Mental Health Questions

The nurse is caring for a patient who has been abusing a CNS depressant and anticipates finding which signs and/or symptoms during the assessment process? Select all that apply. Agitation Decreased respirations Dilated pupils Increased hunger and thirst Memory loss Slurred speech

2,5,6 Signs and symptoms commonly seen with a CNS depressant include: listlessness, decreased respirations, pinpoint pupils, reduced hunger and thirst, memory loss, slurred speech, and ataxic gait. A depressant drug would not produce agitation. A CNS depressant drug would not produce dilated pupils, increased hunger, or increased thirst.REF: Page 1155

17. The nurse is aware of the phases of schizophrenia. Arrange the following symptoms in the correct order according to the phases of schizophrenia. 1. Odd or eccentric behavior 2. Loss of contact with reality 3. Lack of energy and motivation 4. Some relief of symptoms

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5. The nurse is assessing a patient with a diagnosis of schizophrenia for negative, or absent, behavior patterns. Which symptoms would the nurse assess for? (Select all that apply.) 1. Delusions 2. Social withdrawal 3. Hallucinations 4. Disordered thinking 5. Apathy

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18. The leader of a self-help group is discussing the use of defense mechanisms. What information should be included about their use? (Select all that apply.) 1. Once used, they are irreversible. 2. Defense mechanisms are pathologic. 3. They are a means of managing conflict. 4. Defense mechanisms are predominantly unconscious. 5. Defense mechanisms are primarily used to blame others.

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2. A patient with Alzheimer's disease continually wanders. Which snack will best meet the patient's nutritional needs? (Select all that apply.) 1. Candy bars and ice cream sundaes 2. Eggnog milk shakes and oatmeal-raisin cookies 3. Protein bars and juice 4. Root beer and potato chips 5. Cheese and crackers and milk

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10. Amotivational cannabis syndrome is suspected in a patient. What findings would support this diagnosis? (Select all that apply.) 1. Periods of euphoria 2. Obsession with personal hygiene 3. Apathy 4. Sharp increases in appetite, commonly referred to as the "munchies" 5. Irritability

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18. The nurse is caring for a patient who is in the acute care unit for elective surgery. What findings during the patient's hospitalization would be consistent with alcohol withdrawal? (Select all that apply.) 1. Euphoria and hyperactivity 2. Depression and hypersomnia 3. Diaphoresis and nausea 4. Below normal temperature and bradycardia 5. Vomiting and tremors

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14. A teenager wrecks the family car by rear-ending a truck turning left. The teenager says, "It wasn't my fault. I came over the hill and that truck was just sitting there. It was his fault for turning left." What defense mechanism is the teenager using to deal with his situation? 1. Compensation 2. Conversion reaction 3. Projection 4. Rationalization

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16. What factor is most predictive of the onset of a crisis for an individual? 1. The individual has no support system. 2. The individual perceives a stressor to be threatening. 3. The individual is exposed to a precipitating stressor. 4. The individual experiences a stressor and responds with ineffective coping efforts.

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4. The nurse is reviewing the assessment findings for a patient hospitalized with a stress disorder. What findings support the diagnosis? 1. A vague feeling of depression 2. An assumed role to protect the ego 3. A main reason for all mental illnesses 4. A response to any demand made upon the individual

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cognitive therapy (1136)

a. Breaking negative thought patterns and developing positive feelings about memories

6. Hope is characterized as __________________________, even though the hopeful individual does not necessarily expect to achieve a specific goal (744)

confidence

11. In schizophrenia, the ventricles of the brain are larger, with the left ventricle larger than the right, and the cerebral cortex is smaller than normal; theoretically, this may account for the __________________________. (1128)

disorganized thinking

8. The nurse is caring for a patient who is in the emergency department after a suspected "date rape." What benzodiazepine drug is most likely to be implicated? 1. Diazepam (Valium) 2. Flunitrazepam (Rohypnol) 3. PCP 4. LSD

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A nurse is caring for a patient who has anxiety attacks. What symptoms would indicate that the patient is experiencing a severe anxiety attack? The patient has feeling of impending doom. The patient has decreased perceptions. The patient has increased motivation. The patient could cause harm to self or others.

1 A patient that has a feeling of impending doom is having a severe anxiety attack. Decreased perception is an example of a patient with moderate anxiety. Increased motivation is an example of a patient with mild anxiety. The potential for harm to self or others is not an example of a patient with a panic attack.REF: Pages 1115-1116

What does the success of a patient going through a substance abuse treatment program depend on? The motivation of the user The type of assistance received while in the program The treatment plan established by the physician The effectiveness of group therapy

1 All the help available will not help an addict kick a habit and be successful in a cessation program, unless the patient is motivated to stop the abuse.REF: Page 1150-1151

The nurse is working in a long-term care facility taking care of an 87-year-old male patient. The patient states "All my friends have passed on; guess I'm next." The nurse knows that patient is experiencing what type of grief? 1Anticipatory 2Acceptance 3Adjusting 4Anger

1 Anticipatory grief is to expect, await, or prepare for the loss of oneself, a family member, or significant other. Acceptance, adjusting, and anger are strategies that a grieving person may use to try to cope with a loss, but this patient's statement refers to a loss that has not yet occurred.REF: Page 738

A patient has been diagnosed with lung cancer and is undergoing treatments. Based on the importance of providing physical care, which nursing diagnosis would be of highest priority? 1Imbalanced nutrition: less than body requirements 2Risk for impaired skin integrity 3Chronic pain 4Impaired gas exchange

1 Cancer patients are usually ill from treatments, and their intake of food is poor. Providing good nutrition is very important in maintaining skin integrity and providing energy for breathing and dealing with pain.REF: Pages 741-742

The nurse is caring for a patient who is being treated with antipsychotic medications. As part of the plan of care, the nurse monitors the patient for dyskinesia. What would the nurse assess with dyskinesia? Involuntary movements of the mouth and tongue Abnormal breathing Severe flushing, headache, and tremors Migraine headache, hypertension

1 Dyskinesia is an extrapyramidal symptom of pseudoparkinsonism characterized by involuntary movements, such as lip smacking or tongue protruding. Abnormal breathing is not a characteristic of dyskinesia. Severe flushing, headache, or tremors are not characteristics of dyskinesia. Migraine headaches and hypertension are not characteristics of dyskinesia.REF: Page 1141

Of the events listed, which one may precipitate feelings of anxiety? Threats to self-esteem Encouragement in physical strengths Threats to those around us Emotional growth

1 Loss of significant relationships, loss of a spouse, difficulty at work, or loss of job are all threats to self-esteem and influence the amount of anxiety a person has. Encouragement and emotional growth are positive to self-esteem. Threats to others do not affect self-esteem.REF: Pages 1115-1116

A patient is taking lithium carbonate to stabilize his mood and behaviors. The nurse knows that the patient is at risk for toxicity that is commonly encountered with lithium. Which action would increase the risk of toxicity? Restricting fluid intake and sodium in the diet Continually monitoring lithium levels Reporting of nausea and vomiting by the patient Education regarding the taking of the medication

1 Poor fluid intake and salt restrictions increase the risks of toxicity. Continually monitoring lithium levels decreases the risk of lithium toxicity. Reporting any nausea or vomiting by the patient decreases the risk of lithium toxicity. Educating the patient about taking his medication decreases the risk of lithium toxicity.REF: Page 1141

A male patient on a psychiatric unit admits to obtaining sexual gratification by wearing his wife's clothing. What type of sexual disorder do these symptoms indicate? Transvestic fetishism Homosexual Pedophilia Frotteurism

1 Transvestic fetishism involves wearing clothing of the opposite sex to obtain sexual gratification. Homosexual is the term used to describe individuals who express their sexuality with members of the same sex. Pedophilia is fondling and or other sexual activities with a prepubescent child by an adult. Frotteurism is sexual arousal achieved by rubbing against or touching a nonconsenting individual.REF: Page 1135

4. A nurse is assigned to a patient who was recently diagnosed with a terminal illness. While the nurse was assisting her with morning care, the patient asked about organ donation. Which nursing action is most appropriate? 1. Assist her in obtaining the necessary information to make this decision. 2. Have the patient first discuss the subject with her family. 3. Suggest she delay making a decision at this time. 4. Contact the physician so consent can be obtained from the family.

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5. Which statement describes a person experiencing anticipatory grief? 1. A person faces the possibility of losing a loved one. 2. A person has placed the death of a loved one in perspective. 3. A person displays grief responses after a loved one's death. 4. A person has difficulty making decisions after a loved one's death.

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8. Which phrase is most likely to help grieving family members express themselves more easily? 1. "Tell me how you're feeling." 2. "I know just how you feel." 3. "Things will get better." 4. "Time heals all wounds."

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12. A 17-year-old patient was admitted to the orthopedic unit with pelvic fracture, wrist fracture, and multiple contusions and abrasions from an auto accident. She yells for the nurse every 5 minutes, refuses to use her call light, and breaks out in tears when she does not get her way. How would this behavior best be described? 1. Regression 2. Compensation 3. Denial 4. Displacement

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5. The nurse is caring for a patient who is currently voicing feelings of anxiety. The nurse correctly recognizes what as the best description of the feelings that the patient is experiencing? 1. A vague feeling of apprehension 2. Feelings of paranoia 3. Concerns about the impressions that others have of her 4. Emotional stability

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8. The student nurse is working on a presentation regarding OBRA. What was the result of this landmark legislation? 1. Deinstitutionalization 2. Approved surgical treatment for schizophrenia 3. Prohibition of electroshock therapy 4. Increased construction of state facilities for residential mental health care

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16. A 37-year-old patient is not responding to drug therapy for depression. The health care provider has recommended ECT treatments for 1 week as an outpatient. The nurse will stress which point in the pretreatment teaching? 1. "You will need someone to take you to and from the clinic." 2. "Eat a good breakfast because you will sleep through lunch." 3. "Scrub your forearms before coming to the clinic." 4. "Take a laxative the night before so you won't have an accident during the treatment."

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4. A delusional patient becomes agitated while watching television and states, "If I don't buy Crest toothpaste right now, I will have cavities." What is the nurse's best response? 1. "The advertisement on the TV is saying its product will reduce tooth decay if you use their product regularly." 2. "If you feel that it is absolutely necessary we can go to the store now and purchase Crest toothpaste." 3. "You can't believe everything you hear or see on TV." 4. "Any toothpaste can be used to help prevent cavities; not just Crest toothpaste."

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6. Besides feelings of sadness or despair, which is also a sign or symptom of depression? 1. Extreme fatigue 2. Restlessness 3. Flight of ideas 4. Hallucinations

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9. A 47-year-old patient is in the hospital for severe depression. She is unkempt and has lost 15 pounds in the past 2 months. Her family states that she always keeps a knife in her purse. The nurse will consider which intervention for this patient? 1. Suicide precautions to prevent self-injury 2. Occupational therapy to build self-esteem 3. Art psychotherapy to help her express feelings 4. Large-portioned meals to improve nutritional status

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17. A patient has begun attending AA meetings. Which statement reflects the patient's understanding of the purpose of this organization? 1. "They claim they will help me stay sober." 2. "I'll dry out in AA, and then I can have a social drink once in a while." 3. "AA is only for people who have reached the bottom." 4. "If I lose my job, AA will help me find another."

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3. Two days after surgery, a patient is agitated and asking to be discharged home because he cannot get any rest in the hospital. Slight tremors in his hands are noted. The admission records indicate that the patient states he does not use alcohol or drugs. Which coping mechanism is this patient probably using? 1. Denial 2. Regression 3. Guilt 4. Hostility

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9. The nurse is caring for a patient who has been using MDMA (Ecstasy). Why is this substance considered to be neurotoxic? 1. Serotonin is depleted in the brain, which damages brain cells. 2. Dehydration causes neurologic damage. 3. Heart damage results from malignant hyperthermia. 4. Inner ear damage leads to deafness.

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16. A nurse is preparing to care for a dying patient, and several family members are at the bedside. Select the therapeutic techniques that the nurse uses when communicating with the family. (Select all that apply.) 1. Be honest and truthful and let the patient and family know that the nurse will not abandon them. 2. Explain everything that is happening to all family members. 3. Encourage expression of feelings, concerns, and fears. 4. Extend touch and hold the patient's or family member's hand if appropriate. 5. Make the decisions for the family. 6. Discourage reminiscing.

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What are common behaviors seen with illness? Select all that apply. Withdrawal Shock Questioning Acceptance Forgiveness Anxiety

1,2,6 Denial, anxiety, shock, anger, and withdrawal are all common behaviors seen in those with illness. Questioning is often seen during an acceptance phase. Acceptance is usually seen after the patient comes to terms with the reality of their illness. Forgiveness may be seen during an acceptance phase.REF: Page 1119, Box 33-5

6. A patient's nervousness has escalated, and this evening he keeps looking over his shoulder. He shouts out, "There's a fire!" Upon entering his room, the nurse finds the patient huddled in a corner, diaphoretic and with a fearful expression. The nurse reassures him that there is no fire and assesses him, finding the following: blood pressure of 160/95, pulse rate of 132, respiration rate of 30, and temperature of 100° F. Which of these manifestations is consistent with delirium tremens? (Select all that apply.) 1. Fever 2. Abdominal cramping 3. Nervousness 4. Fear 5. Disorientation

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19. What interventions can the nurse use to enhance the assessment of an older adult patient? (Select all that apply.) 1. Identify and accommodate physical needs first. 2. Pledge complete confidentiality on all topics to the patient. 3. Interpret information with consideration of the patient's spiritual or cultural background. 4. Adhere firmly to the sequence of questions on the standardized assessment tool. 5. Determine whether there are any sensory changes in hearing or vision before beginning the assessment.

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17. The nurse is providing postmortem care for a patient. Which interventions are appropriate before allowing the family to visit? (Select all that apply.) 1. Prepare the body to look as clean and natural as possible. 2. Wear sterile gloves to provide postmortem care. 3. Keep the sheet cover over the patient's face until the family is comfortably seated in the room. 4. Remove the external tubes and drains if there is no autopsy required. 5. Call the health care provider to obtain an order to release the body to the mortician.

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16. A person addicted to heroin is likely to exhibit which symptoms of withdrawal? (Select all that apply.) 1. Nausea and vomiting, diarrhea, and diaphoresis 2. Tremors, insomnia, and hypotension 3. Incoordination and unsteady gait 4. Decreased heart rate and flushing 5. Chills and fever

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7. Punishment and abandonment were how mentally ill people were treated in medieval times. These practices continued until the seventeenth and eighteenth centuries. Which care practice that is still being used today did Dr. Philippe Pinel of France advocate? 1. Electroshock therapy for melancholy 2. Humane care with record keeping of behaviors 3. Psychoanalysis 4. Home care in the community

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18. The nurse is caring for a dying patient. What are clinical signs of death? (Select all that apply.) 1. Slow thready pulse 2. Absence of apical pulse 3. Cessation of respirations 4. Cessation of bowel sounds 5. Flat encephalogram

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1. _________________________ often consists of a pattern of behaviors that is conspicuous, threatening, and disruptive of relationship or deviates significantly from behavior that is considered socially and culturally acceptable. (1111)

1. Mental illness

What is one of the most common abuses among older adults? Drug abuse Alcohol abuse Emotional abuse Physical abuse

2 Aging brings physical and mental changes, and also losses. Alcohol is used as a means of coping with grief, depression, loneliness, or boredom. Alcoholism, often hidden or denied, is common among the older population. Although older adults may practice substance abuse to cope with feelings of grief, depression, loneliness, and boredom, drugs are not the most common substance abused. Older adults are more likely to be the victims than the perpetrators of emotional abuse.REF: Page 1118

A patient says that he drinks alcohol on a regular basis. During your discussion, the patient admits to "having a problem." To which support group would the nurse refer the patient? Families Anonymous Alcoholics Anonymous Fresh Start Al-Anon

2 Alcoholics Anonymous consists of abstinent alcoholics helping other alcoholics to become and stay sober through group support, shared experiences, and faith in a power greater than themselves. Families Anonymous is for parents of children who abuse substances.Fresh Start is for nicotine addicts. Al-Anon is a group for families of alcoholics.REF: Page 1152

The nurse is caring for a dying patient. Which vital signs are most indicative of end of life. 1Fast, bounding pulse; lowered blood pressure; abnormally slow respirations. 2Slow, weak, and thready pulse; lowered blood pressure; rapid, shallow, irregular respirations. 3Fast, bounding pulse; increased blood pressure; rapid, shallow, irregular respirations. 4Slow, weak, and thready pulse; increased blood pressure; rapid, shallow, irregular respirations.

2 As a patient is nearing death, he or she will show signs and symptoms of decreased oxygenation by having a slow, weak, thready pulse; decreased blood pressure; and rapid, shallow, irregular respirations.REF: Pages 754-755

A nurse is caring for a patient who is suspected of drug dependence. What is the most appropriate question for the nurse to ask? "How long were you going to try to hide this from your friends?" "What type, how much, and what effects do the drugs have on you?" "Why did you start doing drugs?" The nurse does not ask questions about drugs for fear the patient might deny any problems.

2 During the assessment process, the nurse obtains subjective data that include the patient's normal patterns of use and what effects are seen. The remaining options involve casting blame or being judgmental and insensitive toward the patient, or avoiding garnering subjective data pertinent to the concern.REF: Pages 1152-1153

The physical needs of the dying patient should be of utmost importance to the nurse giving care. Which patient descriptions would require an intervention? 1Patient is lying in bed with side rails up. 2Patient is soiled and needs clothing changed. 3Patient is eating a high-protein, high-calorie diet. 4Patient is being transferred from the bed to the chair with two assistants.

2 Keeping the patient safe and secure is an important aspect of patient care. This description would require an intervention in meeting the patient's needs. The patient lying in bed with the side rails up, a high-protein, high-calorie diet, and transferring the patient from the bed to the chair with two assistants meet the needs of the dying patient to provide safety and security.REF: Pages 753-755, 757

Which woman is credited as being the first psychiatric nurse? Dorothea Dix Linda Richards Florence Nightingale Martha Mitchell

2 Linda Richards, who practiced in the 1880s, has been credited as the first psychiatric nurse. Dorothea Dix, a retired school teacher, compiled surveys that lead to the development of mental hospitals throughout the United States. Florence Nightingale was the "Lady of the Lamp." Martha Mitchell is a nurse educator and clinical specialist in psychiatric-mental health nursing, who was appointed to the President's commission in 1978.REF: Pages 1111-1113

What do the four elements of excessive use or abuse, display of psychological disturbance, decline of social and economic function, and uncontrollable consumption indicating dependence define? Alcoholism Addiction Abuse Addictive personality

2 These are the four elements of addiction that are often used as a synonym for drug dependence and substance abuse. Alcoholism refers to the addiction to alcohol. Abuse is the misuse of alcohol, tobacco, caffeine, nicotine, or other drugs. Addictive personality is a person who exhibits a pattern of compulsive and habitual use of a substance or practice to cope with psychic pain from conflict and anxiety.REF: Page 1145

A nurse is caring for a patient who has stopped drinking and runs the risk of alcohol withdrawal syndrome. The nurse monitors the patient knowing that tremors from alcohol cessation are usually seen __ after cessation. within an hour within 2 days within 1 week within 2 to 3 weeks

2 Tremors from alcohol cessation are seen 6 to 48 hours after the last drink and may last for 3 to 5 days.REF: Page 1148

1. An 82-year-old man was admitted to the long-term care facility with moderate to severe heart failure and is unable to take care of himself at home. After dinner, the patient becomes agitated and confused. There are no significant changes in vital signs, and he has received the same medications he had been taking at home. What cause of acute confusion should the nurse consider? 1. Alzheimer's disease 2. Sundowning syndrome 3. Electrolyte imbalance 4. Acute renal failure

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1. A 77-year-old patient has been admitted with pneumonia. Her husband asks the nurse about the living will. Which statement is correct about living wills? 1. Living wills allow the courts to decide when care can be given. 2. Living wills allow individuals to express their wishes regarding care. 3. Living wills are legally binding in all states. 4. Living wills allow health care workers to withhold fluids and medications.

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13. A healthy 25-year-old who sustained a head injury during a motor vehicle accident is in the emergency department. The patient has no brain activity and is on life support. The family has expressed an interest in organ donation. What should the nurse know about organ donations? 1. Organ donations can only occur if the patient has given prior consent. 2. Vital organs, such as the heart and pancreas, must be harvested while the patient remains on the ventilator. 3. Brain death can be reversed, so the family should be informed to take more time in making their decision. 4. The attending physician must be present in the operating room during harvesting of the organs.

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7. A 25-year-old patient entered the hospital with diagnoses of septicemia and infective endocarditis. He admits to using IV heroin regularly. For what withdrawal symptoms should the nurse monitor? 1. Red rash similar to that of chickenpox 2. Head cold and flulike signs and symptoms 3. Intractable singultus 4. Severe joint pain and back pain

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2. The patient's daughter remained at the bedside of her dying mother throughout the night. When her mother died the following morning, the daughter cried out angrily at the nurse and the physician. Which is the most appropriate action by the nurse? 1. Explain that everything possible was done for her mother. 2. Remain with the daughter and listen to what she is saying. 3. Leave the daughter in privacy and allow her to work through her grief. 4. Notify a clergyman and call other family members.

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7. Which of the following helps family members make difficult decisions? 1. Discussing autopsy and organ donation at the time of the loved one's death 2. Addressing one matter at a time, giving them adequate time to discuss each issue 3. Publicly discussing issues with other hospital staff 4. Addressing all of the issues at once

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1. Who was the English Quaker who advocated humane care and built an asylum to reflect a household? 1. Florence Nightingale 2. William Tukes 3. Sigmund Freud 4. Benjamin Rush

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10. A 14-year-old tells the school nurse that she is self-conscious about her recent breast development. She reports that the boys in her class are teasing her. What is the first step for the nurse to take? 1. Call her parents. 2. Have her describe what happened. 3. Ask who her friends are. 4. Provide her with a pamphlet outlining the changes associated with puberty.

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15. After a few days of hospitalization, a patient is participating in plans to be transferred to a rehabilitation facility to continue therapies to enhance his activities of daily living. Which statement indicates the patient is beginning to adjust to his new situation and future? 1. "I know that once I can walk without assistance, I can go back to my own home." 2. "My late wife would not want me to be by myself if I can't take care of myself." 3. "I'm going to show everybody that I can make it on my own; just you wait!" 4. "I don't know why everybody is making a big deal; I was by myself before I got sick."

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3. What is the best description of personality? 1. The level of mental health that a person attains in life 2. The relatively consistent set of attitudes and behaviors particular to an individual 3. The result of a positive self-concept and acceptable behavior 4. The ability to manage stress

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11. A patient says the anchorwoman on the television news talks to him and told him that there was a car bombing in Israel today. What is the nurse's best response? 1. "I don't think you understand how television projection works." 2. "She is reporting the world news to everyone in the room. It only appears she is looking at you but she is looking in a TV camera that sends a picture to the TV." 3. "If you look in the back of the TV console, you will see there is no person inside." 4. "You are delusional. That is only a projected image of a person reading the news to a camera far away."

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14. A patient is a broker on Wall Street who smokes half a pack of cigarettes a day. He avoids caffeine because he has trouble sleeping. He also often complains of an aching lower back. His physician was not able to find anything wrong physically. What is a possible cause of his back pain? 1. Congenital anomaly 2. Psychophysiologic origins 3. Possible renal calculi forming 4. Dependent personality disorder

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3. The psychiatrist makes a diagnosis with the use of which multiaxial system guide? 1. The Physicians' Desk Reference 2. The Diagnostic and Statistical Manual, Fifth Edition. 3. The hospital formulary 4. Freud's The Ego and the Id

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7. What is the therapy of choice for bipolar, or manic-depressive, disorder? 1. Chlorpromazine (Thorazine) 2. Lithium carbonate 3. Electroconvulsive therapy 4. Fluoxetine (Prozac)

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1. An early age at the onset of drinking alcohol is a strong risk factor for developing which disorder? 1. Alzheimer's disease 2. Alcohol or substance abuse 3. Resistance to chemical dependency 4. Immunity to alcohol

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12. A patient is scheduled for abdominal surgery. He tells the nurse that his uncle became addicted to narcotics after his surgery; fearing that he too could become addicted, he does not want to receive any narcotics. What is the nurse's most appropriate response? 1. "Don't worry. You can refuse to take them." 2. "Usually narcotics are given in the first few days after surgery; then you will be given a milder pain reliever for your pain. You will not be given narcotics long enough to become addicted." 3. "Your fear of addiction is unfounded, but I will tell your health care provider about your concern." 4. "I've never heard of anyone getting hooked on narcotics after surgery."

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13. The nurse is ready to give the end-of-shift report to the nurse in charge of the unit for the next shift. When the oncoming nurse arrives 15 minutes late, she does not make eye contact, she smells of mints, her hands are trembling, her uniform is disheveled, and her shoes are untied. She asks no questions regarding any patients, and leaves the room when the report is completed. What should the first nurse do? 1. Go home because the shift is completed. 2. Call the supervisor and report observations. 3. Stay on the unit until she is sure the oncoming nurse has no questions regarding the patients. 4. Call the state board of nursing and report the oncoming nurse's behavior.

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15. The nurse is performing a physical assessment on a patient who has a history of long-term cocaine use. Which finding is indicative of long-term cocaine use? 1. Constricted pupils 2. Red, irritated nostrils 3. Conjunctival redness 4. Muscle aches

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4. A patient was found unconscious in his apartment with four empty bottles of whiskey and was brought to the hospital by his family. Upon admission, he moans out loud and is having dry heaves and diarrhea. What is the best way to maintain his airway? 1. Elevate the head of the bed to ease breathing, and place an emesis basin on the patient's lap. 2. Place the patient in the side-lying position until the swallowing reflex is intact. 3. Adjust the bed to the reverse Trendelenburg position until the patient regains consciousness. 4. Tape an oral suction catheter in place to avoid aspiration.

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5. What area of the brain is most often affected by psychoactive substances and has the potential to sustain permanent damage? 1. Brainstem 2. Limbic system 3. Cerebellum 4. Corpus callosum

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What is the term that best describes the external manifestation of inner feelings or emotions and is often reflected by one's facial expressions? Defense mechanism Coping response Affect Adaptation

3 A person's affect is part of his or her feelings and behaviors, which are often reflected by facial expression. Defense mechanisms are behavioral patterns that protect the individual against a real or perceived threat. Coping responses are used to reduce anxiety brought on by stress. Adaptation is the individual's ability to adjust to changing life situations using various strategies.REF: Page 1120 Box 33-7

The nurse is caring for a dying mother of a 6-year-old child. Based on the developmental age of the child, what beliefs might the child be feeling? 1Believes that death is reversible 2Seldom thinks about death 3Believes wishes can be responsible for death 4Expresses fear of death

3 Ages 5 to 9 believe that wishes or thoughts can be responsible for someone close to them becoming ill or dying. Ages infant to 5 years believe that death is reversible. Ages 12 to 18 seldom think about death. Ages 9 to 12 often express fear of death.REF: Pages 748-749

A patient is having trouble abstaining from alcohol. Which drug is often prescribed to encourage abstinence? Librium (chlordiazepoxide) Thorazine (chlorpromazine) Antabuse (disulfiram) Wellbutrin (bupropion)

3 Antabuse is the drug of choice if given. It causes facial flushing, nausea, tachycardia, dyspnea, dizziness, and confusion. Librium is an antianxiety drug. Thorazine is an antipsychotic drug. Wellbutrin is an antidepressant drug.REF: Page 1151

"Self" is a complex concept compromising four distinct parts that influence behavior. What part includes feeling about the way one's body functions? Personal identity Role performance Body image Self-esteem

3 Body image is the picture of and feeling toward one's body. Manifestations of body image include: stance, posture, clothing, and jewelry. Personal identity is the organizing principle of the self; it is the "I." Role performance is the expected behavior of an individual in a social position. Self-esteem is the assessment one makes about self-worth.REF: Pages 1114-1115

The LPN/LVN is caring for an older adult who was admitted to the long-term care facility 2 months previously. Three weeks ago his son was killed in a car accident. The patient has been staying in his room and not attending meals or activities. What would be the highest priority nursing diagnosis for this patient? Hopelessness related to relocation to a nursing home Social isolation related to depression Ineffective coping related to the number of recent losses Grieving related to loss of son

3 Losses occur with age. The number of losses and the rapidity with which they occur may affect the coping ability of the older person and result in anxiety, fear, or depression. Hopelessness related to relocation is not a priority; the patient is dealing with loss rather than relocation. Social isolation is not the highest priority. The patient is showing signs of depression as a result of his losses. The patient is not effectively grieving, so this diagnosis would not be a priority at this time.REF: Page 1118

Loss is a natural part of our lives. What is the loss that is felt when one leaves home for college? 1Situational loss 2Perceived loss 3Maturational loss 4Personal loss

3 Maturational loss is a loss resulting from normal life transitions. Situational loss is defined as a loss occurring suddenly in response to a specific external event, such as the sudden death of a loved one. Perceived loss is a loss noted only by that individual. Personal loss is any significant loss that requires adaptation through the grieving process.REF: Page 736

An adolescent who has a history of not getting along with others in school and lies to his mother about fighting and being in trouble so that he can drive the car is an example of which personality disorder? Paranoid personality Borderline personality Antisocial personality Dependent personality

3 Play therapy is used to help children express themselves by using toys as their "spokesperson" of feelings. Cognitive therapy focuses on breaking negative thought patterns and developing positive feelings about memories or thoughts. Group therapy is where a group of patients with similar problems gains insight through discussion or role-playing. Behavior therapy is used to relieve anxiety by conditioning and retraining of behavioral responses by repetition.REF: Page 1136

The use of toys to assist a child to express feelings is known as what type of treatment? Cognitive therapy Group therapy Play therapy Behavior therapy

3 Play therapy is used to help children express themselves by using toys as their "spokesperson" of feelings. Cognitive therapy focuses on breaking negative thought patterns and developing positive feelings about memories or thoughts. Group therapy is where a group of patients with similar problems gains insight through discussion or role-playing. Behavior therapy is used to relieve anxiety by conditioning and retraining of behavioral responses by repetition.REF: Page 1136

Which drug gained notoriety in the 1990s, is associated with club drug use, and is often call the "date-rape" drug? GHB (gamma-hydroxybutyrate) Opioid analgesic heroin Rohypnol (flunitrazepam) Morphine

3 Rohypnol has been misused in many sexual assaults and can have a lethal effect when combined with alcohol. GHB, heroin, and morphine are often abused, but they are not considered the "date-rape" drug.REF: Page 1154

A nurse working on a psychiatric unit knows that there are different therapeutic techniques used. What is the key component to psychiatric-mental health treatment? Working to resolve mental issues through therapeutic communication The development of a helping-trusting relationship The information that the patient shares is only known by one individual on the health care team Therapeutic communication is not a necessary part of treatment.

3 The development of a helping-trust relationship is a therapeutic professional relationship used by the nurse to assist the patient in learning new ways of responding to people or situations. Therapeutic communication is a key in building the helping-trust relationship. Patient information is shared with other members of the team.REF: Page 1136

What are a group of psychotic disorders characterized by severe and inappropriate emotional responses, by prolonged and persistent disturbances of mood and related thought distortions? Anxiety disorders Thought process disorders Mood disorders Personality disorders

3 This is the definition of a group of mood disorders and other symptoms associated with either depressed or manic states. Anxiety is a normal response to stress. Mood disorders are known as affective disorders. Personality disorders are inflexible maladaptive patterns of behavior or thinking that are associated with significant impairment of functioning.REF: Page 1129

The nurse is caring for a dying patient and is showing attentiveness both verbally and nonverbally. What is the best intervention to demonstrate attentiveness? 1Standing in the doorway to ask questions 2Using a loud, clear voice 3Sitting in a chair close to the bed, facing the patient 4Avoiding touching the patient as much as possible

3 Use of therapeutic communication is important, but sitting in a chair close to the bed facing the patient demonstrates nonverbal attentiveness to the patient. Standing in the doorway distances you from the patient and does not demonstrate attentiveness. Use of therapeutic communication is important, but speaking more loudly does not necessarily demonstrate attentiveness to the patient. Avoiding touch distances you from the patient and does not demonstrate attentiveness.REF: Page 752

10. Nurses care for all types of patients with various conditions, including those with a terminal illness. Which statement is true about terminal illnesses? 1. Death from terminal illness is sudden and unexpected. 2. Physicians know when death will occur. 3. An illness is terminal when no reasonable hope of recovery exists. 4. All severe injuries result in death.

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11. After the death of a patient, the nurse leaves the room quickly; she is found sobbing in the utility room. Which action is the most supportive to the nurse? 1. Sending the nurse home for the rest of the shift 2. Reassigning the nurse to an area where it is unlikely a patient will die 3. Sitting with her and allowing her to express herself 4. Insisting that she perform postmortem care for the patient

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12. What type of care allows a patient to make more informed choices, achieve better alleviation of symptoms, and have more opportunity to work on issues such as closure? 1. Acute care 2. Mourning care 3. Palliative care 4. Terminal care

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9. Which of the following is most therapeutic when talking with family members with an unresolved issue? 1. Explain that they are simply experiencing normal anticipatory grief. 2. Explain that they missed their chance to make amends and now it is too late. 3. Encourage them to verbalize their thoughts and feelings to the loved one. 4. Tell them not to worry, and explain that they are just going through the searching and yearning phase of bereavement.

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11. The nurse is instructing a wife to give insulin injections to her husband. The wife is unable to sit still, frequently asks to repeat parts of the instruction for understanding, and sighs often with rapid respirations. What degree of anxiety is the wife experiencing? 1. Mild 2. Moderate 3. Severe 4. Panic

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17. During crisis intervention, what is the highest priority of nursing care? 1. Managing anxiety 2. Identifying situational supports 3. Patient safety 4. Teaching specific coping skills that the patient lacks

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2. Changes in the delivery of mental health care that resulted from the development of electroconvulsive therapy and psychotherapeutic drugs brought about which phenomenon in the twentieth century? 1. Behavioral therapy 2. Personality disorganization 3. Deinstitutionalization 4. Brain surgery

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6. An assembly-line manager in a factory was told that he would be laid off if his line did not meet the hourly quota. He promptly went to his workers and threatened to fire anyone who was found taking even 1 minute extra on a break. What is the manager displaying? 1. Denial 2. Regression 3. Displacement 4. Identification

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13. A patient who was sexually abused as a child recently married but finds sexual intercourse painful. She confides in her friend who is a nurse. What is the appropriate response from her friend? 1. "You should see your gynecologist right away in case you have torn tissues." 2. "It is normal to have pain at first, but you will adjust to your husband over time." 3. "You should seek counseling and make sure to get a good physical examination." 4. "Did you report this abuse to the police?"

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15. A 17-year-old patient is worried about her weight. When she is out with friends, she eats junk food until she vomits and then exercises the next day for 4 hours. If she does not have a daily bowel movement, she takes a laxative. Her dentist has noticed her front teeth have signs of erosion. Her family has noticed her hair falling out, and now they have decided to take her to the family health care provider. What diagnosis do these symptoms support? 1. Anorexia nervosa 2. Laxative addiction 3. Bulimia nervosa 4. Gastroenteritis

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20. To effectively communicate with a patient demonstrating manic, elevated mood behaviors, the nurse will incorporate what technique into the plan of care? 1. Provide detailed explanations to the patient. 2. Joke and use puns with the patient. 3. Be brief and concrete with the patient. 4. Offer prn medications to the patient.

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21. What is the priority nursing intervention when working with the patient with a personality disorder? 1. Encouraging group activity participation 2. Reassuring the patient that he or she is a "good person" 3. Setting limits with the patient 4. Supporting the patient's decisions consistently

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8. A patient admitted to the emergency department is complaining of an anxiety attack. What manifestations are consistent with an anxiety attack? 1. Hypotension and bradycardia 2. Lethargy and thready pulse 3. Hyperventilation and tachycardia 4. Hallucinations and apathy

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14. A patient has begun a substance abuse outpatient treatment program and is allowed to return to work, with supervision. Which statement by the patient indicates that she is recovering from her substance abuse problem? 1. "I wish I knew who turned me in to administration; I would like to give that nosy witch a piece of my mind!" 2. "Just because I had a glass of wine with a meal before I came to work once or twice, I'm going to be watched like a hawk. What a pain!" 3. "I realize that I'm going to have to regain the trust of my coworkers and administrators, but I can do that, one day at a time." 4. "If other people took their jobs as seriously as I take mine, they wouldn't have time to rat on other people."

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14. A bereaved widow of 3 months tells the nurse she has clearly smelled her deceased husband's aftershave scent as she sat in church recently. She questions if she might be "going crazy." What is the widow experiencing? 1. Intrusive memories 2. Dysfunctional or complicated grief 3. Sense of presence 4. Grief attacks

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A nurse is caring for an older adult who lives in a long-term care facility on the Alzheimer unit. Every evening around 5:00 PM, the resident becomes increasingly agitated and more confused, a state that lasts throughout the evening. The nurse recognizes this behavior as: dementia. delirium. personality disorder. sundowning syndrome.

4 A person with nocturnal delirium displays increased disorientation and agitation only during the evening and nighttime. Dementia is a term used to describe an altered mental state secondary to cerebral disease. Delirium is a rapid change in consciousness that occurs over a short time and is associated with reduced awareness and attention to surroundings, disorganized thinking, sensory misinterpretation, and irrelevant speech. Personality disorder is a category of mental disorders.REF: Page 1124

A patient is being cared for in the hospital and had the opportunity to formulate a Living Will and Durable Power of Attorney for Healthcare. These are examples of what type of documents? 1DNR 2Patient rights 3Federal statutes 4Advanced directives

4 Advanced directives are signed and witnessed documents that provide specific instructions for health care treatment in the event that a person is unable to make those decisions personally at the time they are needed. DNR stands for "do-not-resuscitate," for which no interventions will be done to sustain life. Patient rights are written regulations that allow the patient to receive treatment and care with dignity and respect. Federal statutes are written laws that mandate health care providers to address the issue of advanced directives with their patients.REF: Page 751

A patient who has just been sexually assaulted has come to the emergency department. The patient is very calm and quiet. The nurse identifies this behavior as part of which defense mechanism? Suppression Rationalization Projection Denial

4 Denial is a response by victims of sexual abuse. Reality is denied; it does not exist.Suppression is the intentional exclusion of painful thoughts, experiences, or impulses. Rationalization is a process of constructing plausible reasons to explain and justify one's behavior. Projection is blaming personal shortcomings on someone else.REF: Page 1117, Table 33-1

The nurse has been assigned a patient who abuses alcohol. The patient is at risk for DTs (delirium tremens). While monitoring the patient, what signs would alert the nurse to the development of DTs? Hypotension, coarse hand tremors, agitation Stupor, agitation, muscle rigidity Hypotension, ataxia, vomiting Elevated temperature, changes in LOC, hallucinations

4 Elevated temperature, changes in LOC, and hallucinations are signs of DTs.Hypotension, coarse hand tremors, agitation, stupor, muscle rigidity, ataxia, and vomiting are not signs of DTs.REF: Page 1148

Which drug is the most commonly used illegal drug in the United States? Cocaine MDMA (Ecstasy) PCP and LSD Marijuana

4 Marijuana is considered a gateway drug and remains the most commonly used illicit drug used in the United States. Cocaine, MDMA, PCP, and LSD are often abused, but they are not the most commonly used drugs in the United States.REF: Pages 1157-1158

What is the purpose of palliative care for a patient with a terminal illness? 1Do no treatment and let nature take its course by following a patient's DNR status. 2Take decision-making ability away and give it to the power of attorney. 3Place the patient in long-term care to receive 24-hour care. 4Provide prevention, relief, reduction, or soothing of symptoms of a disease without providing a cure.

4 Palliative care is to provide prevention, relief, reduction, or soothing of symptoms of a disease without providing a cure.REF: Page 753

A patient is preparing to receive electroconvulsive therapy. The nurse caring for this patient identifies which nursing diagnosis as the highest priority? Deficient knowledge related to lack of information regarding the procedure Disturbed thought process related to temporary memory loss Disturbed thought process related to confusion Anxiety related to uncertainty of the events of the test

4 Patients undergoing ECT will have a high level of anxiety related to the testing procedures and what to expect. The nurse can alleviate some of the anxiety with continual reassurance, support, and attentiveness before and after each treatment. Anxiety occurs as a result of deficient knowledge; therefore, explaining what to expect will alleviate some of the patient's anxieties. Diagnoses of disturbed thought processes are a result of the ECT following the procedure.REF: Pages 1137-1138

15. The adult children of a dying patient, who is alert and oriented, disagree on the patient's choice of a do not resuscitate order. The children ask the opinion of the nurse, who has cared for this patient over an extended period. How should the nurse respond to this question about the patient's dying request? 1. Encourage the children to speak with the physician regarding their concerns. 2. Remind the children that this is the wish of their parent. 3. Ask the patient to speak with the children regarding their concerns. 4. Listen to the children's concerns and encourage them to talk to their parent.

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3. A newly licensed nurse is assigned to his first dying patient. When caring for a dying patient, what best prepares the nurse? 1. Having completed a course dealing with death and dying 2. Being able to control his own emotions about death 3. Having experienced the death of a loved one 4. Being aware of his own thoughts and feelings towards deat

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3. A newly licensed nurse is assigned to his first dying patient. When caring for a dying patient, what best prepares the nurse? 1. Having completed a course dealing with death and dying 2. Being able to control his own emotions about death 3. Having experienced the death of a loved one 4. Being aware of his own thoughts and feelings towards death

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6. Which is an appropriate therapeutic listening technique? 1. Stating, "I know just how you feel" 2. Saying, "Her death was for the best" 3. Never crying in front of family members 4. Encouraging family members to share their feelings

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13. A college student is brought to the emergency department by her roommate. The roommate states that when the patient returned from her date, she was crying and said she was raped. The patient recounts the evening's events, cracking jokes about her date's trouble keeping an erection and asking if the nurse knows where she can get a replacement for her favorite outfit, which has been torn. How is this defense mechanism best described? 1. Displacement 2. Compensation 3. Denial 4. Dissociation

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9. A 52-year-old patient experienced cardiac arrest from a myocardial infarction. During his acute care stay in the hospital, the patient flirts with all his female nurses. When he is asked to stop, he withdraws and later complains of chest heaviness. What is a possible explanation for the patient's behavior? 1. Boredom from restricted activity 2. Lack of motivation to recover 3. Frustration from illness 4. Threatened self-concept

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10. Antipsychotic medications have a number of side effects that discourage compliance by the patient. Which effect has the potential to lead to a serious permanent problem? 1. Photosensitivity 2. Postural hypotension 3. Chronic constipation 4. Tardive dyskinesia

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12. A 24-year-old woman was admitted for medication adjustment for bipolar disorder. The patient has not slept for 2 days and is unable to sit for more than a few minutes at a time. She has lost 11 pounds in the past week. Which factor will facilitate the best nutrition for the patient while she is in her manic phase? 1. Have her take her meals in her room to reduce distracting stimuli. 2. Have the kitchen double her meal portions, since she eats only half of the food served. 3. Allow the patient to snack on candy bars between meals to gain back her lost weight. 4. Keep sandwiches, granola bars, fruit, and noncaffeinated beverages available at the desk.

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18. A 17-year-old boy tells his mother he is writing a paper for class on all the rock stars who have killed themselves. In the past few months, he has let his hair grow long, bathes only once a week, and stays in his room when he is at home. He is tired and irritable. His mother asks a friend who is a nurse if this is normal teenage behavior. What is the best response? 1. "Yes; all teenagers go through a grunge stage." 2. "Yes; he is just tired from the rapid growth spurt during adolescence." 3. "No, and if he doesn't snap out of it, you might want to take him to a health care provider." 4. "No; he should see a health care provider or counselor right away."

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19. A 70-year-old patient is in the hospital for pneumonia and has been taking sertraline (Zoloft) for 1 year for depression. On the third day of her hospitalization, the patient has a pulse rate of 100, demonstrates trembling in her hands, has an oral temperature of 103° F, and is diaphoretic. What is the nursing assessment? 1. Anxiety, related to hospitalization 2. Increased cranial pressure 3. Impaired airway 4. Serotonin syndrome

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22. When providing care for a depressed patient, what assessment data warrants immediate attention from the nurse? 1. Anorexia and weight loss 2. Lowered self-esteem 3. Inability to care for self effectively 4. Suicidal ideation

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11. A nurse with a history of drug-related charges has action taken against her practitioner's license. Where is this reported? 1. National Health and Welfare Records Department 2. Healthcare Management Organization of the United States 3. Federal Drug Enforcement Agency 4. Healthcare Integrity and Protection Data Bank

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2. In all deaths related to motor vehicles and fatal intentional injuries, alcohol is involved in what percentage of them? 1. 7% 2. 10% 3. 17% 4. 38%

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2. An astounding _______% of people in the U.S. will develop a mental health disorder in their lifetime. (1111)

50

2. An astounding _______% of people in the U.S. will develop a mental health disorder in their lifetime.(1111)

50

35. The nurse uses the CAGE questionnaire to assess a patient. The nurse suspects the patient is an alcoholic if there are affirmative answers for _____ items on the questionnaire.

ANS: 2 two An affirmative answer on two or more questions on the CAGE questionnaire is reason to assess more closely for possible alcohol abuse. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1149 OBJ: 4 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

37. The nurse instructs a patient who has just been prescribed a protocol of fluoxetine HCl (Prozac) that the drug takes ____ to ____ weeks to take effect.

ANS: 2, 4 two, four Antidepressants of this type take 2 to 4 weeks before any effect is felt by the patient. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1130 OBJ: 5 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

36. The nurse recognizes that a woman who has experienced physical abuse and has inadequate income to care for herself and her family would be categorized under Axis ______.

ANS: 4 four Axis 4 queries the environmental and psychosocial information of a patient. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1124 OBJ: 1 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

40. Place the events in the mental health care movement in chronologic order. Put a comma and space between each answer choice (A, B, C, D, etc.). a. Establishment of Pennsylvania Hospital b. Deinstitutionalization movement c. Formation of Committee for Mental Health d. Passage of Omnibus Budget Reconciliation Act (OBRA) e. Dorothea Dix awakens public awareness of plight of mentally ill

ANS: A, E, C, B, D Pennsylvania Hospital—1731, Dorothea Dix—1882, Committee for Mental Health—1909, deinstitutionalization movement—1960, OBRA—1981. PTS: 1 DIF: Cognitive Level: Application REF: Pages 1111-1112 OBJ: 1 TOP: Mental health KEY: Nursing Process Step: N/A MSC: NCLEX: N/A ,

34. When assessing an alcoholic patient, the nurse notes short-term memory loss, painful extremities, footdrop, and muttered incoherent responses to questions. The nurse recognizes these symptoms as most likely related to a condition caused by long-term alcohol abuse, which is known as __________ syndrome.

ANS: Korsakoff Korsakoff syndrome is a permanent condition caused by long-term alcohol use. The patient mutters incoherently and experiences short-term memory loss, painful extremities, and footdrop. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1148 OBJ: 4 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

38. The nurse explains that an alternative therapy that uses essential oils and scented candles to help a patient relax and focuses on the atmosphere of the moment is ______________.

ANS: aromatherapy Aromatherapy uses essential oils and scented candles to soothe the senses and make people aware of the here and now of the pleasant environment. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1142 OBJ: 6 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

38. The situation in which a parent must choose between attending a daughter's ballet recital or a son's baseball game is an example of a __________.

ANS: conflict Conflict occurs when there is a presence of simultaneous goals, only one of which can be met. PTS: 1 DIF: Cognitive Level: Application REF: Page 1116 OBJ: 7 TOP: Mental health KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

21. The nurse explains to a grieving husband that the process of the resolution of the hurt and the reestablishment of his life is called the __________ ___________.

ANS: grief process grieving process The grief process includes the resolution of the hurt and the reestablishment of life activities following bereavement. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 735 OBJ: 13 TOP: Grief process KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

36. The nurse cautions that a person who chronically abuses drugs may experience mental impairment. The area of the brain that can be affected and permanently damaged is the ________ _________.

ANS: limbic system The most commonly abused drugs act on the limbic system of the brain and can cause permanent damage. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1153 OBJ: 4 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

39. The nurse recognizes that stress can cause an ulcer, which is classified as a _______________ illness.

ANS: psychophysical Psychophysical illness addresses the stress-related problems that can result in physical signs and symptoms. Psychophysiological disorders are thought to have an emotional basis, manifested as a physical illness. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1135 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

26. What nursing intervention should be included in the plan of care for a baby born to a drug-addicted mother? a. Swaddle the baby closely b. Place the baby in a brightly lit area c. Hold and rock the baby frequently d. Place the baby in a busy part of the nursery for stimulation

ANS: A A baby born to a drug-addicted mother should be swaddled, placed in an area of low stimulation, and minimally handled. PTS: 1 DIF: Cognitive Level: Application REF: Page 1156 OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

18. A nurse is caring for the dying mother of a 7-year-old child. What is important for the nurse to understand regarding the child? a. The child associates death with aggression. b. The child believes his or her own death cannot be avoided. c. The child lacks understanding of the concept of death. d. The child understands death as the inevitable end of life.

ANS: A A child from 5 to 9 years old understands that death is final, believes one's own death can be avoided, associates death with aggression or violence, and believes wishes or unrelated actions can be responsible for death. A child between the ages of 9 to 12 years understands that death is the inevitable end of life. PTS: 1 DIF: Cognitive Level: Application REF: Page 740, Table 24-1 OBJ: 4 TOP: Understanding of death KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

1. What is the final stage of human growth and development? a. Integrity b. Death c. Despair d. Resolution

ANS: B Death is the final stage of growth and development. PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 735-736 OBJ: 3 TOP: Death KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

9. What is the basis for classifying a person as having a mental illness? a. Behavior exhibited and the context b. Response of society to the behavior c. Ability of the patient to conform d. Patient's history and previous behavior

ANS: A A person is deemed to be mentally ill by the behavior exhibited and the context in which that behavior occurs. PTS: 1 DIF: Cognitive Level: Application REF: Page 1114 OBJ: 2 TOP: Mental health KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

13. Which role is an example of an ascribed role? a. Sex b. Occupation c. Manner of dealing with stress d. Attitude toward homosexuality

ANS: A Ascribed roles are those that a person takes on, but had no personal choice in the matter. Ethnicity, sex, and nationality are examples of ascribed roles. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1115 OBJ: 3 TOP: Mental health KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

12. The nurse cautions a patient to watch his step. What response indicates concrete thinking? a. The patient fixedly begins to watch his feet. b. The patient immediately examines his watch. c. The patient begins to watch the nurse's feet. d. The patient stands rigidly in one place without moving.

ANS: A Concreteness is an indication of disordered thinking. The patient is unable to translate any words except by a very concrete definition. PTS: 1 DIF: Cognitive Level: Application REF: Page 1128 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

5. A young man with malaria spikes a temperature of 105° F and begins to hallucinate. How should the nurse assess this? a. Delirium b. Psychotic break c. Possible stroke d. Anxiety disorder

ANS: A Delirium is an organic mental disorder that is frequently brought on by a severe physical illness, such as fever. PTS: 1 DIF: Cognitive Level: Application REF: Page 1124 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

11. Using Freud's personality theory, what action by a patient indicates a strong ego? a. Laughs at himself for being foolish b. Continually boasts of his accomplishments c. Apologizes continually d. Insists that the TV channel stay tuned to CNN

ANS: A Ego is the reality tester. Laughing at oneself shows that the patient can compare his own foolish behavior to the norm. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1114, Box 33-2 OBJ: 3 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

19. A patient seems bewildered when he confides in the nurse that all of his friends and leisure time have been centered on a drug culture. Which would be the best response by the nurse? a. "What other sort of activities might you enjoy?" b. "You will need to get new friends." c. "Returning to those activities will get you back here and in trouble." d. "You need to get a hobby."

ANS: A Encouraging the patient to imagine new activities is a start toward seeking them. Giving advice is not therapeutic. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 1151-1152 OBJ: 1 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

4. How many people in the United States will develop a mental disorder during their lifetime? a. One in two b. One in five c. One in eight d. One in ten

ANS: A It is estimated that 50% of people in the United States will develop a mental disorder during their lifetime. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1111 OBJ: 2 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

7. The nurse reminds a group of high school students that most states have laws limiting blood alcohol levels of drivers. What is the legal blood alcohol serum level in most states? a. 0.08% b. 0.20% c. 0.40% d. 0.50%

ANS: A Most states designate blood alcohol serum levels of 0.08% as the legal limit for driving a motor vehicle. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1148 OBJ: 3 TOP: Alcoholism KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

30. The patient is concerned about confidentiality and asks the nurse not to tell anyone what is said. What is the best response by the nurse? a. "I am required to report any intent to hurt yourself or others." b. "Conversations between patient and nurse are confidential." c. "What we say can be secret. What I write in the chart is available to the health team." d. "I can't help you unless you trust me."

ANS: A No secrets are allowed to be kept by a member of the health care team. PTS: 1 DIF: Cognitive Level: Application REF: Page 1137 OBJ: 5 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

2. When the patient with a psychosis is thought to be a danger to self or others, by what method should the patient be admitted to the hospital? a. Probating b. Nurse's request c. Physician's order d. Family request

ANS: A Probating can be done if the individual is thought to be a danger to self or others. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1123 OBJ: 4 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

15. What severe side effect will occur if an alcoholic patient consumes alcohol while taking disulfiram (Antabuse)? a. Nausea b. Blackouts c. Headaches d. Hypertension

ANS: A When a person who is taking Antabuse consumes alcohol, severe nausea, tachycardia, shortness of breath, confusion, and dizziness are experienced. The drug is used as a form of aversion therapy. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1151 OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

34. Adjunctive therapies are used for which reasons? (Select all that apply.) a. To increase self-esteem b. To promote positive interaction c. To enhance reality orientation d. To stimulate communication e. To increase energy

ANS: A, B, C The purpose of adjunctive therapies is to increase self-esteem, promote positive interaction, and enhance reality orientation. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1136 OBJ: 6 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

20. Which of the five aspects of human functioning must a nurse address when dealing with a grieving person? (Select all that apply.) a. Physical b. Emotional c. Intellectual d. Financial e. Spiritual

ANS: A, B, C, E The five areas of human function are physical, emotional, intellectual, sociocultural, and spiritual. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 741 OBJ: 5 TOP: Aspects of human function KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

31. During the initial intake assessment of a drug user, the nurse should attempt to obtain which subjective data? (Select all that apply.) a. Usual pattern of use b. Specific drug c. Previous arrests d. Amount of drug used e. Time of last use

ANS: A, B, D, E Determining the drug, strength, frequency, last use, and pattern of use is the basic database on a substance abuser. PTS: 1 DIF: Cognitive Level: Application REF: Page 1149 OBJ: 4 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

36. The nurse uses a diagram to show how the four parts of "self" fit together. What are the four parts? (Select all that apply.) a. Body image b. Ego c. Self-esteem d. Role e. Identity

ANS: A, C, D, E The four parts of the "self" are body image, self-esteem, role, and identity. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1114 OBJ: 3 TOP: Mental health KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

35. What are considered warning signs of suicide? (Select all that apply.) a. Talking about suicide b. Increased interactions with friends and family c. Drug or alcohol abuse d. Difficulty concentrating on work or school e. Personality changes

ANS: A, C, D, E Warning signs of suicide include talking about suicide, decreased interactions with friends and family, drug/alcohol abuse, difficulty concentrating on work or school, and personality changes. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1130, Box 34-1 OBJ: 3 TOP: Suicide KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

32. The nurse should assess a patient for which criteria of addiction? (Select all that apply.) a. Excessive use of the substance b. Increase in social function c. Uncontrollable consumption d. Increase in economic function e. Psychological disturbances

ANS: A, C, E Criteria for addiction include excessive use of the substance, a decrease in social function, uncontrollable consumption, a decrease in economic function, and psychological disturbances. PTS: 1 DIF: Cognitive Level: Application REF: Page 1146 OBJ: 1 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

19. The home health nurse assesses that the goal of grief resolution has been accomplished when the nurse observes that a widow has performed which activities? (Select all that apply.) a. Adjusted to an environment without the spouse b. Put financial affairs in order c. Made plans for a lengthy trip d. Sought new relationships e. Acquired a job

ANS: A, D Environmental adjustment and seeking new relationships are clear evidence of grief resolution. A trip, arranging financial affairs, or finding employment may be a form of denial or activities that may be dictated by the situation and is not necessarily resolution of grief. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 759 OBJ: 13 TOP: Grief resolution KEY: Nursing Process Step: Evaluation MSC: NCLEX: Psychosocial Integrity

21. The nurse concludes that a significant goal of the care plan for an alcoholic patient has been met when the patient makes which statement? a. "I drink because I'm lonely." b. "All my difficulties are related to my drinking." c. "I wouldn't need to drink if I had my family back." d. "My drinking helps me cope with the stress of my job."

ANS: B A major goal for the successful treatment of alcoholics is to have them express responsibility for their behavior. PTS: 1 DIF: Cognitive Level: Application REF: Page 1151, Nursing Care Plan 35-1 OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Evaluation MSC: NCLEX: Psychosocial Integrity

20. What coping mechanism demonstrated by a patient should indicate to the nurse that the patient is seeking ways to deal with and resolve stress? a. Projection b. Adaptation c. Reaction formation d. Compensation

ANS: B An individual who develops ways to deal with stress and resolve it has adapted. PTS: 1 DIF: Cognitive Level: Application REF: Page 1116 OBJ: 9 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

29. What disorder is a severe form of self-starvation that can lead to death? a. Bulimia nervosa b. Anorexia nervosa c. Teenage nervosa d. Obesity nervosa

ANS: B Anorexia nervosa is a severe form of self-starvation that can lead to death. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1135 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

8. A pregnant adolescent tells the nurse that she "only drinks a little." How many drinks per day can cause an adverse effect in an infant? a. One drink a day b. Two drinks a day c. Three drinks a day d. Four drinks a day

ANS: B As few as two drinks per day may cause adverse effects in an infant. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1148 OBJ: 4 TOP: Alcoholism KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

8. What is the first thing the nurse should do before involving the family in the care of a dying patient? a. Ask the patient if he or she wants family care b. Ask family members if they want to assist with care c. Check the hospital policy on the family giving care d. Set a caring example

ANS: B Ascertaining whether the family wants to assist in the patient's daily care will clarify what the family members are comfortable doing. PTS: 1 DIF: Cognitive Level: Application REF: Page 744 OBJ: 13 TOP: Death KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

1. What is the mental health nurse referring to when using the term behavior? a. An isolated incident b. The manner in which a person performs c. A product of a coping strategy d. Failure to adapt

ANS: B Behavior may be defined as the manner in which a person performs any or all of the activities of daily living. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1110 OBJ: 1 TOP: Mental health KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

11. During the detoxification period, what does the nurse aim to achieve when designing interventions? a. Enroll the patient in Alcoholics Anonymous (AA) b. Keep the patient safe from aspiration and seizure c. Help the patient interact in nonaddictive activities d. Help the patient gain insight into the addiction

ANS: B Care for the addicted patient starts with detoxification and is focused on keeping the patient safe from the symptoms of withdrawal. Enrolling the patient in AA, helping the patient interact in nonaddictive activities, and helping the patient gain insight into the addiction would be part of the rehabilitation process. PTS: 1 DIF: Cognitive Level: Application REF: Page 1150 OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

22. When the patient who overeats insists that weight gain is related to retained fluids, the nurse recognizes the patient is using which defense mechanism? a. Compensation b. Rationalization c. Sublimation d. Regression

ANS: B Defense mechanisms are unconscious reactions that offer protection to the self from stressful situations. Rationalization offers a reasonable explanation for an event rather than facing reality. PTS: 1 DIF: Cognitive Level: Application REF: Page 1117, Table 33-1 OBJ: 6 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

12. Which theorist believed that personality development was based on task mastery? a. Sigmund Freud b. Erik Erikson c. Jean Piaget d. Friedrich Nietzsche

ANS: B Erik Erikson provided a framework for understanding personality development in terms of task mastery. Sigmund Freud described personality development as having three parts: id, ego, and superego. Jean Piaget theorized that development was based on how humans acquire and utilize knowledge. Friedrich Nietzsche's theories had more to do with morality than personality development. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1114 OBJ: 2 TOP: Mental health KEY: Nursing Process Step: N/A MSC: NCLEX: Psychosocial Integrity

35. A patient admitted to the hospital after a motorcycle crash that has left him paralyzed from the waist down tells the nurse he has feelings of helplessness and hopelessness. What other feelings may the patient have that should be recognized? a. Isolation b. Suicidal ideation c. Fear d. Anger

ANS: B Hopelessness and helplessness can lead to possible thoughts of suicide. PTS: 1 DIF: Cognitive Level: Application REF: Page 1118 OBJ: 9 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

6. When was psychiatric training for nurses initially offered? a. 1852 b. 1882 c. 1902 d. 1922

ANS: B In 1882, McLean Hospital in Waverly, Massachusetts, provided the first psychiatric training school for nurses. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1112 OBJ: 1 TOP: Mental health KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

10. The nurse is performing an initial assessment on an alcoholic patient. Which of the following actions by the nurse would best ensure honest answers? a. Not asking personal questions b. Having a nonjudgmental attitude c. Including the family d. Promising the patient not to tell anyone

ANS: B Maintaining a nonjudgmental attitude may reassure the patient and allow him to be more honest in his responses to the admission assessment. PTS: 1 DIF: Cognitive Level: Application REF: Page 1149 OBJ: 5 TOP: Alcoholism KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

3. How should the nurse document the behavior of a patient with mental illness? a. Very disruptive to a person in society b. Differing from socially acceptable behavior c. Causing the person to be involved in problems d. Resulting from an inability to exercise control

ANS: B Mental illness can cause behavior that deviates from socially and culturally acceptable behavior. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1111 OBJ: 2 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

22. While creating a methadone protocol for a patient rehabilitating from heroin addiction, the nurse explains that the patient will take methadone for what length of time? a. Daily for the rest of his life b. Daily until stabilized, then gradually reduce the dose to zero c. Weekly for at least 6 months, then decrease the dose to once a month d. Monthly for 6 to 10 months, then decrease the dose to zero

ANS: B Methadone is given daily until the patient is stabilized. The methadone is reduced gradually until the patient does not need to take any. PTS: 1 DIF: Cognitive Level: Application REF: Page 1155 OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

20. When a patient is admitted with an overdose of an opioid narcotic, the nurse should anticipate an order for which drug to reverse the effects of the narcotic? a. Clonidine b. Narcan c. Orlaam d. Methadone

ANS: B Opioid overdose treatment involves administering Narcan as prescribed to reverse the effects of the narcotic. PTS: 1 DIF: Cognitive Level: Application REF: Page 1155 OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

13. After a physician in the emergency department has pronounced a 2-year-old dead following a swimming pool accident, the mother tearfully says to the father, "I am so sorry. I am so sorry." What is the mother expressing? a. Fear b. Guilt c. Hostility d. Grief

ANS: B Parents often harbor extreme guilt in an "out of sequence death." PTS: 1 DIF: Cognitive Level: Analysis REF: Page 738 OBJ: 4 TOP: Out of sequence death KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

8. The majority of people function in a relatively healthy manner. What can diminish their functional capacity? a. Lack of a support system b. Periods of crisis c. Nutritional deficits d. A physical disease process

ANS: B Periods of crisis can decrease functional capacity, moving a person toward the illness end of the continuum. PTS: 1 DIF: Cognitive Level: Application REF: Page 1113 OBJ: 1 TOP: Mental health KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

25. A 14-year-old survivor of a school shooting screams and dives under a table when firecrackers go off. What does this behavior represent? a. Phobia b. Post-traumatic stress disorder c. Obsessive-compulsive disorder d. Disordered thinking

ANS: B Post-traumatic stress disorder describes a response to an intense traumatic experience that is beyond the usual range of human experience. PTS: 1 DIF: Cognitive Level: Application REF: Page 1133 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

24. The patient complains to the nurse that the physician does not like him and wants him to fail at following the diet prescribed. The nurse recognizes that the patient is using which defense mechanism? a. Conversion b. Projection c. Introjection d. Repression

ANS: B Projection is attributing to others characteristics that the person does not want to acknowledge. PTS: 1 DIF: Cognitive Level: Application REF: Page 1117, Table 33-1 OBJ: 6 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

14. The nurse is assessing a young woman who is a teacher, happily married, raising two children, taking care of her disabled mother, and going to school to get a master's degree. How should the behavior of the young woman be classified? a. Ego-centered b. Role integrated c. High-level wellness d. Unbounded energy

ANS: B Role integration is performing several ascribed roles at the same time. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1115 OBJ: 3 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

8. A profound, disabling mental illness is characterized by bizarre, nonreality thinking. What is the illness? a. Manic depressive b. Schizophrenia c. Paranoia d. Bipolar

ANS: B Schizophrenia, a thought process disorder, is one of the most profoundly disabling mental illnesses. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1124 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

9. A patient believes himself to be the president of the United States and that terrorists are trying to kidnap him. The nurse records these observations as which type of behavior? a. Absent behavior b. Positive behavior c. Negative behavior d. False behavior

ANS: B The behaviors of schizophrenic individuals can be categorized as positive (or excessive) or negative (or absent). Examples of positive behaviors include hallucinations, delusions, and disordered thinking. Examples of negative behaviors include apathy, social withdrawal, and flat affect. PTS: 1 DIF: Cognitive Level: Application REF: Page 1128 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

15. How is a durable power of attorney helpful to an incapacitated patient? a. It directs treatment in accordance with the patient's wishes. b. It directs an agent to make health care decisions. c. It gives power to an agent to make decisions regarding health, property, and other assets. d. It can only be executed by an attorney.

ANS: B The durable power of attorney gives an agent the power to make health care decisions. It can be executed by anyone and does not extend beyond health care issues. A living will directs treatment according to the patient's wishes. PTS: 1 DIF: Cognitive Level: Application REF: Page 751 OBJ: 7 TOP: Durable power of attorney KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

29. A family is informed that the brain damage to their daughter is irreversible. The father is later overheard making vacation plans and discussing what the family will do when his daughter leaves the hospital. The nurse recognizes the father is in which crisis stage? a. High anxiety b. Denial c. Reconciliation d. Adaptation

ANS: B The father is exhibiting signs of denial. Once the reality of the situation becomes evident, anger and confusion follow. PTS: 1 DIF: Cognitive Level: Application REF: Page 1119 OBJ: 9 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

14. The nurse explains that Alcoholics Anonymous (AA) consists of abstinent alcoholics who help other alcoholics become and stay sober. What is the foundation of AA? a. Psychotherapy b. A 12-step program c. Treatment center d. Individual counseling

ANS: B The foundation of AA is a 12-step program. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1152 OBJ: 5 TOP: Alcoholism KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

10. When the nurse is developing a care plan for a terminally ill patient, what might be a realistic goal? a. The patient will remain pain-free. b. The patient will function optimally. c. The patient will spend time out of bed. d. The patient will demonstrate improved nutritional status.

ANS: B The goal of the care plan for a terminally ill patient is to assist the patient to function optimally. The other options are not realistic. PTS: 1 DIF: Cognitive Level: Application REF: Page 747 OBJ: 10 TOP: Care plan KEY: Nursing Process Step: Planning MSC: NCLEX: Health Promotion and Maintenance

6. What should the nurse do before approaching a grieving family member? a. Offer sympathy b. Assess level of resolution c. Give assurance that the pain will pass d. Encourage the family member to return to normal activities

ANS: B The nurse should assess each aspect of grieving to fully understand where family members are in their grief in order to offer the most effective assistance. PTS: 1 DIF: Cognitive Level: Application REF: Page 745 OBJ: 6 TOP: Grief KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

30. When developing a care plan for a mentally ill patient, what should the nurse assess first? a. Coping strategies b. Emotional status c. Medications taken d. Nutritional status

ANS: B The nurse's first priority would be to assess the emotional status of the mentally ill patient. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1120 OBJ: 9 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

29. What should the nurse do when suspecting a co-worker of abusing drugs while at work? a. Confront the abuser b. Report observations to a supervisor c. Call the state board of nursing d. Discuss the problem with another co-worker

ANS: B The nurse's observations should be reported objectively, preferably in writing, to the supervisor. PTS: 1 DIF: Cognitive Level: Application REF: Page 1161 OBJ: 7 TOP: Impaired nurse KEY: Nursing Process Step: Implementation MSC: NCLEX: Health Promotion and Maintenance

23. After finding the patient with diabetes eating candy, the nurse reminds the patient that the candy will elevate blood sugar levels. The patient's response is: "It's only a little bit, and it won't do anything." Which defense mechanism is the patient using? a. Conversion b. Denial c. Repression d. Regression

ANS: B The patient is using denial as a defense mechanism. Reality is denied. PTS: 1 DIF: Cognitive Level: Application REF: Page 1117, Table 33-1 OBJ: 6 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

17. A nurse tearfully confides to the head nurse that being assigned to care for eight patients is stressful and overwhelming. What demonstrates the use of a healthy coping mechanism? a. Writing down long lists of needed interventions before starting the day's work b. Delegating appropriate care assignments to nursing assistants c. Asking a co-worker to take one of her patients d. Asking for the day off

ANS: B The use of delegation is an effective coping mechanism. The other options are not healthy as they either delay or avoid dealing with the stress. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1116 OBJ: 2 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

27. The nurse is told that a patient believes he was born into the wrong body. What is the correct terminology for the desire to have the body of the opposite sex? a. Homosexuality b. Transsexualism c. Heterosexuality d. Bisexuality

ANS: B Transsexualism is a persistent desire to be the opposite sex and to have the body of the opposite sex. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1135 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

9. Which of the following would lead the home health nurse to make a nursing diagnosis of unresolved grief for a patient who was widowed 5 months ago? a. Seeing that the patient keeps a picture of the husband by her bed b. The patient said tearfully, "I can't believe he is gone." c. Assessing that the patient eats out frequently rather than cooking at home d. The patient says that she attends church three times a week.

ANS: B Unresolved grief results when a grieving person does not move past some stage of the grief process. The widow is still in denial. It would be expected for the widow to keep pictures of her husband in the home. Eating out frequently and attending church would not lead to a diagnosis of unresolved grief, but instead would be encouraged. PTS: 1 DIF: Cognitive Level: Analysis REF: Pages 741, 742, Table 24-1 OBJ: 4 TOP: Unresolved grief KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

5. What must a patient in the late stages of dependence do in order to recover? a. Gain insight into the addiction b. Receive treatment for substance abuse c. Pledge to lead a completely different lifestyle d. Seek a nondrug-oriented support system

ANS: B Very few people in the late stage of dependence will recover without treatment. The other options may aid in the recovery, but it is the treatment that is essential for recovery. PTS: 1 DIF: Cognitive Level: Application REF: Page 1147 OBJ: 2 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

16. When a nurse informs a patient's spouse that the patient has died, the spouse states, "You must be mistaken." Which of Kübler-Ross's stages of dying is the spouse demonstrating? a. Anger b. Denial c. Depression d. Bargaining

ANS: B When experiencing denial, the individual acts as though nothing has happened and may refuse to believe or understand that loss has occurred. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 740, Box 24-3 OBJ: 3 TOP: Stages of dying KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

16. If the patient tells the nurse, "I'm not an alcoholic. I can stop whenever I want to," what should be the nurse's most therapeutic response? a. "Well, why don't you?" b. "Hasn't alcohol use interfered with your employment?" c. "A positive attitude like that is a good start." d. "What would you call alcoholism?"

ANS: B When the addicted person presents in denial, the nurse should use techniques to set limits on that behavior. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1150 OBJ: 1 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

33. A nurse suspects her a co-worker is abusing drugs. Which of the following symptoms, noticed in the co-worker, would contribute to the suspicions? a. Spending more time with co-workers b. Frequently absent from the unit c. Rapid changes in mood and performance d. Increased somatic complaints e. Patients report they did not receive their medications

ANS: B, C, D, E Signs of drug abuse in a nurse include the nurse becoming more isolated from co-workers, being frequently absent from the unit, rapidly changing mood and performance, increasing somatic complaints, and patients reporting they did not receive their medications. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1146 OBJ: 7 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

37. A variety of factors influence the level of anxiety experienced by the patient faced by a stressful situation. Which would the nurse outline? (Select all that apply.) a. How others perceive the event b. The number of stressors present at one time c. Degree of change the stressors require d. Present role assumption e. Previous experience with a similar situation

ANS: B, C, D, E The number of stressors present at one time, the degree of change the stressors require, present role assumption, and previous experience with a similar situation are all factors that can influence the level of anxiety experienced when faced with a stressful situation. The level of anxiety experienced is also influenced by how the event is perceived by the individual, not how the event is perceived by others. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1115 OBJ: 7 TOP: Mental health KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

10. The patient talks with his dead brother and arranges furniture so that his brother will have a place to sit. How should the nurse document this behavior? a. Disordered thinking b. Anhedonia c. Hallucination d. Alogia

ANS: C A hallucination is a sensory experience without a stimulus trigger. Disordered thinking occurs when the individual is not able to interpret information being received in the brain. Anhedonia describes lack of expressed feelings. Alogia is reduced content of speech. PTS: 1 DIF: Cognitive Level: Application REF: Page 1128 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

7. A dying patient uses the call light frequently to ask the nurse to do simple tasks. The nurse recognizes this as a fear of: a. increased pain. b. failure. c. abandonment. d. isolation.

ANS: C A major fear of the dying patient is fear of abandonment. PTS: 1 DIF: Cognitive Level: Application REF: Page 754 OBJ: 10 TOP: Death KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

21. The home health nurse assesses a patient who creates elaborate excuses for not leaving home. Further questioning reveals the patient had not left home for 6 months. How should this be documented? a. Mania b. Depression c. Agoraphobia d. Anxiety

ANS: C Agoraphobia is a high level of anxiety in which an anxiety attack could occur in individuals who avoid other people, places, or events. PTS: 1 DIF: Cognitive Level: Application REF: Page 1131 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

6. What is the best response by a nurse when a patient inquires how alcohol acts so quickly on his system? a. Alcohol is digested quickly. b. Alcohol is converted to glycogen immediately. c. Alcohol is metabolized into ethanol rapidly. d. Alcohol is excreted in urine slowly.

ANS: C Alcohol is not digested or converted into glycogen, but it is metabolized quickly by the liver to ethanol. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1148 OBJ: 4 TOP: Alcoholism KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

1. The nurse is discussing the differences between a patient with a neurosis and one with a psychosis. What is true of the patient experiencing a neurosis? a. The patient experiences a flight from reality. b. The patient usually needs hospitalization. c. The patient has insight that there is an emotional problem. d. The patient has severe personality deterioration.

ANS: C An individual with a neurosis has insight that he has an emotional problem. A person with psychosis is out of touch with reality and has severe personality deterioration. Treatment for neurosis is usually completed in the outpatient setting, while treatment for psychosis often requires hospitalization. PTS: 1 DIF: Cognitive Level: Application REF: Page 1123 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

20. The nurse is assessing a female patient who has become rapidly and exceedingly anxious because her fingernail polish is chipped. What type of anxiety should the nurse conclude that the patient is exhibiting? a. Signal anxiety b. General anxiety c. Anxiety traits d. Panic disorder

ANS: C An individual with anxiety traits has anxious reactions to relatively nonstressful events. Signal anxiety is a learned response to an event such as test taking. An individual with general anxiety worries over many things. A panic attack occurs suddenly and typically peaks within 10 minutes. PTS: 1 DIF: Cognitive Level: Application REF: Page 1131 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

16. What does any event that requires change stimulate? a. Anger b. Depression c. Stress d. Anxiety

ANS: C Any event that requires change leads to stress, which is the nonspecific response of the body to any demand. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1115 OBJ: 7 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

15. What action consistently done by a patient should indicate to a nurse that the patient has a poor self-concept? a. Wears bright-colored clothing b. Demands the attention of staff c. Apologizes to others repeatedly d. Becomes angry when frustrated

ANS: C Apologizing repeatedly is indicative of self-effacement. Anger, demanding attention, and wearing attention-getting clothing are not characteristics of a poor self-concept. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1115 OBJ: 2 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

27. Why is it important for the nurse to be observant of patient behavior? a. Behavior is preformed b. Behavior is important c. Behavior is learned d. Behavior is repeated

ANS: C Behavior is learned and has meaning. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1119 OBJ: 9 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

12. The nurse spends a great deal of time in the room of a dying 12-year-old because the nurse knows that most children are aware of their condition and want the nurse to do which of the following? a. Keep them clean b. Help them eat c. Care about them d. Keep them comfortable

ANS: C Children, like adults, fear abandonment as death approaches and gain comfort from the presence of the nurse. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 748 OBJ: 6 TOP: Childhood death KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

1. A 60-year-old man was admitted for cholecystitis that resulted in a cholecystectomy. On his third day of hospitalization, he begins to sweat profusely, tremble, and has a blood pressure of 160/100. Based on these findings, what focused assessment should the nurse complete? a. Cardiac problems b. Respiratory problems c. Withdrawal problems d. Circulatory problems

ANS: C Diaphoresis, tremors, and hypertension are all symptoms of withdrawal from alcohol consumption. The nurse, concerned about the patient's medical condition, may not consider substance abuse until withdrawal symptoms appear. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1148 OBJ: 4 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. Changes in health care reimbursement measures have resulted in which of the following changes regarding care of the terminally ill? a. Patients spend more time in hospitals b. Nurses provide more care in hospitals c. More patients die at home d. Patients spend more time in rehab facilities

ANS: C Due to changes in reimbursement measures, more patients are dying at home. PTS: 1 DIF: Cognitive Level: Application REF: Page 736 OBJ: 2 TOP: Death KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

31. When the patient is told that his insurance will no longer pay for his physical therapy, the nurse is aware that this obstruction to his goal may result in which concept? a. Conflict b. Adaptation c. Frustration d. Anxiety

ANS: C Frustration refers to anything that interferes with goal-directed activity. PTS: 1 DIF: Cognitive Level: Application REF: Page 1116 OBJ: 9 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

4. What stage of dependence is described by a patient when he tells the nurse that he has tried to stop his drug habit, but he does not feel "normal" without it? a. Early b. Prodromal c. Middle d. Late

ANS: C In the middle stage, the user shows signs of withdrawal with abstinence and must use the drug to feel normal. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1147 OBJ: 2 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

27. What is the greatest problem with lysergic acid diethylamide (LSD) use? a. The drug is addictive. b. The drug stimulates drug-seeking behavior. c. The drug causes flashbacks. d. The drug sets off hypertensive episodes.

ANS: C LSD causes flashbacks, or "bad trips," unpredictably, and the flashbacks may occur years after ingestion of the drug. LSD is not considered an addictive drug and does not stimulate drug-seeking behavior. Hypertension is not a typical side effect of LSD. PTS: 1 DIF: Cognitive Level: Application REF: Page 1156 OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

18. A home health nurse has a patient who is taking lithium. What should be included in the teaching plan? a. Examine her skin closely for eruptions b. Take her blood pressure twice a day to check for hypertension c. Have her drug blood level checked every month d. Avoid aged cheese and red wine

ANS: C Lithium has a very narrow therapeutic window. The drug blood levels should be closely monitored. PTS: 1 DIF: Cognitive Level: Application REF: Page 1139, Table 34-3 OBJ: 6 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

14. The nurse is caring for a patient with a diagnosis of catatonic schizophrenia. What behavior is consistent with this diagnosis? a. Talks excitedly about going home b. Suspiciously watches the staff c. Stands on one foot for 15 minutes d. States he has a cat under his bed that talks to him

ANS: C Maintaining a rigid pose for long periods of time is an example of behavior expected with catatonic schizophrenia. PTS: 1 DIF: Cognitive Level: Application REF: Page 1129 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

2. What definition should the nurse use to clarify the concept of "mental health"? a. A wellness of attitude b. A person's response to disease and dysfunction c. The ability to cope and adjust to everyday stresses d. How the person performs activities of daily living

ANS: C Mental health can be defined as a person's ability to cope and adjust to everyday stresses. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1110 OBJ: 1 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

24. A patient is frequently late for appointments because he goes back to his room numerous times to assure himself that none of his belongings have been stolen. What does this behavior represent? a. Senseless behavior b. Controlled repetition c. Obsessive-compulsive d. Anxiety tension

ANS: C Obsessive-compulsive disorders have two features: thoughts that are recurrent, intrusive, and senseless; and behaviors that are performed repeatedly and ritualistically. PTS: 1 DIF: Cognitive Level: Application REF: Page 1133 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

7. Using the mental health continuum as a guide, the nurse observes behavior that usually places an individual on the illness end of the continuum. What is true of this behavior? a. It causes extreme concern about health. b. It results in inability to function in society. c. It demonstrates that the person is out of touch with reality. d. It results in inability to interact with people.

ANS: C On the illness end of the mental health continuum, the person is rarely in touch with reality. PTS: 1 DIF: Cognitive Level: Application REF: Page 1113 OBJ: 1 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

28. What is a nursing intervention that helps to build trust, encourages the patient to have faith in the care being received, and meets psychosocial needs? a. Developing a care plan b. Implementing nurse orders c. Patient education d. Meeting patient goals

ANS: C One of the steps to meet the psychosocial needs of the patient is patient education. PTS: 1 DIF: Cognitive Level: Application REF: Page 1118 OBJ: 10 TOP: Mental health KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

23. A 22-year-old patient presents in the emergency department with the characteristics of severe Parkinson disease. The nurse should suspect an overdose of what drug? a. Marijuana b. Cocaine c. Amphetamines d. Valium

ANS: C Over time, dopamine depletion in the brain can cause Parkinson-like symptoms to occur in people who abuse amphetamines. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1156 OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

4. How does a perceived loss differ from an actual loss? a. A perceived loss is more quickly resolved. b. A perceived loss is situational. c. A perceived loss is easily overlooked. d. A perceived loss has a superficial response.

ANS: C Perceived losses are easily overlooked. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 736 OBJ: 1 TOP: Loss KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

14. What is the termination of tube feedings to a dying patient considered? a. Active euthanasia b. Holistic care c. Passive euthanasia d. Terminal care

ANS: C Permitting the death of a patient by withholding treatments is referred to as passive euthanasia. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 750 OBJ: 7 TOP: Passive euthanasia KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

11. What is the prognosis for a schizophrenic patient who is exhibiting positive behaviors? a. Guarded b. Poor c. Good d. Repeatable

ANS: C Prognosis for schizophrenic patients who are exhibiting positive behavior patterns is good. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1128 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

31. What is the term for a long-term and intense form of psychotherapy developed by Sigmund Freud that allows a patient's unconscious thoughts to be brought to the surface? a. Adjunctive b. Behavior c. Psychoanalysis d. Cognitive

ANS: C Psychoanalysis technique was developed by Sigmund Freud and is a long-term and intense therapy. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1136 OBJ: 5 TOP: Psychotherapy KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

21. A 40-year-old patient cries and has a tantrum when the physician refuses to give her a prescription for diet pills. The nurse realizes that this is the use of which defense mechanism? a. Compensation b. Denial c. Regression d. Repression

ANS: C Regression is a behavior that reflects the return to an earlier form of coping. PTS: 1 DIF: Cognitive Level: Application REF: Page 1117, Table 33-1 OBJ: 6 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

34. When assisting the older adult who is despondent about the need to leave his home, what technique should the nurse use? a. Ask him if he has a drinking problem b. Explore the option of his moving in with someone c. Reminisce with the patient and review his life d. Assess for hopelessness and helplessness

ANS: C Reminiscence and life review are effective techniques to help older adults deal with changing life circumstances. PTS: 1 DIF: Cognitive Level: Application REF: Page 1118 OBJ: 10 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

33. The nurse is assessing a nervous 18-year-old patient who has vital signs of P 120, R 30, and BP 160/90. The patient states that he feels something bad is about to happen. Based on this data alone, how should the nurse identify the patient's level of anxiety? a. Mild b. Moderate c. Severe d. Panic

ANS: C Severe anxiety may be manifested by elevated blood pressure, pulse, and respiratory rate, a feeling of impending danger, and feelings of fatigue. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1116, Box 33-3 OBJ: 9 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

28. The patient complains of recurrent, multiple physical ailments for which there is no organic cause. How should the nurse assess this? a. Obsessive-compulsive disorder b. Phobia anxiety disorder c. Somatoform disorder d. Delusional disorder

ANS: C Somatoform disorder is characterized by recurrent, multiple physical complaints for which there is no organic cause. PTS: 1 DIF: Cognitive Level: Application REF: Page 1135 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

33. A patient who is taking a monoamine oxidase inhibitor (MAOI) asks the nurse about the addition of St. John's wort to help with his depression. What would be the best response of the nurse? a. "That is a great idea. Alternative therapies can be very helpful." b. "You will feel better sooner if you include phenylalanine." c. "Did you know that St. John's wort can raise your blood pressure dramatically?" d. "You will need to drink lots of water."

ANS: C St. John's wort can raise blood pressure dramatically in people who are also taking MAOIs. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1141 OBJ: 6 TOP: Psychopharmacology KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

19. What action by a student before taking a test should indicate to a nursing instructor that the student is demonstrating signs of moderate anxiety? a. Studies for 6 hours b. Sleeps 6 hours because of fatigue c. Vomits d. Argues about the scheduling of the test

ANS: C Symptoms of anxiety include the following: vocal changes, rapid speech, increased pulse, respirations, and blood pressure, tremors, restlessness, increased perspiration, nausea, decreased appetite, diarrhea, frequent urination, and vomiting. PTS: 1 DIF: Cognitive Level: Application REF: Page 1115 OBJ: 7 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

3. The Diagnostic and Statistical Manual of Psychiatric Disorders, V (DSM-V), is used by most hospitals and is the current tool used to examine mental health and illness. What approach does the DSM-V use to classify mental disorders? a. Holistic system b. Hierarchical system c. Multiaxial system d. Evaluation system

ANS: C The DSM-V is a multiaxial system. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1123 OBJ: 1 TOP: Mental illness KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

5. Upon being told of her father's death, the daughter cries out, "No! Oh, God, no!" What stage of grief is the daughter in? a. Anger b. Bargaining c. Denial d. Prayer

ANS: C The daughter is exhibiting signs of denial, which is commonly one of the first stages of grief. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 740, Box 24-3 OBJ: 4 TOP: Grief KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

12. What should the entire health team focus on during the rehabilitation phase? a. Establishing a support system b. Seeking and maintaining employment c. Abstaining from drug use d. Addressing the problems related to addiction

ANS: C The focus of rehabilitation is for the patient to abstain from drug use. PTS: 1 DIF: Cognitive Level: Application REF: Page 1151 OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

30. Which statement describes the impaired nurse who is in a peer assistance program? a. The nurse has a revoked nursing license. b. The nurse does not have to notify her employer. c. The nurse will be allowed to work as a nurse under supervision. d. The nurse will be reported to the Healthcare Integrity and Protection Data Bank.

ANS: C The peer assistance program allows the nurse to retain licensure and continue to work under supervision, although possibly in an area where access to controlled drugs is difficult. It is necessary for the employer to have information regarding the peer assistance assignment. Action is not reported to the Healthcare Integrity and Protection Data Bank until final adverse actions are taken, allowing the nurse to complete the peer assistance program. PTS: 1 DIF: Cognitive Level: Application REF: Page 1161 OBJ: 7 TOP: Impaired nurse KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

19. The nurse alters the care plan for a patient with depression to include what type of activity? a. Domino game with three other patients b. Ping-Pong game with one other patient c. Group outing to view wildflowers d. Magazine to read alone

ANS: C The quiet, noncompetitive trip to view wildflowers would be the best option. Depressed people should not be put in situations where they must concentrate or compete. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1132, Care Plan 34-1 OBJ: 5 TOP: Mental illness KEY: Nursing Process Step: Planning MSC: NCLEX: Psychosocial Integrity

26. The patient admitted to the hospital may adjust to illness by assuming a role in which everyday responsibilities are avoided. What is this role called? a. Patient role b. Illness role c. Sick role d. Dependent role

ANS: C The sick role allows the patient to be excused from everyday responsibilities. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1118 OBJ: 8 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

28. What should the nurse do to decrease the damage of bruxism seen in a patient who has been abusing the drug ecstasy? a. Turn the patient to his right side b. Elevate the head of the bed 30 degrees c. Provide the patient with a pacifier d. Administer a muscle relaxant

ANS: C The use of an infant pacifier will reduce the damage to the teeth for a patient who is manifesting bruxism (grinding of the teeth). PTS: 1 DIF: Cognitive Level: Application REF: Page 1157 OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

4. When all five axes of the Diagnostic and Statistical Manual of Psychiatric Disorders, V, are used, it provides what type of assessment approach to comprehensive care? a. Personalized b. Individualized c. Holistic d. Organic

ANS: C Using all five axes of the DSM-V provides a holistic assessment. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1124 OBJ: 1 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

17. A patient whose spouse died 1 year earlier complains of feeling overwhelmingly lonely and has withdrawn from interpersonal interactions. The patient is demonstrating what stage of dying according to Kübler-Ross's stages of dying theory? a. Anger b. Denial c. Depression d. Bargaining

ANS: C When experiencing depression, the individual feels overwhelmingly lonely and withdraws from interpersonal interaction. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 740, Box 24-3 OBJ: 3 TOP: Stages of dying KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

2. A young nurse caring for a dying patient hastens through the care and leaves the room as quickly as possible. What common reaction to the care of the dying is the nurse exhibiting? a. Efficiency b. Anger c. Withdrawal d. Anxiety

ANS: C Withdrawal is a common reaction to the care of the dying. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 744 OBJ: 5 TOP: Withdrawal KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

6. A patient admitted for delirium demonstrates increased disorientation and agitation only during the evening and nighttime. What is the term applied to this type of delirium? a. Disordered thinking b. Schizophrenia c. Dementia d. Sundowning syndrome

ANS: D A patient with sundowning syndrome displays increased disorientation and agitation only during evening and nighttime. Disordered thinking occurs when an individual is not able to interpret information being received in the brain. Disordered thinking is one characteristic of schizophrenia, which is a large group of psychotic disorders that includes non-reality-based thinking. Dementia is an altered mental state secondary to cerebral disease. PTS: 1 DIF: Cognitive Level: Application REF: Page 1124 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

3. Alcohol is involved in motor vehicle accidents, suicides, and homicides. Approximately how many deaths each year are related to alcohol consumption? a. 50,000 b. 70,000 c. 80,000 d. 100,000

ANS: D About 100,000 deaths each year are related to alcohol consumption. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1146 OBJ: 4 TOP: Alcoholism KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

18. A perceived threat to self causes what emotion? a. Fear b. Anger c. Depression d. Anxiety

ANS: D Anxiety can be defined as a vague feeling of apprehension resulting from a perceived threat to self. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1115 OBJ: 7 TOP: Mental health KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

16. For the past 3 weeks, the nurse has observed a patient interacting with staff and other patients, helping decorate the dining room for a party, and leading the singing in the activity room. Today, the patient tearfully refuses to dress or get out of bed. The nurse recognizes these behaviors as evidence of which psychiatric disorder? a. Unipolar depression b. Dysthymic disorder c. Hypomanic episode d. Bipolar disorder

ANS: D Bipolar disorder can cause the patient to experience a sudden shift in emotion from one extreme to the other. PTS: 1 DIF: Cognitive Level: Application REF: Page 1130 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

23. When a patient is experiencing a panic attack, how should the nurse best assist the patient? a. Assist with reality orientation b. Aid in decision making c. Assist with rational thought d. Coach in deep breathing

ANS: D Coaching in relaxation techniques such as deep breathing is an effective intervention for a patient who is experiencing a panic attack. PTS: 1 DIF: Cognitive Level: Application REF: Page 1126, Table 34-1 OBJ: 5 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

7. Dementia is an organic mental disease secondary to what problem? a. Chemical imbalance b. Emotional problems c. Circulatory impairment d. Cerebral disease

ANS: D Dementia describes an altered mental state secondary to cerebral disease. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1124 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

5. During the 17th and 18th centuries, care of patients with mental illness often was cruel. What type of care was used by Dr. Philippe Pinel to bring about change? a. Personal care b. Individual care c. Behavior care d. Humane care

ANS: D Dr. Philippe Pinel advocated humane care. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1112 OBJ: 1 TOP: Mental health KEY: Nursing Process Step: N/A MSC: NCLEX: N/A

32. What is the typical schedule for electroconvulsive therapy (ECT)? a. 3 treatments over 2 weeks b. 6 treatments over 2 months c. 8 treatments over several weeks d. 10 treatments over several weeks

ANS: D ECT is done as a treatment for depression, mania, and schizoaffective disorders that have not responded to other treatments. The usual protocol is 10 treatments over several weeks. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1137 OBJ: 5 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

2. What age of onset of alcohol consumption is most predictive of alcohol addiction? a. 8 or younger b. 10 or younger c. 12 or younger d. 14 or younger

ANS: D Forty-four percent of those who start drinking at the age of 14 or younger will develop alcoholism. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1145 OBJ: 4 TOP: Alcoholism KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

26. What should the nurse preparing a patient for a scheduled appointment for electroconvulsive therapy (ECT) remind the patient to do? a. Drink plenty of fluids before ECT to ensure adequate hydration. b. Bring a change of clothes in case of incontinence. c. Be prepared for visual disturbances after the treatment. d. Arrange for transportation to and from the appointment.

ANS: D If the patient has not arranged for adequate transportation to and from the appointment, the treatment will be canceled because driving after ECT is dangerous. The patient is typically NPO before the procedure. Incontinence and visual disturbances are not common following the procedure. PTS: 1 DIF: Cognitive Level: Application REF: Page 1138 OBJ: 5 TOP: Mental illness KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity

13. The nurse asks a patient with schizophrenia if he had any visitors on Sunday. Which response indicates loose association? a. "No." b. "Yes! I had 90 visitors who came from every state in the union." c. "Sunday is the Sabbath. Do we have visitors on the Sabbath?" d. "We visited Yellowstone Park last summer."

ANS: D Loose association is a type of disordered thinking that occurs when the individual cannot interpret information and the conversation does not flow. PTS: 1 DIF: Cognitive Level: Application REF: Page 1128 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

25. The nurse is sensitive to the fact that patients lose control over their lives when admitted to the hospital. In what does this loss of control frequently result? a. Anger b. Depression c. Fear d. Anxiety

ANS: D Loss of control may result in feelings of apprehension and uncertainty. PTS: 1 DIF: Cognitive Level: Application REF: Page 1118 OBJ: 5 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

22. When a patient demonstrates accelerated heart rate, trembling, choking, and chest pain along with acute, intense, and overwhelming anxiety, the nurse should recognize that the patient is most likely experiencing what condition? a. Terror b. Fright c. Fear d. Panic

ANS: D Panic can be defined as an attack of acute, intense, and overwhelming anxiety. PTS: 1 DIF: Cognitive Level: Application REF: Page 1131 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

17. The nurse recognizes that researchers have identified that hereditary factors account for what percentage of mood disorders? a. 10% to 15% b. 20% to 30% c. 35% to 50% d. 60% to 80%

ANS: D Research indicates that hereditary factors account for 60% to 80% of mood disorders. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1129 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

18. Which drug is often used in date rape? a. Dalmane b. Xanax c. Narcan d. Rohypnol

ANS: D Rohypnol has been abused as a date-rape drug and has not been approved for use in the United States. PTS: 1 DIF: Cognitive Level: Comprehension| Cognitive Level: Knowledge REF: Page 1154 OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

24. A college student has brought his hallucinating roommate to the college clinic. The young man says his roommate has been experimenting with phencyclidine (PCP). How long should the nurse expect the hallucinations to last? a. 30 to 60 minutes b. 1 to 4 hours c. 4 to 6 hours d. 6 to 12 hours

ANS: D Some hallucinogenic effects of PCP can last 6 to 12 hours. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1156 OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

25. The mother of a young woman being treated for amphetamine overdose asks the nurse when the manifestations will subside. What would be the most correct answer by the nurse? a. "Usually in 8 to 10 hours." b. "She will snap out of it in a day or two." c. "Usually in about 2 hours, but the effects will return in 2 to 3 days." d. "The manifestations may be permanent."

ANS: D The manifestations of overdose of amphetamines are frequently permanent. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1156 OBJ: 6 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

15. What is the term used for the beginning stage of schizophrenia, characterized by a lack of energy and complaints of multiple physical problems? a. Prepsychotic b. Residual c. Acute d. Prodromal

ANS: D The prodromal phase is the beginning stage of schizophrenia. Hallucinations and delusions sometimes occur in the prepsychotic stage. In the acute phase, individuals often lose touch with reality. The residual phase follows the acute phase and the symptoms of that phase are similar to those of the prodromal stage. PTS: 1 DIF: Cognitive Level: Application REF: Page 1129 OBJ: 2 TOP: Mental illness KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

10. Using Freud's personality theory, what action by a patient identifies the influence of the superego? a. Eating an entire chocolate pie b. Becoming anxious about having no visitors c. Monopolizing the attention of the physician d. Returning a $5 bill that another patient left on the table

ANS: D The superego is the mediator between right and wrong (the conscience). PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1114, Box 33-2 OBJ: 3 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

13. What should the nurse do to decrease the patient's disorientation at night during the detoxification period? a. Place the patient in a room with another recovering patient b. Instruct the patient to orient himself to his surroundings at bedtime c. Wake the patient up every 4 hours to eat a small snack d. Use nightlights and remove extra furniture from the room

ANS: D Use of nightlights and removing extra furniture that could be misidentified will reduce disorientation. The patient should not be woken up to eat, but if he is awake, small snacks can be offered. The nurse should orient the patient to his surroundings. PTS: 1 DIF: Cognitive Level: Application REF: Page 1150 OBJ: 5 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

32. What is the most likely result when an attempt at adaptation fails? a. Depression b. Anger c. Frustration d. Anxiety

ANS: D When adaptive behavior fails, anxiety increases. PTS: 1 DIF: Cognitive Level: Application REF: Page 1115 OBJ: 5 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

11. Following the death of a day-old infant, the nurse brings the baby to the parents. What is the rationale for the parents' visit with the deceased baby? a. Bond with the family b. Reinforce the individuality of the baby c. Generate preparation for another child d. Make the death a reality

ANS: D When possible, the parents should see, touch, and hold the infant to cope better with the reality of the death. PTS: 1 DIF: Cognitive Level: Application REF: Page 748 OBJ: 6 TOP: Death KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

17. When a patient denies any problems related to addiction, what is the nurse's most therapeutic response? a. "What do you call this hospitalization?" b. "How can anybody help you if you don't see a problem?" c. "Would your family agree that you have no problems?" d. "Can you think of any time your behavior created an unpleasant situation in your life?"

ANS: D When the patient denies that his behavior is problematic, the nurse should ask the patient to recount incidences when the behavior had unpleasant consequences. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1151, Nursing Care Plan 35-1 OBJ: 1 TOP: Addiction KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity

9. The nurse assesses an alcoholic patient carefully for signs of withdrawal. How soon after cessation of alcohol intake do withdrawal symptoms usually appear? a. 3 hours b. 4 hours c. 5 hours d. 6 hours

ANS: D Withdrawal signs can occur as early as 6 hours after cessation of alcohol intake and sometimes last for 3 to 5 days. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1148 OBJ: 4 TOP: Alcoholism KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

39. In the movie Gone with the Wind, Scarlett O'Hara says, "I'll think about that tomorrow. Tomorrow is another day." The nurse recognizes the defense mechanism of __________.

ANS: repression Repression is an unconscious barring of anxiety-producing thoughts. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1117, Table 33-1 OBJ: 6 TOP: Mental health KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

Which lab finding is/are likely to be seen for a patient who chronic alcoholism? (Select all that apply.) (1149) 1. Elevated liver enzymes 2. Decreased hemoglobin 3. Electrolyte imbalances 4. Abnormal blood proteins 5. Hyperglycemia 6. Abnormal clotting times

Answer 1, 2, 3, 4, 6: Elevated liver enzymes, hypoglycemia, abnormal clotting times, and abnormal blood protein levels occur with alcoholism. Magnesium levels will be decreased in some cases. It is not uncommon to find anemia.

30. A wife complains that her husband must be neurotic. What signs and symptoms would the nurse expect the husband to display? (Select all that apply.) (1123) 1. Nervousness 2. Lowself-esteem 3. Out of touch with reality 4. Phobias 5. Impaired judgment

Answer 1, 2, 4: A person with neurosis remains oriented to reality, with some degree of distortion of reality manifested by a strong emotional response to the trigger event. Various complaints of nervousness or emotional upset, compulsions, obsessiveness, and phobias are common with a neurosis. A neurotic person will often exhibit poor self-esteem and have social relationships that suffer due to the various complaints noted. Being out of touch with reality and having impaired judgment are more associated with psychosis.

25. Which action(s) indicate(s) the health care team is fulfilling the Dying person's Bill of Rights (Select all that apply.) (751) 1. Nurse assesses pain and administers pain medication accordingly. 2. Patient's choice of spiritual leader is contacted and rituals are allowed. 3. Family is allowed to decide how much in- formation is given to patient. 4. Health care team creates a living will and advance directives for the patient. 5. Nurse gives comfort measures and talks to a patient who is in a coma. 6. Patient is allowed to make decisions, even though she seems indecisive.

Answer 1, 2, 5, 6: Alleviating pain, meeting spiritual needs, giving comfort measures, and allowing decision-making are within the Dying Persons' Bill of Rights. The patient should be consulted first about how much information he/she wants and if he/she wants to be included in the decision-making. The patient may seem indecisive, but this is normal under stressful circumstances and extra time should be allowed. The nurse may find that patients/families from different cultures have a different approach to information flow and decision-making. But in the United States, the health care team generally takes the approach that the patient will be included in the information and decision-making. The health care team can assist the patient with information about a living will or advance directives, but these decisions should be made by the patient

25. A college student who has used marijuana since early high school is diagnosed with amo- tivational cannabis syndrome. Which behavior characteristics is he likely to develop (Select all that apply.) (1158) 1. Unusual irritability 2. Frequent mood swings 3. Physical aggression 4. Psychosis 5. Depression

Answer 1, 2, 5: Characteristics of amotivational cannabis syndrome are decreased goal-directed activities, abrupt mood swings, abnormal irritability and hostility, apathy, and decline of personal grooming. Depression, paranoia, and suicidal thoughts or attempts are possible.

21. Signs and symptoms that the nurse would expect to assess in the patient nearing death include: (Select all that apply.) (754, 755) 1.lowered blood pressure. 2.rapid, bounding pulse. 3.irregular respiratory pattern. 4. mouth-breathing with dry mucous membranes. 5.rapid, anxious eye movements.

Answer 1, 3, 4: When the patient nears death there are changes in vital signs, including (1) slow, weak, and thready pulse; (2) lowered blood pressure; and (3) rapid, shallow, irregular, or abnormally slow respirations. Mouth breathing occurs, which leads to dry oral mucous membranes. The patient often has a detached look in the eyes.

32. What is the physiologic reason for the vitamin B1, folic acid, and vitamin B12 deficiences that occur in alcoholism? (1148) 1. Alcohol affects the intestinal mucosa and results in decreased absorption. 2. One ounce of alcohol provides 200 kcal but has no other nutritional value. 3. Alcohol has a diuretic effect, so most nutrients are excreted in the urine 4. .The liver metabolizes most of the alcohol, thus the liver is damaged.

Answer 1: All of these statements about alcohol are true, but vitamin B1, folic acid, and vitamin B12 deficiency are caused by the prolonged use of alcohol, which has a toxic effect on the intestinal mucosa that results in decreased absorption of these nutrients

34. Which substance has the most potential for (1148) 1. Alcohol 2. Heroin 3. Amphetamine 4. Nicotine

Answer 1: Delirium tremens (DTs) is a complication of alcohol withdrawal. The risk of death from this complication is as high as 15%, even with treatment.

36. The patient reports nausea, vomiting, and stomach pain. She has a new job with a lot of responsibilities, many people to supervise, and two projects that are due within the month. If physical causes are ruled out, these symptoms are consistent with which mental health disorder? (1135) 1. Psychophysiologic reaction 2. Posttraumatic stress disorder 3. Generalized anxiety disorder 4. Bulimia nervosa

Answer 1: Psychosomatic illness refers to a physical disorder arising as a result of a psychological trigger. Posttraumatic stress disorder is related to experiencing an extreme life-or-death event that results in symptoms that recur with triggering stimuli. Generalized anxiety disorder is characterized by excessive worrying about daily aspects of normal

9. Based on factors that possibly affect mental health, which adolescent is most likely to have the best mental health later in life? (1110) 1. Participates in several school activities and has reasonably good grades 2. Very competitive in sports and especially eager to be better than older brother 3. Has a successful father, but mother died shortly after adolescent was born 4. Has exceptional academic record and parents expect superior performance in all areas

Answer 1: The adolescent who is participating in activities and has reasonably good grades is demonstrating success at school, which is a possible positive factor. The other three adolescents have some evidence of dysfunctional relationships: extreme sibling rivalry, lack of mother-child bonding at birth, and excessive parental expectations.

9. Based on factors that possibly affect mental health, which adolescent is most likely to have the best mental health later in life? (1110) 1. Participates in several school activities and has reasonably good grades 2. Very competitive in sports and especially eager to be better than older brother 3. Has a successful father, but mother died shortly after adolescent was born 4. Has exceptional academic record and parents expect superior performance in all areas

Answer 1: The adolescent who is participating in activities and has reasonably good grades is demonstrating success at school, which is a possible positive factor. The other three adolescents have some evidence of dysfunctional relationships: extreme sibling rivalry, lack of mother-child bonding at birth, and excessive parental expectations.

31.The patient asks the nurse not to tell anyone that he wants to end his life. What should the nurse tell the patient? (1130) 1. "Information must be shared with the rest of the health care team." 2. "All disclosures from patient to nurse are always confidential" 3. "Consider talking to a spiritual advisory before acting impulsively." 4. "Information is documented in writing, but not verbally discussed."

Answer 1: The information has to be shared with other team members to activate a multidisciplinary plan. Disclosures of harm to self or others cannot be kept in confidence. Suggesting a spiritual advisor may be appropriate after assessing the patient's spiritual beliefs. Documentation and verbal discussions will both occur.

28. The patient tells the nurse that he has a durable power of attorney for health care and medical treatment. What is the most important infor- mation to obtain from the patient? (751) 1. The name and phone number of the person who will make health care decisions 2. The name and phone numbers of the fam- ily member who is next of kin 3. The patient's written permission to dis- close information to the attorney 4. The patient's wishes about his or her care when death is near

Answer 1: The name and contact information of the person who will make health care decisions if the patient becomes unable to make those decisions should be on file. Generally, the facility likes to have a copy of the power of attorney on file. That person could be next of kin (e.g., spouse), but could be a sibling or adult child if the spouse is not able to make the decisions. The nurse should direct the patient and family to discuss and record wishes about death in a living will.

26. A patient was prescribed an opiate analgesic for a fractured femur. He states that he has noticed that he doesn't seem to get the relief that he used to, despite the fact that his leg is healing. What should the nurse tell the patient? (1155) 1. "Tolerance to opioids develops rapidly, but abstinence reverse tolerence" 2. "You should switch to NSAIDS". 3. "addiction to opiods is common for those who have chronic pain" 4 "This is an expected effect; I will contact the provider to increase your dosage"

Answer 1: The patient is developing a tolerance, which is expected when patients are prescribed opioids for acute pain; abstinence will resolve the problem. The nurse should not recommend medications; this is outside the scope of practice. For patients who have chronic pain, continued opioid prescriptions can result in addiction, but at this point, the patient is still having acute pain. The health care provider is unlikely to increase the dosage, because the fracture is healing; he/she will probably recommend NSAIDs.

19.The son of an elderly woman who lives in a long-term care facility reports that his mother seems to get sick whenever he tries to take vacation time with his wife. He feels frustrated, but also guilty, so he doesn't leave. What should the nurse do first(1120) 1. Validate the son's feelings of frustration and guilt and offer emotional support. 2. Reassure the elderly mother that she will be well cared for while her son is gone. 3. Suggest that the son take an overnight trip as a trial run for everyone. 4. Tell the son that the mother is manifesting a secondary gain by being sick.

Answer 1: Validating the son's feelings helps him to recognize that even though the situation is complex, he is not alone. Listening to him is supportive and therapeutic. The nurse could consider using the other options to assist this family

19. The son of an elderly woman who lives in a long-term care facility reports that his mother seems to get sick whenever he tries to take vacation time with his wife. He feels frustrated, but also guilty, so he doesn't leave. What should the nurse do first? (1120) 1. Validate the son's feelings of frustration and guilt and offer emotional support. 2. Reassure the elderly mother that she will be well cared for while her son is gone. 3. Suggest that the son take an overnight trip as a trial run for everyone. 4. Tell the son that the mother is manifesting a secondary gain by being sick.

Answer 1: Validating the son's feelings helps him to recognize that even though the situation is complex, he is not alone. Listening to him is supportive and therapeutic. The nurse could consider using the other options to assist this family.

40. Which information is appropriate when pre- paring a patient for electroconvulsive therapy (ECT)? (Select all that apply.) (1131) 1. "Pain will be experienced, but it only lasts a few seconds." 2. "Confusion may last for a few hours." 3. "A grand mal seizure occurs, but it is very brief." 4. "Temporary memory loss is experienced after treatment." 5. "Most patients are kept in the hospital for 2-3 days afterward."

Answer 2, 3, 4: A very small amount of current induces a controlled and brief grand mal seizure. Confusion and memory loss are expected, but both are transient. The patient does not experience pain and the treatments are frequently done on an outpatient basis.

27. Signs and symptoms of schizophrenia typically include: (Select all that apply.) (1128) 1. phobias. 2. delusions. 3. mania. 4. paranoia. 5. redoing.

Answer 2, 4: Schizophrenia is frequently accompanied by psychotic features that can include paranoid delusions, hallucinations, and severe disorganized thinking. Phobias are usually associated with anxiety disorders. Mania is usually associated with bipolar disorder. Redoing is a behavior associated with compulsions.

18. A parent reports that her 8-year-old child has complained of feeling sick on school days, although there is no fever, pain, change in behavior, or any other physical symptoms. Which question should the nurse ask to determine if the child is using the sick role as a coping strat- egy related to a problem at school? (1118, 1119) 1. "Don't you like your school and your teachers anymore?" 2. "Did something happen at school that made you feel uncomfortable?" 3. "What will happen if you keep missing school all the time?" 4. "What do you and your friends like to do during recess and lunch break?"

Answer 2: "Did something happen?" Is a closed question and generally open questions are preferred; however, the child is young and may have some difficulty fully articulating a problem at school. The nurse would assess the child's nonverbal behavior as he/she answers the question. The other questions might also be used during the interview if there seems to be a problem at school.

18. A parent reports that her 8-year-old child has complained of feeling sick on school days, although there is no fever, pain, change in behavior, or any other physical symptoms. Which question should the nurse ask to determine if the child is using the sick role as a coping strategy related to a problem at school? (1118, 1119) 1. "Don't you like your school and your teachers anymore?" 2. "Did something happen at school that made you feel uncomfortable?" 3. "What will happen if you keep missing school all the time?" 4. "What do you and your friends like to do during recess and lunch break?"

Answer 2: "Did something happen?" Is a closed question and generally open questions are preferred; however, the child is young and may have some difficulty fully articulating a problem at school. The nurse would assess the child's nonverbal behavior as he/she answers the question. The other questions might also be used during the interview if there seems to be a problem at school.

33.Which person is likely to have the lowest Global Assessment of Functioning (GAF) score? (1124) 1. Nursing student who just failed an important examination 2. Person who was just released from longterm imprisonment 3. Working mother who just delivered herfirst new baby 4. Teenager who broke his arm during football practice

Answer 2: All of these people are having stress related to a life event, but psychologically, the person who has just been released from prison faces the greatest changes in integrating back into society and is likely to have fewer resources or skills to help him/her adapt.

8. An adolescent female patient tells the nurse that she often feels very "uneasy," but can't identify any specific reasons for this feeling. This patient is experiencing: (1115) 1.stress. 2. Anxiety. 3. Crisis. 4. Mental illness.

Answer 2: Anxiety can be defined as a vague feeling of apprehension that results from a perceived threat to the self. Stress is the nonspecific response of the body to a demand. Crisis can be defined as an unstable period in a person's life characterized by the inability to adapt to a change from a precipitating event. Mental illness or disorder is a manifestation of dysfunction (behavioral, psychological, and biologic).

8. An adolescent female patient tells the nurse that she often feels very "uneasy," but can't identify any specific reasons for this feeling. This patient is experiencing: (1115) 1.stress. 2. anxiety. 3.crisis. 4. mental illness.

Answer 2: Anxiety can be defined as a vague feeling of apprehension that results from a perceived threat to the self. Stress is the nonspecific response of the body to a demand. Crisis can be defined as an unstable period in a person's life characterized by the inability to adapt to a change from a precipitating event. Mental illness or disorder is a manifestation of dysfunction (behavioral, psychological, and biologic).

35. The nurse is interviewing a patient who has an alcohol problem and his wife has decided to file divorce. Which patient statement typifies the most common defense mechanism used by substance abusers? 1. "My wife is the one who has a drinking problem. I am glad she is gone" 2. " I don't have a drinking problem. My wider just used that as an excuse" 3. "Have you ever been married? I wouldn't recommend it to anyone!" 4. " My wide got on my nerves, so somtimes I have a few drinks"

Answer 2: Denial is the most commonly used defense mechanism used by substance abusers.

6. The nurse is assessing an individual's use of defense mechanisms. A parent had a bad day at work and comes home and shouts at the children. This is an example of: (1117) 1. Projection. 2. Displacement. 3. Identification 4. Reaction formation.

Answer 2: Displacement occurs when emotions are expressed toward someone or something other than the actual source of the emotion. Projection is attributing to others undesirable characteristics that the person has, but does not want to admit possessing. Identification incorporates a characteristic (thought or behavior) of another individual or group. Reaction formation is conscious behavior completely opposite to the unconscious process.

6. The nurse is assessing an individual's use of defense mechanisms. A parent had a bad day at work and comes home and shouts at the children. This is an example of: (1117) 1. projection. 2. displacement. 3. identification 4. reaction formation.

Answer 2: Displacement occurs when emotions are expressed toward someone or something other than the actual source of the emotion. Projection is attributing to others undesirable characteristics that the person has, but does not want to admit possessing. Identification incorporates a characteristic (thought or behavior) of another individual or group. Reaction formation is conscious behavior completely opposite to the unconscious process.

21. The patient is in the manic phase of a bipolar affective disorder. What is primary aim of the nurse's therapeutic communication? (1130) 1. To reinforce assertive behaviors 2. To provide focus and consistency 3. To orient to surroundings and time 4. To encourage expression of feelings

Answer 2: During the manic phase, the patient will display excessive energy; thoughts will rapidly shift from topic to topic. Physical motion can be excessive to the point of exhaustion. In the acute phase, the nurse must assist the patient to stay focused enough to eat and rest as much as possible. Inconsistency increases contention and agitation.

17. The home health nurse is visiting an older patient who is socially isolated. The patient is very resistant to talking and rejects all suggestions related to social activities. Based on knowledge of how aging affects mental health, (1118) 1. Conclude that the resistance to socialization is an exaggeration of younger behavior. 2. Assess for physical, financial, or relationship limitations that exist for the patient 3. Assist the patient to reminisce about happier times with friends and family. 4. Locate and contact family members and suggest that they visit the patient.

Answer 2: First the nurse would assess for factors that may constrain the patient from fully participating in social interactions. Based on the assessment findings, the nurse may use the other options.

17. The home health nurse is visiting an older patient who is socially isolated. The patient is very resistant to talking and rejects all suggestions related to social activities. Based on knowledge of how aging affects mental health, what should the nurse do first(1118) 1. Conclude that the resistance to socialization is an exaggeration of younger behavior. 2.Assess for physical, financial, or relationship limitations that exist for the patient. 3. Assist the patient to reminisce about happier times with friends and family. 4. Locate and contact family members and suggest that they visit the patient.

Answer 2: First the nurse would assess for factors that may constrain the patient from fully participating in social interactions. Based on the assessment findings, the nurse may use the other options.

19. Which statement by the family member of a dying patient best indicates a healthy retention of hope? (744, 745) 1. "We are planning to take our father on one last trip to Europe next year." 2. "My sister is coming from California next week; I know he wants to see her." 3. "He really loves to golf and is looking forward to playing again this summer." 4. "We know a man from our church who beat his cancer; Dad can do the same."

Answer 2: For the dying patient and the family, short-term goals are encouraged as being more realistic and achievable; however, the nurse would not discourage expression of the other statements. The family and patient are going through a process and some denial at certain points would be considered a coping mechanism.

23. On assessing the patient, the nurse notes that the pulse rate is 30/min, the respiratory rate is 8/min, and the systolic blood pressure is pal- pated at 60. The patient has a DNR order. What should the nurse do first(750, 751) 1. Call the family to the bedside. 2. Make the patient comfortable. 3. Initiate CPR and call for help. 4.Start an IV and give a fluid bolus

Answer 2: If the patient is DNR, the nurse would stay with the patient and perform comfort measures. All attempts should be made to bring the family to be with the patient. CPR or an IV fluid bolus would be inappropriate because of the DNR order.

34. It's lunchtime and a staff member walks into the dayroom of an acute psychiatric unit and announces, "It's chow time folks! Hop on down." Which patient is most likely to start physically hopping? (1128) 1. Major depression with apathy and flat affect 2. Disorganized schizophrenia with concreteness 3. Panic disorder with agoraphobia and anxiety 4. Dysthymic disorder with suicidal idealizations

Answer 2: Patients who have schizophrenia display concreteness and will have trouble with metaphors or similes or idiomatic language. Patients with dementia will also demonstrate concreteness. (Note to student: The nurse might consider talking to the staff member about use of language forms when talking to patients. The goal of the unit is to move patients toward normal everyday conversation, but it is also likely that other patients wouldhave laughed at the patient who hopped around.)

23. The nurse is aware that a patient who is receiv- ing lithium therapy needs to have an adequate intake of: (1139) 1. calcium. 2. sodium. 3. magnesium. 4. potassium.

Answer 2: Reduced salt intake is a possible contributor to lithium toxicity.

37. A opioid overdose, which is most likely a suicide attempt. The patient is difficult to arouse and the family is hysterical the family is hysterical. What is the priority action?(1155) 1. Assess for time of ingestion. 2. Check airway and respiration. 3.Calm the family to obtain a history. 4. Administer naloxone (Narcan).

Answer 2: Respiratory depression is the most serious problem and the airway should be assessed and managed to prevent aspiration. The other actions are also important.

10. A nurse is talking to people who are in a sub- stance abuse support group. Which statement is evidence of the best level of mental health? (1110) 1. "I don't have any problems with drinking anymore." 2. "I just try to avoid drinking, one day at a time." 3. "As long as my wife doesn't drink, then I won't drink either." 4. "I have had a really hard time in life and I don't like being judged."

Answer 2: Setting small realistic goals is evidence of good mental health. Denial ("don't have any problems") is way of coping, but for substance abusers it is the most common overly used defense mechanism. If one's behavior is contingent on another's success, then the relationship is not healthy. Rationalization is another defense mechanism and the speaker may also be projecting feelings of being judged. Both can be used as excuses for continued substance abuse.

11. Which person is mostly likely to suffer from a maturational loss? (736) 1.. a woman married to a police officer is informed that he has been shot and killed. 2. A college student who has never been away from home goes to Europe to study. 3. A school-aged child witnesses the family pet being killed by a speeding car. 4. A middle-aged woman who was married for 30 years is divorced by her husband.

Answer 2: The college student is experiencing a change related to growing up and going out on his own. He is losing the security and safety of home as he transitions to becoming more independent. The other people are facing situational losses.

39. The nurse is caring for a patient who is scheduled to have surgery in the morning, but she also happens to have an anxiety disorder. What this anxious patient? (1126) 1. Close the door and give the patient some privacy. 2. Ask if sounds, light, or movement are disturbing. 3. Turn off the lights so that the patient can sleep. 4. Limit the number of visitors to decrease noise.

Answer 2: The nurse must first assess what the patient considers as disturbing. Although closing the door, turning off lights, and decreasing sources of sound are good generalpractices, the patient with an anxiety disorder may actually become more anxious if left alone in the dark to contemplate tomorrow's surgery.

35. The nurse's neighbor has a teenage son who displays poor hygiene and odd excessive reli- gious beliefs. Before referral to the health care provider, what could the nurse do to try to differentiate between prodromal phase schizo- phrenia and normal adolescent behavior? (1129) 1. Help the neighbor compare current behav- ior to previous behavior. 2. Talk directly to the teenager and ask about his beliefs and interests. 3. Assess and compare the parent's religious beliefs to the teen's. 4. Ask the neighbor if there is a family history of mental illness.

Answer 2: The nurse would talk to the teenager and assess for other symptoms such as affect, emotional lability, and speech patterns. Content, consistency, and rationality of beliefs and ideas may also give information. The nurse can then point out to the neighbor the normal findings and reinforce the need to follow up with the provider. Advise the neighbor to tell the provider about family history. Comparing current behavior to previous behavior is not very useful, because normal adolescent behavior is generally quite different from previous ages. The neighbor should be able to independently judge whether the son's religious beliefs are consistent with the rest of the family.

28. Which patient statement would indicate a com- pulsion? (1133) 1. "I can't stop thinking about my hand towels being out of place on the towel rack." 2. "I had to drive back home 8 times this morning to be sure I locked my front door." 3. "Those voices in my head are driving me crazy. Can you makenthem stop?" 4. " It terrfies me to think about going fishing; I know there may be spiders in the boat."

Answer 2: The patient is compelled to drive back and check the lock. The patient is obsessed by the thought of disordered towels. Voices in the head are a type of hallucination. Being afraid of spiders is a phobia.

12. Based on Freud's theory of personality development, the superego would cause the nurse to perform which action? (1114) 1. Focuses on own duties and ignores extraneous requests to perform additional tasks 2. Disagrees with patient's decision to refuse treatment, but shows respect and support 3. Minimizes the importance of a medication error to facilitate patient care 4. Obtains the continuing education units required to maintain licensure

Answer 2: The superego guides moral action and allows the nurse to think and act at the highest level of abstraction. The ego is realitybased and would cause the nurse to be focused on duties, although the id may mediate to cause the nurse to ignore requests if those requests cause unpleasantness or threats to self-interest. The id would minimize an error, because it would be easier and less painful than taking responsibility for it. Obtaining CEUs is a reality-based activity driven by the ego.

12.Based on Freud's theory of personality development, the superego would cause the nurse to perform which action? (1114) 1. Focuses on own duties and ignores extraneous requests to perform additional tasks 2. Disagrees with patient's decision to refuse treatment, but shows respect and support 3. Minimizes the importance of a medication error to facilitate patient care 4. Obtains the continuing education units re-quired to maintain licensure

Answer 2: The superego guides moral action and allows the nurse to think and act at the highest level of abstraction. The ego is realitybased and would cause the nurse to be focused on duties, although the id may mediate to cause the nurse to ignore requests if those requests cause unpleasantness or threats to self-interest. The id would minimize an error, because it would be easier and less painful than taking responsibility for it. Obtaining CEUs is a reality-based activity driven by the ego.

29. The nurse is a assessing a patient who has been in the middle stage of substance abuse for years. Which factor is likely to hasten the progression from the middle stage to the late stage(1147) 1. Poor family relationships 2. Multiple substance abuse 3. Gastrointestinal problems 4. Substance abuse on the job

Answer 2: While all of these factors are present in the middle stage, abuse of many different types of substances is most likely to hasten progression to the late stage.

17. The hospice nurse is visiting a family of a deceased patient. During the visit, the son dis- plays symptoms of a grief attack. Which inter- vention would the nurse use? (738) 1. Ensure that other members of the house- hold do not get attacked. 2. Reassure the son that he is safe and that no one will attack him. 3. Help the son recognize that the attack is a type of grief response. 4. Report the symptoms of the attack to the health care provider.

Answer 3: A grief attack is an unexpected emotional or behavioral response to a routine event or behavior. It is even possible that seeing the hospice nurse reminded the son about the deceased patient. The nurse would calmly reassure the patient that over time, his emotions will become more balanced.

26. Which nursing action is most likely to be affect- ed by the patient's advance directives? (751) 1. Instructing the UAP about how to perform select tasks of postmortem care 2. Advising the health care provider that the pain medication is not working 3. Assisting the health care provider to intubate for respiratory arrest 4. Contacting the family if the patient dies unexpectedly during the night

Answer 3: Advance directives are signed and witnessed documents providing specific instructions for health care treatment in the event that a person is unable to make these decisions personally at the time they are needed. Cardiac arrest, respiratory arrest, or other conditions that cause loss of consciousness or change in mental status would apply.

27. The nurse is working in a pediatric outpatient clinic. There is an 8-year-old child whose grandfather has just died. The nurse anticipates, based on the developmental level, that the child will respond by saying the following: (740) 1. "Grandpa will come back soon. He just went to see Grandma." 2. "Grandpa was old and supposed to die. My cat was old; he died too. " 3. "I was bad at school and talked back to Mom. That's why Grandpa died." 4. "It was better that Grandpa died quickly and didn't have to suffer a long time."

Answer 3: Children ages 5-9 years believe that wishes and actions can cause outcomes. (See Table 24-1 on p. 740 for additional information.)

23. The patient is quitting smoking cigarettes. The withdrawal from nicotine may result in the patient having: (1155) 1. lethargy. 2. improved concentration. 3. decreased heart rate. 4. decreased appetite.

Answer 3: If heavy users stop suddenly, withdrawal symptoms occur including craving, irritability, restlessness, impatience, hostility, anxiety, confusion, difficulty concentrating, disturbed sleep, increased appetite, and decreased heart rate.

33. The nurse is caring for a postoperative patient who demonstrates restlessness, tachycardia, and mild diaphoresis. How could the nurse differentiate between suspected alcohol with- drawal and postoperative complications, such as bleeding or infection (1149) 1. Call the provider and obtain an order for blood alcohol level. 2. Monitor vital signs and assess for pain re- lated to the surgery. 3. Explain concerns and then ask the patient about alcohol use. 4. This differentiation is beyond the nurse's scope of practice.

Answer 3: If the nurse suspects alcohol withdrawal, then the nurse gives the patient a matter-of-fact explanation about symptoms and directly asks the patient about alcohol use. Assessing for pain is a correct action, but recall that the symptoms could also be related to other conditions such as pulmonary emboli, anxiety, or hypoglycemia. The nurse would call the provider to report findings. A blood alcohol level is not useful if withdrawal is occurring. Making the medical diagnosis is out of the scope of nursing practice, but gathering data to give to the health care provider is a nursing responsibility

11. What is the best rationale for all nurses to study and be familiar with the concepts of basic mental health? (1110) 1. Every nurse must study mental health concepts that are tested for licensure. 2. Nurses need excellent mental health in order to help their patients. 3. Nurses have daily contact with patients who are at risk for mental health problems. 4. Younger nurses may lack personal experience in dealing with loss or mental illness.

Answer 3: In every care setting on a daily basis, the nurse will care for patients who are vulnerable to stress, anxiety, and depression. In addition, recall that more than 50% of the population in the US is likely to have a mental health disorder in their lifetime. The other options are also true or partially true.

11. What is the best rationale for all nurses to study and be familiar with the concepts of basic mental health? (1110) 1. Every nurse must study mental health concepts that are tested for licensure. 2. Nurses need excellent mental health in or-der to help their patients. 3. Nurses have daily contact with patients who are at risk for mental health problems. 4. Younger nurses may lack personal experience in dealing with loss or mental illness.

Answer 3: In every care setting on a daily basis, the nurse will care for patients who are vulnerable to stress, anxiety, and depression. In addition, recall that more than 50% of the population in the US is likely to have a mental health disorder in their lifetime. The other options are also true or partially true.

30. From a cultural standpoint, which patient is the least likely to develop alcohol? (1147) 1. Asian 2. Irishman 3. Mormon 4. Inuit

Answer 3: Many Asians, American Indians, and Inuit have deficiencies in the enzymes that metabolize alcohol. Alcoholism is higher in these ethnic groups than in the general public. Jews, Mormons, and Muslims have very low rates of alcoholism, whereas the French and the Irish have high rates.

14. There is a fir in the facility. Which patient is least likely to be able to understand and appropriately respond to a simple command? (1116) 1. Using a wheelchair to assist bedbound roommate to safe area 2. Frantically searching through belongings to find her wedding ring 3. Standing in the corner, crying, and clinging to the bedrail 4. Walking towards safe area, but arguing about the need to leave

Answer 3: Panic level of anxiety is demonstrated by extreme terror, possible immobility, and a potential danger to self and others. The patient who is assisting another with a wheelchair is using mild anxiety to problem-solve and move towards productive action. The patient walking towards the safe area is probably arguing to relieve tension and increase feelings of control. The patient who is searching for the wedding ring recognizes that there is a problem, but severe anxiety is distorting her ability to make a logical judgment.

14. There is a fire in the facility and the nurse is attempting to instruct patients to go to a safe area. Which patient is least likely to be able to understand and appropriately respond to a simple command? (1116) 1. Using a wheelchair to assist bedbound roommate to safe area 2. Frantically searching through belongings to find her wedding ring 3. Standing in the corner, crying, and clinging to the bedrail 4. Walking towards safe area, but arguing about the need to leave

Answer 3: Panic level of anxiety is demonstrated by extreme terror, possible immobility, and a potential danger to self and others. The patient who is assisting another with a wheelchair is using mild anxiety to problem-solve and move towards productive action. The patient walking towards the safe area is probably arguing to relieve tension and increase feelings of control. The patient who is searching for the wedding ring recognizes that there is a problem, but severe anxiety is distorting her ability to make a logical judgment.

32.The UAP reports that an elderly patient said, "You have been kind and I want you to remem- ber me," and then she gave the UAP her grand- mother's necklace. What should the nurse do first(1130) 1. Investigate the relationship between the patient and the UAP. 2. Instruct the UAP to return the necklace to the patient. 3. Talk to the patient about the gesture of gift- giving to employees. 4. Praise the UAP for having trust and rap- port with the patient.

Answer 3: Talk to the patient first to assess the gift-giving. Giving valued sentimental items in conjunction with "remember me" could be a signal of suicidal intent. The other options might be used after the initial assessment.

15. A nurse is talking to a 63-year-old woman who underwent grief therapy for unresolved grief related to the death of her husband. Which behavior best indicates that the therapy is help- ing? (741) 1. She frequently visits his grave site. 2. She invites his old friends to dinner. 3. She talks about things they used to enjoy. 4. She cooks and serves his favorite foods.

Answer 3: Talking about things they used to enjoy is the best indicator of the four, because reminiscence is a healthy way to think about the past. The other activities suggest that she is trying to keep him with her in the present environment.

13. The nurse suffered a terrible traumatic event during childhood, but now appears happy and satisfied with her life and career. According Freud's theory on precociousness, the nurse would: (1114) 1. Be unable to recall any memory of the traumatic event. 2. Frequently think about the event and experience growth in reflection. 3. Remember the event, but generally repress the unpleasant aspects. 4. Attempt to experience pleasure and avoid pain at all costs.

Answer 3: The nurse could recall the memory, but generally the memory, especially the painful parts, is repressed. This repression allows the nurse to have a relatively happy life. The unconscious level holds memories that are not readily recalled. The conscious level allows vivid thoughts and memories. The id part of the personality would drive attempts to experience pleasure and block pain.

13.The nurse suffered a terrible traumatic event during childhood, but now appears happy and satisfied with her life and career. According to Freud's theory on precociousness, the nurse would: (1114) 1. be unable to recall any memory of the traumatic event. 2. frequently think about the event and experience growth in reflection 3. remember the event, but generally repress the unpleasant aspects. 4. attempt to experience pleasure and avoid pain at all costs.

Answer 3: The nurse could recall the memory, but generally the memory, especially the painful parts, is repressed. This repression allows the nurse to have a relatively happy life. The unconscious level holds memories that are not readily recalled. The conscious level allows vivid thoughts and memories. The id part of the personality would drive attempts to experience pleasure and block pain.

25. Based on the information provided in the change-of-shift report, which patient will the the nurse see first? (1130) 1. Patient had ECT therapy 30 minutes ago. 2. Patient has refused to take the morning medication. 3. Patient has said, "I am going to meet my [dead] wife." 4. Patient identified "voices" with a message from God.

Answer 3: The nurse recognizes that going to meet the wife (who is dead) could be a veiled suicide threat, a metaphor, a casual remark, or part of a hallucination or delusion. Because of the potential for suicide, this patient needs priority assessment. The nurse also needs to assess the content of the message from God as a possible command hallucination to harm self or others.

13. Following the death of her husband, a wife feels that he is still with her. She also reports having dreams and vivid memories of him. Which question should the nurse ask to assess the sense of presence that the wife has de- scribed? (738) 1. "Do you think he is trying to tell you something?" 2. "What are your religious beliefs about life after death?" 3. "How do you feel about these dreams and experiences?" 4. "Would you like to see a doctor about these symptoms?

Answer 3: The nurse should assess the patient's feelings about the experiences. Sense of presence is a normal grief response and can be comforting if the person sees the deceased as safe and at rest. The other options might be considered once further assessment is conducted.

20. The patient is sobbing. When the nurse tries to find out what is wrong, the patient angrily ssays, "I'm dying! I have pain! My children are losing their mother! We are in debt up to our eyeballs! And God seems to be on a coffee break!" What does the nurse do first in order to use this data to identify and prioritize nursing diagnoses? (745) 1. Use Maslow's Hirarchy and first address the physical issue of pain. 2. Ask the RN to assume care because of mul- tiple complex diagnoses. 3. Collect additional data about each concern and consult with RN. 4. Review the plan of care and determine if these are old or new issues.

Answer 3: The patient is overwhelmed by all of the problems, so the nurse will have to use therapeutic communication and listen to what the patient has to say about each issue. This will help determine which problem is the priority. Addressing pain is a logical place to start; however, there is a possibility that the other problems are more important to the patient. There is a possibility that the nurse may decide to ask the RN to take charge of the case because the issues and analysis of the diagnoses

16. A newly admitted patient appears upset. She says, "I'm going to wear my own clothes. I'm not going to answer any more questions and I'm not giving anyone any blood or pee or any- thing else!" How should the nurse respond? (1118) 1. "You can wear your own nightgown if you would prefer." 2. "Let me call your health care provider, so you can talk to him." 3. " Coming into the hospital is really diffcult. What can I do to help?" 4. "Looks like you are having a bad time. I'll come back later."

Answer 3: When a patient enters the hospital, he/she loses normal social, employment, and family roles. Normal clothes, daily routines, and control over own body are taken away. Acknowledging difficulties and offering self are two forms of therapeutic communication. Offering to call the health care provider deflects the patient's concerns away from the nurse. Suggestion of wearing own clothes is okay, but the nurse should assess first, because the clothes may be the smallest issue. Leaving an angry patient does not help meet emotional needs.

16. A newly admitted patient appears upset. She says, "I'm going to wear my own clothes. I'm not going to answer any more questions and I'm not giving anyone any blood or pee or any- thing else!" How should the nurse respond? (1118) 1. "You can wear your own nightgown if you would prefer." 2. "Let me call your health care provider, so you can talk to him." 3. "coming into the hospital is really difficult. What can I do to help?" 4. "Looks like you are having a bad time. I'll come back later."

Answer 3: When a patient enters the hospital, he/she loses normal social, employment, and family roles. Normal clothes, daily routines, and control over own body are taken away. Acknowledging difficulties and offering self are two forms of therapeutic communication. Offering to call the health care provider deflects the patient's concerns away from the nurse. Suggestion of wearing own clothes is okay, but the nurse should assess first, because the clothes may be the smallest issue. Leaving an angry patient does not help meet emotional needs.

27. The nurse's friend tells her that she thinks her boyfriend may have an alcohol problem. Which question will elicit indicators of the Which question will elicit indicators of early stage of alcoholism? (1147) 1. "What form of alcohol does he drink" 2. " Is drinking controlling him?" 3. "what makes you think there's a problem" 4. "Have you talked to him about this"

Answer 3: When friends and family begin to query use, this is a sign that a problem is developing and the nurse can help the friend evaluate behaviors of an alcohol problem. Substance use becomes a problem when the user loses control and obtaining and using the substance begin to exert control over the individual. The form of alcohol is irrelevant. If the friend has talked to her boyfriend, it is likely that he would deny or minimize the problem.

21. A patient has a blood alcohol level of >500 mg/ dL (>0.50%). Which action is the nurse most likely to use to first?> 1. Assess for changes in mental status. 2. Assist with ambulation because of clumsiness. 3. Set limits for loosening of inhibitions. 4. Assist health care provider with intubation.

Answer 4: A blood alcohol level of >500 mg/ dL (>0.50%) will cause respiratory depression and respiratory arrest in most people. See Table 16-1, p. 433 and Table 35-2, p. 1159 for additional information.

12. A student who normally gets "As" receives a "C" on her project and experiences a loss of confidence. Which Behavior best indicates that the student is achieving growth because of this situational loss? (736, 737) 1. Does the project over and over again until the teacher gives her an "A." 2. Tells her parents to go to see the teacher and advocate for a grade change. 3. Asks another teacher to look at the project and give an opinion about the grade. 4. Requests a review of the project's strengths and weaknesses against the criteria.

Answer 4: A situational loss presents an opportunity to grow and develop. Evaluation of strengths and weaknesses is a way for the student to correct the negatives and repeat positives. The student has recognized that meeting criteria is a way to ensure future success. The other actions indicate that the "C" grade is still a threat to self-esteem and the student is continuing to emotionally struggle with that loss.

31. Which patient represents the leading national health problems i the United States (1147) 1. An infant who has birth defects and fetal alcohol syndrome 2. An adolescent with cancer who smokes medicinal cannabis 3. An executive who uses cocaine to counteract his depression 4. An elderly patient who is an alcoholic with heart disease

Answer 4: All of these patients have serious problems; however, alcoholism is a national health problem surpassed only by heart disease and cancer. In addition, the increasing number of elderly patients who need complex health care services is a national issue.

22. The nurse anticipates that the patient with an obsessive-compulsive disorder (OCD) will re- ceive: (1127) 1. Lithobid (lithium carbonate). 2. Haldol(haloperidol). 3. Thorazine(chlorpromazine). 4. Anafranil(clomipramine).

Answer 4: Drug therapy using clomipramine (Anafranil) has been of great value in treating OCD.

16. As the nurse is performing medication teach- ing, the elderly woman begins to cry. "My grandson got into my pills and overdosed. He didn't die, but my daughter won't even speak to me." What is the most therapeutic response? (738) 1. "Well, thank goodness he is okay; she should be happy about that." 2. "I'm sure everything will work out; she'll get over it, give her time." 3. "You feel like you were to blame for this, but accidents do happen." 4. "Every time you look at your medicine, you think about your family."

Answer 4: First, the nurse acknowledges the pain and loss associated with the triggering factor. Taking the medication on a routine basis would be particularly difficult for the patient because the blame and guilt would recur. The nurse would then perform an assessment and use appropriate interventions. Options 1 and 2 are false reassurances. In option 3, the nurse acknowledges feelings, but then offers a platitude.

26. The patient was admitted to the acute care fa- cility for drug-induced psychosis. He tells the nurse that he has smelled his own flesh rotting␣ for the past 2 days. Which positive symptoms is the patient is experiencing? (1128) 1. Delusion 2. Avolition 3. Akathisia 4. Hallucination

Answer 4: Hallucinations are considered a positive symptom; sensory distortion without a stimulus. Nurse should assess the patient for possible sources of body odor or infection, as there is also a possibility of illusion, which is a misinterpretation of a real stimulus. Avolition is a negative symptom. Akathisia is a side effect of some antipsychotic drugs.

15. Which nursing student is most likely to experience stress during the final examination for a course? (1115) 1. Has done well throughout the semester, but didn't get much sleep the night before the exam 2. Knows that the test is important, but believes that test is just another hurdle to get over 3. Is smart and a good student, has children, works full-time, and spouse has chronic illness 4. Has studied hard for the final examination, but graduating is contingent on test results

Answer 4: If test results have a greater impact on future life events, than the degree of anxiety is likely to be higher. The student who has done well over the semester has a positive history with studying and testing. This student probably would have done better with sleep, but knows that he/she is likely to be okay. The student who sees the test as another hurdle is not threatened by the testing process, but is more likely to see the test as a relatively mundane event. The smart, busy student is also likely to have a lot of stress because of the multiple stressful factors, but this student may have developed coping strategies over time that have helped him/ her juggle multiple stressors. For example, the student may recognize that excellent grades are less important than passing grades when considering the context of his/her life circumstances.

15.Which nursing student is most likely to experience stress during the final exam for a course? (1115) 1. Has done well throughout the semester, but didn't get much sleep the night before the exam 2. Knows that the test is important, but believes that test is just another hurdle to get over 3. Is smart and a good student, has children, works full-time, and spouse has chronic ill-ness 4. Has studied hard for the exam, but graduating is contingent on test results

Answer 4: If test results have a greater impact on future life events, than the degree of anxiety is likely to be higher. The student who has done well over the semester has a positive history with studying and testing. This student probably would have done better with sleep, but knows that he/she is likely to be okay. The student who sees the test as another hurdle is not threatened by the testing process, but is more likely to see the test as a relatively mundane event. The smart, busy student is also likely to have a lot of stress because of the multiple stressful factors, but this student may have developed coping strategies over time that have helped him/ her juggle multiple stressors. For example, the student may recognize that excellent grades are less important than passing grades when considering the context of his/her life circumstances.

14. On seeing the body of his little brother who just died from cancer, a 10-year-old sibling screams, "I won't go to the funeral! I won't go!" The mother is sobbing and the father begins to yell. What should the nurse do first (738) 1. Take the child aside and quietly talk to him about his feelings about death. 2. Encourage the father to stop yelling be- because it is not helpful. 3. Ask the mother to hold her child so that he can be supported and comforted. 4. Calmly close the door and stay with the family while they express themselves.

Answer 4: In this uncomfortable situation, the nurse recognizes that each family member is expressing such intense grief that they are not able to help or consider the feelings of each other. Rather than separate them, the nurse would stay with them as a bonding force and allow expression of emotions. Once the yell

7. Which person is demonstrating regressive behavior? (1117) 1. Victim of sexual abuse laughs while telling about the incident. 2. Aggressive adolescent participates in a lot of competitive sports. 3. An 80-year-old acts as if an incident of in- continence did not occur. 4. An 8-year-old sucks his thumb when hospitalized for the first time.

Answer 4: Regressive behavior is demonstrated by a return to behavior of an earlier age or stage of development. Laughing about abuse would be a manifestation of dissociation. Acting as though incontinence did not occur is an example of repression. Aggression can be sublimated by competitive participation in sports

7. Which person is demonstrating regressive be- havior? (1117) 1. Victim of sexual abuse laughs while telling about the incident. 2. Aggressive adolescent participates in a lot of competitive sports. 3. An 80-year-old acts as if an incident of in- continence did not occur. 4. An 8-year-old sucks his thumb when hospitalized for the first time

Answer 4: Regressive behavior is demonstrated by a return to behavior of an earlier age or stage of development. Laughing about abuse would be a manifestation of dissociation. Acting as though incontinence did not occur is an example of repression. Aggression can be sublimated by competitive participation in sports.

20. The health care provider has just informed a woman that her husband, who is in a coma, is likely to die during the night. The woman is sitting at the husband's bedside and silently weeping. Which action would be the most therapeutic? (1119, 1129) 1. Silently step outside and call other family members to come and support the wife. 2. Ask the health care provider for an order for an antianxiety medication for the wife. 3. Make the patient as comfortable as possible and reassure the wife that he is pain-free. 4. Quietly stand nearby and watch for the wife's receptiveness to touching or hug- ging

Answer 4: Standing close allows the nurse to assess the wife's needs and nonverbal behavior. Closeness, touching, and hugging can be therapeutic if the wife is receptive to physical touch from nursing staff. The nurse would ask if the wife needs assistance to notify family/ friends before initiating the call. Making the patient comfortable and pain-free will help to comfort wife, but first the nurse should address the wife's immediate emotional distress. Antianxiety medication is not needed at this time.

20. The health care provider has just informed a woman that her husband, who is in a coma, is likely to die during the night. The woman is sitting at the husband's bedside and silently weeping. Which action would be the most therapeutic? (1119, 1129) 1. Silently step outside and call other family members to come and support the wife. 2. Ask the health care provider for an order for an antianxiety medication for the wife. 3. Make the patient as comfortable as possible and reassure the wife that he is pain-free. 4. Quietly stand nearby and watch for the wife's receptiveness to touching or hugging.

Answer 4: Standing close allows the nurse to assess the wife's needs and nonverbal behavior. Closeness, touching, and hugging can be therapeutic if the wife is receptive to physical touch from nursing staff. The nurse would ask if the wife needs assistance to notify family/ friends before initiating the call. Making the patient comfortable and pain-free will help to comfort wife, but first the nurse should address the wife's immediate emotional distress. Antianxiety medication is not needed at this time.

24. A patient tells you that he is hearing voices right now that are telling him not to eat. What is the best response? (1125) 1. "What specifically did the voices tell not to eat?" 2. "Did the voices say why they didn't want you to eat?" 3. "Just ignore the voices. Lunch is served at 1:00 PM." 4. "I don't hear any voices. What you are experiencing now?"

Answer 4: The best response is to state reality and then the nurse conducts further assessment. The nurse may try to find the underlying feeling, but should try to phrase questions that do not validate the reality of voices. For example, "What is the reason for not eating?" If the patient persists in talking about the voices, then redirecting is appropriate. For example, "Ignore the voices and come and help me wipe off the lunch table."

37. The nurse is trying to assess a patient who is newly diagnosed with schizophrenia. The patient refuses to speak, but whispers, "They are listening to my conversations through the intercom." What should the nurse do? (1125) 1. Conduct the interview in whispers or by writing. 2. Walk over to the intercom and turn it off. 3. Suggest that they move to the garden area. 4. Acknowledge his feelings of fear and anxiety.

Answer 4: The nurse can acknowledge that the feeling of being listened to would create anxiety and fear. The other actions make it appear that the nurse also believes that "they" are listening. Moving to the garden could be an option, but the nurse would say, "I don't think there is a problem with the intercom, but it's nice day; we could go to the garden if that would be more comfortable for you."

24. Which nursing action demonstrates that the nurse is performing his/her responsibilities ac- cording to the National Organ Transplantation Act (Public Law 98-507, 10-14, 1984) and the Uniform Anatomical Gift Act? (751) 1. Assists the health care provider who certified death to remove the suitable organs 2. Ensures that the clinical signs of death are present before death is certified 3. Explains the process of organ donation and transplant to the family. 4.Contacts a qualified health care professional to ask family about organ donation.

Answer 4: The nurse has a responsibility to make sure that the family has the opportunity to talk to a qualified health care professional about organ donation. This is the law in most states, but also some families are comforted by being able to help other patients and families. The health care provider who certified death should not be involved in the removal or transplant of organs. The nurse is not responsible or qualified to certify death or to explain the organ donation and transplant process.

18. The UAP tells the nurse that the dying patient's family keeps calling for assistance with minor tasks that they could easily do for the patient. What should the nurse do? (744) 1. Tell the UAP to do whatever the family or patient wants him/her to do. 2. Encourage the family to participate in care to increase feelings of control. 3. Ask the UAP to clarify what he/she means by "assistance with minor tasks." 4. Assess the family's desire and ability to participate in the care of the patient.

Answer 4: The nurse must assess on a frequent basis whether the family wants to participate in the patient's care. The family members may have helped yesterday, but today they could be tired, upset, or distracted. They may have fears related to actual or perceived change in the patient's status, or repeatedly asking for assistance could be a sign of stress. Based on the initial assessment, the nurse may decide to use the other options

28. The nurse is caring for a teenager who crashed his parents' car while he was intoxicated. The mother, wracked with guilt, confides she knew he had a drinking problem, but didn't do anything about it. What is the most therapeutic response? (1150) 1. " You can't watch your kids all of the time, especially when they're teenagers 2. "The accident may be a blessinf: now you can get help for his drinking" 3. " You feel like you are to bloame, but it was his choice to drink and drive" 4. "Its hard for parents to really believe that their child has a drinking problem"

Answer 4: The nurse paraphrases the mother's underlying source of guilt. Denial is a normal and typical response for most family members. The other responses are also partially true and the nurse may decide to use them at the appropriate time.

22. The terminally ill patient has been experienceing severe pain and has requested that the health care provider assist her to end her suffering. What should the nurse do if the provider orders a morphine dosage that could cause respiratory depression and respiratory arrest? (759) 1. Administer the medication as ordered. 2. Refuse to give the ordered dose. 3. Tell the provider to administer the dose. 4. Consult the nursing supervisor for advice.

Answer 4: The nurse should consult the nursing supervisor. Active euthanasia is still illegal; even though the staff, the patient, and the family may all agree. If the provider gives the dose, there is still a possibility that the nurse could be liable for failure to intervene.

22. A coworker states that he has had too much caffeine and wants to eliminate it from his diet. Which question would the nurse ask first (1149) 1. "Are you aware that you will have withdrawl symptoms" 2. "Do you take any supplement or over-the counter meds: 3. " Have you ever tried to give up or cut down on your comsumption?" 4. "What woulkd you typically eat and drink during a 24hr peroid?"

Answer 4: The nurse would first assess the current consumption of food and drink, which are the usual sources of caffeine. Supplements and over-the-counter medications can also contain caffeine. The nurse may decide to use all of the questions.

38. The patient says, "The man on the television is telling me to buy that motorcycle." What is the most therapeutic response? (1125) 1. "It's just a television program; he wasn't really talking to you." 2. "You can't buy a motorcycle right now; you are in the hospital." 3. "Have you been thinking about buying a motorcycle?" 4. "Television advertisements try to persuade us to buy products."

Answer 4: The nurse's goal is to reflect reality in the most accurate way possible, thus the nurse makes a general statement about how television advertisements affect all viewers. The nurse needs to recognize that ideas of reference are theorized as demonstrating the patient's need to feel special. "He wasn't really talking to you" demeans the patient's feelings. "You can't buy it right now" is reality, but signals the nurse's agreement that the advertisement was just for the patient. Asking about interest in motorcycles is possible if the nurse feels that the patient would benefit from a "normal" conversation topic.

29. A woman has bipolar disorder and is currently displaying an outgoing personality, produc- tivity in her work, and great optimism. What phase of bipolar disorder is she experiencing? (1126) 1. Manic 2. Depressive 3. Cyclothymic 4. Hypomanic

Answer 4: The woman is hypomanic and is likely to feel very good about herself and the world. At this point she has less incentive to seek medical attention, even though she could progress to mania.

24. The nurse is working at a facility that assists patients who have substance abuse problems. Which substance is unlikely to produce withdrawal sign and symptoms (1159) 1. Cannabis 2. Amphetamine 3. Heroin 4. Hallucinogen

Answer 4: Withdrawal signs and symptoms are not anticipated for abuse of hallucinogens

15. __________________________ is exhibited by a person showing a lack of caring or a state of indifference to the world around him or her. (1128)

Apathy

9. __________________________ are required in circumstances of unusual death (e.g., violent trauma or un- expected death in the home). (756)

Autopsies

4.__________________________ is defined as a common depressed reaction to the death of a loved one (737)

Bereavement

8. __________________________ is a deliberate action taken with the purpose of shortening life to end suffering or to carry out the wishes of a terminally ill patient. (750)

Euthanasia

Behavior that indicates a persistent desire to be the opposite sex is termed Transgender. (1135) T or F

False. Behavior that indicates a persistent desire to be the opposite sex is termed transsexualism.

The National Council of State Boards of Nursing mandates that suspected drug abuse by a nurse must be reported. (1158) T or F

False. Currently, there is no mandatory reporting for suspected abuse. Healthcare Integrity and Protection Data Bank (HIPDB) requires

It is impossible to suffer from more than one addiction at the same time. (1145) T or F

False. It is possible to suffer from more than one addiction at the same time. An example is the alcoholic person who is also a smoker and a compulsive gambler.

Heroin is the most commonly used illicit drug in the United States. (1158) T or F

False. Marijuana is the most commonly used illicit drug in the United States.

Depression affects 1 in every 100 people every year. (1129) T or F

False. One in every 10 are affected.

Despite education of the public and laws set forth to limit availability to minors, there is an increased use of alcohol across all age groups. (1146) T or F

False. There has been a decrease in alcohol use over the years that experts attribute to education of the public and laws set forth to limit availability to minors.

People with neurosis often have no insight that they have a psychiatric problem. (1123) T or F

False. They usually do have insight.

3. __________________________ is a mental health treatment aimed at helping a patient deal with the pain of loss. (737)

Grief therapy

1. _________________________ often consists of a pattern of behaviors that is conspicuous, threatening,, and disruptive of relationships or that deviates significantly from behavior that is consider socially and culturally acceptable. (1111)

Mental illness

5. ___________________ patterns include funerals, wakes, memorials, black dress and defined time of social withdrawal. (737)

Mourning

As many as 70% of people who quit smoking relapse within 1 year. (1155) T or F

True

Hereditary factors account for 60% to 80% of mood disorders. (1129) T or F

True

The first area that alcohol affect are the higher center of the brain including the frontal cortex, which governs self-control. (1148) T or F

True

The older adult sometimes turns to alcohol, prescription and nonprescription drugs, caffeine, and nicotine to cope with the physiologic and sociologic changes of aging. (1145) T or F

True

alcohol(1147)

a. Central nervous system (CNS) depressant

a. Mild anxiety:

a. In a mild anxiety state, the body is readied for action and reaction to danger. Stressful demands are addressed with problem-solving and constructive action. Mild anxiety is common and actually useful in situations where motivation results in purposeful action. For example, it is likely that most nursing students are mildly anxious prior to an examination, so they focus on the material and devote more time to studying.

13. Patients with schizophrenia often experience __________________________, which is a reduced content of speech. (1128)

alogia

12. The inability to experience happiness or joy is known as __________________________. (1128)

anhedonia

b. Moderate anxiety:

b. In moderate anxiety, tension is increased, but perception is decreased. The person is alert to specific information and may feel irritable with some physical signs such as headache or increased vital signs. An example of moderate anxiety is the person who has waited all day long in an airport after repeated delays in flights and has a relatively urgent need to reach his/her destination.

heroin(1154

b. Most widely abused opioid

play therapy (1136)

b. Using toys, such as a puppet, to be a "spokesperson" for feelings

hypnosis(1136)

c. Helps to recover deeply repressed emotions

caffeine (1155)

c. Present in some foods, cold and sinus medications, and appetite suppressants

c. Severe anxiety:

c. Severe anxiety manifests as a narrowing of perceptual field, with distortions in communication and a feeling of impending danger. An example of severe anxiety is a bystander at the scene of a fatal accident who is trying to call 911, but is having trouble clearly communicating the situation to the dispatcher

3. During the 1930s, mental health practitioners developed electroconvulsive therapy (ECT) and insulin shock therapy and used them to treat _________________________. (1112)

schizophrenia

electroconvulsive therapy (1137)

d. A very small amount of electrical current used to trigger a tonic-clonic seizure therapies, and hydrotherapy

nicotine (1155)

d. Treatments include gum, transdermal patches, nasal spray, or bupropion

cocaine(1156)

e. Chronic abuse erodes the nasal septum and often causes sinusitis and rhinitis

therapeutic communication (1136)

e. Share meaning and interact in the interests of problem- solving and growth

adjunctive therapies (1136)

f. Includes occupational, recreational, music, magnetic, and art

amphetamine (1156)

f. Weight loss and malnutrition from the anorexia effect are sometimes severe

14. The patient with schizophrenia shows little or no nonverbal expression of emotions. The nurse docu- ments that the patient displays a(n) __________________________. (1128)

flat affect

lysergic acid diethylamide (LSD) (1156)

g. Associted with flashbacks and "Bad trips"

psychopharmacology (1138)

g. Medications that help modify an individual's behavior

2. The process of adapting to and mourning a loss is called __________________________. (735)

grief work

behavioral therapy (1136)

h. Conditioning and retraining of behavioral responses by repetition

inhalants(1158)

h. Includes solvents, glues, aerosols, refrigerants, and anesthetic gases

5. The reduction in funding has resulted in reduced availability of _________________________; access to care providers; and limited access to psychotropic medications, therapy, and _________________________ services. (1113)

housing; crisis

psychoanalysis (1136)

i. Intense therapy that brings unconscious thoughts to the surface

ecstasy (1157

i. MDMA (study guide answer is wrong, called it a baby pacifier)

group therapy (1136)

j. Group of patients with similar problems gain insight through discussion

marijuana (1157

j. Medicinal use legal in some states

1. When any aspect of self becomes no longer available to a person, that person suffers a(n) __________________________. (735)

loss

16. DSM-V is a(n) __________________________ system used to diagnose psychiatric disorders; it includes the physical, psychiatric, and social factors affecting the individual. (1142)

multiaxial

7. The most frequent symptoms experienced by the dying older adult are __________________________, __________________________, and __________________________. (747)

pain; respiratory distress; confusion

4. In the 1950s, the introduction of _________________________ drugs allowed the individual to control his or her behavior and thus spend more time in the community. (1112)

psychotherapeutic

10. Many believe that about a ______________ must pass before the bereaved can begin to think of the de- ceased without feeling intense emotional pain. (759)

year