BH Final- Chapters 21, 16, 22,23, 24, 27, 26, 25, 28, 30, 31, 17, 15

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

3 Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 548 Feedback: The most frequent side effects from cholinesterase inhibitors include gastrointestinal distress, such as nausea, vomiting, and diarrhea. Other side effects include constipation, ataxia, insomnia, and skin rashes.

12. As part of a community program on crisis prevention, a nurse is describing the phases of crisis. Which event would the nurse identify as occurring first? A) Person has a problem that doesn't "fit" with their usual problem-solving methods B) Trial and error attempts to alleviate the problem C) Automatic relief behaviors take over as the "fight-or-flight" hormones dissipate D) Person has serious personality disorganization

A Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 1 Page Number: 208, 209 Feedback: A crisis occurs in phases as identified by psychiatrist Gerald Caplan. A crisis occurs when a person faces a problem that cannot be solved by customary problem-solving methods. When the usual problem-solving methods no longer work, a person's life balance or equilibrium is upset, and the person uses trial and error to solve the problem. These attempts fail, and the anxiety rises to severe or panic levels, whereby the person then adopts automatic relief behaviors. When these fail, anxiety overwhelms the person and leads to serious personality disorganization, which signals the person is in crisis.

11. A nurse is reviewing with new graduate nurse's information about the types of crisis. The new nurses demonstrate understanding of the information when they identify which event as a developmental crisis? A) Going away to college B) Obtaining a job promotion C) Loss of a pet D) Earthquake

A Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 1 Page Number: 209, 210 Feedback: A developmental crisis is one that occurs with normal growth and development, such as going away to college. Obtaining a job promotion or loss of a pet is an example of a situational crisis. An earthquake is an example of a traumatic crisis.

6. A Red Cross nurse is working with tornado victims. The nurse is interviewing a client whose house was totally destroyed during the night by the tornado. The client's cat died as a result of the tornado. Which statement by the client does the nurse expect to hear? A) "I don't know. I can't feel anything right now. Nothing seems real." B) "Devastated. . . . I just feel totally devastated. I don't know how I can go on living." C) "I just want my insurance man to get here so I can file a claim. Everything I had is gone." D) "I always thought my cat would die peacefully in my arms. Now I'll never be able to hold her again."

A Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 213 Feedback: In the beginning of the crisis, the victim may report the feeling of numbness and shock. The reality of the client's loss has not had sufficient time to "sink in." When it does, the client will experience intense emotions regarding the loss.

10. A nurse is working as part of a community disaster response team. When responding to a community disaster, the nurse integrates understanding of individuals' responses, anticipating which of the following? A) People can become aggressive and violent when their basic needs are threatened. B) People involved in the disaster will always put the welfare of others before their own. C) Losses incurred during the disaster have little, if any, long-term effect on victims. D) The psychological distress associated with disasters is felt immediately.

A Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 219 Feedback: In a disaster, shelter, money, and food may not be available. The absence of basic human needs such as food, a place to live, or immediate transportation quickly becomes a priority that may precipitate acts of violence. Additionally, the victims may experience economic distress because of job loss and loss of other resources. This may ultimately lead to psychological distress, potential acts of aggression, and other mental health problems. Long-term mental health consequences are evident in most disasters.

18. A client has been in a physically abusive relationship for more than a decade. Which statement best demonstrates that the client understands of how fear can influence a reluctance to leave such a relationship? A) "My partner would hunt me down and kill me for sure." B) "The kids love my partner and my partner has been a good parent to them." C) "I do not have a job or anyway to support myself and my kids." D) "No one would believe me if I tell them how terrible life has been."

A Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 3 Page Number: 244, 245 Feedback: Leaving an abusive relationship is a process that can be quite complex. Fear is one of the most important factors in deciding whether to leave or to stay in a violent relationship. Victims recognize the valid concern that leaving may not stop the violence. If victims attempt to leave or actually do leave the relationship, perpetrators often escalate their violence, stalk their partners, and may even kill them, which makes leaving the time of greatest risk in intimate partner violence. While all the options present reasons to stay, the most compelling is fear of future violence and possible death. Multiple Select

2. The nurse is caring for a young adult in the mental health clinic. The client tells the nurse about the physical neglect that the client experienced as a child. The nurse should assess the client for symptoms of which condition? A) Major depression B) Schizophrenia C) Narcissistic personality disorder D) Panic disorder

A Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 254 Feedback: An important outcome of nursing intervention with survivors is appropriate treatment of any disorder resulting from abuse like acute stress disorder, PTSD, anxiety disorders, dissociative identity disorder (DID), major depression, or substance abuse.

1. The nurse is talking to a client who is a survivor of intimate partner violence. The client believes that their spouse has the characteristics of an antisocial personality disorder. The client also informs the nurse that the spouse has an extensive criminal record. The nurse interprets this information and suspects that the client's spouse would most likely demonstrate which behavior? A) A risk for aggressive and assaultive violence toward people within and outside of the family B) Intermittent remorse for the violence and abuse committed C) Symptoms of depression along with feelings of inadequacy D) Purposefully remaining socially isolated from people other than those in the family

A Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 240 Feedback: Evidence suggests that when people with borderline personality disorder are distressed, they are predisposed to interpret social situations as threatening and to respond with emotional dysregulation, verbal attacks, and physical violence. People who meet the diagnostic criteria of antisocial personality disorder, have an extensive history of criminal behavior, and who are generally violent are also more likely to be both aggressive and assaultive. These perpetrators have a heightened sensitivity to emotional displays that predispose them to interpret social situations as threatening, and to respond with emotional dysregulation, verbal attacks, and physical violence.

12. A nurse is assessing a client who is a survivor of abuse. Which form of evaluation is appropriate to use when conducting a lethality assessment? A) Danger Assessment Screen B) Abuse Assessment Screen C) Burgess-Partner Abuse Scale D) Beck Depression Inventory

A Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 5 Page Number: 245 Feedback: The Danger Assessment Screen developed by Jacquelyn Campbell and colleagues is a useful tool for assessing the risk that either the adult survivor or perpetrator will commit homicide. It would be appropriate to use when conducting a lethality assessment. The Abuse Assessment Screen and Burgess-Partner Abuse Scale are appropriate tools to use to screen for violence and abuse. The Beck Depression Inventory is used to screen for depression.

15. A nurse is interviewing a client about their sleep patterns. The client tells the nurse that they go to bed about 11 PM and usually falls asleep by 11:15 PM. The nurse identifies this time period as which of the following? A) Sleep latency B) Sleep architecture C) Sleep efficiency D) Slow-wave sleep

A Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: e-10 Feedback: Sleep latency is the time period measured from lights out, or bedtime, to initiation of sleep. Sleep architecture is the pattern of non-rapid eye movement (NREM) and rapid eye movement (REM) that are in approximately a 90- to

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

A Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 4 Page Number: e-17 Feedback: Zolpidem is a benzodiazepine receptor agonist that exerts its effects by facilitating GABA effects. Serotonin, dopamine, and norepinephrine are not involved.

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

A Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 2 Page Number: e-20 Feedback: The overwhelming urge to sleep is the primary symptom of narcolepsy. This irresistible urge to sleep occurs at any time of the day, regardless of the amount of sleep the client has had. Falling asleep often occurs in inappropriate situations, such as while driving a car or reading a newspaper. These sleep episodes are usually short, lasting 5 to 20 minutes, but may last up to an hour if sleep is not interrupted. Individuals with narcolepsy may experience sleep attacks and report frequent dreaming. They usually feel alert after a sleep attack, only to fall asleep unintentionally again several hours later. Excitement with leg restlessness, worrying, an inability to relax, and the use of sleeping pills are not associated with narcolepsy.

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

A Chapter: 28 Client Needs: Safe and Effective Care Environment: Safety and Infection Control Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 4 Page Number: e-14 Feedback: Safety is a priority for people with insomnia. Sleep deprivation can lead to accidents, falls, and injuries, especially in older clients. Sedating medication could potentially increase falls.

20. The nurse is assessing a child being evaluated for a diagnosis of an autism spectrum disorder. Which example of dysfunctional communication is the nurse likely to observe? A) When the nurse uses the phase, "tell me about," the child repeats the phrase rather than responding appropriately, mimicking the words and phrases spoken by others. B) The child clearly prefers using sign language rather than the spoken word to communicate. C) Regularly responds to questions using a jumble of words that lack true meaning. D) Communicates using a vocabulary that centers on shrieks and clicking sounds.

A Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 1 Page Number: 513 Feedback: In a child with an autism spectrum disorder, impairment in communication is severe and affects both verbal and nonverbal communication. Children with an autism spectrum disorder may manifest delayed and deviant language development, as evidenced by echolalia (repetition of words or phrases spoken by others). Sign language, word salad, and alternate sounds are not associated with communication methods generally used by those diagnosed on the autism spectrum. WWW.NURSYLAB.COM

7. The nurse educates a client's parents about cognitive impairment and adaptive behavior. The nurse determines that additional education is needed when the parent identifies which type of skill as being involved with adaptive behavior? A) Intellectual skill B) Conceptual skill C) Social skill D) Practical skill

A Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Remember Integrated Process: Teaching/Learning Objective: 1 Page Number: 512 Feedback: Adaptive behavior is composed of three skill types: conceptual skills (language and literacy, money, time, number concepts, and self-direction); social skills (interpersonal skills, social responsibility, self-esteem, gullibility, social problem solving, and the ability to follow rules and obey laws and to avoid being victimized); and practical skills (activities of daily living, occupational skills, health care, travel and transportation, schedules and routines, safety, use of money, use of telephone).

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

A Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 3 Page Number: 516 Feedback: Managing the repetitive behaviors depends on the specific behavior and its effect on others and the environment. Because the rocking has no negative effects, ignoring it may be the best approach. If the behavior is unacceptable, redirecting the child and using positive reinforcement are recommended.

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

A Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Teaching/Learning Objective: 3 Page Number: 516 Feedback: Managing the repetitive behaviors of these children depends on the specific behavior and its effects on others or the environment. If the behavior, such as rocking, has no negative effects, ignoring it may be the best approach. If the behavior, such as head banging, is unacceptable, redirecting the child and using positive reinforcement are recommended. In some cases, especially in severely delayed children, these strategies may not work, and environmental alterations and perhaps protective headgear are needed.

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

A Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 3 Page Number: 556 Feedback: Many psychiatric medications affect blood pressure. Generally, these medications may cause orthostatic hypotension, which can lead to dizziness, an unsteady gait, and falls. A baseline blood pressure is needed to effectively monitor medication side effects. Telling the client to stop taking the medications is inappropriate. Asking family members about the client's coping skills and stress level would provide no information about the client's complaints. Using a nonalcohol-based mouthwash would be appropriate for combating dry mouth.

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

A Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 3 Page Number: 537 Feedback: Medical treatment of people with Parkinson disease typically involves anticholinergics and dopamine agonists. In clients with dementia caused by Parkinson disease, anticholinergic medications are likely to increase cognitive impairment.

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

A Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 3 Page Number: 552 Feedback: The threshold for stress is progressively lowered in people with Alzheimer disease and other progressive dementias. A healthy person frequently uses cognitive coping strategies when under stress, but a person with dementia can no longer use many of these strategies. Commonly used therapeutic approaches may exacerbate anxiety in a client with dementia. For example, reality orientation is usually an effective intervention for acutely confused clients. Reality orientation is contraindicated in those with dementia because it is possible that the client's disoriented behavior or language has inherent meaning. If the disoriented behavior or language is continuously neglected or corrected, the client's sense of isolation and anxiety may increase. Effective nursing interventions include simplifying routines, making routines as consistent and predictable as possible, reducing the number of choices the client must make, identifying areas in which control can be maintained, and creating an environment in which the client feels safe. WWW.NURSYLAB.COM Powered by TCPDF (www.tcpdf.org) Downloaded by: zankiamb5511 | [email protected]

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

A Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 535, 536 Feedback: Delirium is typically caused by medications, urinary or upper respiratory tract infections, fluid and electrolyte imbalances, and metabolic disturbances. Therefore, questioning the son about the client's medication use would be most appropriate. Head injury or stroke may lead to changes in consciousness but not delirium. Although acute or chronic stress may be a risk factor for the development of delirium, this would not be the most appropriate question to ask at this time.

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

A Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 552 Feedback: During a catastrophic reaction, the nurse should remain calm, minimize environmental distractions (quiet the environment), get the client's attention, and softly assure the client that he or she is safe. Give information slowly, clearly, and simply, one step at a time, letting the client know that the nurse understands the fear or other emotional response, such as anger or anxiety.

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

A Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 1 Page Number: 536 . Feedback: With dementia, the client's cognition is stable throughout a 24-hour period, but with delirium, the client's cognition fluctuates. Hallucinations are possible with dementia. Psychomotor activity is normal, and cognition is globally impaired with dementia. Multiple Select

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

A Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 3 Page Number: 549 Feedback: The therapeutic relationship is the basis for interventions for the client and family with dementia. Care of the client entails a long-term relationship needing much support and expert nursing care. Interventions should be delivered within the relationship context. Medication therapy, injury prevention, and promoting independent functioning within the limits of the disorder are important components of care, but the therapeutic relationship is critical.

14. A child is prescribed atomoxetine to treat ADHD. When educating the child and parents about common side effects, which does the nurse include? (Select all that apply.) A) Headache B) Abdominal pain C) Decreased appetite D) Nervousness E) Dyskinesias

A, B, C Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Integrated Process: Teaching/Learning Objective: 4 Page Number: 521 Feedback: Common side effects of atomoxetine include headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea. Nervousness and dyskinesias are associated with methylphenidate. Multiple Choice

15. An adolescent client has recently ended a physically and emotionaly abusive initimate relationship. What nursing assessment question(s) will help identify a commonly associated comorbid mental health problem? (Select all that apply.) A) "How much alcohol do you drink in an average week?" B) "Do you ever have thoughts of hurting or killing yourself?" C) "Are your teachers satisfied with the grades you earn in school?" D) "How would you alter your eating habits in order to lose wieght?" E) "Has anyone every told you that you had a problem with your temper?"

A, B, C, D Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 1 Page Number: 240 Feedback: Adolescents who experience violence in intimate relationships are more likely to develop problems such as depression with consideration of suicide, substance use disorders including alcohol use disorder, eating disorders resulting in weight loss, and poor school performance. While not impossible, anger management issues are not as commonly associated with this client's situation. Multiple Choice

18. The nurse is providing medication education to an adult client who has recently been prescribed methylphenidate. Which statement(s) made by the client suggests that the education has been effective? (Select all that apply.) A) "I will be asked periodically to stop taking the medication for short periods?" B) "This medication is not safe for me to take if I start feeling really anxious again." C) "My primary health care provider needs to know if my appetite starts to decrease." D) "It is important that my blood pressure be monitored closely while taking this medication." E) "I need to stop smoking because nicotine decreases the therapeutic effect of this medication."

A, B, C, D Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 4 Page Number: 521 Feedback: Methylphenidate therapy can result in anorexia and increased blood pressure. The drug is discontinued periodically to assess the client's condition and evaluate the effectiveness of the medication. A contraindication for this therapy includes marked anxiety. Although nicotine use has health-related risks, it is not known to affect the effectiveness of this medication.

17. The nurse is interviewing the parents of a child being treated for Tourette syndrome. Which assessment question(s) is relevant when evaluating this child? (Select all that apply.) A) "Have teachers ever mentioned your child having difficulty in class?" B) "Does your child have difficult concentrating on tasks or problems?" C) "Would you describe your child as a worrier?" D) "Are ritual behaviors important to your child?" E) "Is your child easily angered?"

A, B, C, D Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 5 Page Number: 523 Feedback: Some children with Tourette syndrome have attention deficient hyperactivity disorder, and a substantial percentage have symptoms of the anxiety-based disorder obsessive--compulsive disorder. Therefore, in addition to inquiring about tics, the nurse should assess the child's overall development, activity level, and capacity to concentrate and persist with a single task, as well as explore repetitive habits and recurring worries. Anger and aggression are not generally associated with Tourette syndrome.

19. A nurse is working with a client who is in crisis. Which actions by the nurse would be appropriate? (Select all that apply.) A) Support the client's cultural beliefs about expressing feelings. B) Encourage the client to focus on one aspect at a time. C) Provide the client with an understanding that everything will be okay. D) Explain information clearly to clarify any misconceptions or myths.

A, B, D Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Caring Objective: 4 Page Number: 214 Feedback: The nurse should focus on what the information means to the client. Supporting the client's cultural beliefs about expressing his or her feelings, encouraging the client to focus on one thing at a time, and explaining information clearly are appropriate. Telling the client that everything will be okay is false reassurance and blocks communication. Multiple Choice

20. The nurse is providing care to client who is currently in a sexually abusive relationship. To best manage the development of additional comorbid disorders, what question(s) should the nurse ask this client? (Select all that apply.) A) "What community resources related to HIV and pregnancy are you aware of?" B) "What are the early symptoms of posttraumatic stress disorder (PTSD)?" C) "Are you aware of self-defense strategies to physically protect oneself?" D) "Do you have a safety and escape plan in place?" E) "What do you do to avoid angering your abuser?"

A, B, D Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Communication and Documentation Objective: 5 Page Number: 253 Feedback: Information should focus on effective safety and health promotion interventions including relevant health screenings, early symptom identification, and safety plans. Physical self-defense strategies may be acquired but they are an established method of assuring safety in abusive situations. The anger is unpredictable, unavoidable, and outside the control of the abused.

19. The nurse is providing educational information to the parents of a child diagnosed with a chronic mental health disorder. Which statement(s) made by a parent reflects common emotions demonstrated by parents dealing with this challenge? (Select all that apply.) A) "All we ever wanted was a healthy, happy child." B) "We did everything right; we do not deserve this." C) "No one else in our family has ever had this sort of challenge." D) "I should have taken better care of myself during my pregnancy." E) "My child will certainly outgrow these problems especially with the right care."

A, B, D, E Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Caring Objective: 3 Page Number: 516 Feedback: Parents may manifest denial, grief, guilt, and anger at various points as they adjust to their child's condition. The nurse can offer parents the opportunity to express their frustrations and disappointments and can be alert for indications that parents are in need of additional assistance, such as parent support groups or respite care. Expressing a possible lack of meaningful help from family is a concern rather than any emotion mentioned above. Multiple Choice

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

A, C, D, E Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 3 Page Number: 536 Feedback: Risk factors associated with delirium include infection, advanced age, hypotension, acute or chronic stress, bone fractures, and electrolyte or metabolic imbalances, such as dehydration and hyponatremia. Multiple Choice

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

A, C, E Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 537 Feedback: Drugs associated with delirium include propranolol, diphenhydramine, and quinidine. Special attention should be given to combinations of these medications because drug interactions can cause delirium. Acetaminophen and verapamil are not typically associated with delirium. Multiple Choice

14. After teaching a class about circadian rhythm disorders, a nursing instructor determines that the education was successful when the class identifies which of the following as a subtype identified in the DSM-5? (Select all that apply.) A) Delayed sleep phase B) Nightmare C) Sleep terror D) Shift work type E) Jet lag type

A, D Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 2 Page Number: e-23 Feedback: According to the DSM-5, subtypes of circadian rhythm disorders include a delayed sleep phase and shift work type. Although jet lag type is a circadian rhythm sleep--wake disorder, it is not included in the DSM-5. Nightmare and sleep terror are separate disorders. Multiple Choice

13. A nursing instructor is describing the prevalence of sleep--wake disorders as being greater in individuals with mental health disorders. Which disorders would the instructor include as being associated with sleep--wake disorders? (Select all that apply.) A) Depression B) Borderline personality disorder C) Schizophrenia D) Posttraumatic stress disorder E) Anxiety

A, D Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 1 Page Number: e-9 Feedback: Sleep--wake disorders occur independently of the diagnosis of other mental disorders, but they are also seen in people with mental disorders. For example, a core feature of posttraumatic stress disorder (PTSD) is sleep disturbance. Insomnia often increases the risk for relapse of the mental disorder. Documented comorbid conditions include cardiovascular disorders, diabetes, musculoskeletal disorders, respiratory disorders, digestive disorders, pain conditions, and mental disorders including depression, PTSD, and other sleep disorders such as sleep apnea, and restless legs syndrome (RLS). OSA is not associated with borderline personality disorder or schizophrenia.

19. A person found quilty of physically abusing a domestic partner is offered participation in a rehabilitation program as part of the sentencing process. What information should the nurse provide the individual in order to make an informed decision about accepting the offer? (Select all that apply.) A) The program will likely last between 36 weeks and 5 years. B) No contact with the abused partner and/or children will be allowed. C) The participant is responsible for paying a fee to cover program expences. D) If alcohol is a factor, sobriety during the entire period of the program is mandatory. E) When applicable, random drug testing is a criteria of the program's acceptance.

A, D, E Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 6 Page Number: 254 Feedback: Programs meet weekly for an extended period of time, often 36 to 48 weeks. Some programs advocate longer programs, believing that chronic offenders require from 1 to 5 years of treatment to change abusive behavior. When applicable, intervention programs may require abusers to undergo substance use treatment concurrently, so clients are required to remain sober and to submit to random drug testing. States vary on requiring that treatment programs for abusers contact partners and there is usually no fee if the program is mandated by the court.

12. A nurse is preparing an education session for parents of children with autism spectrum disorder. When describing problems associated with communication, which of the following would the nurse most likely include as common? (Select all that apply.) A) Repetition of words or phrases B) Abstract interpretation of language C) Early language development D) Reversal of pronouns E) Abnormal intonation

A, D, E Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Remember Integrated Process: Nursing Process Objective: 3 Page Number: 513 Feedback: The impairment in communication is severe and affects both verbal and nonverbal communication. Children with autism spectrum disorder may manifest delayed and deviant language development, as evidenced by echolalia (repetition of words or phrases spoken by others) and a tendency to be extremely concrete in interpretation of language. Pronoun reversals and abnormal intonation are also common. Multiple Choice

16. The nurse provides care to individuals who have been sexually assaulted during their childhood. Which characteristic is most commonly noted by the nurse during an assessment of such clients? A) Overly self-confident B) Unusually aggressive C) Overly social D) Too trustful

B Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Assessment Objective: 1 Page Number: 242 Feedback: A child who is a survivor of prolonged sexual abuse will develop low self-esteem, as well as developing feelings of worthlessness, and become socially withdrawn, distrustful, or suicidal. Other characteristics of children who have been sexually abused include becoming unusually aggressive.

2. A client's 5-year-old poodle ran in front of a car and was killed. The client continues to be upset by the pet's death and exclaims to a community counseling center nurse that "My Precious meant the world to me, and now my world will never be the same!" If the nurse were to determine that the client is experiencing a crisis, which type of crisis is it most likely to be? A) Maturational B) Situational C) Traumatic D) Developmental

B Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 1 Page Number: 210 Feedback: A situational crisis occurs whenever a specific stressful event threatens a person's biopsychosocial integrity and results in some degree of psychological disequilibrium. The pet's death caused the client to experience a degree of psychological disequilibrium. A developmental or maturational crisis is one involving normal growth and development. A traumatic crisis is initiated by unexpected, unusual events that affect an individual or multitude of people.

7. A nurse is part of team working with hurricane victims. One of the victims is staying in a temporary shelter provided by the Red Cross. To determine the extent to which this victim can cognitively cope with his situation and how much support he needs, which question would be most appropriate for the nurse to ask? A) "What kind of help do you need from us?" B) "What are your thoughts about what you will do during the next few days?" C) "How are you feeling about all that you have gone through?" D) "Are you feeling guilty because you survived and some of your neighbors did not?"

B Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 213 Feedback: By assessing the victim's ability to solve problems, the nurse can evaluate whether the victim can cognitively cope with the crisis situation and determine the kind and amount of support needed. At this point in time, the client may not be able to identify the type of help he needs or what he will be doing for the next few days. Asking about feeling guilty is inappropriate. Additionally, this is a closed-ended question that does not allow the victim to explore what he is feeling.

5. An individual is seeking employment as a nurse in a crisis center. The interviewer asks the job candidate what the candidate would ask someone who called the crisis hotline in order to determine whether the caller is experiencing a crisis. Which response would be most appropriate? A) "To what extent are you involved in a crisis situation?" B) "Tell me about what you are experiencing and what it means to you." C) "How would you rate your level of functioning on a scale from 1 to 10?" D) "Why do you think you are in a crisis situation?"

B Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 213, 214 Feedback: The response to the crisis will also depend on the meaning of the event to the victim. Telling someone to describe what they are experiencing and what that experience means to them elicits more information than asking a person to quantify the extent of the crisis. Asking someone "Why" tends to put an individual on the defensive because the question implies that the individual needs to "justify" his or her perception. Asking about the extent of the crisis would be difficult for the person to answer. In addition, it already assumes that the client is in crisis. Rating the level of functioning would be important information to ask later, after establishing what the client is experiencing.

17. After educating a client about crisis, the nurse determines that the education was successful when the client makes which statement? A) "Crisis triggers maladaptive responses" B) "Crisis is a time-limited event" C) "Chronic crisis is a real situation" D) "Events causing a crisis are similar for everyone"

B Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 1 Page Number: 208 Feedback: Crisis is a time-limited event (usually no more than 4 to 6 weeks) that triggers adaptive or nonadaptive responses to maturational, situational, or traumatic experiences. By definition, there is no such thing as a chronic crisis. People who live in constant turmoil are not in crisis but in chaos. Although the feelings associated with a crisis are similar, the precipitating event and circumstances are unusual or rare, perceived as a threat and specific to the individual.

20. A nurse is reviewing information about grief and bereavement with the family of a client who recently died. Which statement by the nurse provides appropriate information? A) Grief and bereavement are used interchangeably as responses to loss. B) Bereavement is the process of mourning and grief is the emotional reaction. C) Grief involves confronting the stress, but bereavement helps avoid the stresses. D) Bereavement is influenced by culture, but grief is not.

B Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 2 Page Number: 210 Feedback: Grief is an intense, emotional reaction to the loss of a loved one. The reaction is a biopsychosocial response that often includes spontaneous expression of pain, sadness, and desolation. Bereavement is the process of mourning and coping with the loss of a loved one. It begins immediately after the loss, but it can last months or years. Individual differences and cultural practices influence grieving and bereavement.

9. A nurse is explaining to a new nurse on the team about how to respond to individuals who are in the midst of a disaster. Which statement would be most appropriate to include about initial nursing interventions for such individuals? A) "You should ask them to give you a brief medical history so their physical needs can be met." B) "Focus on safety needs and provide simple, clear instructions to help them function effectively." C) "Help them determine what their long-term goals will be so they can maintain a sense of hope." D) "Try to redirect their attention away from the problems at hand so you can decrease their anxiety."

B Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 4 Page Number: 220 Feedback: When responding to a disaster, the nurse would follow the ABCs of psychological first aid: arousal, behavior, and cognition. Thus, the first area to address is arousal. When arousal is present, the intervention goal is to decrease excitement by providing safety, comfort, and consolation. When abnormal or irrational behavior is present, survivors should be assisted to function more effectively in the disaster. If cognitive disorientation occurs, reality testing and clear information should be provided. In the initial phases, the nurse should assist the victim in focusing on the reality of problems that are immediate, with specific goals that are consistent with available resources and with the culture/lifestyle of the victim.

14. A nurse is describing uncomplicated grief during a presentation. Which statement should the nurse include in the presentation? A) Uncomplicated grief differs from normal grief because it lasts longer. B) Most bereaved persons experience uncomplicated grief. C) Uncomplicated grief is primarily loss associated with death. D) This type of grief is less painful and disruptive than normal grief.

B Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Teaching/Learning Objective: 2 Page Number: 211 Feedback: Most bereaved people experience normal or uncomplicated grief after the loss of a loved one. Uncomplicated grief is painful and disruptive. It can be applied to situations other than loss because of death. Multiple Select

10. A nurse is reviewing information about intimate partner violence (IPV). The nurse demonstrates understanding of this topic when the nurse identifies which information? A) Men are more likely to be seriously injured even though more women are typically victims. B) Victims in same-sex couples often receive less support. C) IPV in same-sex couples occurs less frequently as compared with heterosexual relationships. D) The reactions to IPV are similar in male and female victims.

B Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 1 Page Number: e-16, 240 Feedback: Nonheterosexual couples experience IPV at rates similar to heterosexual couples, but victims often receive less support as a result of social stigma associated with nontraditional relationships. Nearly one in four women and one in nine men are victims of IPV at some point in their lives. Women are much more likely than men to be seriously injured as a result of IPV and to require medical treatment. The reaction to IPV may differ by gender.

14. A nurse is developing a safety plan with a client who is a survivor of violence. Which aspect of the plan would the nurse address first? A) Devising an escape route B) Recognizing the signs of danger C) Identifying a safe place to hide D) Identifying a signal to indicate it is safe to leave

B Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 5 Page Number: 251 Feedback: One of the most important teaching goals is to help survivors develop a safety plan. The first step in developing such a plan is helping the survivor recognize the signs of danger. Changes in tone of voice, use of alcohol and other drugs (AOD), and increased criticism may indicate that the perpetrator is losing control. Detecting early warning signs helps survivors to escape before battering begins. The next step is to devise an escape route. This involves mapping the house and identifying where the battering usually occurs and what exits are available. The survivor needs to have a bag packed and hidden, but readily accessible, containing what is needed to get away. If children are involved, the adult survivor should make arrangements to get them out safely. That might include arranging a signal to indicate when it is safe for them to leave the house and to meet at a prearranged place. A safety plan for a child or dependent older adult might include safe places to hide and important telephone numbers, including 911, police and fire departments, and other family members and friends. Multiple Select

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

B Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 246 Feedback: Most survivors do not report violence to health care workers without specifically being asked about it. Survivors may be reluctant to report abuse because of shame and fear of retaliation, especially if the victim depends on the abuser as caregiver. In addition, children may fear they will not be believed.

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

B Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 253 Feedback: Survivors must understand the cycle of violence and the danger of homicide that increases as violence escalates, or when the survivor attempts to leave the relationship. Although survivors also need information about resources (e.g., shelters for battered women), legal services, government benefits, and support networks, the nurse needs to first discuss the possibility of the perpetrator's reaction and the possibility of extreme violence leading to death.

11. A group of newly hired nurses is receiving training about the types of abuse. The nurses demonstrate understanding of the information when they identify a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency as which crime? A) Rape B) Stalking C) Sexual assault D) Intimate partner violence

B Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 1 Page Number: e-18, 242 Feedback: Stalking is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency. Stalkers harass and terrorize their victims through behavior that causes fear or substantial emotional distress. Stalking may include such behaviors as following someone, showing up at the person's home or workplace, vandalizing property, using technology to track or harass someone, or sending unwanted gifts.. Rape is a crime of violence. Sexual assault is any form of nonconsenting sexual activity. Intimate partner violence occurs on a continuum and can involve the other types of violence listed here.

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

B Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Teaching/Learning Objective: 2 Page Number: 243 Feedback: Violent families create an atmosphere of tension, fear, intimidation, and tremendous confusion about intimate relationships. Children in violent homes often learn violent behavior as an approved and legitimate way to solve problems, especially within intimate relationships. Social learning or intergenerational transmission of violence theory posits that children who witness violence in their homes often perpetuate violent behavior in their families as adults. Moreover, children who grow up in violent homes learn to accept violence and expect it in their own adult relationships. Neurochemical imbalances, genetics, or skipping generations are unrelated to this theory.

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

B Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: e-14 Feedback: Insomnia has a greater prevalence among older people and among divorced, separated, and widowed adults. Increasing age, female sex, and comorbid disorders (e.g., medical, mental disorders, and substance use) are all risks for developing insomnia disorder.

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

B Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: e-16 Feedback: Nonpharmacologic, health-promoting interventions are the first choice before administering pharmacologic agents. Sleep hygiene strategies, such as keeping regular times for going to bed and rising, are effective and should be encouraged. The goal is to normalize sleep patterns to improve well-being.

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

B Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 4 Page Number: e-17 Feedback: The nurse can help the client develop bedtime rituals and good sleep hygiene. Bedtime should be at a regular hour, and the bedroom should be conducive to sleep. Preferably, the bedroom should not be a place where the individual watches television or does work-related activities. The bedroom should be viewed as a room for sleeping and sex, and the environment should be cool, with minimal lighting.

16. What characteristic will the nurse note regarding a client who is experiencing dysfunctional slow-wave sleep? A) Easy arousal B) Generally feeling "unrested" C) Electroencephalogram shows K complexes D) Alpha rhythm is gradually being replaced by theta rhythm

B Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Understand Integrated Process: Nursing Process Objective: 1 Page Number: e-12 Feedback: Slow-wave sleep, or the deepest state of sleep, characterizes stages 3 and

4. The nurse is preparing to initiate a behavioral treatment program for a child with encopresis. Which would the nurse implement first? A) Administration of mineral oil B) Bowel cleansing C) Low-fiber diet D) Toilet sitting after each meal

B Chapter: 30 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Understand Integrated Process: Nursing Process Objective: 8 Page Number: 530 Feedback: Before initiating behavioral treatment, cleaning out the bowel is usually necessary in many cases. The bowel catharsis is usually followed by administration of mineral oil, which is often continued during the bowel retraining program. A high-fiber diet is often recommended. The behavioral treatment program follows, which involves daily sitting on the toilet for a predetermined period after each meal.

6. A nurse is reviewing medications used to treat attention deficit hyperactivity disorder. The nurse identifies methylphenidate as which class of medication? A) Selective serotonin reuptake inhibitor B) Psychostimulant C) Noradrenergic reuptake inhibitor D) Alpha agonist

B Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Integrated Process: Teaching/Learning Objective: 4 Page Number: 520, 521 Feedback: Methylphenidate is a psychostimulant. Fluoxetine is an example of a selective serotonin reuptake inhibitor. Atomoxetine is a noradrenergic reuptake inhibitor. Alpha agonists include guanfacine and clonidine.

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

D Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 546 Feedback: Catastrophic reactions are overreactions, or extreme anxiety reactions, to everyday situations. As the disease progresses, the client may exhibit catastrophic responses such as night awakening, wandering, agitation, and panic.

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

B Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 516 Feedback: When children with autism spectrum disorder are hospitalized, a consistent, structured environment with predictable routines for activities, mealtimes, and bedtimes (termed "milieu management") is necessary for successful treatment. Changes in routine, including numerous caregivers, stimulation, or "time-out" may provoke disorganization in the child, leading to emotional disequilibrium and explosive behavior. The safety of the inpatient unit offers an opportunity to try behavioral strategies, such as rewards for managing transitions. Time-out would be appropriate for aggressive or assaultive behavior. Multiple Select

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

B Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 3 Page Number: 527, 528 Feedback: For the child with a communication disorder, the interventions focus on fostering social and communication skills and making referrals for specific speech or language therapy. Modeling appropriate communication in spontaneous situations with the child can be a useful intervention for some children. Nonverbal activities or stopping the child if stuttering begins would not foster the development of communication skills. Medication therapy is not used for communication disorders.

5. A nurse is assessing a girl age 8 years with a mood disorder. Which would the nurse expect to assess? A) Statement from the child that she feels sad B) Behavioral problems C) Recurrent obsessions D) Ritualistic behavior

B Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 7 Page Number: 528 Feedback: Children with mood disorders may not spontaneously express their feelings (sadness, irritability) and are more likely to show their suffering through their behavior. These children may act out their feelings rather than discuss them. Thus, behavior problems may accompany depression. Recurrent obsessions and ritualistic behavior would suggest obsessive--compulsive disorder.

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

B Chapter: 31 Client Needs: Health Promotion and Maintenance Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 3 Page Number: 535 Feedback: Impaired consciousness is the key diagnostic criterion for delirium. The client becomes less aware of his or her environment and loses the ability to focus, sustain, and shift attention. Cognitive changes include problems with memory, orientation, and language. The client may not know where he or she is, may not recognize familiar objects, or may be unable to carry on a conversation. This problem developed during a short period.

18. A nursing instructor is preparing a presentation on the etiology of Alzheimer disease. When discussing the role of neurotransmitters in the course of the disease, which of the following would the instructor most likely emphasize? A) Serotonin B) Acetylcholine C) Dopamine D) Norepinephrine

B Chapter: 31 Client Needs: Physiological Integrity: Physiological Adaptation Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 2 Page Number: 541 Feedback: Acetylcholine is a major neurotransmitter involved with Alzheimer disease (AD). Cell loss in the nucleus basalis leads to deficits in the synthesis of cortical acetylcholine, but the number of ACh receptors is relatively unchanged. The reduced ACh is related to a decrease in choline acetyltransferase (a critical enzyme in the synthesis of ACh), especially in the forebrain. That is, there are fewer enzymes available to synthesize ACh, which leads to a reduction in cholinergic activity. Other neurotransmitters that are affected include norepinephrine and serotonin. Deficiencies in norepinephrine are associated with a loss of cells in the locus ceruleus, and neuronal loss in the raphe nuclei leads to a loss of serotonergic activity. Dopamine is not involved with AD.

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

B Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 536, 545 Feedback: Hallucinations occur frequently in dementia and are usually visual or tactile (they can also be auditory, gustatory, or olfactory). Visual, rather than auditory, hallucinations are the most common in people with dementia.

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

B Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 3 Page Number: 537 Feedback: By interviewing family members, the nurse expands the scope of the client assessment. Moreover, the nurse has an opportunity to evaluate the caregivers themselves to determine whether they can care for the client adequately and how they are coping with the situation.

15. Assessment of a client indicates complicated grief. Which statements would the nurse identify as supporting this reaction? (Select all that apply.) A) "It's been two months, and I still want my son back." B) "I still wait for him to come right through the door every day." C) "I'm really struggling with trusting anybody anymore." D) "I wish I could go back to the days before he died." E) "Life seems so empty now that he's gone. What will I do?"

B, C, D, E Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 2 Page Number: 212 Feedback: Complicated grief, which occurs in about 10% to 20% of bereaved persons, is characterized by the person being frozen or stuck in a state of chronic mourning. They feel bitter over their loss and wish that their lives could revert to the time when they were together. In addition, the person experiences an intense longing and yearning for the deceased for more than 6 months. Additionally, the person may have trouble accepting the death, an inability to trust others since the death, excessive bitterness related to the death, and feeling that life is meaningless without the deceased person.

16. A client is experiencing traumatic grief resulting from the suicide of a family member. In addition to the usual emotions experienced with bereavement and grief, which of the following will the person most likely exhibit? (Select all that apply.) A) Acceptance of the loss B) Sense of rejection C) Disgust D) Stigmatization E) Self-blame

B, D, E Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 2 Page Number: 209, 211, 212 Feedback: Bereavement of family members for those who committed suicide seems to differ from bereavement related to other sudden deaths. Common experiences during the bereavement process of family members who committed suicide include stigmatization, shame, guilt, and a sense of rejection. The bereaved person may experience self-blame for contributing to the family member's death. Acceptance and disgust are least likely. Multiple Choice

1. The nurse is assessing a 35-year-old client who is seeking assistance at a local community counseling center. Which statement made by the client would indicate that the client is experiencing a crisis? A) "I'm so upset; my spouse has never left me like this before." B) "I'm confused and hurt; I have lost my best friend and my lover." C) "I don't understand; I can't seem to function like I usually do." D) "No matter what I do, I am still overcome by these sad feelings."

C Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 1 Page Number: 208 Feedback: Crisis occurs when there is a perceived challenge or threat that overwhelms the capacity of the individual to cope effectively with the event. Life is disrupted, and unexpected emotional (e.g., depression) and biologic (e.g., nausea, vomiting, diarrhea, headaches) responses occur. Functioning is severely impaired. Although feelings of upset, confusion, hurt, and sadness may occur with a crisis, the key component is impaired functioning.

3. A 62-year-old client has lost an 87-year-old father a week ago. The hospice nurse is making a follow-up visit to determine how the client is handling the father's death. Which statement made by the client indicates to the hospice nurse that client is in the acute mourning stage of bereavement? A) "I keep thinking about my father; I have trouble believing he's dead. I feel guilty because I didn't go to the nursing home to visit him last week!" B) "I've been grieving my father; losing him is a tremendous loss, but I have to get on with my life." C) "My father was a saint. I am so angry at God for taking him away! I'm crying all the time; I haven't been able to work for days." D) "I'm going to spend the weekend with my children; they understand what I've been going through, and I can relax around them."

C Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 3 Page Number: 212, 213 Feedback: The fact that the client is crying all the time, feeling angry for much of the time, missing work, and idealizing his father are all indicators of the acute mourning stage of bereavement. This stage is characterized by intense feeling states, social withdrawal, and identification with the deceased person. The statement about having trouble believing he is dead suggests the shock stage. The statement about grieving but having to get on with life suggests the beginning of the resolution stage, as does the statement about spending the weekend with the children to relax.

18. The nurse is providing follow-up care to victims of a disaster that occurred several months ago. Assessment of which condition would lead the nurse to suspect that the victims are experiencing possible aftereffects of the disaster? A) Tachycardia B) Profuse perspiration C) Unexplained gastrointestinal disturbance D) Tremors

C Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 6 Page Number: 219 Feedback: Unexplained physical symptoms such as headache, fatigue, pain, chest pain, and gastrointestinal disturbances have been reported in the aftermath of a disaster in both traumatized and nontraumatized populations. Tachycardia, profuse perspiration, and tremors or shakiness are more typically assessed in the period immediately after the disaster. Multiple Select

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

C Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 1 Page Number: 241 Feedback: The statement about telling child services that the client is a bad parent reflects coercion and threats. The statement about the abuse never happening reflects power and control through minimizing, denying, and blaming. The statement about whom the client can and cannot see reflects power and control through the use of isolation. The statement about the partner being the master of his castle reflects power and control through the use of the male privilege.

17. Which assessment finding should cause the nurse the greatest concern regarding the possible abuse of an older adult client? A) Has lost weight since breaking an ankle B) Has developed a urinary tract infection C) Sends money every month to each adult child D) Often cries, mourning the recent death of a beloved pet

C Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 1 Page Number: 242 Feedback: Older adults may be victims of physical, psychological, or sexual abuse. The most common type of elder abuse is financial abuse, in which older adults may be manipulated by family or caregivers to give up control of their money. While all options could be explained by non-abusing situations, the option regarding money is the most troublesome and should be researched further to confirm the lack of possible financial abuse.

3. The emergency department nurse is assessing a client with traumatic injuries. To assess whether or not the client's injuries have resulted from abuse, which question would be most appropriate for the nurse to ask the client? A) "Is your partner being mean to you?" B) "Why do you think your spouse has beaten you?" C) "It looks like someone has hurt you. Tell me about it." D) "Can you describe the person who did this to you?"

C Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Remember Integrated Process: Nursing Process Objective: 5 Page Number: 252 Feedback: The nurse should say to the client, "It looks like someone has hurt you. Tell me about it." This is an open-ended statement and allows the client to verbalize her thoughts and feelings. Asking if the partner is being mean or asking why the client thinks the spouse has beaten him or her already assumes that the client has been abused. Asking about the person who did this would be ineffective because survivors of violence are unlikely to disclose sensitive information unless they perceive the nurse to be trustworthy and nonjudgmental. Additionally, this question is a closed question that does not allow the client to verbalize her thoughts and feelings openly.

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

C Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 3 Page Number: 245 Feedback: Removing children and older adults from their families or caregivers often is necessary to ensure immediate safety. If the home of an abused or neglected child or older adult cannot be made safe, the nurse must facilitate other professionals involved in placing the child or older adult in a foster home or nursing home. Still, intervening in cases of elder abuse is not a clear-cut issue. When an older adult's decision making is not impaired (competence is the legal term), he or she must be allowed an appropriate degree of autonomy in deciding how to manage the problem, even if the choice is to remain in the abusive situation. Forcing someone to do something against his or her wishes is in itself a form of victimization and denies autonomous decision making.

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

C Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: e-16 Feedback: Caffeine causes increased sleep latency, decreased total sleep time, and decreased REM sleep. It does not affect slow-wave sleep.

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

C Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 4 Page Number: e-19 Feedback: Family and friends should be encouraged to support the new habits that the client is trying to establish. Avoiding stimulating activities and engaging in relaxing activities before bedtime are crucial, and family and friends can help create an environment conducive to sleep. Alcohol, spicy foods, and caffeine should be avoided.

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

C Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 513 Feedback: The long-term goal for this family and child is to have the child function independently as an adult. Independence may be delayed but is not impossible. Multiple Select

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

C Chapter: 31 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 548, 549 Feedback: Memantine is classified as an NMDA receptor antagonist that has been shown to improve cognition and activities of daily living in clients with moderate to severe symptoms of dementia. Risperidone, olanzapine, and quetiapine are examples of atypical antipsychotics. Galantamine, donepezil, rivastigmine, and tacrine are cholinesterase inhibitors. Clonazepam, alprazolam, and lorazepam are examples of benzodiazepines.

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

C Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 3 Page Number: 543 Feedback: Although Family Coping, Activity Intolerance, and Powerlessness may be issues, the priority nursing diagnosis is Caregiver Role Strain related to social isolation, as evidenced by the wife's statement of not being out of the house for 2 weeks. The nurse should assist the client's wife in obtaining respite care if it is available.

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

C Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 535 Feedback: The key diagnostic indicator for delirium is impaired consciousness, which is usually sudden in onset. Although infection may be an underlying cause, and other cognitive changes may occur such as problems in memory, orientation, and language, impaired consciousness developing over a short period is key. Multiple Select

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

C Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 546 Feedback: The husband is describing hypervocalization, which involves screams, cursing, moaning, groaning, and verbal repetitiveness, which reflect aberrant motor behavior. Hypersexuality is manifested by inappropriate and socially unacceptable sexual behavior, in which the client begins talking and behaving in ways that are uncharacteristic of premorbid behavior. Disinhibition is acting on thoughts and feelings without exercising appropriate social judgment, such as removing clothes in public or walking into a room naked because the client was unable to find clothes. Apathy is the inability or unwillingness to become involved with one's environment, which leads to withdrawal from the environment and a gradual loss of empathy for others.

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

C Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 540 Feedback: Agnosia is the failure to recognize or identify objects despite intact sensory function. Aphasia is alterations in language ability. Apraxia is the impaired ability to execute motor activities despite intact motor functioning. Executive functioning is the ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior.

13. A nurse is assessing the parents of a 6-year-old child who has died from leukemia. The nurse is integrating the dual process model for the assessment. Which action would the nurse identify as reflecting the parents' loss-oriented coping? A) Engaging in new activities B) Denying the grief C) Developing new relationships D) Thinking about the lost child

D Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 3 Page Number: 211 Feedback: According to the dual process model, the person adjusts to the loss by oscillating between loss-orientated coping (in which there is preoccupation with the deceased person, such as thinking about the lost child) and restoration-oriented coping (in which the bereaved person is preoccupied with stressful events as a result of the death, such as financial issues, new identity as a widow, etc.). Engaging in new activities, denying the grief, and developing new relationships reflect restoration-oriented coping.

8. A family has just lost their home in a fire. An on-call nurse from a community counseling center has been called in to the emergency department to help them with this traumatic event. Which action would the nurse identify as the priority for this family? A) Arranging for follow-up therapy to deal with the crisis B) Completing a family genogram to determine family patterns C) Assessing the impact of the loss on their lifestyle D) Arranging for emergency shelter and food supplies

D Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 4 Page Number: 214 Feedback: Safety interventions to protect people in crisis from harm should include preventing the individuals from committing suicide or homicide, arranging for food and shelter (if needed), and mobilizing social support. Additionally, the priorities of physical needs surpass those of psychosocial needs. After the individual's safety needs are met, the nurse can address the psychosocial aspects of the crisis.

4. A 25-year-old legal secretary is seeking counseling because of a recent unexpected job loss. Which question would be most appropriate for the nurse to use in assessing the client's response to this loss? A) "What happened to cause you to lose your job?" B) "How did you feel immediately after being told you no longer had a job?" C) "How do you expect yourself to be able to handle this situation?" D) "How have you responded to previous stressful situations?"

D Chapter: 15 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 4 Page Number: 214, 219 Feedback: Individual responses to a crisis can be best understood by assessing the usual responses of the person to stressful events. The response to the crisis will also depend on the meaning of the event to the person. Asking about the cause of job loss, immediate feelings, and how the person expects to handle the situation do not address the client's response to the job loss.

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

D Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 2 Page Number: 244 Feedback: During phase 3 of the cycle, the perpetrator becomes kind, contrite, and loving, begging for forgiveness and promising never to inflict abuse again. The actual violence occurs in phase 2. Yelling at the client for not having dinner ready and calling her stupid and incompetent reflect phase 1, or tension building.

4. A client has been admitted to the inpatient psychiatric facility with a diagnosis of posttraumatic stress disorder after a history of violence by the client's significant other. During the initial assessment interview, which assessment would be the priority? A) Nutritional status B) Hydration status C) Sleep patterns D) Suicide risk

D Chapter: 17 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 5 Page Number: 245 Feedback: The first, and most important, assessment conducted is a lethality assessment that determines whether the survivor is in danger for his or her life, either from homicide or suicide and, if children are in the home, whether they are in danger. Then the physiologic areas such as nutrition, hydration, and sleep areas can be assessed.

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

D Chapter: 28 Client Needs: Physiological Integrity: Basic Care and Comfort Cognitive Level: Apply Integrated Process: Teaching/Learning Objective: 6 Page Number: e-17 Feedback: Routines are important, especially when preparing the body to sleep. Therefore, establishing and maintaining a regular time for bedtime and awakening is appropriate. Clients with insomnia should be counseled not to eat anything heavy for several hours before retiring. Spicy foods, alcohol, and caffeine should be avoided. Additionally, exercise promotes sleep, but regular exercise should be planned for 3 hours before bedtime.

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

D Chapter: 28 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Integrated Process: Teaching/Learning Objective: 4 Page Number: e-17, e-18 Feedback: Ramelteon is a melatonin receptor agonist. Trazodone and mirtazapine are sedating antidepressants. Estazolam is a benzodiazepine classified as a benzodiazepine receptor agonist. Multiple Select

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

D Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 2 Page Number: e-14 Feedback: Living with a family member with insomnia is challenging. Irritability, complaints of sleeplessness, and chronic fatigue interfere with quality interpersonal relationships. It would be highly unlikely that things are not problematic or that the effects of the insomnia would be positive.

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

D Chapter: 28 Client Needs: Psychosocial Integrity Cognitive Level: Analyze Integrated Process: Nursing Process Objective: 4 Page Number: e-19 Feedback: Stimulus control is a technique used when the bedroom environment no longer provides cues for sleep, but has become the cue for wakefulness. Clients are instructed to avoid behaviors in the bedroom that are incompatible with sleep, including watching television, doing homework, and eating. This allows the bedroom to be reestablished as a stimulus for sleep. Clients often increase their time in bed to provide more opportunity for sleep, resulting in fragmented sleep and irregular sleep schedules. With sleep restriction, clients are instructed to spend less time in bed and to avoid napping. Relaxation training involves the use of progressive relaxation, autogenic training, and biofeedback to relieve physical or emotional distress impacting sleep. Cognitive behavior therapy identifies the maladaptive behavior, bringing the distortions to the client's attention and extinguishing the association between effort to sleep and increased arousals.

16. The parent of an adolescent diagnosed with Tourette disorder shares with the nurse that the tics have gotten more frequent with longer duration since the child has started elementary school. The parent asks that the dose of the prescribed antipsychotic medication be increased to help manage the tics more effectively. What response should the nurse provide to address the parent's concern? A. "It sounds as if we need to introduce some form of stress management techniques." B. "Maybe it is time to discontinue the original medication and prescribe something new." C. "Increasing the medication will trigger some very serious cardiac focused side effects." D. "Increasing the dose will most likely result in the lessening of the therapeutic effectiveness."

D Chapter: 30 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Integrated Process: Nursing Process Objective: 5 Page Number: 523 Feedback: Attempts to eradicate all tics by increasing the dosages of these antipsychotics almost certainly will result in diminishing therapeutic returns and additional side effects. The most frequently encountered side effects include drowsiness, dulled thinking, muscle stiffness, akathisia, increased appetite and weight gain, and acute dystonic reactions. Cardiac side effects are not generally associated with increased doses of this classification of medications. Multiple Select

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

D Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 515 Feedback: Based on the mother's comments, the priority nursing diagnosis is Social Isolation related to poor social skills of the child. This nursing diagnosis is substantiated by the mother's statement that the child has few playmates and has difficulty interacting with other children. There is no information provided to suggest a Self-Care Deficit or Risk for Injury. Statements about the family's issues with the child and his disorder would support a nursing diagnosis of Compromised Family Coping.

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

D Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Remember Integrated Process: Nursing Process Objective: 4 Page Number: 517 Feedback: Impulsiveness is the tendency to act on urges, notions, or desires without adequately considering the consequences. This is manifested by risk-taking behaviors and use of poor judgment, often leading to more than the usual bumps, lumps, and bruises. The inability to wait his turn and restlessness reflect hyperactivity. Difficulty completing a task reflects inattention.

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

D Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Nursing Process Objective: 3 Page Number: 527 Feedback: The nurse suspects that the child is exhibiting symptoms of dyslexia or a reading disability, which is considered a learning disorder. A communication disorder involves speech or language impairments. Attention deficit hyperactivity disorder involves a persistent pattern of inattention, hyperactivity, and impulsiveness. Asperger syndrome is characterized by severe and sustained impairment in social interaction and restricted, repetitive patterns of behavior, interests, and activities in conjunction with age-appropriate language and intelligence.

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

D Chapter: 30 Client Needs: Psychosocial Integrity Cognitive Level: Understand Integrated Process: Teaching/Learning Objective: 3 Page Number: 516 Feedback: The nurse should explain to the parents of a child with autism spectrum disorder that a structured physical environment will most likely be important. Keeping furniture, dishes, and toys in the same place helps ease anxiety and fosters secure feelings. The nurse should identify the child's specific needs for structure in the physical environment, and record what occurs when the physical environment is changed. Approximately 25% of children with autism spectrum disorder have seizure disorders, and about 50% have intellectual disability. Dyslexia is associated with a learning disorder.

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

D Chapter: 31 Client Needs: Health Promotion and Maintenance Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 543 Feedback: Instrumental activities of daily living are part of the functional status assessment of older adults. These activities include shopping, talking on the telephone, and driving or using other transportation. Bathing, showering, dressing, and cooking are examples of activities of daily living.

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

D Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 1 Page Number: 545 Feedback: Common delusional or suspicious thoughts for clients with dementia include "People are stealing my things," "This is not my house," and "My relative is an imposter."

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

D Chapter: 31 Client Needs: Psychosocial Integrity Cognitive Level: Apply Integrated Process: Nursing Process Objective: 3 Page Number: 545, 550 Feedback: Suspiciousness and delusional thinking must be addressed to be certain that they do not endanger the client or others. Often, delusions are verbalized when clients are placed in situations they cannot master cognitively. The principle of nonconfrontation is most important in dealing with suspiciousness and delusion formation. No efforts should be made to ease the client's suspicions directly, or to correct delusions. Rather, efforts should be directed at determining the circumstances that trigger suspicion or delusion formation, and creating a means of avoiding these situations.