexual functioning.

ANS: C Exploration of fears and feelings should be the initial intervention after the patient's statement of concern. Each of the other interventions might be appropriate at a later time. DIF: Cognitive Level: Application REF: Text Pages: 512-513 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25 A nurse shares with a mentor, "When my patient brought up the subject of resuming sexual relations after surgery, I felt flustered. While I realized I wasn't letting the patient express concerns, I couldn't stop monopolizing the conversation." The nurse describes experiencing the stage of the self-awareness process called: a. anger. b. action. c. anxiety. d. cognitive dissonance.

ANS: C In the stage of anxiety, the nurse may exhibit behaviors that hinder the discussion of sexual issues, such as talking too much, failing to listen, and being preoccupied with facts rather than feelings. DIF: Cognitive Level: Comprehension REF: Text Page: 501 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

27 Which relaxation technique will a nurse implement for a patient who reports panic attacks that "come over me for no apparent reason" but denies being agoraphobic? a. Implosion therapy b. Relaxation technique c. Interoceptive exposure d. Progressive muscle relaxation

ANS: C Interoceptive exposure is used to desensitize patients to specific symptoms that they experience when anxious, such as tachycardia, blurred vision, and shortness of breath. After establishing a hierarchy of the symptoms, the patient does the things that cause him or her to experience extreme anxiety. These are then paired with a movement such as running in place or spinning around. This method has been proven successful with patients whose panic attacks seem spontaneous and unprovoked, which causes increased worry. However, it is not successful for agoraphobic patients. DIF: Cognitive Level: Application REF: Text Page: 563 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

26 A nurse observes a patient diagnosed with schizophrenia tapping both feet, smacking both lips, and making contorted faces while speaking to another patient. These behaviors prompt the nurse to suspect the patient is experiencing: a. neuroleptic malignant syndrome. b. Parkinson syndrome. c. tardive dyskinesia. d. torticollis.

ANS: C Tardive dyskinesia usually occurs with long-term conventional antipsychotic agent treatment and is evidenced by stereotypical involuntary movements (e.g., tongue protrusion, lip smacking, chewing, blinking, grimacing, choreiform movements of the limbs and trunk, foot tapping). DIF: Cognitive Level: Comprehension REF: Text Page: 553 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

27 A nurse instructing a group of patients in the sequence of progressive muscle relaxation tells the group to tense and relax which area first? a. Eyes b. Toes c. Hands d. Mouth

ANS: C The hands are tensed and relaxed first, followed by the biceps and triceps, shoulders, neck, mouth, eyes, breathing, back, midsection, thighs, stomach, calves and feet, and finally toes. DIF: Cognitive Level: Application REF: Text Page: 563 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27 Which behavior would a nurse focus upon when using a token economy as a method of positive reinforcement? a. Altering cognitive perceptions b. Reinforcing cognitive congruence c. Performing assigned tasks in a cooperative manner d. Pairing desired behaviors with undesired behaviors

ANS: C Token economy, a form of positive reinforcement, has been used successfully to reward patients for performing behaviors such as the activities of daily living. DIF: Cognitive Level: Application REF: Text Page: 568 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25 A nurse consults with local elementary and secondary school teachers about implementing strategies to reinforce the concept of "say no to unwanted sexual advances." The most helpful method the nurse can suggest is: a. pretesting for accurate sexual knowledge. b. explaining why saying "no" is appropriate for teens. c. role playing assertive behavior in potentially difficult sexual situations. d. brainstorming examples of behaviors that will promote good sexual health.

ANS: C Understanding that one should say "no" is much simpler than saying "no" when under pressure. A sex education program must give students tools with which to make appropriate decisions and the behavioral skills necessary to implement the decisions. Role playing assertive ways of saying "no" is the most effective behaviorally focused intervention listed. DIF: Cognitive Level: Application REF: Text Page: 511 TOP: Nursing Process: Planning MSC: NCLEX: Health Promotion and Maintenance

25 A patient being treated for cellulitis tells a nurse, "I feel like you and I should get romantic tonight. What do you say to closing the door and crawling into bed with me?" The nurse should respond by saying: a. "Stop joking around. You've got to be kidding." b. "Now that you've gotten my attention, tell me what you really need." c. "Sex is not part of our relationship. Your comment makes me uncomfortable." d. "I wonder what I did to make you think I would be willing to have sex with you."

ANS: C When patients behave seductively toward nurses, it is appropriate to set limits firmly and matter-of-factly. DIF: Cognitive Level: Application REF: Text Page: 512 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25 The best expected outcome for a patient with maladaptive sexual response is, "The patient will a. identify sexual questions and problems." b. implement one new behavior to improve sexual functioning." c. state comfort and satisfaction with gender identity and sexual orientation." d. achieve a mutually acceptable level of sexual response with a consenting partner."

ANS: D An expected outcome is a broad statement relating to resolution of maladaptive sexual response. The remaining options are more circumscribed and are considered short-term goals. DIF: Cognitive Level: Application REF: Text Page: 499 TOP: Nursing Process: Outcome Identification MSC: NCLEX: Psychosocial Integrity

25 A nurse requests that a patient assignment be changed, saying, "I learned in school that homosexuality is not an illness and I want to be therapeutic, but every time I see my patient with a same-sex partner, I think it's a sickness!" The nurse is experiencing which stage of the self-awareness process? a. Anger b. Anxiety c. Choosing values d. Cognitive dissonance

ANS: D Cognitive dissonance arises when two opposing beliefs exist at the same time. DIF: Cognitive Level: Comprehension REF: Text Pages: 500-501 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

27 Which response best indicates that a nurse is employing reframing with a patient who responds angrily and aggressively when family members confront the patient's abusive drinking behavior? a. "Would you like to take a 10-minute time-out to get your anger under control?" b. "It is good that you can display anger. Now, can you tell us what it is you really want to say?" c. "Would you consider joining Alcoholics Anonymous and offering this up to a higher power?" d. "Can you feel the love and concern that prompted your family to say these things to you?"

ANS: D In reframing, the nurse changes the meaning of a behavior in order to change the patient's response. In this situation, the nurse helps the patient to view the family's behavior as concern rather than as an attack. DIF: Cognitive Level: Application REF: Text Page: 567 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27 Which strategy will help evoke relaxation when using meditation? a. Playing soft background music b. Ten-second deep breathing and exhaling c. Ten-second tensing and relaxing of muscle groups d. Providing a word or scene on which the patient can focus

ANS: D Meditation requires a quiet milieu, a passive attitude, a focus word or scene, and a comfortable position. DIF: Cognitive Level: Comprehension REF: Text Page: 563 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25 A nurse caring for an attractive patient of similar age and background begins fantasizing about having a social and sexual relationship with the patient. The most effective means of dealing with these feelings is to: a. make a personal promise to not act on the feelings. b. limit contact with the patient to include only care. c. ask to change patient assignments immediately. d. seek advice from an experienced peer.

ANS: D Sexual attraction and fantasy are part of the human experience. Nurses are not immune. Nurses, however, must recognize and deal appropriately with the feelings or risk interference with the quality of care. The feelings should not be denied, nor should they be tested or shared with the patient. It is the nurse's responsibility to preserve professional boundaries. Consultation is a constructive way of dealing with the situation. DIF: Cognitive Level: Application REF: Text Page: 511 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26 When a patient requires an ever-increasing dose of a medication to achieve the same therapeutic effect, the nurse must assess the patient for: a. withdrawal. b. patency. c. side effects. d. tolerance.

ANS: D Some patients become less responsive to the same dose of a particular drug over time, which is called tolerance, requiring that higher doses of the drug be given over time to obtain the same therapeutic effect. DIF: Cognitive Level: Knowledge REF: Text Page: 527 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25 A patient hospitalized for depression will be discharged tomorrow. The patient asks a nurse, "Could the two of us meet for coffee away from the hospital sometime?" The most therapeutic response by the nurse would be: a. "That sounds nice, but I'm already in a romantic relationship with someone." b. "The hospital has a policy that does not allow professional staff to date patients." c. "I guess there would be no harm in meeting for coffee, if we know in advance that we're meeting just as friends." d. "We've developed a positive working relationship, and meeting socially would have a negative impact on that relationship."

ANS: D Termination is a time for evaluating progress and bidding farewell. Patients who view their nurses in a positive fashion are often reluctant to terminate and seek to continue the relationship on a social basis after discharge. Helping the patient clarify the therapeutic aspect of the nursing role is appropriate. DIF: Cognitive Level: Application REF: Text Pages: 517-518 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment: Management of Care

27 A patient says, "My partner doesn't love me! Even the roses I get are the wrong color. It doesn't matter if I am not happy." The nurse responds: a. "How do you want your partner to show you that you're loved?" b. "When was the last time your partner made you feel really loved?" c. "Everyone deserves to be shown by their partners that they are loved. What did your partner have to say in his defense?" d. "Let me see if I understand you. You think your partner doesn't love you because the gifted roses were of the wrong color?"

ANS: D The patient is demonstrating cognitive distortions by thinking in extremes and magnifying the problem and solution. The most therapeutic communication is the one that seeks clarification. Presenting the patient's statements allows the patient to "listen with a third ear" and take a view that places the event in perspective. DIF: Cognitive Level: Analysis REF: Text Page: 564 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27 A patient says, "I've been sick a lot this last year but I'm still the biggest seller. I think my boss wants me to leave because a big change in our health insurance plan was implemented last week." The nurse responds: a. "So you've been sick but you're the best seller. That makes you a valued employee." b. "It's hard to get up one day and find that you're the oldest person in any group. It's only natural that you'd be sicker than everyone else." c. "You're still the best seller. It's important not to be suspicious of what is probably only a necessary change in health insurance coverage." d. "So you think that while you're still the best seller the fact you've been sick a lot this year is a problem? You feel that your employer's change in health insurance indicates they want you to leave?"

ANS: D The patient is demonstrating the cognitive distortion of personalization and arbitrary inference. The therapeutic communication that reflects a cognitive behavioral assessment is the one that first asks, "What is the problem?" Identifying the problem from the patient's perspective in a neutral, nonjudgmental style of communication helps the patient to take this first step. The antecedent and feared consequences also are identified. DIF: Cognitive Level: Analysis REF: Text Page: 564 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27 A patient tearfully says to a nurse, "I don't want to go on living now that my spouse has left me for someone else after 20 years. Our children are grown and don't need me. I just want to die." Which response is the most therapeutic? a. "You're young, and you will manage well. I know several people your age who've actually done better after divorcing their spouses." b. "It always seems bleak when we lose someone we've loved. Don't worry, it will work out—we just need to think this through." c. "So your spouse is off having a midlife crisis and you are here thinking of killing yourself. Let's focus on how to make you feel better." d. "I am very concerned about you wanting to die because your spouse left. Rather than trying to solve all the problems immediately let's focus on your feelings of hopelessness right now."

ANS: D The patient is demonstrating the cognitive distortions of dichotomous thinking (thinking in extremes) and overgeneralization. The patient is clearly in crisis and may be experiencing suicidal ideation. By identifying the most important problem and giving the patient permission to view one problem at a time with the therapist, the nurse is supporting effective problem solving by the patient. Using a cognitive behavioral approach, the nurse is able to perform a lethality assessment and then help the patient to expand alternatives and become a more flexible thinker. DIF: Cognitive Level: Analysis REF: Text Page: 564 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27 A high school student says to the school nurse, "If I don't make the honor roll every term, a college will never want me." The most therapeutic nurse response is: a. "If making the honor role every term was the admissions criterion, very few people would get into college." b. "I can understand your concern. The pressures are truly great to assure acceptance into college today." c. "It's true that a consistent record of academic achievement will ensure college acceptance." d. "It sounds as if you believe that colleges will only admit students that are perfect academically."

ANS: D The patient is projecting perfectionism onto the criteria for college acceptance. Perfectionism is a cognitive distortion, and this is best explored by reflecting the patient's distortion back to have the patient reexamine his or her thinking. DIF: Cognitive Level: Analysis REF: Text Page: 564 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

27 A patient says, "The people I work with hate me even though I'm given the hardest assignment. My boss makes it look like I'm doing less than the others." An appropriate response by the nurse would be: a. "It seems like you're in a very difficult position. No job is worth that kind of stress. Why not change jobs?" b. "You can't have the hardest assignment and yet your co-workers don't see that and hate you. How can you be so sure that you're hated?" c. "I think you should sit down and talk out your feelings with your boss. Perhaps you can come to a more agreeable situation with your co-workers." d. "Let me see if I understand. Your assignment appears to be easy, but it is really difficult. You feel your co-workers won't see that it's hard, and they'll hate you."

ANS: D This is a difficult situation. The patient is cognitively distorting the situation. Catastrophizing is thinking the worst about people and events. There may be other distortions, but using cognitive behavioral therapy involves separating issues for the patient to examine. DIF: Cognitive Level: Analysis REF: Text Page: 564 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

25 A patient is seeking help after being diagnosed with hypertension. A nurse plans to include questions about sexual health in the assessment. Which question would be most effective to introduce this topic? a. "Which elements of sexual dysfunction have you noticed since your diagnosis of hypertension?" b. "I assume your hypertension hasn't caused you any significant problems with sex, has it?" c. "How are you and your partner getting along sexually since you've developed hypertension?" d. "Can you identify any changes in your sexual activity since you learned about your hypertension?"

ANS: D This open-ended question is more sensitive than the other answers and is worded so as to make the patient more comfortable in answering, encouraging the patient to share information. DIF: Cognitive Level: Application REF: Text Page: 502 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity: Physiological Adaptation

25 When a patient tells a nurse, "I think I'm impotent," which response by the nurse would be most therapeutic? a. "That must be very scary for you." b. "How is your overall health?" c. "What medications are you currently taking?" d. "Please tell me what you mean by 'impotent.'"

ANS: D Validating terminology is a vital first step. After the nurse understands the patient's complaint, further assessment can take place. DIF: Cognitive Level: Application REF: Text Page: 502 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity