Mental Health Exam 2 Chapter 18,19,20,21,22 EAQs

The nurse is interviewing a patient with sleep disorder. Which question does the nurse ask to analyze if the disorder is related to hypersomnia?

"Did anybody tell you that you snore in your sleep?"

Which teaching would the nurse provide to a patient who has just been prescribed a selective serotonin reuptake inhibitor (SSRI)?

"Do not abruptly stop taking the medication."

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?

"Do you continue to eat even after you feel full?"

The nurse prepares to conduct an oppositional defiant disorder (ODD) assessment for a pediatric patient. Which question will the nurse include in the assessment? "Do you ever bully or scare other people?" "Do you ever bother people on purpose?" "Are you ever physically mean to animals?" "Can you think of a time when you ran away from home?"

"Do you ever bother people on purpose?" Asking if the patient ever bothers other people on purpose is an appropriate question to ask, as this can help the nurse gauge the child's behaviors that are characteristic of ODD. Asking if the patient has ever bullied or scared other people, been physically mean to animals, or ran away from home are more appropriate for assessing conduct disorder, not ODD.

The nurse is caring for a patient with arousal disorder. Upon observation, the nurse finds the calf and shoulder muscles of the patient to be weakened and paralyzed. Which question by the nurse is appropriate during the assessment?

"Do you have a tendency to act out your dreams?"

A patient tells the nurse, "I just don't sleep more than five hours at night." The nurse responds best by asking

"Do you usually feel rested and alert when you get up?"

A nurse is screening patients for sleep disorders. Which questions should the nurse ask to yield information related to hypersomnia? Select all that apply.

"Have you experienced uncontrollable sleepiness?" "Have your family members complained that you snore?"

A nurse is screening patients for sleep disorders. Which questions should the nurse ask to yield information related to hypersomnia? Multiple choice a. "Are you troubled by nightmares?" b. "Do you have difficulty falling asleep?" c. "Have you experienced uncontrollable sleepiness?" d. "Have your family members complained that you snore?" e. "Do you feel a strange sensation in your legs that disturbs your sleep?"

"Have you experienced uncontrollable sleepiness?" "Have your family members complained that you snore?" Asking patients targeted questions about uncontrollable sleepiness and snoring may help the nurse recognize certain sleep disorders associated with hypersomnia such as narcolepsy and sleep apnea. Asking questions about nightmares, difficulty falling asleep, or unpleasant sensations in the legs would be more useful in identifying sleep disorders associated with insomnia. These include arousal sleep disorder, nightmare disorder, and restless leg syndrome. Inquiring about different unpleasant sensations in the legs gives information about hypersomnia caused by restless leg syndrome.

A 10-year-old diagnosed with childhood-onset conduct disorder gave a snack with a hidden peanut ingredient to a classmate with a known allergy to peanuts. The classmate suffered a severe allergic reaction. When the nurse counsels the child about this harmful behavior, which comment is most likely? "I am sorry I did it. I didn't mean to hurt him." "I did not know there were peanuts in that snack." "Why are you blaming me? I did not give snacks to anyone." "He should have helped me cheat on a test when I asked him."

"He should have helped me cheat on a test when I asked him." Children diagnosed with conduct disorders believe their aggressive behavior is justified. These children often display antisocial reasoning when rationalizing aggressive behavior. Denial is possible, but rationalization is more likely. Remorse is not an expected response.

Review the following information. Which assessment question best demonstrates the implementation of the suggested evidence-based practice intervention for a patient diagnosed with depression?

"How is your depression affected when you are sleeping well?"

The nurse appropriately assesses an obese, hypertensive, Type 2 diabetic patient for sleep disorders when asking,

"How much sleep do you usually get each night?"

Which assessment question should be asked of a patient suspected of demonstrating characteristics of anorexia nervosa?

"How would you describe your body?"

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 exercise to reduce weight."

Which statement demonstrates that a patient understands good sleep hygiene techniques? Select all that apply.

"I drink water or milk in the evenings." "I get up between 7:30 and 8:00 AM every morning." "My television is a flat screen model on the living room wall." "Don't telephone after 10:00 PM because I'll be in bed."

Which statement is least likely to be made by a patient diagnosed with bulimia nervosa during the assessment interview?

"I eat three meals each day and purge every evening."

The nursing instructor is teaching nursing students about cognitive-behavioral therapy for insomnia (CBT-I). What statement made by a nursing student indicates a need for further learning? "I have to ask what constitutes healthy sleep for the patient." "I have to educate the patient regarding sleep and sleep needs." "I have to help the patient to set realistic expectations about sleep." "I have to find the total number of hours the patient spends sleeping."

"I have to find the total number of hours the patient spends sleeping." Finding information about the total number of hours spent sleeping is not important and has no value. Focusing on the number of hours slept increases the insomnia experience. Therefore, focus should be kept on the quality rather than quantity of sleep. Educating the patient about sleep and setting realistic expectations helps the patient to understand the importance and influence of sleep for a healthy life. Asking about the patient's feelings about healthy sleep helps to clarify any misconceptions about sleep.

Which statement made by a patient diagnosed with bulimia indicates that an appropriate outcome for treatment has been met?

"I'm both a hard worker and a compassionate person."

Which statement describes a common sexual side effect of diazepam (Valium)? "I'm just not interested in sex as much" "I'm experiencing vaginal dryness" "I don't have orgasms anymore" "My breasts have gotten larger"

"I'm just not interested in sex anymore"

Which patient statement suggests a concern over one's ability to perform sexually? "My partner and I aren't as close as we once were" "I'm not as desirable as I once was" "My personal life has changed a lot" "I'm not the partner I used to be"

"I'm not the partner I used to be"

A nurse assesses personality traits of a patient with an eating disorder. Which comment by the patient indicates bulimia nervosa rather than anorexia nervosa? "I feel good. I feel just fine. I don't have any problems." "I try to do what my parents want, but I usually don't get things right." "If I want to do something, I just do it. I don't like to analyze things too much." "I don't look as good as most of my friends. That's why I don't have many dates."

"If I want to do something, I just do it. I don't like to analyze things too much." Impulsivity is characteristic of bulimia nervosa. The other options indicate low self-esteem, feelings of ineffectiveness, and alexithymia, which are findings in all eating disorders.

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." 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.

While completing a patient history the patient states, "I have been having problems sleeping and I think I need medication to help me sleep. I've seen a lot of commercials on television about sleep drugs." Which of the following statements would be the most appropriate nursing response?

"Medications are one type of treatment that may help some people with sleep problems. Tell me more about how you get ready for bed and your sleep history."

Which statement by the nurse demonstrates communication specifically appropriate for a patient diagnosed with antisocial personality disorder? select all "You don't have to go to the unit party if it will make you anxious." "Referring to the staff in a sexual manner is not acceptable behavior." "I don't accept responsibility for you losing privileges for arguing with staff. " "No, I don't think the rules are the problem, but you need to follow the rules." "Remember you promised to tell me if you begin to think about hurting yourself."

"Referring to the staff in a sexual manner is not acceptable behavior." "I don't accept responsibility for you losing privileges for arguing with staff. " "No, I don't think the rules are the problem, but you need to follow the rules." Those individuals diagnosed with antisocial personality disorder can be manipulative and exploitative of others as well as being seductive. Staff must prevent the patient from instilling unwarranted guilt on others for their actions or behaviors. Social anxiety is associated with avoidance disorder, whereas self-harm is associated with borderline personality disorder.

A patient begins a new prescription for eszopiclone (Lunesta). Which instructions should the nurse provide about taking this medication? Select all that apply.

"Take this medication just before you get ready for bed." "Even though you take this medication, you should still practice good sleep habits." "Let's discuss some safety precautions you should use until you know how this medication affects you."

A patient begins a new prescription for eszopiclone. Which instructions should the nurse provide about taking this medication? Multiple selection question "Take this medication after your evening meal." "Take this medication just before you get ready for bed." "Even though you take this medication, you should still practice good sleep habits." "This medication works better the longer you take it. Most patients use it for about 3 months." "Let's discuss some safety precautions you should use until you know how this medication affects you."

"Take this medication just before you get ready for bed." "Even though you take this medication, you should still practice good sleep habits." "Let's discuss some safety precautions you should use until you know how this medication affects you." Eszopiclone is a benzodiazepine-like hypnotic medication. Nurses often provide education about the benefits, side effects, untoward effects, and the fact that medications usually are prescribed for no more than 2 weeks because tolerance and withdrawal may result. For best effects, the patient should take the medication just before going to bed rather than earlier in the evening. Because this medication has sedative effects, the nurse should teach about safety precautions. Encouraging the patient to use good sleep hygiene practices will support stability of the sleep pattern when the patient discontinues use of eszopiclone.

The nurse is caring for a patient who started lithium therapy 6 weeks ago. The patient states, "This medication is not helping me." Which nursing responses are appropriate?

"The medication should be working by now; let's contact the health care provider." "Your medication regimen likely needs to be adjusted."

The nurse is caring for a patient who has a new prescription for sertraline. The patient states, "I am so glad I can take this medication while I am trying to get pregnant." Which nursing response is appropriate?

"There may be risks to the newborn infant. Let's talk with your health care provider."

A patient diagnosed with depression has reported fatigue and poor concentration. When the patient is told that the results of the sleep study show that he or she has excessive rapid eye movement (REM) sleep cycles, the patient asks the nurse to explain what those results mean. What is the nurse's best answer in response to the patient's concerns?

"Too much REM sleep deprives you of deep restoring sleep."

The nurse is preparing to manage the care of a patient diagnosed with a borderline personality disorder. The nurse demonstrates an understanding of therapeutic interventions that focus on the characteristics of such disorders when making which statement to the patient? Multiple choice question a. "You must feel threatened when staff is involved with the problems of the other patients." b. "When you feel the triggers of your agitation starting, come to me so I can help you de-escalate." c. "When you want my attention, please explain that to me rather than resorting to manipulative behavior." d. "We are here to keep you safe, so I will ask you several times a day whether you feel the need to harm yourself."

"When you want my attention, please explain that to me rather than resorting to manipulative behavior." Patients with borderline personality disorder are often manipulative. Providing them with an alternative behavior is therapeutic. To be threatened when the needs of others interfere with meeting one's own needs is characteristic of narcissism. The statement about triggers of agitation is directed at aggressive disorders such as posttraumatic stress disorder. The statement regarding asking the patient whether he or she feels the need to harm him- or herself is directed toward depression and suicidal ideations.

A patient has an impulse-control disorder. The nurse is teaching the patient's family how to prevent an aggressive response from the patient. What statements made by a family member indicate a need for further education? (SATA)

-"I should avoid using matter-of-fact sentences." -"I should avoid setting limits consistently." Nurses, staff, and family should use matter-of-fact sentences while communicating with such patients to reduce confrontation. One of the best ways to communicate with a hostile patient is by consistently setting limits. It provides a climate of safety for the patient and others. High-expressed emotion, such as criticism, resentment, or annoyance in the treatment environment is a major cause of aggressive response from patients with an impulse-control disorder. The nurse, the hospital staff, or the family members should not stand too close and should not act in an authoritative manner. Such behavior may indicate aggression and may generate an aggressive response, including violence, from the patient. pp. 403-404

Which characteristic in a child serves to support the diagnosis of oppositional defiant disorder? (SATA)

-Deliberately agitating family members -Vindictive responses to imagined personal wrongs -Cannot assume responsibility when proven responsible for failures Primarily a childhood disorder, oppositional defiant disorder is a repeated and persistent pattern of having an angry and irritable mood in conjunction with demonstrating defiant and vindictive behavior. The person with this disorder also shows a pattern of deliberately annoying people and blaming others for his or her mistakes or misbehavior. Aggressiveness rather than manipulation is characteristic of this disorder. pp. 393-394

A nurse is assessing a patient with conduct disorder. Which assessment findings would indicate suicidal risk in the patient? (SATA)

-Feelings of despair -Impulsive behavior -Past suicide attempts Feelings of despair, hopelessness, or changes in energy levels increase the risk of suicide. Impulsive behavior or poor judgment increases the patient's risk of suicidal behavior. A history of suicidal attempts increases the patient's chances of repeating suicidal behavior. Fine coping skills show better adaptability, whereas patients with decreased coping skills are at an increased risk of suicide. Improved decision making shows positive performance; decreased decision-making ability indicates low self-esteem and an increased risk of suicide. pp. 399-400

The nurse is caring for a patient with an impulse disorder who is undergoing multisystemic therapy. How would the patient demonstrate improvement due to this therapy? (SATA)

-Improvement in functioning of the child within the family -Improvement in school performance Multisystemic therapy is an evidence-based approach. Implementation of this therapy shows improvement in family functioning, school performance, and peer relationships. Psychodynamic psychotherapy helps the patient to uncover underlying feelings and reasons behind rage or anger. Cognitive therapy teaches patients to recognize the onset of the impulse to explode or act aggressively and to identify circumstances or triggers that are associated with the onset. Dialectical behavioral therapy improves mindfulness, emotional regulation, distress tolerance, and personal effectiveness. p. 403

Which characteristic supports the diagnosis of intermittent explosive disorder? (SATA)

-Man who is 19 years old -Often demonstrates anger by shouting -Has a history of damaging the property of others Characteristics of intermittent explosive disorder include being 19 years of age (diagnosed at age 18); onset is often abrupt; 7.3% more men than women are affected; and impulsive and unwarranted emotional outbursts, violence, and destruction of property are common. Poor cognitive abilities are not associated with this disorder. p. 399, Table 21.1

The nurse is meeting with the healthcare team of a child who has intermittent explosive disorder. The team is discussing pharmacologic interventions. Which medications may be prescribed for this patient? (SATA)

-Paroxetine (Paxil) -Fluoxetine (Prozac) -Escitalopram (Lexapro) Selective serotonin reuptake inhibitors (SSRIs) may be used to treat intermittent explosive disorder based on the premise that explosive behaviors are related to dysfunction of serotonin production. Fluoxetine (Prozac), paroxetine (Paxil), and escitalopram (Lexapro) are SSRIs that may be prescribed for this patient. Alprazolam (Xanax) and lorazepam (Ativan) are benzodiazepines which are contraindicated for individuals with intermittent explosive disorder because they can further reduce inhibitions. p. 396

The nurse is assessing a patient with impulse disorder for suicidal tendencies. What suicidal predictors does the nurse assess for in the patient? (SATA)

-Past suicidal attempts -Family history of suicide attempt -Feeling of hopelessness -Drug or alcohol use Past suicide attempt is the number one predictor of suicide attempt. Impulsivity and aggression in such patients increases the possibility of future suicide attempts. Patients with a family or close friend who committed or attempted suicide may show suicidal tendencies. A feeling of hopelessness also leads to suicidal behavior. Drug abuse and alcohol consumption also increase tendency toward suicide. Hostile laughter shows a patient's ineffective coping skills. Clenched fists and jaws are the predictors of a risk of other-directed violence. pp. 399-400

Which statement supports that the patient may be developing a tolerance? Select all that apply. 1 - "Over the years it has taken more alcohol to get me drunk." 2 - "If I don't drink my usual amount of alcohol, I get nervous and jumpy." 3 - "I've learned that I may develop a tolerance for my heart medicine." 4 - "Drinking a bottle of wine today doesn't affect me like it did five years ago." 5 - "I need to tell my health care provider that my antidepressant isn't working like it did."

1 - "Over the years it has taken more alcohol to get me drunk." 3 - "I've learned that I may develop a tolerance for my heart medicine." 4 - "Drinking a bottle of wine today doesn't affect me like it did five years ago." 5 - "I need to tell my health care provider that my antidepressant isn't working like it did." People with addictions experience tolerance to the effects of their respective substances. Tolerance is either needing increasing amounts of a substance to receive the desired result or finding that using the same amount over time results in a much-diminished effect. Some prescribed medications might have the same effect, such as some antianxiety medications, analgesics, and beta-blockers. Even antidepressants may result in tolerance. Withdrawal is a set of physiological symptoms that begin to occur as the concentration of the chemical decreases in an individual's bloodstream. It will be specific to the substance ingested, and each substance will have its own characteristic syndrome. Text Reference - p. 409

The nurse is caring for a woman with chronic alcohol intoxication. The woman is prescribed disulfiram to treat the condition. Which information given by the nurse is appropriate about disulfiram? 1 - "You may experience adverse effects if you consume alcohol." 2 - "You may experience nausea during the course of medication." 3 - "You may experience seizures during the course of medication." 4 - "You may experience sedation during the course of medication."

1 - "You may experience adverse effects if you consume alcohol." Disulfiram is used to treat substance abuse in patients. It is helpful in the period of maintenance. However, the patient should be sure to avoid consuming alcohol during the course of medication. The drug reacts with alcohol to form a toxic reaction, resulting in gastrointestinal and respiratory disorders. Nausea, seizures, and sedation are not observed in the course of medication. Nausea is observed when a patient consumes alcohol during the course of drug therapy. Seizures and sedation are observed during the course of medications like chlordiazepoxide, phenobarbital, and diazepam. Text Reference - p. 425, Table 22.6

The patient tells the nurse, "I have been smoking pot for several years to help me sleep, and I want to quit." What statement made by the nurse reflects accurate information? 1 - "You may experience insomnia and disturbing dreams." 2 - "Marijuana has very little effect on the quality of your sleep." 3 - "You will be provided a prescription for an antianxiety medication." 4 - "You should not experience any symptoms if you only smoke it at night."

1 - "You may experience insomnia and disturbing dreams." When people use cannabis as a sleep aid, insomnia and disturbing dreams may ensue without it. Cannabis causes drowsiness and impairs motor skills for eight to ten hours. Antianxiety medications are not prescribed for treatment of cannabis withdrawal. The patient will experience some symptoms after a prolonged use of the drug, even if use has only been at night. Text Reference - p. 414

The nurse is caring for a patient with a substance use disorder. What statement describes the correct way to deal with transference or countertransference for patient care in substance use disorders? 1 - A nurse remains objective throughout the process. 2 - A residential care facility is needed for monitoring. 3 - An ongoing evaluation of the patient may not be necessary. 4 - A new nurse will take over the responsibility of patient care in each session.

1 - A nurse remains objective throughout the process. The nurse remains cautious about personal thoughts, opinions, and feelings, and remains objective throughout the process. A therapeutic relationship should be established between the nurse and the patient. There is no need of introducing a new nurse in each session. An ongoing evaluation of the process must be conducted to eliminate transference or countertransference. This is done to maintain the objectivity of the treatment process and teach the patient new skills to acquire a healthy lifestyle after recovery. A residential care facility is needed depending on the patient's health-related issues. This has no effect on the nurse-patient relationship. Text Reference - pp. 423-425

A patient describes experiences of having blackouts. The nurse suspects abuse of 1 - Alcohol 2 - Cocaine 3 - Mescaline 4 - Psilocybin

1 - Alcohol Chronic abuse of alcohol is associated with blackouts (periods for which the patient has no memory). Abuse of cocaine produces feelings of euphoria. Abuse of mescaline and psilocybin causes alterations in perception. Text Reference - pp. 420-421

A patient is trying to quit the habit of drinking alcohol. Which symptoms does the nurse recognize as the effect of mild alcohol withdrawal? Select all that apply. 1 - Anorexia 2 - Insomnia 3 - Restlessness 4 - Hypersensitivity 5 - Grand mal seizures

1 - Anorexia 2 - Insomnia 3 - Restlessness Mild alcohol withdrawal occurs as the alcohol concentration in the blood slightly reduces. It can lead to anorexia or loss of appetite, insomnia or lack of sleep, and restlessness. Hypersensitivity to noise and light, and grand mal seizures occur in extreme cases of severe alcohol withdrawal as the alcohol concentration in the blood is greatly reduced. Text Reference - p. 420

Which assessment data would be most consistent with a severe opiate overdose? 1 - Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min 2 - Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min 3 - Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min 4 - Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min

1 - Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression. Text Reference p. 416, Box 22.1

Which symptoms does the nurse look for in a patient with opioid intoxication? Select all that apply. 1 - Bradycardia 2 - Tachycardia 3 - Hypotension 4 - Hypothermia 5 - Hypertension

1 - Bradycardia 3 - Hypotension 4 - Hypothermia Opioids have a sedating effect, which reduces the pulse rate, causing bradycardia, and decreases the blood pressure, causing hypotension. Opioids also tend to reduce the body temperature, causing hypothermia. Tachycardia, or fast pulse, and hypertension are seen in opioid withdrawal as a result of reduced concentration of opioids in the blood. Text Reference - p. 416, Box 22.1

To identify possible complications, a nurse managing the care of patients experiencing alcohol withdrawal will focus on which assessments? Select all that apply. 1 - Confusion 2 - Temperature 3 - Abdominal pain 4 - Increased appetite 5 - Rash development

1 - Confusion 2 - Temperature 3 - Abdominal pain Medical complications associated with alcohol withdrawal include infections, hypoglycemia, gastrointestinal (GI) bleeding, undetected trauma, hepatic failure, cardiomyopathy with ineffective pumping, pancreatitis, and encephalopathy (generalized impaired brain functioning). A rash and increased appetite are not characteristic signs of any medical complication associated with alcohol withdrawal. Text Reference - p. 420

Which principles of counseling does the nurse use when planning care for persons with alcoholism? Select all that apply. 1 - Create a plan to deal with relapse. 2 - Recognize that recovery is an achievable goal. 3 - Assist the individual to learn to limit use of illegal substances. 4 - Support the individual to identify reasons for substance abuse. 5 - Help the individual replace unhealthy defenses with healthy coping.

1 - Create a plan to deal with relapse. 2 - Recognize that recovery is an achievable goal. 5 - Help the individual replace unhealthy defenses with healthy coping. To maintain long-term sobriety, each individual must prepare for and anticipate the possibility of relapse. Recognizing that recovery is an achievable goal is part of instilling hope. Addicted persons use the unhealthy defense of denial but need help learning to use healthy coping strategies. Addicted persons must avoid all use of substances. Identifying reasons for substance abuse is part of the unhealthy use of rationalization. Text Reference p. 427

A nurse interviews a 15-year-old who has engaged in frequent substance abuse. In addition to assessing substance abuse, the nurse should screen for which other problems in this adolescent? Select all that apply. 1 - Depression 2 - Eating disorder 3 - Conduct disorder 4 - Antisocial personality 5 - Obsessive-compulsive disorder

1 - Depression 2 - Eating disorder 3 - Conduct disorder 4 - Antisocial personality The high prevalence of psychiatric comorbidity is supported by statistics from multiple national population surveys. Individuals with mood and anxiety disorders, antisocial behaviors, or histories of conduct or oppositional disorders as adolescents are more than twice as likely to have a substance use disorder. Eating disorders may occur in people abusing stimulants or caffeine. Obsessive-compulsive disorder is not a comorbidity associated with substance abuse. Text Reference - pp. 412, 414, 427

Which medication prescribed to a patient for treatment of alcohol addiction may be associated with intense vomiting, respiratory difficulty, and mental confusion? 1 - Disulfiram 2 - Phenobarbital 3 - Chlordiazepoxide 4 - Acamprosate calcium

1 - Disulfiram Disulfiram is used for the maintenance of alcohol abstinence. However, the medication should be taken consistently to maintain the alcohol aversion. Alcohol consumption while on disulfiram leads to a toxic reaction that results in symptoms such as intense nausea, vomiting, respiratory difficulty, and mental confusion. Chlordiazepoxide is used to reduce withdrawal agitation and can cause sedation and seizures. Phenobarbital could result in sedation. Acamprosate calcium causes side effects such as itching, diarrhea, and intestinal gas. Text Reference - p. 425, Table 22.6

Prescription of which medication represents part of an aversive therapy approach to treatment of addiction? 1 - Disulfiram 2 - Naltrexone 3 - Quetiapine fumarate 4 - Acamprosate calcium

1 - Disulfiram When taking disulfiram, an individual who ingests alcohol will experience a toxic reaction that causes intense nausea and vomiting, headache, sweating, flushed skin, respiratory difficulties, and confusion. These symptoms are intended to create an aversion to use of alcohol. Quetiapine fumarate, acamprosate calcium, and naltrexone are medications prescribed to reduce discomfort associated with withdrawal. Text Reference - p. 425, Table 22.6

A patient is brought to the emergency room with extreme alcohol intoxication. Which health effects of high doses of alcohol does the nurse expect to find in the patient? Select all that apply. 1 - Drowsiness 2 - Constipation 3 - Slurred speech 4 - Loss of coordination 5 - Low body temperature

1 - Drowsiness 3 - Slurred speech 4 - Loss of coordination 5 - Low body temperature High doses of alcohol adversely affect the nervous system and may cause drowsiness, slurred speech, reduction in body temperature, and loss of coordination. These effects are due to the depressive action of alcohol on the brain and the nervous system. Constipation is an aftereffect seen with the intake of opium. Text Reference - p. 420

3 Vindictiveness is defined as spiteful, malicious behavior. The person with this disorder also shows a pattern of deliberately annoying people and blaming others for his or her mistakes or misbehavior. This child may frequently be heard to say "He made me do it!" or "It's not my fault!"

When parents share that their 8-year-old child seems to "always try to be annoying and hateful," the nurse suspects the child is 1 Emotionally immature 2 Experiencing anxiety 3 Vindictive 4 Depressed

Which statement regarding nursing practice and addiction treatment is true? Select all that apply. 1 - Every nurse needs to be familiar with the addiction screening process. 2 - Every nurse should be familiar with the referral process regarding addiction. 3 - Hospitals are responsible for educating nurses regarding the addiction process. 4 - All practice areas require that nurses understand the disease of addiction. 5 - Comprehensive addiction treatment is based on an effective assessment process.

1 - Every nurse needs to be familiar with the addiction screening process. 2 - Every nurse should be familiar with the referral process regarding addiction. 4 - All practice areas require that nurses understand the disease of addiction. 5 - Comprehensive addiction treatment is based on an effective assessment process. It is important for all nurses, regardless of their practice area, to develop an understanding of the disease of addiction. Nursing curricula should include the content and practicing the skills necessary for addiction screening, early detection, and referral to appropriate treatment. Without an accurate assessment for substance use and other mental health disorders, individuals will be unable to receive comprehensive treatment planning and quality care. The education of nurses is not the responsibility of hospitals but rather schools of nursing. Text Reference - pp. 408, 422-423

How should the nurse begin a brief intervention for a patient addicted to cigarettes? 1 - Give feedback to the patient about personal risk. 2 - Provide information about smoking cessation tools. 3 - Set agreeable goals for reducing cigarette smoking. 4 - Arrange a follow-up or specialty referral for the patient.

1 - Give feedback to the patient about personal risk. The nurse can begin an effective intervention for a patient who is addicted to cigarettes by first providing feedback to the patient about personal risk. This first step helps the patient understand the benefits of smoking cessation. Setting agreeable goals for reducing is a follow up intervention once the patient is ready to begin cessation. The nurse should arrange a follow-up or specialty referral for the patient and provide information regarding tools that may help the patient quit smoking. Text Reference p. 410, Table 22.1

The nurse is assessing a patient brought to the emergency room with tachycardia, hypertension, and hyperthermia. On examination, the nurse finds the pupils are dilated and the reflexes are heightened. What does the nurse suspect this condition to be? 1 - Opioid withdrawal 2 - Opioid intoxication 3 - Alcohol withdrawal 4 - Stimulant withdrawal

1 - Opioid withdrawal Opioid withdrawal manifests as a set of physiologic symptoms that begin to occur when the concentration of opium decreases in the patient's bloodstream. It is characterized by tachycardia, hypertension, and hyperthermia. These symptoms are not caused by opioid intoxication, alcohol withdrawal, or stimulant withdrawal. Opioid intoxication is characterized by decreased heart rate, blood pressure, body temperature, body reflexes, and pinpoint pupils. Alcohol withdrawal is characterized by restlessness, irritability, impairment in functioning, and trembling. Stimulant withdrawal is characterized by depression, poor concentration, and paranoia. Text Reference - p. 416, Box 22.1

The nurse observes a patient in the intensive care unit (ICU) with insomnia who used to take opioids for chronic pain. After diagnosis, the nurse finds that the patient has enlarged pupils associated with continuous tearing of the eyes. In the report the nurse would document that the patient was showing signs of what? 1 - Opioid withdrawal 2 - Opioid intoxication 3 - Stimulant withdrawal 4 - Stimulant intoxication

1 - Opioid withdrawal Screening or diagnosis of substance use disorders includes identification of related symptoms. Symptoms of opioid withdrawal are characterized by difficulty in regular sleep pattern (insomnia), enlarged pupils (mydriasis), and continuous tearing of eyes. These symptoms do not indicate opioid intoxication, stimulant withdrawal, or stimulant intoxication. Opioid intoxication is characterized by bradycardia, feelings of sedation, and pinpoint pupils (meiosis). Stimulant withdrawal is characterized by symptoms ranging from decreased energy and dilated pupils to depression, chest pain, and irregular breathing pattern. Stimulant intoxication is characterized by fatigue, anxiety, and irritability. Text Reference p. 416, Box 22.1

A nurse is teaching high school students about commonly abused drugs and their effects. Which common substances are abused through swallowing? Select all that apply. 1 - Opium 2 - Heroin 3 - Alcohol 4 - Nicotine 5 - Marijuana

1 - Opium 3 - Alcohol 5 - Marijuana The substances that are abused by swallowing included opium, alcohol, and marijuana. Opium is an opioid that can be swallowed and smoked. Alcohol is found in liquor, beer, and wine and is abused through swallowing. Marijuana is a cannabinoid and can be swallowed and smoked. Nicotine is the main ingredient in tobacco and is smoked, snorted, or chewed. Heroin is an opioid and can be injected, snorted, and smoked. Text Reference p. 410-412, Table 22.1

A 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be a priority outcome for this patient's treatment plan while in the hospital? 1 - Patient will be medically stabilized while in the hospital. 2 - Patient will return to a predrug level of functioning within 1 week. 3 - Patient will take a leave of absence from college to alleviate stress. 4 - Patient will state within 3 days that he or she will totally abstain from drugs and alcohol.

1 - Patient will be medically stabilized while in the hospital. If the patient has been abusing substances heavily, he or she will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated. The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal, such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge. It is not likely that the patient will make a total commitment to abstinence within 1 week. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely. Text Reference - p. 423

The nurse is assessing an individual for substance abuse disorder. What initial assessments does the nurse do to determine a proper plan of treatment and care? Select all that apply. 1 - Pattern of substance use 2 - Assessment of comorbidities 3 - Clinical examination of background 4 - Strength and level of willingness to change 5 - Willingness for a referral to a support group 6 - Assessment of measures to prevent relapse

1 - Pattern of substance use 2 - Assessment of comorbidities 3 - Clinical examination of background 4 - Strength and level of willingness to change The initial assessment involves a clinical examination of the background, including the patient's history, any history of trauma, a family history of substance use or mental health problems, and any disabilities. Knowledge about the pattern of substance use, such as type of substance, frequency, age at initiation, and so forth, helps in properly planning the treatment and care. An individual's strengths and level of willingness to undergo the treatment helps in planning the treatment strategy. Assessment of comorbidities is also done because they may need to be treated simultaneously. A discussion pertaining to a support group takes place in the planning phase, and a support group is involved in the treatment process. It is not a part of the initial assessment. The relapse prevention measures are discussed after the detoxification or rehabilitation is successfully completed. Text Reference - pp. 423, 427

What should the nurse make a priority for the care of a patient hospitalized with a history of cocaine abuse? 1 - Promoting sleep in the patient 2 - Assisting the patient in setting goals 3 - Encouraging hygiene practices in the patient 4 - Developing a therapeutic relationship with the patient

1 - Promoting sleep in the patient Most often, substance abuse results in the neglect of personal needs such as sleep and food. Therefore, the nurse should first aim to promote sleep and safety in the patient. Assisting the patient in setting goals can be done once the patient's condition is stabilized. It instills hope and direction in the patient. The patient is encouraged to perform self-hygiene practices to improve self-esteem. Thereafter, the patient is helped in exploring harmful thoughts and anxieties by developing a therapeutic relationship. Text Reference - pp. 410, 418, 424

What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with the ethical obligation when the nurse observes a peer who is under the influence of alcohol? 1 - Supervisory staff should be informed as soon as possible in both cases. 2 - Neither should be reported until the nurse has collected factual evidence. 3 - No report should be made until suspicions are confirmed by a second staff member. 4 - The nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol-using nurse until a second incident takes place.

1 - Supervisory staff should be informed as soon as possible in both cases. If indicators of impaired practice are observed, the observations need to be reported to the nurse manager. Intervention is the responsibility of the nurse manager and other nursing administrators. However, clear documentation (specific dates, times, events, consequences) by coworkers is crucial. The nurse manager's major concerns are with job performance and patient safety. Reporting an impaired colleague is not easy, even though it is a responsibility. To not "see" what is going on, nurses may deny or rationalize, thus enabling the impaired nurse to potentially endanger lives while becoming sicker and more isolated. Impairment can occur whether the nurse is under the influence of alcohol or a narcotic drug. Text Reference - p. 423

The nurse planning educational materials for parents of children with a history of opioid abuse will emphasize which signs when discussing opioid withdrawal? Select all that apply. 1 - Sweating 2 - Runny nose 3 - Sleeplessness 4 - Slurred speech 5 - Enlarged pupils

1 - Sweating 2 - Runny nose 3 - Sleeplessness 5 - Enlarged pupils Signs of opioid withdrawal include dilated pupils, insomnia, diaphoresis, and rhinorrhea. Slurred speech is associated with opioid intoxication. Text Reference - p. 416, Box 22.1

A patient hospitalized after a heroin overdose shares, "I've been using more heroin lately to get my usual high." The nurse determines that this information supports the existence of what abuse-related outcome? 1 - Tolerance 2 - Addiction 3 - Intoxication 4 - Withdrawal

1 - Tolerance Tolerance is described as needing increasingly greater amounts of a substance to become intoxicated or finding that using the same amount over time results in a much diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships. Text Reference - p. 409

Nursing assessment of an alcohol-dependent patient experiencing uncomplicated moderate alcohol withdrawal would most likely reveal the presence of 1 - Tremors 2 - Seizures 3 - Blackouts 4 - Hallucinations

1 - Tremors Tremors are a sign of mild to moderate alcohol withdrawal. Hallucinations, seizures and blackouts would indicate complicated or severe ETOH withdrawal. Text Reference - p. 420

A patient is administered naloxone for an opioid overdose. What withdrawal symptoms does the nurse anticipate? Select all that apply. 1 - Yawning 2 - Rhinorrhea 3 - Nystagmus 4 - Lacrimation 5 - Piloerection

1 - Yawning 2 - Rhinorrhea 4 - Lacrimation 5 - Piloerection Withdrawal symptoms the nurse can anticipate include rhinorrhea, yawning, lacrimation, and piloerection. Nystagmus occurs in patients experiencing phencyclidine intoxication. Text Reference - p. 415

Which response is appropriate when teaching a patient regarding a prescription for naltrexone? 1 - "It will keep you from experiencing flashbacks." 2 - "It helps prevent relapse by reducing your drug cravings." 3 - "It helps your mood so that you don't feel the need to do drugs." 4 - "It is a sedative that will help you sleep at night so you are more alert and able to make good decisions."

2 - "It helps prevent relapse by reducing your drug cravings." Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. Improving mood, preventing flashbacks, and helping one to sleep do not describe accurately the action of naltrexone. Text Reference - p. 417

A patient is brought to the emergency department for suspected inhalant intoxication and is exhibiting signs of severe agitation and aggression. What plan of care does the nurse anticipate to help stabilize the patient? 1 - Administer naloxone. 2 - Administer haloperidol. 3 - Place the patient in restraints. 4 - Keep the patient calm; intoxication is self-limiting.

2 - Administer haloperidol. The nurse will anticipate administering haloperidol, which can be used carefully to manage severe agitation for patients experiencing inhalation intoxication. Restraints should be used judiciously and only after other interventions have been tried or if the patient tries to harm him- or herself or others. Naloxone is used to treat narcotic overdoses. Severe agitation and aggression can occur as a result of inhalant intoxication and is self-limiting, lasting a few hours to a few weeks. It may not be possible to keep the patient calm. Text Reference - p. 415

A patient presents to the clinic seeking help for excessive gambling. Which type of psychiatric condition is this patient experiencing? 1 - Substance addiction 2 - Behavioral addiction 3 - Substance use disorder 4 - Impulse control disorder

2 - Behavioral addiction Behavioral addictions (also called process addictions) include gambling and other compulsive actions that are reinforced through the dopamine glutamate cycle and can become dysfunctional for the individual, resulting in many of the same problematic behaviors and functional issues as ingested substances. Individuals with impulse control disorders are typically children or adolescents who have problems relating to others in socially acceptable ways, such as with oppositional defiant and conduct disorders. Substance use disorder occurs when the patient briefly alters the brain by ingesting a substance. Substance addiction occurs when ingesting a substance has resulted in permanent brain alteration. Text Reference - p. 408

On examination, the nurse finds that a patient who is a drug addict has nasal damage. Which substance abuse does the nurse suspect? 1 - Opium 2 - Cocaine 3 - Hashish 4 - Lysergic acid diethylamide (LSD)

2 - Cocaine Cocaine is a stimulant and is administered by smoking, injecting, or snorting. Snorting cocaine causes nasal damage. LSD is a hallucinogen that is swallowed or absorbed through tissues in the mouth. Opium is an opioid that is swallowed or smoked. Hashish is a cannabinoid that is smoked or swallowed. Text Reference - p. 410, Table 22.1

The nurse is performing an assessment of a patient who has a history of drug abuse and has many injection marks on the arm. Which drug should the nurse suspect the patient to be abusing? 1 - Opium 2 - Cocaine 3 - Hashish 4 - Marijuana

2 - Cocaine Cocaine is a stimulant and is administered by snorting, smoking, or injecting. Opium is an opioid that is swallowed or smoked. Hashish is a cannabinoid that is smoked or swallowed. Marijuana is a cannabinoid that is smoked or swallowed. Text Reference - pp. 410-412, Table 22.1

A nurse cares for a patient hospitalized 3 days ago with gastrointestinal bleeding. Today, the patient is irritable and restless and complains to the nurse, "There is too much noise in this hospital. The lights are so bright they are blinding me." What is the nurse's best action? 1 - Conduct a thorough search in the patient's room for hidden alcohol. 2 - Complete a comprehensive assessment for signs and symptoms of alcohol withdrawal. 3 - Assess for a delayed reaction to a blood transfusion given the first day of hospitalization. 4 - Notify the facility's maintenance manager to adjust the lighting and intercom level in the patient's room.

2 - Complete a comprehensive assessment for signs and symptoms of alcohol withdrawal. Gastrointestinal bleeding is a medical complication of chronic alcohol abuse; the admitting diagnosis is a clue to be observant for alcohol-related problems. Hypersensitivity to noises (which seem louder than usual) and light (which appears brighter than usual) is associated with severe alcohol withdrawal. Irritability and restlessness are additional clues to alcohol withdrawal. If the patient had been using alcohol from a hidden source, he or she would not be experiencing alcohol withdrawal. Reactions to blood transfusions occur immediately. After assessing the patient, the nurse may decide to adjust the room's lighting and noise. Text Reference p. 421

The nurse is working with a support team for managing patients with substance use disorders. Why would the nurse consider providing encouragement for self-care as an important step? 1 - To explore harmful thoughts 2 - To see beyond current situation 3 - To improve self-esteem of the patients 4 - To test newly acquired coping skills in a safe setting

3 - To improve self-esteem of the patients Providing support and encouragement helps to improve self-esteem of the patients because most may have neglected themselves. To explore harmful thoughts, developing a therapeutic relationship can help. Current coping skills should be understood and new skills should be identified by the patient to help test the skills in safe settings. To see beyond the current situation and become hopeful, the patient should be assisted in goal setting. Text Reference p. 424

A patient is undergoing detoxification for heroin abuse at a residential rehabilitation program. What teaching by the nurse can help prevent a relapse in the future? Select all that apply. 1 - Assisting in the development of awareness and commitment 2 - Counseling to identify the potential triggers of substance use 3 - Helping the patient understand and admit that there is a problem 4 - Helping in acquiring skills to regain abstinence in the event of relapse 5 - Teaching stress management skills to address triggers that may lead to substance use 6 - Counseling on adopting healthy coping measures and a sustainable recovery lifestyle

2 - Counseling to identify the potential triggers of substance use 4 - Helping in acquiring skills to regain abstinence in the event of relapse 5 - Teaching stress management skills to address triggers that may lead to substance use 6 - Counseling on adopting healthy coping measures and a sustainable recovery lifestyle Individuals must prepare for and anticipate the possibility of relapse to maintain long-term sobriety. A nurse can help in identifying the triggers to substance use, and teaching the patient to regain abstinence in the event of a relapse. The patient should learn how to handle stress effectively. The patient is counseled on healthy coping measures and how to sustain a healthy life after treatment. Precontemplation is the initial stage of admitting that there is a problem of addiction so that an assessment can start. Helping the patient understand the problem and admit there is a problem is important, but it is not part of a teaching plan. The development of awareness and a commitment is at the very beginning of the treatment of addiction. Assisting the patient to develop awareness is also not part of a teaching plan. Text Reference p. 427

The nurse is planning care management for a patient with alcohol misuse. What intervention does the nurse plan for rehabilitation of this patient? 1 - Avoid repeated counseling. 2 - Develop motivation and self-help skills. 3 - Refrain from assessing alcohol consumption. 4 - Avoid discussing the effects of alcohol intake.

2 - Develop motivation and self-help skills. The patient needs assistance with motivation, support, and self-help skills to instill hope and positivity. Repeated counseling, follow-ups, or specialty referrals should be planned as required. Alcohol consumption should be assessed using a brief screening tool. The patient should be clearly advised about the effects of alcohol consumption. Text Reference p. 425

Which chemical in tobacco causes addiction? 1 - Opium 2 - Nicotine 3 - Cocaine 4 - Cannabinoids

2 - Nicotine Nicotine is found in tobacco and causes an addictive disorder. This chemical overpowers the reward pathway circuit and releases the neurotransmitter dopamine, which gradually becomes more important than the reward of pleasure. The increased saliency of the addictive process cancels the inhibitory function of the frontal cortex, leading to craving. Cannabinoids are the chemicals found in marijuana. Cocaine and opium are other substances that cause addiction. These are not found in tobacco. Text Reference - pp. 413, 418

How could being part of a family where there is alcoholism and codependency affect nurses in their profession? 1 - Codependency in families helps the nurses to learn better stress management skills. 2 - Nurses with codependency may see themselves as providers of care, excluding their own needs. 3 - Codependency in families teaches the nurses to be objective and helps in patient care. 4 - Nurses with codependency often live a full and satisfying life by caring for others.

2 - Nurses with codependency may see themselves as providers of care, excluding their own needs. The nurses may be at higher risk for relationship difficulties related to codependence if they have grown up in environments where one or more family members were addicted. This may play a role for the nurses to choose this profession because they see themselves as care providers for the patient. This disrupts the objectivity of the treatment process. A codependent person develops an attitude of helping others excluding one's own self and that prevents the person from living a full, satisfying life. Codependency does not help to manage stress. Rather, the individuals may develop maladaptive thoughts or behaviors that may bring on stress in their lives. Text Reference - p. 423

A patient has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, nursing measures should include 1 - Induction of vomiting 2 - Observation for cardiac dysfunction 3 - Administration of ammonium chloride 4 - Monitoring of opiate withdrawal symptoms

2 - Observation for cardiac dysfunction Cardiac dysfunctions are observed in patients experiencing central nervous system stimulant overdose. Text Reference - p. 418, Box 22.2

The treatment team meets to discuss the plan of care for a patient diagnosed with addiction to heroin. Which factor will have priority when planning interventions? 1 - Financial ability 2 - Readiness to change 3 - Current college performance 4 - Availability of immediate family

2 - Readiness to change The plan will take into account acute safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and the individual's cultural needs. Current college performance, financial ability, and availability of immediate family may be factors but are not the priority factors in planning interventions for the patient as much as the patient's perceived need for change and having others who can lend support outside the hospital. Text Reference p. 423-424

When caring for a patient who is intoxicated from alcohol, which need has the highest priority? 1 - Self-esteem needs 2 - Safety and security 3 - Physiologic stability 4 - Cultural preferences

2 - Safety and security The plan should address safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and cultural needs. Safety is the highest priority because of the patient's imminent risks for injury while intoxicated. Physiologic stability has the second highest priority. Text Reference - p. 424

What schedule of drugs have a high potential for abuse, are considered dangerous, and are only available by prescription? 1 - Schedule I 2 - Schedule II 3 - Schedule III 4 - Schedule V

2 - Schedule II Schedule II drugs have a high potential for abuse, are considered dangerous, and are only available by prescription. Schedule I drugs carry a high potential for abuse and have no medical use. Schedule III drugs have a low to moderate potential for misuse and are available only by prescription. Schedule V drugs contain limited quantities of certain narcotics. Text Reference - p. 410

Which are clinical features of fetal alcohol syndrome? Select all that apply. 1 - Spina bifida 2 - Short stature 3 - Microcephaly 4 - Renal agenesis 5 - Craniofacial malformations

2 - Short stature 3 - Microcephaly 5 - Craniofacial malformations Clinical features of fetal alcohol syndrome include short stature, microcephaly, and craniofacial malformations. Spina bifida and renal agenesis are not associated with fetal alcohol syndrome. Text Reference - p. 421

The nurse notices withdrawal symptoms in a patient with substance use disorder. What is the priority substance use disorder outcome measure when planning the care of this patient? 1 - Motivation for treatment 2 - Stabilization of the patient 3 - Pursuit of a recovery lifestyle 4 - Maintenance of proper nutrition intake

2 - Stabilization of the patient The patient needs to be medically stable before addressing nutrition or recovery. Maintenance of proper nutrition is important for patients with substance abuse because their nutrition is often either less or more than their body requires. If the patient is actively using the substance, motivation for treatment is an important outcome measure. Pursuit of recovery lifestyle is a desired outcome measure for the postdischarge period. However, when the patient has withdrawal symptoms, stabilization of the patient is of primary importance. Text Reference - p. 423

What is occurring in the patient with a substance abuse disorder who no longer responds to the effect of the substance? 1 - Addiction 2 - Tolerance 3 - Withdrawal 4 - Intoxication

2 - Tolerance A patient with a substance abuse disorder who no longer responds to the effect of the substance is experiencing tolerance. Withdrawal is a set of physiological symptoms that occur when a person stops using a substance. Addiction is a primary chronic disease of dysregulation in the hedonic (pleasure-seeking) or reward pathway of the brain. Intoxication occurs when a substance is used to excess. Text Reference - p. 409

The nurse is assessing a patient who has been smoking cigarettes for 5 years and has slowly increased the number of cigarettes consumed per day. What does the nurse recognize this condition as? 1 - Addiction 2 - Tolerance 3 - Withdrawal 4 - Intoxication

2 - Tolerance Tolerance occurs when a person needs increased quantities of a substance to obtain the desired effect, thereby increasing the total intake of a substance. Addiction is caused by a disturbance in the regulation of the pleasure-seeking pathway of the brain leading to the need for an increased dose of the same substance for relief. Withdrawal occurs when a person experiences physiologic symptoms as a result of a decrease of the substance in the bloodstream. Intoxication occurs when a person uses a substance in excess. Text Reference - p. 409

In confidence, an emergency department nurse said to a nursing colleague, "I know I am addicted to narcotics but I'm afraid I will lose my nursing license if I talk to my supervisor about it." Select the colleague's best initial response. 1 - "For the safety of your patients, you cannot use narcotics anymore. I hope you will get help." 2 - "I am glad you were willing to tell me about this problem. Narcotics Anonymous can help you." 3 - "There are special programs that can help you with your addiction so you can continue to practice. Talk to your supervisor." 4 - "There are many careers where you can use your nursing knowledge but not actually practice nursing. I will be glad to help you find one."

3 - "There are special programs that can help you with your addiction so you can continue to practice. Talk to your supervisor." The colleague should first provide information about programming to give hope to the addicted nurse. Approximately 10% to 15% of nurses have problems related to abuse or addiction. For nurses who are engaging in risk-taking behaviors, there are nonpunitive alternatives to discipline programs in the form of peer assistance. Diversion legislation allows addicted nurses to attend a treatment or recovery program, have their progress monitored, meet specific criteria to return to work, and be spared revocation or suspension of their licenses if they follow the recommendations of their program. After responding, the colleague has a legal responsibility to report this information. Text Reference - p. 423

An appropriate long-term goal/outcome for a recovering substance abuser would be that the patient will 1 - Discuss the addiction with significant others 2 - State an intention to stop using illegal substances 3 - Abstain from the use of mood-altering substances 4 - Substitute a less-addicting drug for the present drug

3 - Abstain from the use of mood-altering substances Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term. Text Reference - p. 424, Table 22.5

The nurse is attempting to address the patient's inability to motivate him- or herself to stop abusing alcohol. To best facilitate this change in behavior, the nurse 1 - Interviews family members to gain insight into the patient's life and relationships. 2 - Assesses the patient's cognitive ability to retain information after 10 years of chronic alcohol abuse. 3 - Asks the patient to identify three negative outcomes that chronic alcohol abuse has had on his or her life. 4 - Encourages the patient to attend an Alcoholics Anonymous (AA) meeting to become familiar with the concept of support groups.

3 - Asks the patient to identify three negative outcomes that chronic alcohol abuse has had on his or her life. Everyone has ambivalence about changing, and there are always advantages and disadvantages to making a change. People are motivated to change when their values and goals conflict with their current behavior and when the benefits of change outweigh the benefits of staying the same. With the patient's permission, interviewing family members would likely be helpful for the purpose of information gathering but has limited potential for stimulating the patient's motivation to change behavior. It is an appropriate intervention to assess the patient's cognitive ability to learn and retain information, but it has limited potential for stimulating the patient's motivation to change behavior. Encouraging the patient to attend AA would be appropriate once the patient is motivated to bring about a change in his or her drinking behavior. Text Reference - p. 426

A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested 1 - ReVia 2 - Clonidine 3 - Gamma-hydroxybutyrate (GHB) 4 - Levo-alpha-acetylmethadol (LAAM)

3 - Gamma-hydroxybutyrate (GHB) The drugs most commonly used to facilitate a sexual assault (rape) are flunitrazepam, a fast-acting benzodiazepine, and GHB and its congeners. These drugs are odorless, tasteless, and colorless; mix easily with drinks; and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur. LAAM is indicated as a second-line treatment for the treatment and management of opioid dependence if patients fail to respond to drugs like methadone. Naltrexone is an opioid receptor antagonist used primarily in the management of alcohol dependence and opioid dependence. Clonidine hydrochloride is a centrally acting α-agonist hypotensive agent. Text Reference - p. 411, Table 22.1

Which statements are true regarding substance addiction? Select all that apply. 1 - Intoxication occurs as a result of years of substance use. 2 - Addiction is the result of emotional, not physical, factors. 3 - Hedonistic behaviors are demonstrated by the addicted individual. 4 - Addiction currently is described as being chronic and affecting motivation. 5 - The term commonly used to describe substance use disorders is addiction.

3 - Hedonistic behaviors are demonstrated by the addicted individual. 4 - Addiction currently is described as being chronic and affecting motivation. 5 - The term commonly used to describe substance use disorders is addiction. A term that people commonly use to describe substance use disorders is addiction. The most current definition of addiction states that it is a "primary, chronic disease of brain reward, motivation, memory, and related circuitry." It is a disease of dysregulation in the hedonic (pleasure seeking) or reward pathway of the brain. When people are in the process of using a substance to excess they are said be experiencing intoxication. Text Reference - pp. 408-409

Cocaine exerts which of the following effects on a patient? 1 - Slowed reaction time 2 - Drowsiness 3 - Increased metabolism 4 - Immediate imbalance of emotions

3 - Increased metabolism Cocaine exerts a stimulant effect on metabolism Text Reference - p. 410, Table 22.1

A nurse is learning how to manage patients with substance abuse disorders. Which step should the nurse apply as a first-line intervention in such cases? 1 - Sedating the patients 2 - Secluding the patients 3 - Providing safety and sleep 4 - Encouraging strenuous activities

3 - Providing safety and sleep Because patients with substance use disorders are under variable influence of the drug effects, providing safety and sleep is essential to help the body recover. Strenuous activity should be avoided to prevent fatigue. Seclusion and sedation may not help the patient; these measures are used only when the patient is aggressive and harmful to self or others. Text Reference - p. 424

What is the most appropriate nursing diagnosis for a patient who exhibits impulsiveness and experiences a loss of relationships and occupation due to a focus on alcohol use? 1 - Risk for injury 2 - Hopelessness 3 - Risk for suicide 4 - Ineffective coping

3 - Risk for suicide The nursing diagnosis that is most appropriate for a patient who exhibits impulsiveness and experiences a loss of relationships and occupation due to a focus on alcohol use is risk for suicide. The impulsive behavior is the key component that may result in the patient harming him- or herself. A patient at risk for injury exhibits signs that include impairment, overdose, withdrawal from substances, and hallucinations. A patient who displays hopelessness presents with a lack of initiative, is passive, and reports seeing no alternatives or personal control. Signs and symptoms of a patient with ineffective coping include the decreased use of social support, destructive behavior toward him- or herself and others, inadequate problem-solving, poor concentration, and a reported inability to cope. Text Reference - p. 424

The nurse is learning about commonly abused substances and their effects. Which type of drug does the nurse understand to cause increased mental alertness? 1 - Alcohol 2 - Opioids 3 - Stimulants 4 - Cannabinoids

3 - Stimulants Stimulants have a stimulating effect that increases energy, heart rate, and mental alertness. Alcohol can cause mild stimulation and relaxation but in higher doses causes impaired memory. Opioids cause impaired coordination, confusion, and drowsiness. Cannabinoids cause relaxation, disturbed balance and coordination, and impaired memory and learning. Text Reference - pp. 410-412, Table 22.1

The term tolerance, as it relates to substance abuse, refers to 1 - The use of a substance beyond acceptable societal norms 2 - The additive effects achieved by taking two drugs with similar actions 3 - The need to take larger amounts of a substance to achieve the same effects 4 - The signs and symptoms that occur when an addictive substance is withheld

3 - The need to take larger amounts of a substance to achieve the same effects With regard to substance abuse, tolerance is defined as the need to take higher and higher doses of a drug to achieve the desired effect. The use of a substance beyond acceptable societal norms, the additive effects achieved by taking two drugs with similar actions, and the signs and symptoms that occur when an addictive substance is withheld do not correctly describe the term tolerance. Text Reference - p. 409

Which finding indicates that treatment for imbalanced nutrition has been effective for a patient with a history of cannabis abuse? 1 - The patient expresses feelings. 2 - The patient remains injury free. 3 - The patient eats a well-balanced diet. 4 - The patient feels refreshed on awakening in the mornings.

3 - The patient eats a well-balanced diet. Cannabis use causes abnormal eating patterns that can result in obesity. Therefore, effective treatment should enable the patient to eat a well-balanced diet that provides adequate nutrients to meet the metabolic demands of the body. Patients who have a risk of suicide begin to express feelings after successful therapy. Effective treatment of patients with a risk for injury because of substance use will result in the patient remaining free from injuries. Patients who experience disturbed sleep patterns will begin to sleep well and feel refreshed on awakening in the mornings after treatment. Text Reference - p. 424, Table 22.5

When a couple in their early 40s tells the nurse that they have not had sexual relations in more than five years, the nurse should initially Remain noncommittal and allow them to take the lead Ask the couple about any medical conditions they have Mention that a lack of sexual desire is not an uncommon problem Ask whether the couple finds this troublesome and are seeking help

Ask whether the couple finds this troublesome and are seeking help The nurse should not assume that the couple wishes to change this circumstance; the nurse must ask them if that is the case.

A patient is admitted to the unit for alcohol withdrawal and presents with moderate agitation and tremors. What is the nurse's priority action? 1 - Administer diltiazem IV. 2 - Administer diazepam IV. 3 - Administer lorazepam IM. 4 - Administer chlordiazepoxide IV.

4 - Administer chlordiazepoxide IV. The nurse's priority action is to administer chlordiazepoxide intravenously (IV). Chlordiazepoxide is useful for tremulousness and mild to moderate agitation. IV diltiazem is a calcium channel blocker for hypertension. Diazepam IV is a common treatment for withdrawal seizures. Intramuscular (IM) lorazepam is used for withdrawal in which psychosis is present. Text Reference - p. 420

What is the nurse's most important intervention when caring for a patient experiencing severe alcohol withdrawal symptoms? 1 - Administer prescribed appetite stimulants. 2 - Administer prescribed hypnotic medication. 3 - Administer prescribed antipyretic medication. 4 - Administer prescribed anticonvulsant medication.

4 - Administer prescribed anticonvulsant medication. The patient experiencing severe symptoms of alcohol withdrawal will experience generalized seizures, which are managed by administration of prescribed anticonvulsant medication. It is the most important nursing intervention in patients with severe alcohol withdrawal symptoms. Prescribed hypnotic medications are administered to treat insomnia, which is a mild symptom of alcohol withdrawal. Anorexia is also a mild symptom of alcohol withdrawal and can be managed with suitable appetite stimulants. Patients with severe alcohol withdrawal symptoms may experience a high-grade fever, generally above 101° F. The nurse should administer the prescribed antipyretic to reduce the fever. However, it is not the most important intervention. Text Reference - p. 420

The nurse suspects a patient of substance abuse. What should be the nurse's first intervention? 1 - Referral to detoxification program 2 - Positron emission tomography of the brain 3 - Magnetic resonance imaging study of the brain 4 - Assessment for substance use and comorbidities

4 - Assessment for substance use and comorbidities An accurate assessment for substance use and other mental health disorders is the key to successful treatment planning. The nurse needs to determine what substance or substances the patient is using, as well as identify underlying medical and mental health disorders that may affect treatment. A referral is done after the assessment and counseling. Magnetic resonance imaging and a positron emission tomography help in understanding the underlying neurobiology of the brain. They provide better understanding of the mental health disorder and help in detection and treatment. Text Reference - p. 422

The nurse is educating a group of adolescents about different kinds of substance abuse. In which category can magic mushrooms be classified? 1 - Opioids 2 - Stimulants 3 - Cannabinoids 4 - Hallucinogens

4 - Hallucinogens Substances may be classified according to their mechanism of action. Magic mushrooms, a common street name of psilocybin, can be classified as hallucinogens for their severe hallucinogenic effects. Stimulants, cannabinoids, and opioids are other categories of substances. Cocaine, amphetamine, and methamphetamine are stimulants. They cause hyperreactivity and provide feelings of exhilaration. Marijuana and hashish are cannabinoids. Heroin and opium are opioids Text Reference - p. 411, Table 22.1

What symptoms suggest the use of marijuana by a patient? 1 - Hallucinations and sweating 2 - Violent behavior and psychosis 3 - Disorientation and memory loss 4 - Increased heart rate and appetite

4 - Increased heart rate and appetite A patient who has been using marijuana will have an increased heart rate and appetite. People who use marijuana often get "the munchies" from the effects of this drug. Violent behavior and psychosis happen from using amphetamines. Disorientation and memory loss come from gamma-hydroxybutyrate (GHB). People develop hallucinations and sweating when using lysergic acid diethylamide (LSD). Text Reference - p. 410, Table 22.1

How does the advanced practice nurse integrate motivational interviewing as a tool in the treatment plan of a patient with a substance use disorder? 1 - It introduces an alternative treatment process that is parallel to the current treatment process. 2 - It assesses the substance-related disorder and determines if other comorbidities are present. 3 - It modifies the current treatment process by allowing the nurse to evaluate the process frequently and gives input related to health care. 4 - It helps the advanced practice nurse assess the stage of change the patient is in and match it with an appropriate treatment process.

4 - It helps the advanced practice nurse assess the stage of change the patient is in and match it with an appropriate treatment process. An advanced practice nurse first understands the change that is occurring in the individual as it relates to the patient's substance use disorder. Then, the nurse assists the patient in correlating the change in the individual with the treatment process. A nurse works as a part of the treatment process rather than introducing an alternative plan. A nurse assists the patient to develop coping skills and motivates the patient to follow the treatment plan. The evaluation of the treatment plan is not a part of counseling. The assessment of substance use disorder and comorbidities is done after the screening and based on that assessment, the counseling starts. Text Reference - p. 425

Symptoms that would signal opioid withdrawal include 1 - Fatigue, lethargy, sleepiness, and convulsions 2 - Illusions, disorientation, tachycardia, and tremors 3 - Synesthesia, depersonalization, and hallucinations 4 - Lacrimation, rhinorrhea, dilated pupils, and muscle aches

4 - Lacrimation, rhinorrhea, dilated pupils, and muscle aches Symptoms of opioid withdrawal resemble the flu; they include runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever. The characteristic symptoms of opioid withdrawal are not described accurately as illusions, disorientation, tachycardia, tremors, fatigue, lethargy, sleepiness, convulsions, synesthesia, depersonalization, and hallucinations. Text Reference - p. 416

The nurse assesses a patient who abuses various substances and discovers significant dental problems. The nurse expects that this patient abuses which substance? 1 - Opiates 2 - Alcohol 3 - Inhalants 4 - Methamphetamines

4 - Methamphetamines Abuse of methamphetamine is associated with severe dental problems. If opiates are injected, damage to the skin and veins occurs. Alcohol abuse is associated with gastrointestinal erosion as well as other physiologic consequences. Abuse of inhalants is damaging to the respiratory tract. Text Reference - p. 410, Table 22.1

The nurse should plan to educate the male patients prescribed a statin medication on the possible development of which commonly observed side effect? Impotence Gynecomastia Decreased libido Delayed Ejaculation

Decreased libido

A patient presents to the clinic stating, "I don't feel good, I think I drank too much coffee and my heart feels like it is pounding." What further physical assessment findings does the nurse anticipate? 1 - Agitation 2 - Tachypnea 3 - Restlessness 4 - Muscle twitching

4 - Muscle twitching The nurse can anticipate muscle twitching during the assessment of the patient. Caffeine intoxication is characterized by several physical and behavioral symptoms. A behavioral symptom associated with caffeine intoxication is agitation. Tachypnea is not a typical finding in patients experiencing caffeine intoxication. Restlessness is another behavioral symptom of caffeine intoxication. Text Reference - p. 414

An adult has been abusing amphetamines. As this person withdraws, which assessment finding is most likely? 1 - Dilated pupils 2 - Irregular heart rate 3 - Excessive motor activity 4 - Psychomotor retardation

4 - Psychomotor retardation Withdrawal from amphetamines commonly is associated with symptoms of depression. Psychomotor retardation commonly accompanies depression. Dilation of the pupils, dryness of the oronasal cavity, irregular heart rate, and excessive motor activity are symptoms of amphetamine intoxication. Text Reference - p. 418, Box 22.2

Which type of facility would best support the needs of an impaired patient who is need of long-term help related to hallucinogen abuse? 1 - Halfway house 2 - Partial hospitalization 3 - Intensive outpatient program 4 - Residential rehabilitation center

4 - Residential rehabilitation center A patient with severe impairment as a result of hallucinogen abuse can receive long-term professional medical care in a residential rehabilitation center. Residents of halfway houses reside at the house but continue working outside. These patients may be more vulnerable to relapse. Partial hospitalization provides a combination of psychotherapy and educational groups without having to reside at the hospital but is not the best support for the patient who is severely impaired. An intensive outpatient program is a nonresidential setup that only provides medication oversight, and this would not be the best choice to a patient who is severely impaired. Text Reference - p. 427

Why is cognitive-behavioral therapy indicated in a patient with an addiction? 1 - To enhance motivation in the patient 2 - To allow a sustainable recovery lifestyle 3 - To break the denial behavior of the patient 4 - To identify irrational core beliefs in the patient

4 - To identify irrational core beliefs in the patient Cognitive-behavioral therapy is conducted for a patient who has an addiction in order to identify irrational core beliefs. Mindfulness and meditation are helpful in sustaining a recovery lifestyle. Motivational interviewing is a technique that helps assess the status of the patient and break denial while enhancing motivation. Cognitive-behavioral therapy aids the patient in exploring thought patterns so that core beliefs can be analyzed. Text Reference p. 425

A patient with severe addiction to alcohol plans to undergo a detoxification program. Why is 24-hour professional supervision needed during this process? 1 - To support and motivate patients while they experience detoxification 2 - To assess and maintain adequate nutritional intake during the withdrawal process 3 - To check if the patient is still abusing any substances while undergoing detoxification 4 - To monitor and intervene during the process because there are uncomfortable and even fatal side effects

4 - To monitor and intervene during the process because there are uncomfortable and even fatal side effects Alcohol withdrawal has many uncomfortable and sometimes fatal side effects. Therefore, detoxification is available as a medically monitored program with 24-hour medical supervision based on the severity of symptoms and the presence of comorbid conditions. Supportive and motivational counseling is a continuous process that starts before the detoxification program and goes on throughout the treatment process. The patient is cut off from any substances he or she might abuse while undergoing detoxification. It is important to monitor that metabolic needs are met, but a 24-hour professional supervision is not needed for that. Text Reference p. 427

A patient is diagnosed with mouth cancer. Which substance abuse should the nurse inquire about with the patient? 1 - Opium 2 - Alcohol 3 - Cocaine 4 - Tobacco

4 - Tobacco Substance use disorders arise from cravings for drugs or other substances and eventually turn to physical addictions. Oral and injection are the common routes of administration. Addiction to tobacco causes disorders like hypertension, chronic lung disorders, and mouth cancer. These symptoms are not seen in cases of opium, alcohol, and cocaine addictions. Addiction to opium may result in constipation, hepatitis, and endocarditis. Addiction to alcohol may result in loss of consciousness, visual distortions, sexual dysfunction, and liver and heart disorders. Addiction to cocaine may result in hypertension. Text Reference - p. 410, Table 22.1

Which observation indicates to the nurse that a patient is at risk for codependent behavior? 1 - Irresponsible behavior 2 - Lack of care toward others 3 - Family history of tobacco abuse 4 - Values for himself or herself are based on self-assets and actions

4 - Values for himself or herself are based on self-assets and actions Codependence is a behavioral pattern in which the patient values himself or herself based on self-assets, actions, and looks rather than what he or she is as a person. The patient exhibits overresponsible behavior and performs activities for others that they could perform on their own. The patient defines self-worth based on his or her care for others even at the cost of neglecting his or her own needs. Codependence refers to a group of behaviors linked to families with alcoholic patients. Text Reference - p. 423

What term is used to identify a syndrome that occurs after stopping the long-term use of a drug? 1 - Enabling 2 - Amnesia 3 - Tolerance 4 - Withdrawal

4 - Withdrawal Withdrawal is a condition marked by physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in dosage. Amnesia, tolerance, and enabling are not used to identify the described event. Text Reference - p. 409

4 Kleptomania is characterized by an uncontrolled desire to steal objects and failing to resist the urge. The urge does not have to be related to actual need. Defiance in oppositional defiant disorder is characterized by irritability, getting angry, and being defiant and vindictive. Pyromania is the uncontrolled desire to deliberately set fire and experiencing pleasure by doing so. Callousness is a lack of sensitivity and empathy for others.

A nurse is assessing an adolescent boy from an upper-class family. He has an irresistible desire to steal objects from others' bags. What does the nurse diagnose this condition as? 1 Defiance 2 Pyromania 3 Callousness 4 Kleptomania

4 Oppositional defiant disorder is characterized by irritability, getting angry, and being defiant and vindictive. Getting remorseful for an act of aggression is observed in intermittent explosive disorder and usually in adults. Exploding in anger is observed in intermittent explosive disorder, usually seen in adults. A child with conduct disorder has a callous attitude.

A nurse is caring for a child with behavior issues and reads the diagnosis as oppositional disorder. Which behavior does the nurse observe in relation to this diagnosis? 1 The child is remorseful. 2 The child explodes in anger. 3 The child shows callousness. 4 The child is irritable and vindictive.

Glutamate

A neurotransmitter that sends signals between nerve cells and plays a role in learning and memory

1 Safety is the nurse's priority concern. The number one predictor of suicidal risk is a past suicide attempt. Impulsivity and aggression make the possibility of suicide attempts more likely. Ineffective coping, impaired adjustment, and impaired social interaction may apply, but are not the priority.

A nurse assesses a 15-year-old who stole and wrecked a neighbor's classic antique car. Two years ago, this adolescent self-inflicted stab wounds. Which nursing diagnosis has priority? 1 Risk for suicide 2 Ineffective coping 3 Impaired adjustment 4 Impaired social interaction

1, 2, 3 Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. The aggression can be verbal or physical; therefore, fearfulness from the parents is expected. Intermittent explosive disorder also is associated with conflict and violence in the family of origin. It is common for these families to have had a history of addiction and substance abuse. Higher levels of the hormone testosterone are associated with intermittent explosive disorder, which would lead to masculine rather than feminine behaviors. Homosexuality usually is not associated with this diagnosis.

A nurse interviews the parents of a 19-year-old man diagnosed with intermittent explosive disorder. Which comments from these parents are most likely? Select all that apply. 1 "We get scared that our son will hurt us." 2 "There has always been chaos in our family." 3 "All of our son's grandparents are alcoholics." 4 "Our son has often behaved in a feminine way." 5 "We have always thought our son was secretly gay."

A male arrested for inappropriate sexual contact in a subway car denies the allegation. Upon interviewing the man, the nurse suspects frotteuristic disorder due to his: lack of relationships overall aggressive nature criminal history including robbery intense hatred of women

lack of relationships

1 Consistently setting limits helps to manage a hostile patient and avoids confrontation. A neutral tone of voice and calm communication help to manage hostility. The body posture should be unthreatening and calm when communicating with a hostile patient to avoid confrontation. Using negotiations when correcting the behavior of hostile patients should be avoided to prevent aggression.

A nurse is caring for a patient with hostile behavior. What strategies should the nurse adopt when communicating with this patient? 1 Apply consistent limits 2 Use an angry tone when talking 3 Maintain a threatening body posture 4 Use negotiations to correct behavior

4 Rigid body posture and clenched fists signal increased chances of inflicting violence on others. Risk of suicide is noted when the person has a history of suicidal attempts, talks about suicidal thoughts, or shows impulsivity. Ineffective coping is observed when the person blames others for his or her behaviors. Impaired parenting includes an unsafe home environment or hostility or rejection by the child's family.

A nurse is caring for a patient with impulse control disorders. What nursing diagnosis is appropriate when the patient shows clenched fists and has a rigid body posture? 1 Risk of suicide 2 Ineffective coping 3 Impaired parenting 4 Risk of violence to others

2 A supportive family environment can help in the normal development of the child and also improve the child's future. Conflicts in marriage or at home can affect a child's development and increase the chances of impulse disorders in children. Oppositional behavior such as anger outbursts should not be encouraged but should be identified and resolved in a timely manner. Inconsistent parenting and harsh discipline can make the child emotionally detached and affect child development.

A nurse is teaching a group of parents in a child development class. What does the nurse suggest to the parents to avoid impulse disorders in children? 1 Encourage anger outbursts 2 Provide support to the child 3 Follow flexible rules of parenting 4 Encourage oppositional behavior

2 Planned ignoring and additional positive reinforcement for on-task actions can be helpful. Criticism can increase the chances of aggressive behavior and violence. Physical restraints may be used to protect the child from acting out impulses or hurting self or others. Receiving immediate attention would accomplish the child's objective and may increase the behavior in the future.

A nurse is teaching a group of teachers about managing oppositional behaviors in children. Which technique should the nurse suggest when a child shows disruptive behavior to seek attention? 1 Use of criticism 2 Planned ignoring 3 Physical restraints 4 Immediate attention

1 If communication skills of the UAPs improve, decreased aggressive behavior among the adolescents should result. High expressed emotion is a major cause of aggressive responses from patients with impulse control disorders. Violence increases when people act in an authoritarian way or engage in power struggles. Body language and tone of voice can indicate aggression on the part of staff. Increased competition for the staff's attention, increased use of physical restraint to manage behavior, and better recognition of the consequences of inappropriate behavior suggest the UAPs' communication skills did not improve.

A nurse observes unlicensed assistive personnel (UAPs) in a residential treatment setting for adolescents diagnosed with impulse control disorders. The UAPs often are controlling, challenging, and demanding during interactions. The nurse plans staff development sessions focused on improving communication skills. Which finding regarding the adolescents shows that the desired learning occurred? 1 Decreased aggressive behavior 2 Increased competition for the staff's attention 3 Increased use of physical restraint to manage behavior 4 Better recognition of the consequences of inappropriate behavior

Attain a weight of 114.3 lbs

A patient diagnosed with anorexia nervosa currently weighs 97 lbs. The patients ideal body weight is 127 lbs. Which goal is the highest priority for this patient?

Bulimia nervosa

A patient presents with decreased cardiac output. The nurse notes that the patient experiences bingeing and then purges to make up for the calories gained. Which condition would the nurse suspect/

4 Kleptomania is a repeated failure to resist urges to steal objects not needed for personal use or monetary value. The person experiences a buildup of tension before taking the object, followed by relief or pleasure following the theft. Eustress is a positive type of stress. Pyromania refers to repeated deliberate fire setting. Dysthymia refers to a type of depressed mood.

A patient says, "When I go to the mall, I steal things. I don't know why I do it because I take things I don't need." Which term applies to this behavior? 1 Eustress 2 Pyromania 3 Dysthymia 4 Kleptomania

Which patient has the greatest risk for suicide? A patient who expresses the inability to stop searching the internet for child pornography A patient who reports having lost interest in having a sexual relationship with his wife A patient with a history of exposing himself to female strangers on the bus A patient whose attraction to prepubescent girls had increased

A patient who expresses the inability to stop searching the internet for child pornography

hypokalemia

A patient with anorexia nervosa reveals self induced vomiting as often as 12 times a day. The nurse would expect assessment findings to reveal which symptom?

fluid and electrolyte levels

A patient with bulimia nervosa uses enemas and laxatives to purge to maintain weight. For which imbalance would the nurse assess?

Epworth Sleepiness Scale (ESS) evaluates the safety risk associated with excessive sleepiness. What score is considered normal using this tool?

A score of less than 10

The most effective nursing intervention regarding the accurate assessment of sleep disorders involves

A sleep diary

A patient is suspected of having insomnia. Which investigation does the nurse anticipate to be prescribed for this patient?

Actigraphy Actigraphy is a test used to record body movements over a period of time. This helps to evaluate sleep patterns and sleep duration, and therefore is useful for patients with insomnia. Hypnogram is not a test. It is a graphical representation of structural organization of nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. Polysomnography is a test used to diagnose and evaluate a patient with sleep-related breathing disorder. The multiple sleep latency test is a daytime nap test that measures sleepiness in a sleep-conducive setting.

A patient is suspected of having circadian rhythm disorder, which can be confirmed by monitoring the patient's body movements and sleep patterns. Which investigation should the nurse anticipate to be prescribed for this patient? Actigraphy Hypnogram Polysomnography (PSG) Multiple sleep latency test (MSLT)

Actigraphy is a test used to monitor body movements for a time, which helps to evaluate sleep patterns and sleep duration. A hypnogram is a graphical representation of sleep architecture of nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. Polysomnography is a test used to diagnose and evaluate a patient with sleep-related breathing disorder. The multiple sleep latency test is a daytime nap test that measures sleepiness in a sleep-conducive setting.

The nurse provides care to a patient who was diagnosed with impulse control disorder. The nurse wants to use the therapeutic technique of role playing to manage the patient's disruptive behaviors. What action will this include?

Acting out a scenario to enhance understanding Acting out a scenario to enhance understanding is role playing, a counseling technique that can help the nurse or patient better comprehend a particular role or behaviors. Ignoring the patient is a therapeutic approach known as planned ignoring. Giving the patient increased physical space is called physical distance and touch control. Providing the patient with emotional support is a form of positive feedback. p. 402

Which of the following is a nursing intervention directed at the psychological needs of an abused person? Multiple choice question a. Encourage the patient to immediately leave the abuser. b. Affirm that the patient did not deserve or cause the abuse. c. Provide a referral to social services for economic problems. d. Facilitate contact with law enforcement to take legal action.

Affirm that the patient did not deserve or cause the abuse.

Tryptophan

An amino acid essential to serotonin synthesis and is only available through diet

Bupropion, although seemingly effective, is contraindicated in patients who purge. What is the reason for this?

An increased risk of seizures

The nurse is assessing a patient with low weight, lanugo, and cool extremities. The nurse finds that the patient has a fear of gaining weight. What disorder does the nurse suspect as the cause for the presence of these symptoms?

Anorexia nervosa

The client who will most likely respond well to drug therapy for the management of compulsive deviant sexual behavior is one with which diagnosis? Exhibitionism Antisocial personality disorder Low sexual drive Fetishism

Exhibitionism Libido and compulsive deviant sexual behavior is best managed pharmacologically in individuals with high sexual drive such as exhibitionists. This is not true of the other options.

The Food and Drug Administration (FDA) has approved selective serotonin reuptake inhibitors (SSRIs) to treat which conditions?

major depressive disorder OCD panic disorder PTSD premenstrual dysphoric disorder

When conducting an assessment interview the nurse is prompted to inquire about the existence of a dysfunctional sleep disorder when the patient reports being prescribed which classification of medications? Select all that apply.

Anticonvulsant Antihistamine Second generation antipsychotics Antidepressant

Which classification of medication may be prescribed in intermittent explosive disorder?

Anticonvulsants Although considered off-label use, anticonvulsants may reduce outbursts and contribute to mood stabilization. Psychostimulants, benzodiazepines, and MAO inhibitors are incorrect for use in intermittent explosive disorder. p. 396

The health history for an adolescent diagnosed with conduct disorder indicates frequent callous behavior toward others. When this adolescent reaches adulthood, which personality disorder is most likely to emerge?

Antisocial Callousness may be a predictor of a future antisocial personality disorder in adults. Callousness refers to a lack of empathy, such as disregarding and being unconcerned about the feelings of others, lack of remorse or guilt, unconcerned about meeting obligations, and demonstrating a shallow, unexpressive, and superficial affect. Histrionic, dependent, and schizotypal disorders are associated with other behaviors. p. 397

Which mental health disorder has been identified as a comorbid disorder associated with childhood abuse that can last the child's entire life? select all? Anxiety Suicidal ideations Chronic depression Post-traumatic stress disorder (PTSD) Obsessive-compulsive disorder (OCD)

Anxiety Suicidal ideations Chronic depression Post-traumatic stress disorder (PTSD) The secondary effects of abuse, such as anxiety, depression, and suicidal ideation, are health care issues that can last a lifetime. Depression and PTSD are two of the most prevalent disorders resulting from childhood trauma. OCD is not associated with abuse as frequently.

2 The comment evidences denial of the pain endured by his victims. It shows a lack of empathy. Empathy involves having concerns for the feelings of others. There is no evidence of feelings of guilt or remorse in this comment, although he later apologized to his victims and asked for forgiveness.

Ariel Castro was convicted in 2013 of kidnapping, raping, and torturing three women for over 10 years. At his sentencing hearing he said, "We had a lot of harmony going on in that home." Which sentiment is most evident in his comment? 1 Guilt 2 Denial 3 Remorse 4 Empathy

1 Individuals with childhood-onset conduct disorder are more likely to have problems that persist through adolescence, and without intensive treatment, they develop antisocial personality disorder as adults. There is no research to definitively associate childhood onset conduct disorder with any of the other options.

As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at high risk for developing what? 1 Antisocial personality disorder 2 Obsessive-compulsive disorder 3 Kleptomania 4 Depression

A male patient with paraphilia tendencies tells the nurse that "I'm disgusted with my lifestyle." The nurse most appropriately a. Assesses him for the existence of suicidal ideations b. Recommends inpatient behavioral modification therapy c. Assures him that his condition responds well to treatment

Assesses him for the existence of suicidal ideations Tells him that the first step to managing his behavior is recognizing it as unhealthy Such patients may be severely depressed and have suicidal ideations that must be recognized immediately.

A client with paraphilia tendencies tells the nurse that "I'm disgusted with my lifestyle." What is the nurse's initial intervention? Assuring the client that this condition responds well to treatment. Telling the client that the first step to managing this behavior is recognizing it as unhealthy. Assessing the client for the existence of suicidal ideations. Recommending inpatient behavioral modification therapy. taken all legal steps to change name and legal status.

Assessing the client for the existence of suicidal ideations. Such clients may be severely depressed and have suicidal ideations that must be recognized immediately. The priority intervention is to address client safety

An adolescent patient diagnosed with anorexia nervosa currently weighs 97 pounds. The patient's ideal body weight is 127 pounds. Identify the highest priority goal for this patient.

Attain a weight of 114.3 pounds

A nurse is assessing a child who does not like certain foods in the daily diet. On examination, the nurse notes that the body mass index (BMI) of the child is very low. What should the nurse anticipate the diagnosis to be?

Avoidant/restrictive food intake disorder

Which effect is the priority for the nurse to educate a patient about who is newly prescribed duloxetine?

Beginning duloxetine may cause suicidal ideations; this is the priority for the nurse to teach the patient who is newly prescribed this medication. The nurse should instruct the patient to contact the health care provider or a suicide hotline immediately if experiencing this adverse effect.

The nurse observes that a patient has sustained a severe injury due to an accident. Upon interaction with the family members, the nurse finds that the patient has a tendency to drive a car while sleeping. What is the treatment of choice in managing the condition?

Benzodiazepines Sleepwalking (somnambulism) is an arousal disorder characterized by unusual behaviors, like driving a car during sleep. Benzodiazepine medication is the treatment of choice for managing the condition. It is prescribed for a patient who has a risk of meeting with accidents or injuries frequently. Stimulant medication, serotonergic medication, and amphetamine medication are not prescribed for patients with sleepwalking disorder. Stimulant medication is prescribed for patients with narcolepsy. Serotonergic medication is prescribed for patients with rapid eye movement sleep behavior disorder. Amphetamine medication induces the secretion of norepinephrine and dopamine responsible for wakefulness.

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

Arrange the different stages of the sleep cycle in the order they occur.

Body temperature declines and muscles relax. Heart rate and respiratory rate decline. Sympathetic activity declines. Skeletal muscle tone declines.

What clinical finding can the nurse anticipate when caring for a patient diagnosed with anorexia?

Bradycardia

What clinical finding can the nurse anticipate when caring for a patient diagnosed with anorexia? Bradycardia Leukocytosis Hyperkalemia Hyperthyroidism

Bradycardia The nurse can anticipate bradycardia during the assessment of a patient with anorexia. Hypokalemia (not hyperkalemia), leukopenia (not leukocytosis), and hypothyroidism (not hyperthyroidism) are other clinical findings in an anorexic patient.

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?

Bulimia nervosa

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?

Bupropion

After reviewing the following information, select the intervention that best addresses the evidence-based care identified as a need of the hospitalized child diagnosed with conduct disorder. (Image: Evidence-Based Practice -- Predicting Future Conduct Disorders for Early Intervention)

Care plans will include daily relationship-strengthening activities with each child. The study identified a need to include family therapy issues, such as parenting and management skills. Family therapy, a male unit population, and therapy groups assigned by age and symptoms are not focused on the needs identified by the study, but rather items found within the study format itself. p. 403

The nurse is assessing a patient with narcolepsy. The nurse notices that the patient has a brief episode of bilateral loss of muscle tone when laughing. What should the nurse interpret it as?

Cataplexy

The nurse is attending to a patient with sleep deprivation. While interviewing the patient the nurse learns that the patient became obese during periods of sleep deprivation. What does the nurse analyze as the reasons for the patient's obesity? Select all that apply.

Changes in leptin levels Changes in ghrelin levels

Which statement about persons diagnosed with personality disorders is accurate? Patients readily recognize their problems and seek professional assistance. Extended hospitalization is the best intervention and commonly needed for stabilization. Characteristics of these disorders are most evident in social and interpersonal interactions. Research has produced multiple medications that effectively manage symptoms of personality disorders.

Characteristics of these disorders are most evident in social and interpersonal interactions. The presence of a personality disorder interferes with, or complicates, social and interpersonal function. Individuals who meet criteria for these disorders have problems with empathy or intimacy within their relationships. Persons diagnosed with personality disorders tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them. Although short-term hospitalization may sometimes be necessary when acute problems occur, extended hospitalizations tend to be counterproductive for this population. In the United States, there are no Federal Drug Administration-approved medications specifically for treating personality disorders; however, some health care providers prescribe selected psychotropic medications for off-label use.

The nurse prepares the plan of care for a 9-year-old diagnosed with childhood-onset conduct disorder. Which nursing diagnosis is most likely to apply to this child?

Chronic low self-esteem Children diagnosed with childhood-onset conduct disorder attempt to project a strong image, but they actually have low self-esteem, which is chronic rather than situational. These children have impaired social interactions rather than social isolation. They may also have learning impairments, but that clinical condition is different from the nursing diagnosis deficient knowledge. p. 397

1 Oppositional defiant disorder is related to a variety of other problems, including attention deficit hyperactivity disorder, anxiety, depression, suicide, bipolar disorder, and substance abuse. Conversion disorder is not generally associated with oppositional defiant disorder.

Comorbid conditions commonly associated with oppositional defiant disorder do NOT include 1 conversion disorder. 2 attention deficit hyperactivity disorder (ADHD). 3 bipolar disorder. 4 anxiety.

The nurse is assessing an adult patient with a history of immature coping skills and poor problem-solving abilities. Which impulsive disorder do these features represent?

Conduct disorder Children with conduct disorder tend to use immature styles of coping and problem solving. A patient with intermittent explosive disorder shows aggressive outbursts, which are a way of protecting the ego. Oppositional deficient disorder and attention deficit hyperactivity disorder are the predisposing factors of child-onset conduct disorder. p. 397

The mother of a 6-year-old child expresses concern over the child's frequent temper outbursts. The child deals with any frustration by bullying and hitting and seldom shows any remorse for his or her actions. The nurse who gathers this data will note that the child's behaviors are most consistent with the Diagnostic and Statistical Manual of Mental Disorders DSM-5 diagnosis of

Conduct disorder The data are most consistent with the aggressive pattern of childhood-onset conduct disorder of the aggressive type. p. 397

When working with a patient demonstrating impulse control disorders, all of the following nursing interventions have priority except

Confronting the patient concerning the disruptive behavior The three most important interventions with this population are to promote a climate of safety for the patient and for others, establish rapport with the patient, and set limits and expectations. p. 402

The nurse feels uncomfortable talking with a young male client about his sexual problem. Which action should the nurse take? Ask another nurse to take over the interview so you don't project your feelings onto the patient. Pause the interview and take time to gather your thoughts and do positive self-talk. Continue the interview using an appropriate professional tone and matter-of-fact approach. Ask Lance whether he would feel more comfortable speaking with a physician about his problem.

Continue the interview using an appropriate professional tone and matter-of-fact approach. Remembering your position as a professional and addressing the topics in a tone and manner appropriate of a professional will increase your comfort, along with the patient's. The response in the first option would be confusing to the patient and does not address your feelings or work to resolve them. Pausing the interview would not be appropriate because self-assessment is best done before patient interaction. Asking the patient whether he would feel more comfortable speaking with a physician projects your feelings of being uncomfortable onto the patient and does not carry out your professional role and responsibility.

A nurse observes unlicensed assistive personnel (UAPs) in a residential treatment setting for adolescents diagnosed with impulse control disorders. The UAPs often are controlling, challenging, and demanding during interactions. The nurse plans staff development sessions focused on improving communication skills. Which finding regarding the adolescents shows that the desired learning occurred? Decreased aggressive behavior Increased competition for the staff's attention Increased use of physical restraint to manage behavior Better recognition of the consequences of inappropriate behavior

Decreased aggressive behavior If communication skills of the UAPs improve, decreased aggressive behavior among the adolescents should result. High expressed emotion is a major cause of aggressive responses from patients with impulse control disorders. Violence increases when people act in an authoritarian way or engage in power struggles. Body language and tone of voice can indicate aggression on the part of staff. Increased competition for the staff's attention, increased use of physical restraint to manage behavior, and better recognition of the consequences of inappropriate behavior suggest the UAPs' communication skills did not improve.

What are the likely causes of low libido? Depression Hypertension Prostatectomy Hypothyroidism Alcoholic neuropathy

Depression Hypothyroidism Alcoholic neuropathy Low libido or lack of sexual desire is a type of sexual dysfunction that can result from a variety of causes. These include psychiatric conditions such as depression, neurological disorders such as alcoholic neuropathy, and endocrine disorders such as hypothyroidism. Hypertension and prostatectomy (surgical removal of prostate gland) may result in impotence (erectile dysfunction) but libido is intact.

A client has been diagnosed with gender identity disorder. The nurse can expect that the client will evidence which characteristic? Intense sexual urges focused on an object Discomfort with biological gender Self-humiliation during the sexual act Inability to maintain sexual arousal

Discomfort with biological gender Gender identity disorder involves the lack of a match between biological gender and psychological gender anxiety. The client will state that he is a woman who was mistakenly given a man's body. None of the other options are associated with this disorder

After reviewing the following information, select the intervention that best addresses the evidence-based practice needs of a unit that cares for patients diagnosed with anorexia nervosa.

Discuss the unreliability of the information provided on websites that support behaviors associated with eating disorders as part of the unit's therapy sessions.

A patient with bulimia nervosa uses enemas and laxatives to purge to maintain his or her weight. For which imbalance should the nurse assess?

Disrupted fluid and electrolyte balance

A patient has changes in sleep routines affecting social and vocational functioning. How should the nurse document the changes in sleep routine?

Disturbed sleep pattern

The nurse identifies which drug type as the mainstay of treatment for a patient with restless leg syndrome (RLS)?

Dopamine agonists

Desire is the first phase of the sexual response cycle. What are the main components of desire? Drive Motive Values Orgasm Excitement

Drive Motive Values There are three components to desire: drive, motive, and values. Drive is the biologically motivated interest that prompts a focus on the sexually appealing aspects of another, physiological response, and desire for connection. Motive is based on choices, aspirations, and motives for interpersonal connection. Values impact sexuality by imparting certain familial, religious, and cultural beliefs and guidelines to responses and behaviors. Excitement is the second phase and orgasm is the third phase of the normal sexual response cycle.

What does the nurse teach a patient with sleep disorder about sleep hygiene?

Eat limited meals before bedtime.

A patient is suspected of having anorexia nervosa. What clinical manifestations does the nurse identify as symptoms of anorexia nervosa? Select all that apply.

Emaciation Yellow skin Dehydration

What is the nurse's priority while trying to improve the condition of a patient with a binge-eating disorder?

Ensure steady weight loss

refeeding syndrome may be occurring

Enteral nutrition is initiated for a patient hospitalized with anorexia nervosa. 2 days later, the nurse notes that the patient has developed peripheral edema. Which evaluation is correct for this finding?

When sorting the medicines of a patient at a long-term care home, the nurse finds sildenafil tablets. What conditions does the nurse think the patient might be suffering from? a. Arousal disorder b. Erectile disorder c. Orgasmic disorder d. Premature ejaculation e. Hypoactive sexual desire

Erectile disorder Orgasmic disorder Sildenafil therapy is most commonly used to treat male sexual disorders, including male erectile disorder and male orgasmic disorder. Arousal disorder or female sexual interest disorder is managed with a testosterone patch in menopausal women. Alprostadil cream, Tibolone, or lubrication may also be used. Premature ejaculation may be treated with selective serotonin reuptake inhibitors or topical anesthetics. Male hypoactive sexual desire disorder is treated with testosterone therapy.

What is the initial task of an outpatient clinic nurse who is working with a client experiencing a sexual disorder? Establish trust with the client Assess the client's physical health Explain that the nurse is a therapeutic agent Orient the client to the clinic's programs, use as part of therapy

Establish trust with the client The initial task in working with any client is to establish trust

Which nursing intervention is appropriate for a care plan that focuses on intermittent explosive disorder?

Establishing a trusting relationship with the patient Establishing rapport with the patient is essential in working to set goals, boundaries, and consequences, and for providing opportunities for goal achievement. Intensive family therapy is not a basic-level registered nurse (RN) intervention. Boundaries and structure are essential. Opportunities for patients to make good decisions and reach goals should be given, not limited. p. 402

Atypical Antidepressants

Ex: Bupropion affect one or two of the neurotransmitters (NE, Epi, serotonin) Effects w/in 2 weeks, full effects 8-14 weeks not taken with MAOIs or within 14 days of discontinuing an MAOI

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Ex: Duloxetine Inhibits reuptake of serotonin and NE, increasing their availability 4 weeks until effects occur Uses: depression and anxiety

Selective Serotonin Reuptake Inhibitors (SSRIs)

Ex: Sertraline block serotonin reuptake, increasing its availability 4 weeks until effects on depression occur

A nurse assesses an adolescent female with anorexia nervosa. Which physical findings support the diagnosis? Select all that apply.

Facial lanugo Pulse rate of 39 Temperature of 96.7°

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

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

Which area will the nurse focus upon when evaluating whether a patient has experienced improved sleep quality?

Fewer awakenings during the night A decrease in the amount of time it takes to fall asleep A decrease in the time it takes to fall back to sleep after awakening Daytime sleepiness is lessened

vomiting

For which reason would the nurse assess a patient with bulimia nervosa for the presence of dental caries?

A depressed patient is likely to report a sleep disorder that includes

Frequent awakenings during the night

A patient has been hospitalized with anorexia nervosa. The patient's weight is 65% of normal. A realistic short-term goal for the first week of hospitalization would be which of the following?

Gain a maximum of 3 pounds

In which area of the body is the majority of lithium absorbed?

Gastrointestinal (GI) tract

Which hormone regulates hunger?

Ghrelin

A patient with binge-eating disorder is prescribed Qsymia. What side effects are most likely to be observed in the patient? Diarrhea Glaucoma Paresthesia Hypersalivation Taste alteration

Glaucoma Paresthesia Taste alteration Qsymia contains topiramate and phentermine. It is known to cause side effects such as glaucoma, paresthesia (tingling of hands and feet), and taste alteration due to the presence of topiramate. Other side effects of Qsymia include dryness of the mouth and constipation. It does not cause hypersalivation or diarrhea.

Which instruction will the nurse include when educating a patient regarding the principles of stimulus control to improve sleep? Select all that apply.

Go to bed when you feel sleepy Reserve the bedroom for sleeping and intimacy only Get out of bed if falling asleep is difficult

Bupropion side effects

HA, dizziness, dysrhythmas, N/V, wt loss

A patient tells the nurse that when the patient was younger, he or she slept 8 to 10 hours nightly, whereas now the patient sleeps only 6 or 7 hours and has to take a nap each afternoon. The nurse can assess that the patient

Has an age-related sleep pattern change

The nurse can determine that inpatient treatment for a patient diagnosed with an eating disorder would be warranted when which criterion is met?

Has systolic blood pressure less than 70 mm Hg

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 Most patients with eating disorders have low self-esteem.

Which question should the nurse ask when self-assessing for personal sleep problems? Select all that apply.

How many hours of sleep are you getting each 24-hour period? Do you get out of bed at the same time most days? How often do you work 12-hour shifts? How much overtime do you usually work per pay period?

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?

Hypercarotenemia

A patient referred for sleep studies reports frequent daytime lethargy, unintended lapses into sleep, and never feeling rested on awakening in the morning. These symptoms/signs best support which diagnosis?

Hypersomnolence

A patient referred for sleep studies reports frequent daytime lethargy, unintended lapses into sleep, and never feeling rested on awakening in the morning. These symptoms/signs best support which diagnosis? Hypersomnolence Circadian rhythm disorder Breathing-related sleep disorder Rapid eye movement (REM) sleep behavior disorder

Hypersomnolence The patient with hypersomnolence reports recurrent periods of sleep or unintended lapses into sleep, frequent napping, nonrefreshing nonrestorative sleep regardless of the amount of time slept, and difficulty with full alertness during the wake period. Circadian rhythm sleep disorders occur when there is a misalignment between the timing of the individual's normal circadian rhythm and external factors that affect the timing or duration of sleep. Patients with REM sleep disorder display elaborate motor activity associated with dream mentation. Breathing-related sleep disorder is characterized by frequent upper airway obstruction.

The nurse is teaching the family of a patient with intermittent explosive disorder. What conditions may be associated with intermittent explosive disorder? Hypertension Diabetes Depression Anxiety disorders Attention deficit hyperactivity disorder

Hypertension Diabetes Anxiety disorders Intermittent explosive disorder can lead to hypertension, diabetes, and anxiety disorders. This is probably because the patient is under a lot of stress and in an agitated state for a prolonged period. Depression is a comorbid condition, as is kleptomania. Attention deficit hyperactivity disorder is a predisposing factor in child- and adolescent-onset conduct disorder that is seen in children. Intermittent explosive disorder is an adult-onset disorder.

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?

Imbalanced nutrition: less than body requirements

A nurse is assessing a patient experiencing anorexia nervosa. What diagnosis should the nurse consider when the patient exhibits destructive behavior towards self?

Ineffective coping

An adult complains, "I fall asleep as soon as I go to bed but wake up between 3 and 4 AM every morning; then, I can't go back to sleep. It's causing me problems concentrating at work and I don't have enough energy to take care of my family." Which nursing diagnosis applies to this scenario?

Insomnia

What nursing diagnosis would be most appropriate for a patient who reports disruption in the amount and quality of sleep?

Insomnia

The nurse is assessing a patient who complains of dissatisfaction with sleep quality and difficulty initiating sleep. On interviewing, the nurse finds that the patient awakens early with difficulty returning to sleep. What disorder does the nurse analyze as the cause for these symptoms?

Insomnia disorder

A nurse is assessing a young man who has repeated outbursts of aggression. The family complains that the man seems to calm down initially but then explodes with rage and may even hit others. What does the nurse identify this condition as?

Intermittent explosive disorder Intermittent explosive disorder is seen when a person is unable to control aggressive impulses. A person with conduct disorder violates other's rights and social norms. Oppositional defiant disorder is characterized by irritability, getting angry, and being defiant and vindictive. Obsessive-compulsive disorder is characterized by repetitive thoughts or a strong urge to perform a task or activity repetitively. p. 395

A nurse is learning about substances that induce sleep disturbances. What does the nurse understand about the effects of nicotine? Select all that apply.

It increases heart rate. It increases blood pressure. It increases respiratory rate.

A patient says, "When I go to the mall, I steal things. I don't know why I do it because I take things I don't need." Which term applies to this behavior? Eustress Pyromania Dysthymia Kleptomania

Kleptomania Kleptomania is a repeated failure to resist urges to steal objects not needed for personal use or monetary value. The person experiences a buildup of tension before taking the object, followed by relief or pleasure following the theft. Eustress is a positive type of stress. Pyromania refers to repeated deliberate fire setting. Dysthymia refers to a type of depressed mood.

A nurse is assessing an adolescent boy from an upper-class family. He has an irresistible desire to steal objects from others' bags. What does the nurse diagnose this condition as?

Kleptomania Kleptomania is characterized by an uncontrolled desire to steal objects and failing to resist the urge. The urge does not have to be related to actual need. Defiance in oppositional defiant disorder is characterized by irritability, getting angry, and being defiant and vindictive. Pyromania is the uncontrolled desire to deliberately set fire and experiencing pleasure by doing so. Callousness is a lack of sensitivity and empathy for others. p. 399

An adult diagnosed with antisocial personality disorder begins an outpatient program at the community mental health center. Which is an appropriate outcome for this patient? a. Avoid self-mutilation. b. Listen attentively as others share their feelings. c. Limit time spent engaging in compulsive behaviors. d. Attend the program dressed in seasonally appropriate clothing.

Listen attentively as others share their feelings. Impaired social interaction in persons diagnosed with antisocial personality disorders are characterized by unstable relationships, lack of empathy, hostility, behaviors unaccepted by the dominant cultural group, grandiosity, dysfunctional interactions, and unacceptable social behavior. Desired outcomes include receptiveness, sensitivity and consideration of others, cooperation with others, and respectful interactions with others. Persons diagnosed with antisocial personality disorder are violent with others rather than self (through self-mutilating behaviors). Compulsive behaviors are seen in persons diagnosed with obsessive-compulsive personality disorder. Persons diagnosed with schizotypal personality disorder are likely to have difficulty selecting seasonally appropriate clothing.

The nurse is caring for a patient with a history of bipolar disorder and mania who has been nonadherent to medication therapy in the past. Which medication would the nurse anticipate will be prescribed by the health care provider?

Lithium

Staff working on an inpatient adolescent mental health unit desire to maintain safety and a calm milieu. Which technique should staff use most for interactions with patients?

Low expressed emotion Low expressed emotion uses calm communication that reduces confrontation and decreases the need for seclusion and restraint. Clarification is a type of low expressed emotion and can help correct misunderstandings that may be the source of frustration and potential loss of control. High expressed emotion includes criticisms, resentment, or annoyance about patient behavior, which ultimately increases aggression. Direction may be perceived as high expressed emotion. pp. 403-404

The nurse is learning about sleep-related hypoventilation. Sleep-related hypoventilation is most commonly seen in patients having which disease? a. Neurologic disorders b. Advanced cardiac disease c. Lung parenchymal disease d. Advanced pulmonary disease

Lung parenchymal disease Sleep-related hypoventilation is mostly seen in patients with lung parenchymal disease. Sleep-related hypoventilation is associated with sustained oxygen desaturation during sleep in the absence of apnea or respiratory events. Central sleep apnea is seen in patients with advanced cardiac or pulmonary disease or with neurologic disorders. Respiration stops during sleep without associated ventilator effort, and it is caused by instability of the respiratory control system.

The nurse is learning about sleep-related hypoventilation. Sleep-related hypoventilation is most commonly seen in patients having which disease?

Lung parenchymal disease Sleep-related hypoventilation is mostly seen in patients with lung parenchymal disease. Sleep-related hypoventilation is associated with sustained oxygen desaturation during sleep in the absence of apnea or respiratory events. Central sleep apnea is seen in patients with advanced cardiac or pulmonary disease or with neurological disorders. Respiration stops during sleep without associated ventilator effort and it is caused by instability of the respiratory control system.

A nurse is assessing a child who exhibits disruptive behavior at home and school. Which intervention does the nurse advise to the parents when the child throws furniture at home?

Make the child replace the disturbed furniture Making the child replace the disturbed furniture is simple restitution for correcting the behavior by bringing the environment back to its original state. Criticizing the child for disruptive behavior can increase chances of aggression and violence. Firm punishment may not be effective for a disruptive child as it may further frustrate the child and caregivers. Ignoring the child's behavior may have a negative impact and increase the chances of aggression. p. 402, Box 21.1

What outcome is most important for a patient with bulimia nervosa to reduce the feeling of powerlessness?

Making informed life decisions

A nurse is caring for a young female patient who is unaware of the sensation of orgasm. Which appropriate therapy does a nurse practitioner suggest to this patient? Medication Sensate focus Behavioral therapy Masturbation training

Masturbation training Masturbation training is given to women who have never had an orgasm so that they learn about their body and sexual responses. Medications may not help to increase the sensation of orgasms. Sensate focus is a treatment in which patients learn to progress from touching and cuddling to more intimate expressions. Behavioral therapy is advised for men with premature ejaculation caused by psychological factors.

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

Meal planning Effects of purging Relaxation techniques 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. Following 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.

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

A nurse cares for a patient recently diagnosed with bulimia nervosa. Which nursing action is most appropriate?

Monitor the patient's bathroom trips after meals.

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. 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.

When providing care for a patient diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with the patient's a. Mood shifts, impulsivity, and splitting b. Grief, anger, and social isolation c. Altered sensory perceptions and suspicion d. Perfectionism and preoccupation with detail

Mood shifts, impulsivity, and splitting Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned. They often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings.

A patient reports being unable to move just before falling asleep. On further assessment, the nurse finds that the patient has visual hallucinations. The patient's lab reports reveal alterations in hypocretin levels. Which disorder is likely responsible for the patient's condition?

Narcolepsy

Which assessment finding can the nurse anticipate for a patient newly diagnosed with binge-eating disorder?

Normal weight

The nurse is assessing a patient reporting problems with sleep. What symptoms in the patient help the nurse to analyze the disorder as disturbed sleep pattern?

Not feeling well rested

Which statement demonstrates a facility's commitment to health policy that supports the Healthy People 2020's focus on sleep health? Select all that apply.

Number of patients being treated successfully for sleep disorders has increased by 10% over the last year. Nursing staff present sleep hygiene information to incoming freshmen at local high schools. Assessment interviews of all facility units include questions related to possible sleep disorders.

A patient was diagnosed with narcissistic personality disorder. Which aspect of the nursing assessment is most important? Pain rating Level of anxiety Nutritional status Attention span, hyperactivity

Nutritional status Anorexia nervosa and substance use disorders are often comorbidities for persons diagnosed with narcissistic personality disorder; therefore, it is important for the nurse to assess the patient's nutritional status. Although it's important to assess pain in all patients, the greater risk in this scenario applies to the patient's nutritional status. Anxiety is associated with antisocial, avoidant, and obsessive-compulsive personality disorders. Attention-deficit/hyperactivity disorder is more often a comorbidity of borderline personality disorder.

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.

Obtain a replacement dose for administration Complete a controlled substance discrepancy form

A patient with bipolar disorder taking lithium reports still experiencing manic episodes. Which request would the nurse make to the health care provider?

Order a lithium level.

Screening for which personality disorder should be focused on the male population? Paranoid Antisocial Borderline Dependent Schizotypal

Paranoid Antisocial Schizotypal Statistically more men than women are diagnosed with antisocial, paranoid, and schizotypal personality disorders. More women than men are diagnosed with borderline and dependent personality disorders.

Disorders that involve variations in sexual behaviors are called Paraphilias Frotteurism Pedophilias Sadomasochism

Paraphilias The essential features of paraphilias are recurrent and intense sexually arousing fantasies, sexual urges, or behaviors generally involving inanimate objects, the suffering or humiliation of oneself or a partner, or the use of children or other nonconsenting persons

Disorders that involve sexual behaviors associated with nonhuman objects are identified by which term? Pedophilias Paraphilias Frotteurism Sadomasochism

Paraphilias The essential features of paraphilias are recurrent and intense sexually arousing fantasies, sexual urges, or behaviors generally involving inanimate objects, the suffering or humiliation of oneself or a partner, or the use of children or other nonconsenting persons. This description does not accurate relate to any of the other options.

The client reveals to the nurse that, "I'm turned on by little girls, not adult women." This statement supports which possible diagnosis? Exhibitionism Hedonism Pedophilia Voyeurism

Pedophilia Pedophilia involves sexual fantasies, urges, or behaviors with a child aged 13 years or younger. This is not a characteristic of any of the other options.

The patient reveals to the nurse that, "I'm turned on by little girls, not adult women." The nurse can assess this condition as Hedonism Voyeurism Pedophilia Exhibitionism

Pedophilia Pedophilia involves sexual fantasies, urges, or behaviors with a child aged 13 years or younger.

An overweight patient reports falling asleep during the daytime even though she has slept all night. Her husband says she snores, and her blood pressure is noted to be in the low hypertensive range. The nurse anticipates that the patient will be scheduled for which diagnostic test?

Polysomnography

Which diagnostic test is performed to evaluate a nocturnal seizure disorder?

Polysomnography

The nurse is assessing a patient with binge-eating disorder. What term is used to document the symptom where the patient shows feelings of shame and guilt?

Powerlessness

You are interviewing Lance, a 31-year-old patient who has been referred to the sexual disorders clinic by his primary care provider. A client describing his problem states, "I can have an orgasm, no problem. It just happens way too soon." This descriptions support what form of sexual dysfunction? Erectile disorder Premature ejaculation Delayed ejaculation Male hypoactive sexual desire disorder

Premature ejaculation In premature ejaculation, a man persistently or recurrently achieves orgasm and ejaculation before he wishes to. Erectile disorder (also called erectile dysfunction and impotence) refers to failure to obtain and maintain an erection sufficient for sexual activity. In delayed ejaculation, a man achieves ejaculation during coitus only with great difficulty. Male hypoactive sexual desire disorder is characterized by a deficiency or absence of sexual fantasies or desire for sexual activity.

A nurse is planning management for patients suffering from insomnia. What positive outcomes should the nurse plan for? Select all that apply.

Proper sleep induction Consistent sleep pattern Appropriate hours of sleep

A nurse is planning management for patients suffering from insomnia. What positive outcomes should the nurse plan for? Proper sleep induction Consistent sleep pattern Adequate hours of sleep Appropriate hours of sleep Feeling refreshed after sleep

Proper sleep induction Consistent sleep pattern Appropriate hours of sleep Insomnia refers to a sleep disorder characterized by difficulty in falling asleep or staying asleep as desired. Proper sleep induction is important for patients with insomnia because they may have difficulty falling asleep. Consistent sleep pattern is essential to maintain sleep throughout the night with minimal awakening. Appropriate hours of sleep should be managed according to the patient's schedule, and daytime sleeping should be avoided. Adequate hours of sleep are essential in the case of patients with sleep deprivation. Feeling refreshed after sleep is important for patients with sleep deprivation and disturbed sleep pattern.

What is the most beneficial nursing intervention directed toward minimizing the discomfort associated with conducting a sexually focused assessment? Assure the client that the responses will be kept confidential. Provide the client with a rationale for asking the questions. Begin with the most relevant, non-personal question. Project a relaxed, causal demeanor when questioning the client.

Provide the client with a rationale for asking the questions. Letting the client know why the questions are being asked increases openness and cooperation

A patient prepares for discharge from the emergency department after treatment for injuries associated with intimate partner violence. The patient plans to return home. Which action by the nurse has priority? Refer the patient for pastoral counseling. Provide the patient with contact information for the local shelter. Encourage the patient to file criminal charges against the perpetrator. Tell the patient, "I have documented your injuries and treatment thoroughly."

Provide the patient with contact information for the local shelter. Safety is the nurse's highest priority. Patients should be given the number of the nearest available shelter, even if they decide for the present to stay with their partners. Referral phone numbers may be kept for years before deciding to call. Pastoral counseling may be helpful, but is not the priority. The nurse should not give advice, such as encouraging the patient to file criminal charges against the perpetrator. Documentation is part of the nurse's responsibility, but adamantly informing the patient of the documentation is likely to increase fear.

The nurse performs an assessment on a child and finds that the child deliberately sets fires and becomes excited when talking about them. Which term best describes this behavior? Pyromania Kleptomania Oppositional defiance Impulse control disorder

Pyromania Pyromania is the deliberate and repeated act of setting things on fire. People who engage in pyromania behaviors become tense or excited before setting things on fire and show an unusual interest in fire and its contexts, like matches or smoke. Kleptomania is the repeated failure to resist urges to steal objects. Oppositional defiance describes a general group of oppositional behaviors. Impulse control disorder is related to pyromania but is not the best term used to describe the child's behaviors.

The nurse performs an assessment on a child and finds that the child deliberately sets fires and becomes excited when talking about them. Which term best describes this behavior?

Pyromania Pyromania is the deliberate and repeated act of setting things on fire. People who engage in pyromania behaviors become tense or excited before setting things on fire and show an unusual interest in fire and its contexts, like matches or smoke. Kleptomania is the repeated failure to resist urges to steal objects. Oppositional defiance describes a general group of oppositional behaviors. Impulse control disorder is related to pyromania but is not the best term used to describe the child's behaviors. p. 399

Which behavior is characteristic of the tension-building stage of the violence cycle? Remorse is felt and expressed. Rationalization is used to justify the anger. Calmness returns for a short period of time. Tension is released thorough physical violence. Alcohol may be employed to manage the tension.

Rationalization is used to justify the anger. Alcohol may be employed to manage the tension. The tension-building stage is characterized by abusers rationalizing that their abusive behavior is acceptable. As the tension escalates, both participants may try to reduce it. The abuser may try to reduce the tension with the use of alcohol or drugs. During the acute battering stage, the abuser releases the built-up tension by brutal beatings, which can result in serious injuries. The honeymoon stage may be characterized by kindness and loving behaviors. The abuser, at least initially, feels remorseful and apologetic. Over time, the periods of calmness and safety become briefer, and the periods of anger and fear are more intense.

A nurse is caring for a patient with confusional arousals. Which appropriate treatment measures should the nurse suggest? Select all that apply.

Reassurance Safety measures Lifestyle management Confusional arousals are characterized by a confused state upon waking up from sleep. Reassurance is required when the patient has an episode of waking up confused. Safety measures will ensure safety as the patient is at risk for injury or accident when waking up confused. Lifestyle management includes maintaining proper sleep hygiene, stress reduction, limiting alcohol, and obtaining sufficient sleep. Reducing obesity is more helpful in the case of breathing-related sleep disorders. Sleep partner safety is more important in the case of rapid eye movement sleep disorder behavior disorder.

What are the characteristics of stage 1 sleep? Select all that apply.

Relaxation of muscles Rolling eye movements Decreased body temperature

A nurse assesses a 15-year-old who stole and wrecked a neighbor's classic antique car. Two years ago, this adolescent self-inflicted stab wounds. Which nursing diagnosis has priority? Risk for suicide Ineffective coping Impaired adjustment Impaired social interaction

Risk for suicide Safety is the nurse's priority concern. The number one predictor of suicidal risk is a past suicide attempt. Impulsivity and aggression make the possibility of suicide attempts more likely. Ineffective coping, impaired adjustment, and impaired social interaction may apply, but are not the priority.

A nurse assesses a 15-year-old who stole and wrecked a neighbor's classic antique car. Two years ago, this adolescent self-inflicted stab wounds. Which nursing diagnosis has priority?

Risk for suicide Safety is the nurse's priority concern. The number one predictor of suicidal risk is a past suicide attempt. Impulsivity and aggression make the possibility of suicide attempts more likely. Ineffective coping, impaired adjustment, and impaired social interaction may apply, but are not the priority. p. 401, Table 21.2

Which medical complication is associated with the diagnosis of bulimia nervosa? Select all that apply.

Russell's sign Hypochloremia Parotid gland enlargement

A nurse is caring for a patient complaining of difficulty sleeping. On interviewing, the nurse finds that the patient has recently started taking citalopram (Celexa), which is a selective serotonin reuptake inhibitor (SSRI). What should the nurse explain to the patient regarding the medication?

SSRI treatment can cause sleep difficulty in the beginning.

Which education would the nurse include when teaching a patient who has just been prescribed a selective serotonin reuptake inhibitor (SSRI)?

SSRIs can cause the patient to experience drowsiness. It is important for patients to not operate automobiles or machinery until they know how the medication affects them.

Which statement accurately applies to exhibitionism? Seldom a precursor to sexual assault or rape. Generally viewed as a victimless crime. Rarely prosecuted. Generally viewed as an illness by the courts.

Seldom a precursor to sexual assault or rape. Exhibitionism is generally done more for shock value, and actual physical contact is rarely sought. None of the other options are accurate statements regarding this disorder

What is a common cause of excessive sleepiness?

Self-imposed sleep restriction

Which statement provides accurate information regarding transvestic disorder? Most people with this disorder are homosexual. Only men are diagnosed with transvestic disorder. Sexual orientation has no bearing on transvestic disorder. Transvestic behavior develops in middle adulthood.

Sexual orientation has no bearing on transvestic disorder. Unlike in gender dysphorias, in transvestic disorder there are no sexual orientation issues, and people with transvestic disorder do not desire a sex change. Transvestites are usually heterosexual. Although more common in men, women are also diagnosed with transvestic disorder. Transvestic disorder usually develops early in life.

A client confides to the nurse that she is sexually excited by dominating her partner and achieves orgasm only when she humiliates her partner. This admission supports which sexual disorder? Sexual sadism Orgasmic disorder Sexual pain disorder Immature sexual gratification

Sexual sadism Sexual sadism involves the need to give psychological or physical pain to achieve sexual gratification. No other option is supported by the statement

Which medications are currently approved for the treatment of male erectile disorder? select all that apply Sildenafil (Viagra) Flibanserin (Addyi) Tadalafil (Cialis) Vardenafil (Levitra) Avanafil (Stendra)

Sildenafil (Viagra) Tadalafil (Cialis) Vardenafil (Levitra) Avanafil (Stendra)

Which term describes the distribution of sleep and wakefulness across the sleep period in a patient?

Sleep continuity

The nurse performs an assessment on a 12-year-old child. Which finding does the nurse identify as a risk factor for conduct disorder?

Slower resting heart rate A slower resting heart rate is associated with conduct disorder. Increased blood pressure, elevated normal temperature, and decreased respirations are not risk factors associated with conduct disorder. p. 398

Which stage of the sleep cycle is characterized by a decrease in temperature and relaxation of muscles?

Stage 1

Which intervention would be removed from the plan of care for a patient diagnosed with bulimia nervosa?

Support importance of avoiding forbidden foods.

Anorexia nervosa

The nurse is assessing a patient with low weight, lanugo, and cool extremities. The nurse finds that the patient has a fear of gaining weight. Which disorder would the nurse suspect as the cause for the presence of these symptoms?

Which statement is appropriate with respect to the symptoms of restless leg syndrome?

Symptoms are worse during the evening.

A student nurse in the emergency department is assigned to care for a client convicted of the sexual abuse of a child. The student is repulsed by the client because of the nature of his crime and doesn't know how to care for the client under these circumstances. What action should the student nurse take? Refuse the assignment because personal feelings will prevent the student from providing good care. Talk with a faculty member or an experienced nurse in the emergency department. Perform the activities of care but not engage in conversation with the client. Suggest to the client that he request a different nurse.

Talk with a faculty member or an experienced nurse in the emergency department. Nurses may experience distress when providing care for someone who engages in what they view as objectionable, or even reprehensible, acts. This is sometimes compounded by knowing someone who was a victim or having been victimized ourselves. Talking with a faculty member, a nurse mentor, or someone at a mental health clinic can be helpful and important and may even result in better personal understanding and coping. Refusing an assignment is not an option. Performing the activities of care but not engaging in conversation does not appropriately or fully care for the patient. Telling the patient how she feels would be unprofessional and inappropriate, and is putting the burden of our own feelings onto the patient

How can the nurse working with patients diagnosed with eating disorders help families develop effective coping mechanisms?

Teaching the family about the disorder and the patient's behaviors

When attempting to determine the cause of low sexual drive in either a male or female client, the nurse can expect evaluation of the client's serum level of which hormone? Testosterone Estrogen Thyroxin Insulin

Testosterone Testosterone, present in both males and females, appears to be essential to sexual desire in both men and women. This is not true of any of the other options.

Which statement best defines basal sleep requirement?

The amount of sleep needed to be fully awake and perform well in the daytime

The nurse assesses a 9-year-old child whom the parents report was recently suspended from school for physically assaulting a peer. When asked about it, the child states, "I don't care if I got suspended. He deserved it!" The parents admit that the child is very bright but disrupts the class so much that the child has started to fall behind. What can the nurse infer about the child?

The child presents with criteria for conduct disorder. The child is presenting with criteria for conduct disorder, showing signs of antisocial reasoning when stating "he deserved it." Individuals with conduct disorder can have normal intelligence, which the parents report is the case with the child. This is not normal behavior for a 9-year-old child. This child presents with more violent and disruptive behaviors than are common with oppositional disorders. Impulse control is not evident in this scenario. p. 397

2 Antipsychotic medications for persons diagnosed with conduct disorder are directed at problematic behaviors such as aggression, impulsivity, and hyperactivity. Beta-blocking medications also may help to calm individuals with intermittent explosive disorder by slowing the heart rate and reducing blood pressure. Medications for intermittent explosive disorder might include the selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers, such as lithium or an anticonvulsant agent. Antianxiety medications, such as benzodiazepines, should be avoided because they reduce inhibitions and self-control in a similar way as alcohol.

The health care provider considers medication for a 14 year old diagnosed with conduct disorder. This adolescent's behavior shows aggression, impulsivity, and hyperactivity. The nurse will prepare educational materials regarding which type of medication? 1 Beta blocker 2 Antipsychotic 3 Anticonvulsant 4 Benzodiazepine

2 Callousness may be a predictor of a future antisocial personality disorder in adults. Callousness refers to a lack of empathy, such as disregarding and being unconcerned about the feelings of others, lack of remorse or guilt, unconcerned about meeting obligations, and demonstrating a shallow, unexpressive, and superficial affect. Histrionic, dependent, and schizotypal disorders are associated with other behaviors.

The health history for an adolescent diagnosed with conduct disorder indicates frequent callous behavior toward others. When this adolescent reaches adulthood, which personality disorder is most likely to emerge? 1 Histrionic 2 Antisocial 3 Dependent 4 Schizotypal

A nurse interacts with a patient who was physically and sexually abused. Which action of the nurse is indicative of an effective nurse-patient interaction? The nurse establishes trust and rapport. The nurse maintains a distance of 1 ft from the patient. The nurse helps the patient to acknowledge his or her mistake. The nurse frequently restates the statements made by the patient.

The nurse establishes trust and rapport. Patients who have been neglected experience mental trauma and respond slowly. The nurse should spend some time with the patient to establish trust and rapport. Sitting and spending time with the patient gives him or her assurance and support. Communicating with the patient from a distance of 1 ft would be inappropriate. The patient may feel rejected if the nurse maintains a distance while communicating. The nurse should sit beside the patient to comfort the patient. The nurse should not restate what the patient has said. It could interrupt the patient's conversation and make the patient feel rejected. Patients must be allowed to explain their feelings and situations without interruption to avoid distraction. The nurse should reassure a patient that it was not his or her mistake and that he or she is free from blame. When patients blame themselves, it can make them feel guilty and depressed.

1, 2, 4 Providing a climate of safety to the patient and others, setting limits and expectations for patients, and providing structure and boundaries are the general psychosocial interventions used to manage patients with conduct disorder because these interventions are aimed at correcting faulty personality (ego and superego). Antipsychotic medicines are a pharmacological intervention used for their calming effects. Physical restraint is the last resort of management of a patient with conduct or impulse disorder when he or she becomes violent. It is not a type of psychosocial intervention.

The nurse is caring for a patient with conduct disorder. What psychosocial interventions may be needed for this patient? Select all that apply. 1 Provide a climate of safety. 2 Set limits and expectations. 3 Prescribe antipsychotic medicines. 4 Provide structure and boundaries. 5 Use a physical restraint.

1 Pyromania is the deliberate and repeated act of setting things on fire. People who engage in pyromania behaviors become tense or excited before setting things on fire and show an unusual interest in fire and its contexts, like matches or smoke. Kleptomania is the repeated failure to resist urges to steal objects. Oppositional defiance describes a general group of oppositional behaviors. Impulse control disorder is related to pyromania but is not the best term used to describe the child's behaviors.

The nurse performs an assessment on a child and finds that the child deliberately sets fires and becomes excited when talking about them. Which term best describes this behavior? 1 Pyromania 2 Kleptomania 3 Oppositional defiance 4 Impulse control disorder

3 Children diagnosed with childhood-onset conduct disorder attempt to project a strong image, but they actually have low self-esteem, which is chronic rather than situational. These children have impaired social interactions rather than social isolation. They may also have learning impairments, but that clinical condition is different from the nursing diagnosis deficient knowledge.

The nurse prepares the plan of care for a 9-year-old diagnosed with childhood-onset conduct disorder. Which nursing diagnosis is most likely to apply to this child? 1 Social isolation 2 Deficient knowledge 3 Chronic low self-esteem 4 Situational low self-esteem

binge eating

The nurse recognizes bariatric surgery as treatment for which disorder?

A nurse plans to give secondary prevention to a patient who was sexually abused. Which action by the nurse indicates effective nursing practice? The nurse treats the injuries of the patient. The nurse identifies families at high risk for abuse. The nurse teaches mindfulness techniques to the patient. The nurse arranges a housekeeper for the patient's family. The nurse arranges a legal advocacy program for the patient.

The nurse treats the injuries of the patient. The nurse arranges a housekeeper for the patient's family. -Secondary prevention involves interventions to reduce the long-term effects of abuse in the patient. Patients who are victims of sexual abuse get depressed and fearful, so the nurse should teach them mindfulness techniques. This helps to reduce the stress in the patient. The nurse should treat the physical injuries of the patient to reduce the risk of infection. Such patients have feelings of hopelessness and suicidal intentions. Patients who are victims of sexual abuse develop suicidal intentions, so constant monitoring of the patient must be done. Caregiving becomes a burden to the patient's family members so the nurse should arrange a housekeeper to reduce the burden. Mindfulness-based stress reduction and legal advocacy programs are arranged for the survivors of abuse in tertiary prevention. Identifying families at high risk for abuse is part of primary prevention of abuse.

Increased serum amylase levels

The nurse understands that facial edema found next to the ear in a patient diagnosed with bulimia nervosa is most likely caused by which condition?

The nurse notes a patient's lithium level as 0.1 mEq/L. Which prescription from the health care provider would the nurse anticipate receiving?

The nurse would anticipate an increase in the lithium dose because the laboratory results demonstrate that it is not therapeutic at the level currently taken. Therapeutic plasma levels for maintenance of lithium are between 0.4 and 1 mEq/L, not to exceed 1.5 mEq/L.

2 In conduct disorder, the patient violates others and social norms and rules. The patient can even be involved in physical fights, destruction of property, and drug abuse. Intermittent explosive disorder involves aggressive behavior, a delayed consequence of which is remorsefulness. In oppositional defiant disorder, the patient shows defiant and vindictive behavior and a pattern of annoying people and blaming others for his or her own behavior. Kleptomania is the repeated failure to resist urges to steal objects.

The parents and teachers of a young adult have reported that the person does not obey school rules, destroys school property, and is involved in physical fights. What could be the possible diagnosis for this condition? 1 Kleptomania 2 Conduct disorder 3 Oppositional defiant disorder 4 Intermittent explosive disorder

The telehealth nurse receives a call from a spouse who reports that the patient started sertraline 2 days ago and is now confused, anxious, sweating, and feverish. Which nursing response is appropriate?

The patient is exhibiting signs of serotonin syndrome, which can be fatal if treatment is not sought. The patient should seek immediate treatment.

A nurse is educating a patient newly diagnosed with anorexia nervosa about the medication dosage and side effects. The patient becomes upset and tearful, stating, "No! I will not take that medication!" What is the most likely reason for the patient's feelings?

The patient is upset about the possible side effect of weight gain.

Lithium

med for stabilizing bipolar effective disorder administered in divided daily doses (short T1/2 and toxic) Effects within 14 days decreased Na levels decrease the excretion of lithium bc kidneys retain lithium as if it were sodium ..vice versa...

The patient is diagnosed with sexual masochism. Which assessment data would the nurse expect to record? a. The patient secretly watches people in dressing rooms. b. The patient urinates on his or her partner during sexual activity. c. The patient makes his or her partner suffer for sexual satisfaction. d. The patient rubs or touches nonconsenting people for sexual gratification.

The patient makes his or her partner suffer for sexual satisfaction. Sexual masochism is characterized by making one's partner suffer by being beaten, humiliated, or bound. Voyeurism is described as secretly watching people in dressing rooms or other intimate settings. A frotteuristic disorder is characterized by rubbing or touching a nonconsenting person for sexual gratification. Urophilic disorder involves a person urinating on his or her partner during sexual activity.

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 may be experiencing refeeding syndrome

A patient diagnosed with hypersomnolence asks the nurse what medication likely will be prescribed. The nurse's response is based on what fact?

The patient may be prescribed a stimulant.

How does the patient with bulimia differ from the patient with anorexia nervosa?

The patient with bulimia maintains a normal weight.

1 Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. The aggression can be verbal or physical and targeted toward other people, animals, property, or even themselves.

The primary characteristic that separates intermittent explosive disorder (IED) from oppositional defiance is that IED 1 Is diagnosed in individuals 18 years of age or older 2 Has very specific, predictable triggers 3 Rarely involves physical self-harm 4 Seldom results in remorse for the aggressive behavior

A client explains that he is heterosexual but prefers to dress in feminine clothing. This characteristic behavior is suggestive of which sexual disorder? Fetishism Exhibitionism Voyeurism Transvestism

Transvestism Transvestism is a paraphilia that involves dressing in the clothing of the opposite sex. This behavior is not characteristic of any of the other options

Obtaining a sexual history can be embarrassing for the patient and practitioner. Experience with addressing the topic can help, as well as: Using informal language familiar to the patient's age Avoiding specifics and keeping the interview on general topics Avoiding eye contact Using a professional tone of voice and a relaxed posture

Using a professional tone of voice and a relaxed posture

What medication order does the nurse anticipate for a patient diagnosed with antisocial personality disorder displaying aggressive behavior? Multiple choice question Fluoxetine Clonazepam Valproic acid Methylphenidate

Valproic acid The nurse can anticipate a medication order for valproic acid, which will help with aggression, depression, and impulsivity. Fluoxetine may be administered to decrease irritability and help with anxiety and depression. Clonazepam is a benzodiazepine that may help with anxiety but should be used with caution because it is an addictive agent. Methylphenidate is used if there is a comorbidity of attention-deficit/hyperactivity disorder

When parents share that their 8-year-old child seems to "always try to be annoying and hateful," the nurse suspects the child is

Vindictive Vindictiveness is defined as spiteful, malicious behavior. The person with this disorder also shows a pattern of deliberately annoying people and blaming others for his or her mistakes or misbehavior. This child may frequently be heard to say "He made me do it!" or "It's not my fault!" p. 393

Which statement reflects a fact about family violence? Violence occurs in families of all backgrounds. Ninety-five percent of abuse victims are women. Alcohol and stress are the major causes of abuse. The victim's behavior is often the cause of the violence.

Violence occurs in families of all backgrounds. Violence occurs in families of all backgrounds is a true statement. Ninety-five percent of abuse victims are women, the victim's behavior is often the cause of the violence, and alcohol and stress are the major causes of abuse are false.

A nurse is assessing a patient suffering from bulimia nervosa. For what reason would the nurse assess the patient for the presence of dental caries?

Vomiting

4 The three most important interventions with this population are to promote a climate of safety for the patient and for others, establish rapport with the patient, and set limits and expectations.

When working with a patient demonstrating impulse control disorders, all of the following nursing interventions have priority except 1 Providing a safe environment 2 Setting and enforcing limits and expectations 3 Establishing a therapeutic nurse-patient relationship 4 Confronting the patient concerning the disruptive behavior

Inspection of oral cavity

Which assessment by the nurse is important for a patient suspected of experiencing bulimia nervosa?

dental erosion

Which assessment finding is associated with bulimia nervosa?

normal weight

Which assessment finding would the nurse anticipate for a patient newly diagnosed with binge eating disorder?

Bradycardia hypokalemia leukopenia hypothyroidism

Which clinical finding would the nurse anticipate when caring for a patient diagnosed with anorexia?

dry skin emaciation decreased urine output

Which clinical finding would the nurse expect in a patient with anorexia nervosa?

If I want to do something, I just do it. I don't like to analyze things too much. (Impulsivity is characteristic of bulimia nervosa.)

Which comment by the patient indicates bulimia nervosa rather than anorexia nervosa?

Teaching the family about the disorder and the patients behaviors

Which education would the nurse working with patients diagnosed with eating disorders provide to help family develop effective coping mechanisms?

Support importance of avoiding forbidden foods

Which intervention would be removed from the plan of care for a patient diagnosed with bulimia nervosa?

altered serotonin

Which neurobiological factor contributes to the dysregulation of appetite, mood, and impulse control in eating disorders?

2 Predisposing factors for conduct disorder are ADHD, oppositional child behaviors, parental rejection, inconsistent parenting with harsh discipline, early institutional living, chaotic home life, large family size, absent or alcoholic father, antisocial and drug-dependent family members, and association with delinquent peers.

Which of the following would not be considered a predisposing factor for conduct disorder? 1 Chaotic home life 2 Being an only child 3 Attention-deficit/hyperactivity disorder (ADHD) 4 Exposure to drug abuse among family members

Ensure steady weight loss

Which patient outcome is appropriate for a patient with a binge eating disorder?

Hypercarotenemia

Which physiological response may cause a finding in a patient with severe anorexia and yellow skin?

weight restoration

Which priority outcome is associated with the acute treatment for anorexia nervosa?

Binge eating

Which reason would the nurse suspect for the presence of gastric dilation in a patient with bulimia nervosa?

I do not exercise to reduce weight

Which statement by a patient indicates the presence of a binge eating disorder?

Maintains a normal weight

Which statement is true related to a patient with bulimia nervosa?

Fear of gaining weight

Which subjective symptom would the nurse expect to note during assessment of a patient with anorexia nervosa?

Maintain a normal weight

Which symptoms is consistent with bulimia?

impaired circulation to extremities Decreased bone density Elevated blood carotene

Which type of medical complication would the nurse likely observe in a patient with anorexia nervosa?

What positive outcome does the nurse plan when managing a patient with sleep deprivation?

Work and sleep balance

Which of the following problems are classified as paraphilic disorders? select all? Gender dysphoria Zoophilic disorder Necrophilic disorder Klismaphilic disorder Hypoactive sexual desire disorder

Zoophilic disorder Necrophilic disorder Klismaphilic disorder Paraphilic disorders include necrophilic disorder (obsession with having a sexual encounter with a cadaver), zoophilic disorder (incorporation of animals into sexual activity), and klismaphilic disorder (sexual activity that incorporates enemas). Gender dysphoria refers to feelings of unease about one's incongruent maleness or femaleness. Low interest in sex is characterized by a deficiency or absence of sexual fantasies or desire for sexual activity and is called hypoactive sexual desire disorder; it is not a paraphilic disorder.

A 79-year-old patient in the emergency department is 5' 6", weighs 93 pounds, and is wearing old, dirty clothes that have holes. The patient is diagnosed with pneumonia. Which comment by this patient suggests a significant risk for abuse? Multiple choice question a. "Our family is poor, so my daughter gets my monthly retirement and Social Security checks." b. "Volunteers from our community food bank have been bringing my groceries for the last few months." c. "I've lived alone all my life. I have my own ways of doing things and I don't like others to interfere." d. "I've had a bad cold for months. My daughter made chicken noodle soup for me, but I kept getting worse."

a Economic abuse is controlling a person's access to economic resources. This patient may be a victim of economic abuse. "Volunteers from our community food bank have been bringing my groceries for the last few months," "I've lived alone all my life. I have my own ways of doing things and I don't like others to interfere" and "I've had a bad cold for months. My daughter made chicken noodle soup for me, but I kept getting worse" reflect challenges faced by many elderly people.

Which nursing interventions are helpful when working with parents or caregivers of children and adolescents with impulse disorders? select all? a. Teach them role-playing techniques. b. Show them how to make home a safe environment. c. Refer parents and caregivers to local self-help groups. d. Tell them to have strict control over the child behavior. e. Teach them to manage the child with physical power if they become violent.

a, b, c Role-playing is a behavior modification technique. It helps parents and caregivers to tackle different problem situations that might arise with their child or adolescent. Patients who show aggressive behavior may become violent. In such situations, family members should be aware of weapons, drugs, and attempts by the patient to talk separately with other family members. When the family knows these things it can make the home a safe environment in which to live. Local self-help groups teach good parenting skills that have a positive effect on the child behavior. If parents or caregivers are overly controlling, the child may suffer detrimental effects at the developmental point at which the trauma occurs. This may precipitate an aggressive response and the disorder may worsen. If parents engage in physical power, this shows confrontational behavior with the patient, which may further increase the patient aggression.

Which action is considered a nursing responsibility related to the abuse of a patient? select all a. Reporting is a legal obligation. b. Abuse need only be suspected. c. Most states require a report within 24 hours. d. The nurse is required to display a neutral attitude. e. The report needs support by another healthcare provider.

a, b, d Nurses are mandated legally to report suspected or actual cases of child and vulnerable adult abuse. Nurses must attempt to maintain both an appropriate level of suspicion and a neutral, objective attitude. Each state has specific guidelines for reporting, including whether the report can be oral, written, or both, and within what time period the suspected abuse or neglect must be reported (immediately, within 24 hours, or within 48 hours). No collaboration by another nurse is required.

A nurse works in a psychiatric clinic and manages patients with impulsive disorders. Why should the nurse apply cognitive-behavior therapy (CBT)? select all? a. To develop realistic and positive thoughts b. To teach mindfulness and emotional regulation c. To focus on the patient's emotions and behavior d. To identify the triggers of maladaptive behaviors e. To improve parenting strategies of child interaction

a, c,d CBT is a talk therapy. It is based on the concept that when thoughts become realistic and positive, the way of experiencing life can be changed. CBT focuses on the patient's emotions and behavior for improvement. It aims at recognizing the triggers of maladaptive behaviors and finding methods to prevent them. Teaching mindfulness and emotional regulation is dealt with in dialectical behavioral therapy (DBT). Improving parenting strategies of child interaction is the aim of parent-child interaction therapy (PCIT).

The community health nurse is teaching about prevention of abuse. Which are examples of tertiary prevention? Multiple selection question a. Support groups for survivors b. Reduction of stress for the abuser c. Teaching of coping skills to the abuser d. Legal advocacy programs for survivors e. Screening programs for high-risk individuals

a, d Tertiary prevention involves treating survivors of abuse, for example with support groups and legal advocacy programs. Reducing stress for the abuser and increasing his or her coping skills are strategies for primary prevention of abuse. Screening programs for high-risk individuals are examples of secondary prevention of abuse.

When providing sleep hygiene information to a patient reporting difficulty falling asleep, the nurse includes a. Taking a 20-minute walk after dinner b. Keeping the bedroom warm to induce coziness c. Taking a short nap after lunch whenever possible d. Drinking a small amount of alcohol to relax just before bedtime

a. Light, daily exercise often promotes sleep; however, the exercise should not be done right before bedtime.

Which sexual dysfunction information should the nurse include in the discharge teaching for a female patient recovering from a vaginal prolapse repair? a. You may experience genito-pelvic pain. b. You may have bizarre sexual fantasies c. You will have increased vaginal lubrication. d. You will likely experience impaired orgasms.

a. A vaginal prolapse repair can cause genito-pelvic pain. Decreased vaginal lubrication can result from a vaginal prolapse repair. Bizarre sexual fantasies are often related to a schizophrenia diagnosis. Impaired orgasms are often a result of a neurological medical condition.

Which classification of medication may be prescribed in intermittent explosive disorder? a. Anticonvulsants b. Benzodiazepines c. Psychostimulants d. Monoamine oxidase (MAO) inhibitors

a. Although considered off-label use, anticonvulsants may reduce outbursts and contribute to mood stabilization. Psychostimulants, benzodiazepines, and MAO inhibitors are incorrect for use in intermittent explosive disorder.

A nurse is caring for a patient with hostile behavior. What strategies should the nurse adopt when communicating with this patient? a. Apply consistent limits b. Use an angry tone when talking c. Maintain a threatening body posture d. Use negotiations to correct behavior

a. Consistently setting limits helps to manage a hostile patient and avoids confrontation. A neutral tone of voice and calm communication help to manage hostility. The body posture should be unthreatening and calm when communicating with a hostile patient to avoid confrontation. Using negotiations when correcting the behavior of hostile patients should be avoided to prevent aggression.

Refeeding syndrome

metabolic alterations that may occur during nutritional repletion of starved patients

The primary characteristic that separates intermittent explosive disorder (IED) from oppositional defiance is that IED a. Is diagnosed in individuals 18 years of age or older b. Has very specific, predictable triggers c. Rarely involves physical self-harm d. Seldom results in remorse for the aggressive behavior

a. Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. The aggression can be verbal or physical and targeted toward other people, animals, property, or even themselves.

A patient with anorexia nervosa was discharged from a specialized eating-disorder unit three weeks ago, weighing 123 lb. The patient returns to the outpatient clinic for a follow-up visit. The patient's ideal body weight is 154 lb, but the current body weight is 112 lb. What is the nurse's priority action? a. Notify the health provider. b. Obtain a 24-hour diet recall. c. Request to view the nutrition log. d. Proceed with the treatment plan.

a. The nurse's priority action is to notify the healthcare provider. The patient weights 75% below his or her ideal body weight and will require immediate medical stabilization. Obtaining a 24-hour diet recall, requesting to view the nutrition log, and proceeding with the treatment plan are actions that may be taken once the healthcare provider is consulted.

What guideline for nursing care should the nurse implement when caring for a patient with schizoid personality disorder? Multiple choice question a. Avoid being too nice or friendly. b. Teach and role model assertiveness. c. Maintain strict adherence to schedules. d. Respect the patient's need for social isolation.

a. When caring for the patient with schizoid personality disorder, the guideline for nursing care is to avoid being too nice and friendly. Patients with this disorder are somewhat expressionless and operate with a restricted range of emotional expression. They do not seek out or enjoy close relationships. Teaching and role modeling assertiveness is beneficial for the patient diagnosed with histrionic personality disorder. Due to suspicion and distrust, maintaining strict adherence to schedules is important when caring for a patient with a paranoid personality disorder. Respecting the patient's need for social isolation is important when caring for a patient diagnosed with schizotypal personality disorder.

The nurse is caring for a patient with antisocial behavior. The patient is aggressive, exploits the group members during any group activities, and lacks sympathy toward others. What appropriate action should the nurse take while caring for the patient? a. Note signs of aggression in the patient. b. Administer morphine to calm the patient. c. Stop involving the patient in group tasks. d. Make the patient feel guilty for exploiting others during group activities.

a. Patients with antisocial behavior are aggressive and seductive. They exploit others and lack sympathy. The nurse should note signs of aggression that can help to assess the patient and provide appropriate treatment. The nurse should involve the patient in tasks and set limits to promote good behavior. The nurse should not make the patient feel guilty but try to explain that the patient's behavior is unacceptable. Morphine is a narcotic drug and substance abuse often enhances antisocial behavior in patients. The nurse may administer benzodiazepines to reduce aggression in the patient. pp. 459-460

Which child is demonstrating behaviors that support a diagnosis of adolescent onset conduct disorder? a. A 12-year-old male who steals a bicycle as a gang initiation b. A 9-year-old male who smokes half a pack of cigarettes a day c. A 12-year-old female who regularly bullies her younger siblings d. A 9-year-old female who engages in sexually provocative behaviors

a. A 12-year-old male who steals a bicycle as a gang initiation In adolescent-onset conduct disorder, no symptoms are present prior to age 10. Affected adolescents tend to act out misconduct with their peer group (e.g., early onset of sexual behavior, substance abuse, risk-taking behaviors). Males are more likely to fight, steal, vandalize, and have school discipline problems, whereas girls tend to lie, be truant, run away, abuse substances, and engage in prostitution.

Which of the following classifications of medication may be prescribed in intermittent explosive disorder? a. Anticonvulsants b. Psychostimulants c. Antianxiety agents such as benzodiazepines d. Monoamine oxidase (MAO) inhibitors

a. Anticonvulsants Although considered off-label use, anticonvulsants may reduce outbursts and contribute to mood stabilization. The other options are incorrect for use in intermittent explosive disorder.

As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at high risk for developing which comorbid disorder? a. Antipersonality disorder b. Obsessive-compulsive disorder c. Kleptomania d. Depression

a. Antipersonality disorder Individuals with childhood-onset conduct disorder are more likely to have problems that persist through adolescence, and without intensive treatment, they develop antisocial personality disorder as adults. Research does not support any of the other options.

The nurse is preparing to set goals for a 10-year-old diagnosed with an impulse control disorder. To best ensure the expected therapeutic outcomes, the nurse includes goals that focus on what client need? a. Client centered and includes the client's input b. Age appropriate and achievable in a short period of time c. Simple and easily defined d. Family centered and long term in nature

a. Client centered and includes the client's input Whenever possible, outcomes should be client centered and agreed upon by both the nurse and the client or the client's designee. While the other options may be appropriate, they are not the priority.

A client diagnosed with conduct disorder craves what experience? a. Excitement without concern for possible negative outcomes b. Control of situations and constantly strategizes for such power c. Friendship but from those older than themselves d. Material possessions but lacks focus and direction

a. Excitement without concern for possible negative outcomes People with conduct disorder crave excitement and do not worry as much about consequences as other people do. None of the other options demonstrates a need associated with conduct disorder.

When Melissa was a small child, she insisted that she was a boy, refused to wear dresses, and wanted to be called Mitch. As Melissa reached puberty, she no longer displayed a desire to be male. This change in identity is considered: Gender dysphoria reaction formation normal early transgender syndrome

normal

An adult complains, "I fall asleep as soon as I go to bed but wake up between 3 and 4 AM every morning; then, I can't go back to sleep. It's causing me problems concentrating at work and I don't have enough energy to take care of my family." Which nursing diagnosis applies to this scenario? a. Insomnia b. Impaired comfort c. Sleep deprivation d. Disturbed sleep pattern

a. Insomnia Criteria for insomnia include absenteeism, changes in affect, energy, mood, quality of life, concentration, and sleep. Patients with insomnia report a lack of energy, sleep disturbances, and early wakening. Sleep deprivation is associated with acute confusion, agitation, anxiety, apathy, fatigue, poor concentration, irritability, lethargy, malaise, perceptual disorders, and slowed reactions. Changes in normal sleep pattern, decreased ability to function, dissatisfaction with sleep, awakening, no difficulty falling asleep, and not feeling well rested are criteria for the diagnosis disturbed sleep pattern. Impaired comfort is a nursing diagnosis that relates to unpleasant sensations such as pain, itching, or gastrointestinal distress.

Which of the following statements are true regarding childhood-onset conduct disorder? (Select all that apply.) a. It is more commonly diagnosed in males. b. It is characterized by feelings of remorse and regret. c. It is usually diagnosed in late teen years. d. It is characterized by disregard for the rights of others. e. Those with conduct disorder rationalize their aggressive behaviors. f. It is usually outgrown by early adulthood.

a. It is more commonly diagnosed in males. d. It is characterized by disregard for the rights of others. e. Those with conduct disorder rationalize their aggressive behaviors. Childhood-onset conduct disorder is more common in male patients and is seen before the age of 10 years. Hallmarks include disregard for the rights of others, physical aggression, poor peer relationships, and lack of feelings of guilt or remorse. The other options are the opposite of what is correct.

The nurse is educating a community of parents about psychological and environmental factors that may lead to conduct disorder. What psychological and environmental factors that can lead to conduct disorder should the nurse include in the teaching? Multiple selection question a. Low self-esteem b. Low intelligence c. Violence in the family d. Chaotic and negligent parenting e. Conflict in marriage f. Remorseful nature

a. Low self-esteem b. Low intelligence d. Chaotic and negligent parenting e. Conflict in marriage Patients with conduct disorder have low self-esteem and low intelligence (immature coping and problem-solving abilities). These patients tend to cover and compensate for these abnormalities with impulsive behavior. People who are brought up in chaotic and negligent conditions develop poor emotional responses. Conflict in marriage is associated with emotion and attachment that may lead to conduct disorder. Intermittent explosive disorder is associated with conflict and violence in the family of origin. Exposure to family violence at an early age makes it likely that the behavior will be repeated as the child matures. Delayed consequences of aggressive behavior in patients with intermittent explosive disorder are feelings of remorse, regret, and embarrassment.

What distinction can be made between abuse and neglect? a. Neglect is a failure to provide; abuse is a failure to control physical aggression. b. Neglect is perpetrated against children; abuse victims can be children or adults. c. Neglect is always physical; abuse can be verbal, physical, sexual, or emotional. d. Neglect occurs in the psychological domain; abuse occurs in the physical domain.

a. Neglect is a failure to provide; abuse is a failure to control physical aggression. Neglect can occur in both the psychological and physical domains. Neglect is not always physical in its form and can be directed towards all age groups.

What is the nurse's initial intervention when beginning the management of care for an individual diagnosed with a maladaptive eating disorder? a. Personally reflect on weight-related biases. b. Establish a therapeutic patient-focused relationship. c. Evaluate the individual's current state of physical and emotional health. d. Assure the individual that the treatment plan will be agreed upon mutually.

a. Personally reflect on weight-related biases. Before working with patients with maladaptive eating regulation responses, nurses must closely examine their own feelings and prejudices about weight and body size. Although establishing a therapeutic patient-focused relationship, evaluating the individual's current state of physical and emotional health, and assuring the individual that the treatment plan will be agreed upon mutually all reflect appropriate interventions, there is a different intervention among the options that has priority in this situation.

When working with a client demonstrating impulse control disorders, which nursing interventions have initial priority? (Select all that apply.) a. Providing a safe environment b. Establishing a therapeutic nurse-client relationship c. Setting and enforcing limits d. Confronting the client concerning the disruptive behavior e. Presenting appropriate expectations

a. Providing a safe environment b. Establishing a therapeutic nurse-client relationship c. Setting and enforcing limits e. Presenting appropriate expectations The most important interventions with this population are to promote a climate of safety for the patient and for others, establish rapport with the patient, and set limits and expectations. Confronting behaviors is not an initial priority.

Pyromania, a behavior associated with impulse control disorders, causes an individual to engage in what behavior? a. Starting fires b. Stealing for thrill c. Self-mutilate d. Directing anger toward others

a. Starting fires Pyromania is described as repeated, deliberate fire setting. This behavior does not include any of the other stated options.

Which outcomes will the nurse identify for a patient who has a nursing diagnosis of risk for suicide? a. Talks about suicidal ideas b. Expresses feelings to others c. Makes fun plans for the future d. Refrains from thinking about suicidal behaviors e. Replaces thoughts about suicide with work or play

a. Talks about suicidal ideas b. Expresses feelings to others c. Makes fun plans for the future Outcomes for patients with a nursing diagnosis of risk for suicide include expressing feelings, making plans for the future, and talking about suicidal ideas. It is not realistic for the patient to refrain from thinking about suicidal behaviors. Replacing suicidal thoughts with other things is just masking the issue rather than dealing with it.

A mother brings her 4-year-old daughter to the emergency department and states that the child has been "acting funny." The mother states, "She touches her vagina and rubs herself down there all the time and she never did that before." This behavior best supports which conclusion? a. The child has been sexually abused. b. The mother needs education in parenting skills. c. This is normal developmental behavior in a 4-year-old child. d. The child has been exposed to graphic sexual images on television.

a. The child has been sexually abused. Sexualized behavior is one of the most common symptoms of sexual abuse in children. Younger children may draw sexually explicit images, demonstrate sexual aggression, or act out sexual interactions in play, for example, with dolls. Masturbation may be excessive in sexually abused children. This is not normal developmental behavior for a 4-year-old child. The mother may need education in parenting skills or the child may have been exposed to graphic sexual images, but sexual abuse is more likely and must be investigated.

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 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.

A newly admitted patient has an axis II diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be to Multiple choice question a. Set firm limits on behavior b. Respect need for social isolation c. Encourage expression of feelings d. Involve in milieu and group activities

b Schizoid personality disorder has the primary feature of emotional detachment. The person does not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization. pp. 454-455

A patient with a history of a binge-eating disorder is prescribed Orlistat to help reduce his or her weight. What statement will the nurse include in the patient teaching? Multiple choice question a."The medication may decrease your blood sugar." b. "It is important to take a multivitamin with this medication." c. "The medication may cause numbness or burning of the skin." d. "The medication may cause constipation, so you will need to increase your dietary fiber."

b. The nurse will tell the patient it is important to take a multivitamin with this medication. Orlistat causes steatorrhea, which can result in deficiencies of fat-soluble vitamins. Liraglutide may cause hypoglycemia. Side effects of phentermine and topiramate may include numbness or burning of the skin. A side effect of naltrexone and bupropion is constipation.

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? a. Qsymia b. Bupropion c. Olanzapine d. Lorcaserin

b. 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.

An older adult who reports taking a late afternoon nap every day to make up for disrupted sleep at night still feels tired. The nurse explains that a. A noontime nap includes very little REM sleep b. A late afternoon nap does not compensate for nighttime sleep c. The elderly always need less than 6 hours of sleep each night d. An afternoon nap includes a great deal of rapid eye movement (REM) sleep

b. A late afternoon nap does not compensate for nighttime sleep Daytime naps do not compensate for a lack of nighttime sleep. Daytime naps differ in structure from normal nighttime sleeping as a result of a circadian cycle.

Which comorbid conditions are commonly associated with oppositional defiant disorder? (Select all that apply.) a. Conversion disorder b. Attention deficit hyperactivity disorder (ADHD) c. Depression d. Anxiety e. Substance abuse

b. Attention deficit hyperactivity disorder (ADHD) c. Depression d. Anxiety Oppositional defiant disorder is related to a variety of other problems, including attention deficit hyperactivity disorder, anxiety, and depression. Neither of the remaining options are closely associated with this diagnosis.

The mother of a 6-year-old child expresses concern over the child's frequent temper outbursts. He deals with any frustration by bullying and hitting and seldom shows any remorse for his actions. The nurse who gathers this data will note that the child's behaviors are most consistent with which diagnosis? a. Social phobia b. Conduct disorder c. Oppositional defiant disorder d. Attention deficit hyperactivity disorder (ADHD)

b. Conduct disorder The data are most consistent with the aggressive pattern of childhood-onset conduct disorder of the aggressive type.

Which nursing intervention is appropriate for the management of intermittent explosive disorder? a. Providing intensive family therapy b. Establishing a trusting relationship with the patient c. Setting up loose boundaries so the patient will feel relaxed d. Limiting decision-making opportunities to avoid frustration

b. Establishing a trusting relationship with the patient Establishing rapport with the patient is essential in working to set goals, boundaries, and consequences, and providing opportunities for goal achievement. Intensive family therapy would not be a basic level RN intervention. Boundaries and structure are essential. Opportunities for patients to make good decisions and reach goals should be given, not limited.

A 17-year-old patient is admitted to the psychiatric unit after threatening his mother during an argument and is diagnosed with conduct disorder. Which of the following would be an appropriate short-term outcome for this patient? a. Engages in appropriate coping skills to manage stressors b. Expresses feelings c. Maintains self-control during hospitalization d. Mother will improve communication skills to interact with Eli.

b. Expresses feelings Expressing feelings is an appropriate short-term outcome and would be a good start to working with the patient to establish rapport, develop coping skills, and set goals. Engaging in appropriate coping skills and maintaining self-control are desired outcomes. Outcomes for the patient are being discussed, not outcomes for the patient's mother.

The nurse suspects that a patient is a victim of family violence. What should the nurse assess to identify family violence? Multiple selection question a.Mismanagement of medicine b. Family coping patterns of abuse c. Characteristics of the perpetrator d. Drug or alcohol use in the family e. Presenting signs and symptoms of abuse

b. Family coping patterns of abuse d. Drug or alcohol use in the family e. Presenting signs and symptoms of abuse The nurse documents the family coping patterns and past or current history of drug or alcohol use. The nurse assesses the presenting signs and symptoms of the victims carefully. The mismanagement of medicine is assessed when neglect of older adults is suspected. It is not a feature of family violence. The characteristics of the perpetrators are assessed in the secondary prevention method.

When treating impulse control disorders, psychodynamic psychotherapy is directed toward ? a. Mastering relaxation techniques b. Identifying the triggers of the rage c. Teaching the patient self-distracting techniques d. Helping the patient replace the rage with acceptable alternative feelings

b. Identifying the triggers of the rage Psychodynamic psychotherapy focuses on underlying feelings and motivations and explores conscious and unconscious thought processes. In working with impulse control problems, the therapist may help the patient to uncover underlying feelings and reasons behind rage or anger. This may help the patient to develop better ways to think about and control his or her behavior.

When treating impulse control disorders, psychodynamic psychotherapy is directed toward which goal? a. Mastering relaxation techniques b. Identifying the triggers of the rage c. Teaching the client self-distracting techniques d. Helping the client replace the rage with acceptable alternative feelings

b. Identifying the triggers of the rage Psychodynamic psychotherapy focuses on underlying feelings and motivations and explores conscious and unconscious thought processes. In working with impulse control problems, the therapist may help the patient to uncover underlying feelings and reasons behind rage or anger. This may help them to develop better ways to think about and control their behavior. None of the other options are considered goals of this form of therapy.

A nurse is assessing a patient with major injuries. The nurse suspects that the patient was physically abused by his or her intimate partner. The patient is unable to interact due to a language barrier. What appropriate action should the nurse take while documenting the clinical report of abuse? a. Immediately report against the patient's partner in the community health department. b. Maintain a balance of suspicion and a neutral, objective attitude. c. Ask the patient's family member to translate the conversation. d. Give the patient some time, and conduct the interview after 72 hours.

b. Maintain a balance of suspicion and a neutral, objective attitude. The nurse should prepare a clinical document to report the physical abuse of the patient. While interacting with the patient, the nurse should maintain a balance of suspicion and a neutral, objective attitude. It helps the nurse not to jump to conclusions and to complete a thorough examination to make proper assessment of the patient's condition. Suspecting the patient's partner without evidence may lead to incomplete assessment of the patient. Without proof the nurse should not come to a conclusion and file a complaint against the patient's partner. The nurse should not ask the patient's family member to translate the interaction. Presence of a family member during documentation of the report results in loss of patient's confidence. The patient can avoid interacting due to threat of future punishment. The report of the abuse must be done within 24-48 hours. So the nurse should interact with the patient within 48 hours and complete the document.

Which statement is true about the characteristics of the oppositional defiant child? a. The defiance is generally directed toward parents and siblings. b. These behaviors are a predictor of future mental health disorders. c. Arguing tends to be more prevalent in boys. d. Girls display more blaming than do boys.

b. These behaviors are a predictor of future mental health disorders. Oppositional defiant disorder is often predictive of emotional disorders in young adulthood. None of the other statements are necessarily correct.

A patient with a history of anorexia nervosa is currently being treated with fluoxetine for obsessive-compulsive behavior. The patient asks the nurse, "Will this medication help keep my anorexia from worsening?What is the nurse's best response? a. The medication will prevent a relapse of anorexia. b. You will be taking a different medication to treat your anorexia. c. The medication is being used to treat obsessive-compulsive behavior. d.The medication will treat both the anorexia and obsessive compulsive behavior

c.

A community mental health nurse works with an adult patient diagnosed with borderline personality disorder. The patient says to the nurse, "I'm under so much stress, I feel like cutting my throat." What should the nurse do first? a. Extinguish the behavior by ignoring it. b. Immediately notify the health care provider. c. Talk with the patient about the feelings of stress. d. Initiate the process for involuntary hospitalization of the patient.

c. Patients diagnosed with borderline personality disorder are impulsive, with significant risks for suicide and self-mutilation. Discussing the dynamics of feelings and stress help the patient feel understood and is a positive action. The nurse as a therapeutic agent should respond and interact with the patient, but it is important to inform the treatment team (including the health care provider) afterward. If the nurse fails to respond, the patient may follow through with a suicide attempt. Involuntary hospitalization is not indicated at this point.

Which benzodiazepine drug should the nurse expect to be prescribed for treating insomnia? a. Trazodone b. Ramelteon c. Quazepam d. Doxylamine

c. The pharmacologic approach to insomnia includes several classes of drugs, like benzodiazepines, melatonin receptor agonists, antidepressants, and antihistamines. The primary goal of pharmaceutical agents in treating insomnia is sedation. Quazepam is the benzodiazepine drug used to treat insomnia. It has an onset of action within 20 to 45 minutes, with a long-lasting effect. Trazodone, doxylamine, and ramelteon are not benzodiazepine drugs. Trazodone is an antidepressant drug used to treat insomnia. Doxylamine is an antihistamine drug used to treat insomnia. Ramelteon is a melatonin receptor antagonist approved by the Food and Drug Administration (FDA) to treat insomnia.

Assessment for oppositional defiant disorder should include which interventions? a. Assessing the history, frequency, and triggers for violent outbursts b. Assessing moral development, belief system, and spirituality for the ability to understand the impact of hurtful behavior on others, to empathize with others, and to feel remorse c. Assessing issues that result in power struggles and triggers for outbursts d. Assessing sibling birth order to understand the dynamics of family interaction

c. Assessing issues that result in power struggles and triggers for outbursts Oppositional defiant disorder is characterized by defiant behavior, power struggles, outbursts, and arguing with adults, so assessment of these factors would be important. Assessing for violent outbursts refers to assessment for intermittent explosive disorder. Oppositional defiant disorder is not characterized by violent behaviors. Assessing for the ability to understand the impact of hurtful behaviors on others refers to assessment for conduct disorder. Birth order is not known to play a part in oppositional defiant disorder.

When parents share that their 8-year-old child seems to "always try to be annoying and hateful," the nurse suspects the child is demonstrating which characteristic? a. Emotionally immature b. Anxiety c. Vindictiveness d. Depression

c. Vindictiveness Vindictiveness is defined as spiteful, malicious behavior. The person with this disorder also shows a pattern of deliberately annoying people and blaming others for his or her mistakes or misbehavior. This child may frequently be heard to say "He made me do it!" or "It's not my fault!" The description is not associated with any of the other options.

Which behavior consistently demonstrated by a child is a predictor of future antisocial personality disorder in adults? a. Sadness b. Remorse c. Guilt d. Callousness

d. Callousness Callousness may be a predictor of future antisocial personality disorder in adults. The remaining options would indicate a degree of empathy not observed in a client who is demonstrating antisocial tendencies.

A patient who travels often and therefore experiences jet lag regularly reports the use of over-the-counter (OTC) melatonin supplements. The nurse responds by informing the patient that a. Hypertension is a common side effect of melatonin supplement therapy. b. Melatonin is a naturally secreted hormone and thus is a safe supplement. c. Research has supported the effectiveness of using melatonin supplements for jet lag. d. Currently no standardized, safe therapeutic dosage range for melatonin supplements has been established

d. Currently no standardized, safe therapeutic dosage range for melatonin supplements has been established Because melatonin is an OTC product, the Food and Drug Administration has no input on the identification of effective dosage ranges or standardization of nutraceutical ingredients.

A poorly developed sense of empathy is thought to be the result of having what life experience? a. A family history of mental illness b. a low serum testosterone level c. suffered head trauma at an early age d. unmet physical and emotional needs

d. unmet physical and emotional needs A history of not having one's own needs met may indicate an individual who has a less well-developed sense of empathy. Research does not support any of the other options.

Which dietary recommendations would the nurse make to the patient who is taking lithium?

decrease intake of coffee stabilize salt intake

Phillip, a 63-year-old male, has exposed his genitals in public for all of his adult life, but the act has lost some of the former thrill. A rationale for this change in his experience may be: an increasing sense of shame disgust over his lack of control desire waning with age progression onto actual assault

desire waning with age

depression

feelings of persistent sadness and despair, loss of energy and difficulty dealing with everyday life, lasting more than 2 weeks

The cause of restless legs syndrome (RLS) is unknown, though links with other disorders have been established. Which factors may contribute to the development of RLS? Gender Genetics Sedentary lifestyle Sodium deficiency Serotonin decrease

gender genetics sedentary lifestyle RLS tends have a genetic component, and is more common in women. Symptoms tend to occur after periods of inactivity. Iron deficiency, not sodium deficiency, is also associated with RLS. The condition may be related to the dysfunction of the basal ganglia and dopamine, not serotonin, regulation.p. 363

duloxetine side effects

insomnia, visual disturbance, nausea

A patient says, "I've been taking triazolam (Halcion) to help me sleep. I sleep all night but I'm still so tired during the day. How could that happen?" Which physiological effect best explains this patient's complaint? Triazolam:

interferes with slow wave sleep

3 A history of not having one's own needs met may indicate an individual who has a less well-developed sense of empathy.

poorly developed sense of empathy is thought to be the result of having 1 A family history of mental illness 2 A low serum testosterone level 3 Unmet physical and emotional needs 4 Suffered head trauma at an early age

Pedophilic disorder is the most common paraphilic disorder where adults have primary or exclusive sexual preference for prepubescent children. A subset of this disorder is termed hebephilia and is defined as attraction to: Infants Pubescent individuals Teens between the ages of 15 and 19 Males only

pubescent individuals

A client, prescribed which class of antidepressantive medication should be monitored for the development of premature ejaculation? Monoamine oxidase (MAO) inhibitors Tricyclic antidepressants Atypical antipsychotics selective serotonin reuptake inhibitor (SSRI) antidepressants

selective serotonin reuptake inhibitor (SSRI) antidepressants Treatments include antidepressants in the SSRI category. Conversely, pharmacotherapy may cause erectile dysfunction, and medications may need to be evaluated for change or dose reduction. The other options are not used for premature ejaculation

SSRIs side effects

sexual dysfunction, weight gain, dizziness, fatigue, rashes, diarrhea, nausea, sweating

Pyromania, a behavior associated with impulse control disorders, causes an individual to engage in which problematic behavior?

start fires. Pyromania is described as repeated, deliberate fire setting. None of the other options adequately describes pyromania. p. 399

Hormone therapy for the purpose of surgical gender reassignment is initiated when the client has successfully demonstrated a genuine intent to change genders. taken on the dress and manners of the preferred gender. successfully lived the crossgender role in all aspects of life.

successfully lived the crossgender role in all aspects of life. After living as a member of the desired gender, if the client still wishes to proceed with gender reassignment, hormone therapy can be initiated. All the other options are secondary to the correct option