Exam 3 - Sherpath

Which statement made by a patient illustrates a primary coping style of persons with borderline personality disorder (BPD)? -"My health care provider says I might get out of here tomorrow. Do you think I'm ready to go?" -"Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." -"I will never again speak to any of my messed up family members. I know that this will help me be more functional." -"I promise I am not feeling suicidal. I won't hurt myself."

"Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." Rationale A primary coping style used by patients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person. The statements "My health care provider says I might get out of here tomorrow. Do you think I'm ready to go?", "I will never again speak to any of my messed up family members. I know that this will help me be more functional," and "I promise I am not feeling suicidal. I won't hurt myself" do not describe splitting, which is a primary coping style of patients with BPD. p. 463

How is the behavior of a cluster B personality disorder described? Odd or eccentric Anxious or fearful Aggressive or destructive Dramatic, emotional, or erratic

- Dramatic, emotional, or erratic Rationale The behavior of a cluster B personality disorder is described as dramatic, emotional, or erratic. The behaviors in a cluster A personality disorder are described as odd or eccentric. Anxious or fearful behavior is descriptive of a cluster C personality disorder. Aggressive or destructive behaviors are not descriptive of any cluster of personality disorders. p. 452

The nurse is interviewing a patient with an eating disorder. What statement by the patient indicates the presence of a binge eating disorder? -"I do not want to eat food." -"I overuse diuretics and laxatives." -"I do not exercise to reduce weight." -"I have a tendency to induce vomiting."

-"I do not exercise to reduce weight." Rationale Patients with binge eating disorder have episodes of uncontrolled eating followed by feelings of guilt. But they show no compensatory behavior, such as exercise to reduce the weight. Patients with anorexia nervosa do not want to eat food due to fear of weight gain and they starve themselves. Patients with bulimia nervosa may use diuretics or laxatives to compensate for overeating. They may induce vomiting to compensate for overeating. p. 346

A patient diagnosed with a borderline personality disorder shows the nurse multiple new, shallow self-inflicted cuts. Select the nurse's therapeutic response. -"I will not be caught up or manipulated by your attention-seeking behavior." -"This suicide attempts scare me. I am placing you on suicide precautions immediately." -"These are shallow wounds that do not need attention. It's time for you to go to group now." -"I will care for your wounds, and then you should write down what you were thinking and feeling when this happened. We will discuss it later."

-"I will care for your wounds, and then you should write down what you were thinking and feeling when this happened. We will discuss it later." Rationale An approach useful for patients with borderline personality disorder relates to responses to superficial self-destructive behaviors. The nurse should remain neutral and provide wound care in a matter-of-fact manner. Then the patient is instructed to write down the sequence of events leading up to the injury, as well as the consequences, before staff will discuss the event. This cognitive exercise encourages the patient to think independently about his or her behavior instead of merely ventilating feelings. It facilitates the discussion with staff about alternative actions. It is not therapeutic to deny the seriousness of the wounds or confront the patient with the behavior. Instituting suicide precautions reinforces the behavior. pp. 464, 470, 471, 476, Table 24.2

Buspirone is prescribed for a patient with anxiety. Which instruction should the nurse provide to this patient? -"Take this medication on an empty stomach." -"Take this medication only when you feel anxious." -"It will take two to four weeks for you to feel the full benefit." -"Consume aged cheese products while you are taking this medication."

-"It will take two to four weeks for you to feel the full benefit." Rationale Buspirone is an alternative antianxiety medication that does not cause dependence, but two to four weeks are required for it to reach full effects. It should be taken with food. The drug may be used for long-term treatment and should be taken regularly. Aged cheese products should be avoided when taking MAOIs (monoamine oxidase inhibitors). p. 288

A patient tells the nurse, "I eat whenever I'm stressed." What would be the nurse's best response to confirm if the patient has developed ineffective coping when stressed? -"Have you gained any weight recently?" -"How do you feel about your body image?" -"Can I check you for increased blood pressure?" -"Do you continue to eat even after you feel full?"

--"Do you continue to eat even after you feel full?" Rationale The patient reports eating when stressed, which could indicate ineffective coping. The nurse can confirm that the patient has ineffective coping behaviors if the patient continues to eat after feeling full. Therefore, this statement would be the nurse's best response. Confirming if the patient has gained weight does not necessarily confirm if the patient has ineffective coping skills because weight gain can be related to a number of issues. Increased blood pressure may be a result of obesity from overeating or of stress-related anxiety but it does not confirm ineffective coping skills. A patient with a disturbed body image may be self-conscious about his or her body, but this does not necessarily confirm ineffective coping strategies. p. 348, Table 18.6

Which statement made by a patient diagnosed with bulimia indicates that an appropriate outcome for treatment has been met? -"I purge only once a day now instead of twice." -"I'm both a hard worker and a compassionate person." -"I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers." -"I always purge when I'm alone so that I'm not a bad role model for my younger sister."

--"I'm both a hard worker and a compassionate person. Rationale An appropriate overall goal for the bulimic patient would include that the patient be able to identify personal strengths, leading to improved self-esteem. Purging only once a day instead of two is not an appropriate outcome because the goal is to refrain from purging altogether. A goal is for the patient to express feelings without food references. Purging when alone is incorrect because the patient is still purging. p. 343

The nurse is caring for a rheumatoid arthritis patient with borderline personality disorder. Which behavior does the nurse find in the patient compared with other patients in the ward? -The patient is always calm and depressed. -The patient abuses peers and hospital staff. -The patient shows extreme fluctuating emotions. -The patient feels uncomfortable with the nurse's attention.

--The patient shows extreme fluctuating emotions. Rationale Patients with borderline personality disorder have unstable moods. Such patients exhibit rapid emotional shifts. They may be extremely aggressive and suddenly become extremely calm. They have a history of violence and impulsivity. They are not always aggressive but they are emotionally unstable and may exhibit a range of emotions. The patients have attention-seeking behavior and may try to attract the attention of the nurse. p. 464

How does the patient with bulimia differ from the patient with anorexia nervosa? -The patient with bulimia maintains a normal weight. -The patient with bulimia exercises more rigorously. -The patient with bulimia purges to keep weight down. -The patient with bulimia holds a distorted body image.

--The patient with bulimia maintains a normal weight. Rationale Many bulimics are at or near normal weight, whereas patients with anorexia nervosa are underweight. p. 344, Table 18.5

The nurse caring for a patient experiencing a panic attack anticipates that the psychiatrist would prescribe a stat dose of -Anticholinergic medication -Standard antipsychotic medication -Tricyclic antidepressant medication -A short-acting benzodiazepine medication

-A short-acting benzodiazepine medication Rationale A short-acting benzodiazepine is the only type of medication listed that would lessen the patient's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety, tricyclic antidepressants have very little antianxiety effect and have a slow onset of action, and standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects. p. 288

Which is true of pharmacologic therapies for treatment of personality disorders? -Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. -Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients. -Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. -Although there are no Food and Drug Administration (FDA)-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident.

-Although there are no Food and Drug Administration (FDA)-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. Rationale At this time in the United States, there are no FDA-approved medications for treating personality disorders. Prescribers are using the medications "off- label" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although patients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life. p. 461

Bupropion, although seemingly effective, is contraindicated in patients who purge. What is the reason for this? -An increased risk of seizures -Historically poor patient compliance -The potential to cause gastric ulcers -The long-term effects on liver function

-An increased risk of seizures Rationale Bupropion, although seemingly effective, is contraindicated in patients who purge because of an increased risk of seizures. p. 349, Table 18.7

What mental health disorder can be a direct physiological result of hyperthyroidism? -Anxiety -Panic attacks -Generalized anxiety disorder -Obsessive-compulsive disorder

-Anxiety Rationale Anxiety can be a direct physiological result of hyperthyroidism. Panic attacks are a key feature of panic disorders. Generalized anxiety disorder is excessive worry, which is out of proportion to the true impact of events or situations. It is often comorbid with major depressive disorder and other anxiety disorders. Obsessive-compulsive disorder is characterized by both obsession and compulsions that may occur due to a genetic disposition or trauma. p. 279

A person diagnosed with obsessive-compulsive personality disorder is consistently late for appointments and says, "I have to check the safety features and fluid levels on my car six times before I leave home." Which nursing diagnosis has the highest priority? -Anxiety -Altered family processes -Altered role performance -Impaired social interaction

-Anxiety Rationale Internally, this person is fearful of imminent catastrophe. This fear produces anxiety. Persons diagnosed with obsessive-compulsive personality disorder try to control the environment through perfectionism and orderliness. Traits include compulsivity, oppositionality, lack of emotional expressiveness, and perfectionism. Social interactions, family processes, and role performance for this individual will improve after the anxiety is reduced; therefore, these diagnoses have a lower priority. p. 458

Which conditions are comorbidities of borderline personality disorder? Select all that apply. Bipolar disorder Anxiety disorder Substance abuse Depressive disorder Schizoaffective disorder

-Anxiety -Substance -Depressive Rationale Comorbidities for borderline personality disorder include substance abuse, anxiety disorder, and depressive disorder. Bipolar and schizoaffective disorders are not comorbidities of borderline personality disorder. p. 464

Which personality disorders are categorized as cluster C? Select all that apply. Avoidant Paranoid Antisocial Dependent Obsessive-compulsive

-Avoidant -Dependent -OCPD Rationale Avoidant, dependent, and obsessive-compulsive disorders are cluster C personality disorders. Paranoid personality disorder is in cluster A. Antisocial personality disorder is in cluster B. p. 452

Which category of medication used to treat anxiety has a potential for dependence? -Tricyclics -Benzodiazepines -Selective serotonin reuptake inhibitors -Selective serotonin norepinephrine reuptake inhibitors

-Benzodiazepines Rationale Benzodiazepines commonly are prescribed for anxiety because they have a quick onset of action; however, because of the potential for dependence, these medications ideally should be used for short periods. Benzodiazepines are not recommended for patients with a known substance abuse history. Tricyclics, selective serotonin reuptake inhibitors, and selective serotonin norepinephrine reuptake inhibitors do not create dependency. p. 288

The nurse recognizes bariatric surgery as a treatment for which disorder? Rumination Binge eating Bulimia nervosa Anorexia nervosa

-Binge eating Rationale Bariatric surgery is an option to treat binge eating disorder as the patients are obese due to overeating, with no compensatory activities such as exercise. Patients with anorexia nervosa are underweight as they starve themselves due to fear of weight gain. They do not need bariatric surgery. Patients with bulimia nervosa tend to overeat, which is followed by compensatory behaviors, such as excessive exercise or misuse of laxatives. They are usually normal in weight or close to ideal weight and they do not need bariatric surgery. In rumination disorder the patient regurgitates the food, which is followed by rechewing and reswallowing or spitting. It does not cause obesity and bariatric surgery is not necessary. pp. 348-349

A patient at the mental health center says to the nurse, "Most of the staff does not care about me, but you are different. You understand my problems." When the nurse tells this patient about an upcoming career change, the patient becomes very angry. An hour later, the patient loudly announces, "I'm going to cut my wrists. I need to be hospitalized immediately." Given this scenario, which personality disorder is most likely? -Avoidant -Histrionic -Borderline -Narcissistic

-Borderline Rationale The scenario describes splitting of staff and impulsivity associated with self-mutilation. These are common behaviors among persons diagnosed with borderline personality disorder. Persons diagnosed with narcissistic personality disorder are exploitive, grandiose, and disparaging. Persons diagnosed with avoidant personality disorder are excessively anxious in social situations and hypersensitive to negative evaluation. Persons diagnosed with histrionic personality disorder are seductive, flamboyant, attention seeking, and shallow. pp. 464, 470, 471, Table 24.2

The nurse is caring for a patient with bulimia nervosa who overuses laxatives but does not purge. Which drug is known to be effective to treat the patient? Qsymia Bupropion Olanzapine Lorcaserin

-Bupropion Rationale Bupropion is known to be effective in patients with bulimia nervosa who do not purge. It is contraindicated in patients who purge as it increases the risk of seizures. Antipsychotic agents such as olanzapine are effective to treat anorexia nervosa. Olanzapine improves the mood, decreases obsessive behaviors, and reduces resistance to weight gain. Lorcaserin and Qsymia are known to be effective to treat patients with binge eating. They block appetite signals and produce feelings of fullness. p. 349, Table 18.7

The nurse is providing teaching to a preoperative patient just before surgery. The patient is becoming more and more anxious as the information is presented. Soon the patient begins to report dizziness and heart pounding. The nurse observes obvious trembling and that the patient appears confused. What is the nurse's immediate intervention? -Reinforcing the preoperative teaching by restating it slowly -Ceasing any further attempt at preoperative teaching at this time -Having the patient read the teaching materials instead of listening to them -Having a familiar family member read the preoperative materials to the patient

-Ceasing any further attempt at preoperative teaching at this time Rationale Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. Restating the preoperative teaching slowly, having the patient read the teaching materials instead of listening to them, and having a familiar family member read the preoperative materials to the patient would not be effective because the nurse is still attempting to teach someone who has a severe level of anxiety. p. 272

A man continues to speak of his wife as though she were still alive, three years after her death. This behavior suggests the use of Altruism Denial Undoing Suppression

-Denial Rationale Denial involves escaping unpleasant reality by ignoring its existence. p. 274

Which assessment finding is most likely to occur in a patient diagnosed with bulimia nervosa? -Lymphocytosis -Dental erosion -Osteoporosis -Muscle wasting

-Dental erosion Rationale Dental erosion is most likely to occur in patients diagnosed with bulimia nervosa due to chronic self-induced vomiting. Lymphocytosis, osteoporosis, and muscle wasting are conditions that are more likely to occur as a result of anorexia nervosa, not bulimia nervosa. p. 337

A patient is suspected of having anorexia nervosa. What clinical manifestations does the nurse identify as symptoms of anorexia nervosa? Select all that apply. Select all that apply -Emaciation -Yellow skin -Dehydration -Russell's sign -Hyperkalemia

-Emaciation -Yellow skin -Dehydration Rationale Anorexia nervosa is an eating disorder in which the patient has intense fear of weight gain and refuses to maintain optimal weight. Due to malnourishment and starvation, the patient is emaciated and dehydrated. The skin is yellow due to elevated carotene levels in the blood. Patients with bulimia nervosa have Russell's sign or calluses and scars on the hand due to self-induced vomiting. Hypokalemia is present in patients with anorexia nervosa due to dehydration. pp. 336, 338, Table 18.1, Table 18.3

Which behaviors are demonstrated characteristically by a patient diagnosed with narcissism? -Perfectionism and preoccupation with detail -Grandiose, exploitive, and rage-filled behavior -Angry, highly suspicious, aloof, and withdrawn behavior -A dramatic expression of emotion, while easily being led

-Grandiose, exploitive, and rage-filled behavior Rationale Narcissistic patients give the impression of being invulnerable and superior to others to protect their fragile self-esteem. A dramatic expression of emotion while easily being led, perfectionism and preoccupation with detail, and angry, highly suspicious, aloof, and withdrawn behavior are not generally associated with narcissism. p. 456

During assessment of a patient with anorexia nervosa, it is not likely that the nurse would note indications of which of the following? Introversion Social isolation High self-esteem Obsessive-compulsive tendencies

-High self-esteem Rationale Most patients with eating disorders have low self-esteem. pp. 337, 338

What signs and symptoms are associated with the nursing diagnosis of "defensive coping" for a patient diagnosed with antisocial personality disorder? Select all that apply. Rigid posture Hostile laughter Lack of empathy Ridicule of others Substance misuse

-Hostile Laughter -Ridicule of others Rationale The signs and symptoms associated with the nursing diagnosis "defensive coping" for a patient diagnosed with antisocial personality disorder may include hostile laughter and ridicule of others. A rigid posture and substance misuse would be associated with the nursing diagnosis "risk for other-directed violence." Lack of empathy is associated with "impaired social interaction." Test-Taking Tip: Have a general knowledge of which topics are covered and how many questions there are in each topic area. Know the amount of time you will have. Study the sample questions for style and format. p. 461

A patient is admitted to the hospital with severe anorexia. Upon assessment, the nurse notes the patient's skin is yellow. Which physiological response may cause this finding? Hypoalbuminemia Hypercarotenemia Hyperbilirubinemia Estrogen deficiency

-Hypercarotenemia Rationale Hypercarotenemia causes the skin to appear yellow in patients with severe anorexia. Estrogen deficiency causes decreased bone density. Hypoalbuminemia results in peripheral edema. Hyperbilirubinemia is the result of excessive red blood cell breakdown, not anorexia. p.272

A patient who is 16 years old, 5 foot, 3 inches tall, and weighs 80 pounds eats one tiny meal daily and engages in a rigorous exercise program. What is the nursing diagnosis for this patient? Death anxiety Ineffective denial Disturbed sensory perception Imbalanced nutrition: less than body requirements

-Imbalanced nutrition: less than body requirements Rationale A body weight of 80 pounds for a 16-year-old who is 5 foot, 3 inches tall is ample evidence of imbalanced nutrition. p. 337

A primary health care provider is planning therapy for a patient with narcissistic personality disorder. What treatment option does the nurse anticipate as most effective for the patient? -Assertiveness training -Omega-3 supplements -Low-dose antipsychotic medications -Individual cognitive-behavioral therapy

-Individual cognitive-behavioral therapy Rationale There is no medication indicated for narcissistic personality disorder. Treatment includes individual cognitive-behavioral therapy, family therapy, and group therapy. Patients with borderline personality disorders often respond to omega-3 supplementation for mood and emotion dysregulation symptoms. Patients with narcissistic personality disorder already have an inflated view of their self-importance, and assertive training may not help them. Such training helps patients with avoidant, dependent, or histrionic personality disorders to express their needs more openly and improves their self-esteem. Patients with borderline and schizotypal personality disorders benefit from low-dose antipsychotic medications, which reduce psychotic-like symptoms and improve day-to-day functioning. p. 461

A nurse is assessing a patient experiencing anorexia nervosa. What diagnosis should the nurse consider when the patient exhibits destructive behavior towards self? Powerlessness Ineffective coping Imbalanced nutrition Disturbed body image

-Ineffective coping Rationale Ineffective coping is presented as destructive behavior toward oneself or inability to meet expectations. Powerlessness is presented by indecisive behavior or a feeling of shame. Imbalanced nutrition is diagnosed when there are signs of emaciation or decreased urine output. Disturbed body image is noted when there is excessive self-monitoring regarding body image. p. 338, Table 18.3

A nurse caring for a patient who has been diagnosed with a personality disorder should expect that the patient will exhibit which behavior? -Abnormal ego functioning -Frequent episodes of psychosis -Inflexible and maladaptive responses to stress -Constant involvement with the needs of significant others

-Inflexible and maladaptive responses to stress Rationale Personality patterns persist unmodified over long periods. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder. Psychosis, abnormal ego functioning, and caregiving tendencies generally are not characteristic of personality disorders. p. 458

The nurse learns that Qsymia contains two components, namely topiramate and phentermine. What is the function of phentermine? -It burns calories quickly. -It reduces the taste sensation. -It produces feelings of fullness. -It influences leptin blood levels.

-It influences leptin blood levels. Rationale Phentermine influences the blood concentration of the appetite-regulating hormone leptin by releasing the neural norepinephrine. Thereby it acts as an appetite suppressant. Topiramate is an antiseizure medication that produces feelings of fullness, reduces the taste sensation, and burns calories quickly. p. 337, Table 18.7

A nurse assesses an adolescent female diagnosed with anorexia nervosa. Which physical findings support the diagnosis? Select all that apply. Lanugo Oily skin Irregular heart rate Extremities hot to touch Pulse rate 48 beats per minute

-Lanugo -Irregular HR -Pulse rate 48 BPM Rationale Lanugo and cold extremities are the result of starvation. The skin is often yellow because of hypercarotenemia. Dehydration contributes to dry skin. Cardiovascular changes, including bradycardia and an irregular heart rate, are also a consequence of dehydration and electrolyte abnormalities. p. 336, Table 18.1

What is the primary goal of milieu therapy for patients diagnosed with personality disorders? -Managing the effect of the behavior on the entire group. -Helping the patient remain uninvolved with other patients. -Promoting a laissez-faire attitude among the staff members. -Providing one-on-one therapy for each member of the milieu.

-Managing the effect of the behavior on the entire group. Rationale The primary goal of milieu therapy is affect management in a group context. One-on-one therapy is not a goal of milieu management. Helping the patient remain uninvolved is not therapeutic. The staff would not be able to effectively manage the milieu if they adopted a laissez-faire attitude. p. 468

A nurse is planning care management for a patient with an eating disorder. The patient is thin and weak but refuses to eat due to fear of weight gain. What actions should the nurse perform? Select all that apply. -Monitor diet at meal times. -Teach relaxation techniques. -Ensure adequate food intake. -Allow additional food availability. -onitor diet at meal times. Teach relaxation techniques. Ensure adequate food intake.Ensure rigorous exercise program.

-Monitor diet at meal times. -Teach relaxation techniques. -Ensure adequate food intake. Rationale Meal times should be monitored to ensure that the entire meal is properly taken by the patient. Relaxation techniques should be practiced to provide support and build a positive self-image. Adequate food intake should be ensured to adequately meet the caloric needs of the patient. Allowing additional food availability may lead to binge eating. Therefore, availability of food should be restricted to scheduled meals and snacks. A rigorous exercise program will make the patient weaker. Physical activity should be limited until optimal weight is achieved. p. 351, Box 18.4

A nurse cares for a patient recently diagnosed with bulimia nervosa. Which nursing action is most appropriate? -Weigh the patient twice daily. -Monitor the patient's bathroom trips after meals. -Provide snacks whenever the patient requests them. -Encourage the patient to make menu selections independently.

-Monitor the patient's bathroom trips after meals. Rationale The nurse should monitor the patient's bathroom trips after meals to prevent self-induced vomiting. Weighing the patient twice daily is excessive. Providing snacks whenever the patient requests them reinforces dysfunctional eating patterns. Encouraging the patient to make menu selections independently may occur later but not initially. p. 339

A patient diagnosed with panic disorder begins a new prescription for lorazepam. The nurse should provide instructions to discontinue which of this patient's usual daily activities? Sewing Mowing the lawn Playing video games Preparing dinner for the family

-Mowing the lawn Rationale Lorazepam is a benzodiazepine commonly prescribed for short-term management of anxiety. These medications may make it unsafe to handle mechanical equipment, such as a lawn mower. It would be safe for the patient to sew, play video games, and prepare meals. p. 288, Box 15.2

As the nurse prepares to administer lorcaserin to a patient diagnosed with binge eating disorder, the tablet accidentally falls on the floor. What are the nurse's best actions? Select all that apply. -Omit the dose. Reschedule the dose for a later time. -Obtain a replacement dose for administration. -Complete a controlled substance discrepancy form. -Ask the patient, "Are you willing to take this pill after it fell on the floor?"

-Obtain a replacement dose for administration. -Complete a controlled substance discrepancy form. Rationale Lorcaserin makes people feel full after eating smaller meals by activating a serotonin 2c receptor in the brain and blocking appetite signals. It is a Schedule IV drug; therefore, the nurse should complete a controlled substance discrepancy form for a wasted dose. The nurse should also obtain a replacement dose for administration rather than omitting the dose. It is not appropriate to ask the patient to consider taking a contaminated drug or reschedule the dose for a later time. p. 349

A nurse observes that a patient with osteoarthritis behaves rudely to the staff and refuses to take treatment. On inquiry, the nurse learns that the patient thinks that all staff members are planning to harm and deceive him or her. What is the patient likely to be suffering from? -Schizoid personality disorder -Paranoid personality disorder -Narcissistic personality disorder -Obsessive-compulsive personality disorder

-Paranoid personality disorder Rationale Patients with paranoid personality disorder are suspicious and believe that others want to exploit, harm, and deceive them. They develop a defense system and try to counterattack the other person, and reject the treatment. They behave rudely and develop jealousy toward others. Patients with schizoid personality disorder have reduced emotional attachment and depression. Patients with obsessive-compulsive personality disorder have repetitive behavior. They remain preoccupied with minute details. In narcissistic personality disorder, patients are extremely worried about their prestige. They feel intense shame and fear of abandonment by others. p. 458

A possible outcome criterion for a patient diagnosed with anxiety disorder is -Patient reports reduced hallucinations -Patient reports feelings of tension and fatigue -Patient demonstrates effective coping strategies -Patient demonstrates persistent avoidance behaviors

-Patient demonstrates effective coping strategies Rationale The patient demonstrating effective coping strategies is the only desirable outcome. p. 284

Which of the following statements is true of bulimia? -Patients with bulimia have lanugo. -Patients with bulimia severely restrict their food intake. -Patients with bulimia often appear to have a normal weight. -Patients with bulimia binge eat but do not engage in compensatory measures.

-Patients with bulimia often appear to have a normal weight. Rationale Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. Not engaging in compensatory measures, severely restricting food, and lanugo do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa. p. 344, Table 18.4

The nurse is assessing a patient for a possible personality disorder. What behavior does the nurse identify as feature of paranoid personality disorder? -Excessive emotionality -Reluctance to answer any questions -Defers questions to his or her mother -Dichotomous thinking

-Reluctant Rationale A person with paranoid personality disorder generally views others with suspicion and may be reluctant to answer any questions. People with histrionic personality disorder may exhibit excessive emotionality to the extent of being considered melodramatic. A person with dependent personality disorder may have low self-esteem and may be dependent on others for minor issues. For instance, the person may ask a family member to answer questions during an interview. A person with borderline personality disorder may have dichotomous thinking. This is due to splitting or an inability to view both the positive and negative aspects of a person as a part of the whole. p. 454

A 20-year-old was sexually molested at age 10, but can no longer remember the incident. The ego defense mechanism in use is Projection Repression Displacement Reaction formation

-Repression Rationale Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness. p. 274

An adult invites 14 guests for Thanksgiving dinner. Just before the guests arrive, the adult notices the turkey is burned and inedible. Which behavior by this adult indicates adaptive coping? The adult -Goes to bed and leaves the guests unattended -Telephones all the guests and cancels the invitation for dinner -Tells the guests, "My oven malfunctioned. You will have to eat burned turkey." -Says to the guests, "We are having a vegetarian Thanksgiving dinner this year."

-Says to the guests, "We are having a vegetarian Thanksgiving dinner this year." Rationale Anxiety is a part of everyday life. Normal anxiety is a healthy reaction necessary for survival. It provides the energy needed to carry out the tasks involved in living and striving toward goals. Anxiety motivates people to make and survive change. It prompts constructive behaviors. In this scenario, announcing a vegetarian dinner indicates the adult has adapted to the anxiety-producing situation. Cancelling the dinner and leaving guests unattended are dysfunctional responses. Saying the oven malfunctioned demonstrates maladaptive use of displacement. pp. 273, 274, Table 15.2

Which behavior is demonstrated by a patient who engages in splitting? -Evidences a lack of personal boundaries. -Sees things as divided into "all good" or "all bad." -Places responsibility for behavior outside the self. -Unconsciously represses undesirable aspects of self.

-Sees things as divided into "all good" or "all bad." Rationale Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad. Splitting is not described accurately by unconsciously repressing undesirable aspects of self, placing responsibility for behavior outside the self, or evidencing a lack of personal boundaries. p. 464

An adult states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems okay except for these times, but it's affecting my ability to go to work." This information supports which psychiatric diagnosis? -Agoraphobia -Panic disorder -Social anxiety disorder -Separation anxiety disorder

-Separation anxiety disorder Rationale People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There also may be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others. p. 273

A patient diagnosed with anorexia nervosa and which assessment finding meets the criteria for hospitalization? -Oral temperature 98.1°F -Heart rate 56 beats per minute -Serum potassium level 2.6 mEq/L -Systolic blood pressure 88 mm Hg

-Serum potassium level 2.6 mEq/L Rationale Hypokalemia (less than 3 mEq/L) or other electrolyte disturbances warrant hospitalization because of risks regarding cardiac regulation. Other criteria for hospitalization include severe hypothermia (temperature lower than 36°C or 96.8°F), heart rate less than 40 beats per minute and systolic blood pressure less than 70 mm Hg. p. 338

A patient with anorexia nervosa presents with severe dehydration and rapid weight loss in the last week. What appropriate action should the nurse take? -Wait and watch -Prescribe sedatives -Obtain orders for lab work -Suggest hospital admission

-Suggest hospital admission Rationale A patient with anorexia nervosa showing severe dehydration and rapid weight loss should be admitted beginning with appropriate treatment and observation. If untreated, this condition can become life-threatening. Wait and watch approach is not advisable in this case as it can have life-threatening consequences and needs attention. The appropriate treatment can be decided after the patient is hospitalized for inpatient care. Sedatives may help the patient to sleep but may not be helpful in managing anorexia nervosa. Laboratory investigations can be performed once the patient is hospitalized for inpatient care. p. 338

Which intervention would be removed from the plan of care for a patient diagnosed with bulimia nervosa? -Assist patient to identify trigger foods. -Teach that fasting sets one up to binge eat. -Support importance of avoiding forbidden foods. -Teach patient to plan and eat regularly scheduled meals.

-Support importance of avoiding forbidden foods. Rationale No foods should be considered forbidden foods. This issue may be a focus of cognitive behavioral therapy. p. 339

Therapeutic nutrition is initiated for a patient hospitalized with anorexia nervosa. Two days later, the nurse notes that the patient has developed peripheral edema. What is the nurse's correct analysis of this situation? -The patient's electrolyte balance has improved. -The patient may be experiencing refeeding syndrome. -Peripheral edema is the consequence of preexisting low bone density. -The therapeutic nutrition program has improved the patient's hydration.

-The patient may be experiencing refeeding syndrome. Refeeding syndrome is a potential complication of initiation of therapeutic nutrition for patients diagnosed with anorexia nervosa. An assessment finding associated with this problem is peripheral edema. Serum electrolytes, particularly sodium and potassium, are likely to be abnormal in this situation. Low bone density is an assessment finding associated with estrogen deficiency or low calcium intake. Peripheral edema is not a finding associated with normal hydration.

According to current theory, which statement is true regarding eating disorders? -They are frequently misdiagnosed. -They are possibly influenced by sociocultural factors. -They are rarely comorbid with other mental health disorders. -They are psychotic disorders in which patients experience body dysmorphic disorder.

-They are possibly influenced by sociocultural factors. Rationale The Western cultural ideal that equates feminine beauty with tall, thin models has received much attention in the media as a cause of eating disorders. Studies have shown that culture influences the development of self-concept and satisfaction with body size. Eating disorders are not psychotic disorders. There is no evidence that eating disorders are frequently misdiagnosed. Comorbidity for patients with eating disorders is more likely than not. Personality disorders, affective disorders, and anxiety frequently occur with eating disorders. pp. 335-336

Which statement is descriptive of patients with a personality disorder? -They are resistant to behavioral change. -They have an ability to tolerate frustration and pain. -They usually seek help to change maladaptive behaviors. -They have little difficulty forming satisfying and intimate relationships.

-They are resistant to behavioral change. Rationale Personality disorders are deeply ingrained and pervasive. Patients with personality disorders find it very difficult, if not nearly impossible, to change and are not open to changing their behavior. They have difficulty establishing and maintaining intimate relationships that are satisfying. This disorder makes a patient easily frustrated and intolerant of pain. p. 458

A 72-year-old patient is diagnosed with Parkinson's disease and anxiety. The health care provider prescribes a benzodiazepine. The nurse questions this prescription based on what fact related to this classification of medications? -This medication would increase the patient's risk for falls. -Older adults become addicted faster than younger patients. -Benzodiazepines have serious side effects, so patients are often noncompliant. -Cognitive therapies rather than medication are more effective for the older patient.

-This medication would increase the patient's risk for falls. Rationale An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a patient who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia, leading to more falls. There is no evidence to suggest that elderly patients become addicted faster than younger patients. This classification of medications generally is not associated with nonadherence and would not lead one to question this drug prescription. Medication and other therapies are used congruently with all age levels. p. 288

A nurse is teaching a patient with bulimia nervosa about scheduling healthy, balanced meals. Why does a nurse consider providing this patient education important? To identify trigger foods To realize health effects To include forbidden foods To avoid binge-purge cycles

-To avoid binge-purge cycles Rationale Learning about scheduled balanced meals can help the patient to maintain a steady dietary regimen and avoid binge-purge cycles. Identifying trigger foods can be done by encouraging the patient to explore ideas about trigger foods. Including forbidden foods can be achieved by discussing the patient's irrational thoughts regarding those foods. Health effects of purging can be taught by educating the patient about the ill effects of induced vomiting. p. 345

Which intervention would be least useful for accurate assessment of the weight of a patient diagnosed with anorexia nervosa? -Weigh fully clothed before breakfast. -Permit no oral intake before weighing. -Do not reweigh patient when patient requests. -Weigh two times daily, then three times weekly.

-Weigh fully clothed before breakfast. Rationale Patients should be weighed wearing only underwear before ingesting any food or fluids in the morning. p. 340, Case Study 18.1

What is the focus for the acute phase of treatment for anorexia nervosa? -Weight restoration -Improving interpersonal skills -Learning effective coping methods -Changing family interaction patterns

-Weight restoration Rationale Weight restoration is the priority goal of treatment for the patient with anorexia nervosa because health is threatened seriously by the underweight status. P. 338

A nurse manages care for an individual with a personality disorder. What is the most attainable outcome for this patient? -Within 1 week, the patient will make a permanent commitment never to self-mutilate. -Within 2 weeks, the patient will establish a satisfying intimate relationship with another adult. -Within 4 weeks, the patient will describe personal characteristics of reactions to stress. -Within 5 days, the patient will identify factors that led to development of the personality disorder.

-Within 4 weeks, the patient will describe personal characteristics of reactions to stress. Rationale Personality disorders are pervasive, long-standing patterns of behavior. It is unrealistic to expect dramatic changes in a short period of time. Outcomes should be realistic and focused on problem-solving and cognitive reframing. p. 457

The nurse is assessing a patient with binge eating disorder. What diagnosis should the nurse consider when the patient shows feelings of inadequacy? -Anxiety -Ineffective coping -Imbalanced nutrition -Disturbed body image

Anxiety Rationale The nursing diagnosis of anxiety is made when the patient shows feelings of discomfort or inadequacy. Ineffective coping is noted if the patient uses eating as a coping method. Imbalanced nutrition is diagnosed when the patient shows irregular eating patterns and is overweight. Disturbed body image is noted when the patient shows embarrassment due to weight gain. p. 348, Table 18.6

A nurse who is idealized by a patient is at risk for -Developing a prejudicial, blaming orientation -Stringent enforcement of boundaries and limits -Becoming indecisive about planned interventions -Becoming overinvolved and being protective and indulgent

Becoming overinvolved and being protective and indulgent Rationale Finding an approach for helping patients with personality disorders who have enormous needs can be overwhelming for caregivers. For example, a female patient with borderline personality disorder may briefly idealize her male nurse on the inpatient unit, telling staff and patients alike that she is "the luckiest patient because she has the best nurse in the hospital." The rest of the team initially realizes that this behavior is an exaggeration, and they have a neutral response. But after days of constant dramatic praise, some members of the team may start to feel inadequate and jealous of the nurse. They begin to make critical remarks about minor events to prove that the nurse is not perfect. Open communication in staff meetings and ongoing clinical supervision are important aspects of self-care for the nurse working with these patients to maintain objectivity. p. 466

A nurse is attending to a patient with bulimia nervosa. What reason does the nurse suspect for the presence of gastric dilation in the patient? Binge eating Induced vomiting Use of laxatives Ipecac intoxication

Binge eating Rationale Binge eating can cause gastric dilation or rupture. Induced vomiting causes reflux of hydrochloric acid over the tooth enamel, causing dental cavities. Ipecac intoxication can cause cardiac failure. Use of laxatives causes electrolyte imbalances. p. 344, Table 18.4

A patient presents with decreased cardiac output. The nurse notes that the patient experiences bingeing and then exercises excessively to make up for the calories gained. What should the nurse suspect? Binge eating Bulimia nervosa Anorexia nervosa Weight management

Bulimia nervosa Rationale Bulimia nervosa is having repeated episodes of binge eating followed by inappropriate behaviors to compensate such as exercise, induced vomiting, or purgation. Binge eating is repeated episodes of overindulgence in eating followed by a feeling of guilt and distress but no compensatory behavior. Anorexia nervosa is having intense fear of weight gain and refusing to maintain optimal weight. Weight management has a specific plan of diet and exercise and does not include bingeing followed by excessive exercise. p. 341

Working to help the patient view an occurrence in a more positive light is called Flooding Desensitization Response prevention Cognitive restructuring

Cognitive restructuring Rationale The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive. p. 276

Which is the best treatment method for the patient who speaks of several failed relationships and appears arrogant and lacks empathy for others? Psychotherapy Cognitive-behavioral therapy Administration of citalopram Administration of venlafaxine

Cognitive-behavioral therapy Rationale A patient who appears arrogant and lacks empathy for others tells about several failed relationships. These are signs and symptoms of narcissistic personality disorder. The best treatment for narcissistic personality disorder is cognitive-behavioral therapy. The patient is taught to replace narcissistic thoughts that have formed irrational core beliefs with more appropriate thoughts and beliefs. Psychotherapy is effective in managing patients with histrionic personality disorder. Citalopram is a selective serotonin reuptake inhibitor that effectively treats avoidant personality disorder. Selective norepinephrine reuptake inhibitors such as venlafaxine are also effective in treating avoidant personality disorder. p. 470

What assessment finding can the nurse expect in a patient experiencing a panic level of anxiety? Withdrawal Depersonalization Scattered attention Distorted perceptual field

Depersonalization Rationale The nurse can expect to find depersonalization in a patient experiencing a panic level of anxiety. Depersonalization is the sense of feeling unreal. Withdrawal, scattered attention, and a distorted perceptual field are more likely to occur in the patient experiencing severe anxiety. p. 272

A patient with bulimia nervosa uses enemas and laxatives to purge to maintain his or her weight. For which imbalance should the nurse assess? Elevated serum sodium level Increased red blood cell count Elevated serum potassium level Disrupted fluid and electrolyte balance

Disrupted fluid and electrolyte balance Rationale Disruption of the fluid and electrolyte balance is usually the result of excessive use of enemas and laxatives. p. 336

A nurse assesses an adolescent female with anorexia nervosa. Which physical findings support the diagnosis? Select all that apply. Oily skin Facial lanugo Pulse rate of 39 Sensitivity to heat Temperature of 96.7°

Facial lanugo Pulse rate of 39 Temperature of 96.7 Rationale Decreased body temperature and pulse rate are common findings in anorexia nervosa. Lanugo (fine body hair) often appears on the face. There is sensitivity to cold because of the loss of insulating body fat. The skin is dry. p. 336

What is a subjective symptom the nurse would expect to note during assessment of a patient with anorexia nervosa? Lanugo Hypotension 25-lb weight loss Fear of gaining weight

Fear of gaining weight Rationale Fear of gaining weight is the only subjective datum listed and is universally true. p. 334

A woman gets a report of abnormal cells from a routine pap test. She anxiously says to her spouse, "I have cancer. It probably has spread all over my body." Which nursing diagnosis and etiology best apply to this situation? -Ineffective coping related to panic level anxiety -Self-esteem disturbance related to outcome of pap test -Disturbed body image related to malignant cervical cancer -Fear related to misinterpretation and misinformation about pap tests

Fear related to misinterpretation and misinformation about pap tests Anxiety has an unknown or unrecognized source, whereas fear is a reaction to a specific threat. There is no evidence of spiritual distress or ineffective coping at this point. The patient's level of anxiety is moderate. While the body image may be disturbed, it is not related to malignant cancer. There is no evidence the self-esteem is disturbed. p. 271

When assessing a patient for personality disorders, the nurse notices that a patient behaves in a melodramatic way and acts flirtatiously. What personality disorder is the nurse most likely to suspect in the patient? -Schizoid personality disorder -Paranoid personality disorder -Histrionic personality disorder -Narcissistic personality disorder

Histrionic personality disorder Rationale People with histrionic personality disorder have emotional attention-seeking behaviors. They are often melodramatic and act flirtatiously. People with paranoid personality disorder are extremely suspicious and often believe others will harm them. People with schizoid personality disorder exhibit emotional detachment and are viewed as loners. People with narcissistic personality disorder are arrogant and need constant admiration. p. 456

A patient reveals that he or she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to reveal which of the following? Tachycardia Hypokalemia Hypolipidemia Hypercalcemia

Hypokalemia Rationale Vomiting causes loss of potassium, leading to hypokalemia. p. 344, Table 18.4

If the record mentions that the patient habitually relies on rationalization, the nurse might expect the patient to -Miss appointments -Make jokes to relieve tension -Justify illogical ideas and feelings -Behave in ways that are the opposite of his or her feelings

Justify illogical ideas and feelings Rationale Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener. p. 274, Table 15.2

What outcome is most important for a patient with bulimia nervosa to reduce the feeling of powerlessness? Making informed life decisions Willingness to call others for help Using a personal support system Being satisfied with body appearance

Making informed life decisions Rationale When the patient makes informed life decisions, there is a sense of control and power over his or her own life. Development of this skill reduces the feeling of powerlessness associated with bulimia nervosa. When the patient is satisfied with body appearance, there is a reduction of disturbed body image and obsession with the body. When the patient is willing to call others for help, it decreases social isolation. By using a personal support system, the patient can develop effective coping mechanisms. p. 348, Table 18.6

A nurse is caring for a patient with bulimia nervosa. Which factors should the nurse discuss when educating the patient about the eating disorder? Select all that apply. Meal planning Effects of purging Effects of starvation Relaxation techniques Eating "forbidden" foods

Meal planning Effects of purging Relaxation techniques Eating "forbidden" foods Rationale Bulimia nervosa is characterized by repeated episodes of binge eating followed by inappropriate behaviors like induced vomiting or purgation to compensate. Meal planning will help the patient follow a healthy diet and avoid bingeing and purging. Understanding the effects of purging is important to be able to avoid it and maintain a healthy routine. Use of relaxation techniques can help in relieving stress by ways other than using food and help in recovery. Understanding the effects of starvation are more important in case of patients with anorexia nervosa as there is avoidance of food due to fear of weight gain. These patients should also be encouraged to eat "forbidden" foods. p. 345

Which assessment finding can the nurse anticipate for a patient newly diagnosed with binge-eating disorder? Russell sign Hypotension Normal weight Use of laxatives

Normal weight Rationale The nurse may find that the patient newly diagnosed with a binge-eating disorder is of normal weight. Over time, repeated binge eating can result in obesity. Hypotension is more likely to be found with anorexia or bulimia nervosa as the disease state worsens. Russell sign and the use of laxatives are more typical of patients with bulimia nervosa. p. 346

A potential problem for a patient diagnosed with severe obsessive-compulsive disorder is Sleep disturbance Excessive socialization Command hallucinations Altered state of consciousness

Sleep disturbance Rationale Patients who must engage in compulsive rituals for anxiety relief rarely are afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep. p. 287

A patient with anorexia nervosa presents with severe dehydration and rapid weight loss in the last week. What appropriate action should the nurse take? Wait and watch Prescribe sedatives Obtain orders for lab work Suggest hospital admission

Suggest hospital admission A patient with anorexia nervosa showing severe dehydration and rapid weight loss should be admitted beginning with appropriate treatment and observation. If untreated, this condition can become life-threatening. Wait and watch approach is not advisable in this case as it can have life-threatening consequences and needs attention. The appropriate treatment can be decided after the patient is hospitalized for inpatient care. Sedatives may help the patient to sleep but may not be helpful in managing anorexia nervosa. Laboratory investigations can be performed once the patient is hospitalized for inpatient care. p. 338

A nurse observes a patient who often pulls out his or her hair. What appropriate condition does the nurse report to the primary health care provider based on this observation? -The patient has trichorrhexis. -The patient has trichophagia. -The patient has trichotillomania. -The patient has Rapunzel syndrome.

The patient has trichotillomania. Rationale Psychiatric patients often pull out hair to relieve stress. This condition is called trichomoniasis. Trichorrhexis is a defect in the hair shaft where the hair becomes thin and breaks off easily. Patients who secretly swallow the pulled hair have a condition called trichophagia. The masses of hair present in the stomach are referred to as Rapunzel syndrome. pp. 280, 281

Which defense mechanism has an adaptive use? Splitting Undoing Projection Conversion

Undoing Rationale Projection is a defense mechanism that is considered immature and does not have an adaptive use. Splitting and conversion also do not have adaptive uses and are almost always pathological. Undoing is a defense mechanism with an adaptive use. p. 274