N129 Chapter Review Q's

You are assessing Lindy, a 25-year-old woman who came to the emergency department with a broken arm. She states she slipped on the ice on the steps outside her home. She has numerous other bruises in different stages of healing. Her boyfriend, with whom she lives, accompanied her to the emergency department and aggressively responds to questions posed to the patient, while the patient remains silent. What is your best response to the boyfriend? a. "It sounds as if you care a lot about Lindy. She is lucky to have such support." b. "By answering the questions for her, it sounds as if you don't want her to answer. What are you afraid of?" c. "I now need to examine Lindy in private. Please wait outside the room. I will come get you when we are finished." d. "I am calling security to have you escorted out because you are being obnoxious."

c. "I now need to examine Lindy in private. Please wait outside the room. I will come get you when we are finished."

You are working in the emergency department caring for 21-year-old Larissa, who has just been raped. Which is your best initial nursing response? a. "We need to examine you for injuries and collect evidence for the police." b. "May I get your consent to test you for pregnancy and HIV?" c. "You are safe here." d. "I will get you the number for the crisis intervention specialist."

c. "You are safe here."

You are working at a telephone hotline center when Abby, a rape victim, calls. Abby states she is afraid to go to the hospital. What is your best response? a. "I'm here to listen, and we can talk about your feelings." b. "You don't need to go to the hospital if you don't want to." c. "If you don't go to the hospital, we can't collect evidence to help convict your rapist." d. "Why are you afraid to seek medical attention?"

a. "I'm here to listen, and we can talk about your feelings."

Andie is a patient anxiously waiting her turn to speak with you. As you are very busy, you ask Andie if she can wait a few minutes so that you can finish your task. Unfortunately the task takes longer than anticipated and you are delayed getting back to Andie. On seeing you approach her, Andie accuses you of lying and refuses to speak with you. Which response is most likely to be therapeutic at this time? a. "You are angry that I didn't speak with you when I promised I would." b. "I'm sorry for being late, but screaming at me is not the best way to handle it." c. "You are too angry to talk right now. I'll come back in 20 minutes, and we can try again." d. "Why are you angry? I told you that I was busy and would get to you as soon as I could."

a. "You are angry that I didn't speak with you when I promised I would."

The psychiatric forensic nurse (PFN) has been asked to evaluate an incarcerated patient who has mental health problems for a competency hearing. As the patient is being considered for sentencing, what is the PFN's role? Select all that apply. a. Assess the patient for level of competency b. Determine whether the patient is guilty or innocent c. Assist in determining the length of the sentence d. Complete a formal report to the court e. Become an advocate for the incarcerated patient

a. Assess the patient for level of competency

Josefina was raped 6 months ago. Which symptom(s) should you anticipate for long-term successful outcomes? Select all that apply. a. Evidence of comfort in relationships b. Numbness, shock, and disbelief c. Recognition of the right to be protected from abuse d. Fear of sexual encounters e. Dreams with violent content f. Anxiety being replaced by calmness g. Absence of phobia of being alone

a. Evidence of comfort in relationships c. Recognition of the right to be protected from abuse f. Anxiety being replaced by calmness g. Absence of phobia of being alone

Perpetrators of domestic violence tend to: Select all that apply. a. Have relatively poor social skills and to have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. c. Force their mates to work and expect them to handle the financial decisions. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family.

a. Have relatively poor social skills and to have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family.

Brittany is caring for a patient with bulimia. She recognizes which of the following nursing interventions as being most appropriate? a. Monitor the patient on bathroom trips after eating. b. Allow the patient extensive private time with family members. c. Provide meals whenever the patient requests them. d. Encourage the patient to select foods that she likes.

a. Monitor the patient on bathroom trips after eating.

An appropriate expected outcome in family therapy regarding the perpetrator of abuse would be: a. A decrease in family interaction so that there are fewer opportunities for abuse to occur. b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses. c. The perpetrator will not live with the family but have supervised contact while undergoing intensive inpatient therapy. d. A triad of treatment modalities, including medication, counseling, and role-playing opportunities.

b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses.

ou are preparing Genevieve, an 86-year-old patient diagnosed with Alzheimer's disease, for discharge and giving discharge education to Genevieve's family, who will be caring for her. Which of the following intervention(s) would be beneficial to teach Genevieve's family? Select all that apply. a. Recommend switching to hospital-type gowns to facilitate bathing, dressing, and other physical care of the patient. b. Discourage wandering by installing complex locks or locks placed at the tops of doors where the patient cannot readily reach them. c. For situations in which the patient becomes upset, teach loved ones to listen briefly, provide support, and then change the topic. d. Recognize that the patient can no longer successfully interact with others; provide a darkened, quiet room for her to spend her time. e. Encourage caregivers to care for themselves, as well as the patient, via use of support resources such as adult day care or respite care. f. If the patient is prone to wandering away, encourage family to notify police and neighbors of the patient's condition, wandering behavior, and description.

a. Recommend switching to hospital-type gowns to facilitate bathing, dressing, and other physical care of the patient. b. Discourage wandering by installing complex locks or locks placed at the tops of doors where the patient cannot readily reach them. c. For situations in which the patient becomes upset, teach loved ones to listen briefly, provide support, and then change the topic. e. Encourage caregivers to care for themselves, as well as the patient, via use of support resources such as adult day care or respite care. f. If the patient is prone to wandering away, encourage family to notify police and neighbors of the patient's condition, wandering behavior, and description.

You respond to a loud, angry voice coming from the day room, where you find that Alex is pacing and shouting that he isn't "going to take this (expletive) anymore." Which of the following responses is likely to be helpful in de-escalating Alex? Select all that apply. a. Remain calm, quiet, and in control. b. Tell Alex that his actions are unacceptable and that he must go to his room. c. Match Alex's volume level so that he is able to hear over his own shouting. d. Ask Alex if he can tell you what is upsetting him so you may be able to help. e. Stand close to Alex so you can intervene physically if needed to protect others. f. Tell Alex that he could be placed in seclusion if he cannot control himself so that the patient is aware of negative consequences.

a. Remain calm, quiet, and in control. d. Ask Alex if he can tell you what is upsetting him so you may be able to help.

Which of the following are believed to help individuals mediate, or lessen, the effects of stress? Select all that apply. a. Spirituality and/or religious beliefs b. Wealth c. Higher education level d. Social support e. Culture

a. Spirituality and/or religious beliefs d. Social support e. Culture

The nurse is planning care for a patient with a binge eating disorder. What outcomes are appropriate? Select all that apply. a. The patient will identify stressors that lead to binge eating. b. The patient will identify four alternate coping skills. c. The patient will increase dietary intake. d. The patient will experience satisfaction in eating alone.

a. The patient will identify stressors that lead to binge eating. b. The patient will identify four alternate coping skills.

While on an inpatient unit, you are caring for newly admitted Alyssa, a 16-year-old diagnosed with anorexia nervosa. Number the following nursing interventions in order of priority: a. Initiate a therapeutic relationship. b. Promote caloric consumption. c. Assess for suicidal ideation d. Review accomplishments made during treatment. e. Explore feelings of underlying anxiety and low self-esteem.

a. _1_ Initiate a therapeutic relationship. b. _3_ Promote caloric consumption. c. _2_ Assess for suicidal ideation d. _5_ Review accomplishments made during treatment. e. _4_ Explore feelings of underlying anxiety and low

Neal, age 30, will be undergoing biofeedback. Which statement by Neal indicates a need for further teaching? a. "This will measure my muscle activity, heart rate, and blood pressure." b. "It will help me recognize how my body responds to stress." c. "I will feel a small shock of electricity if I tell a lie." d. "The instruments will know if my skin temperature changes."

b. "It will help me recognize how my body responds to stress."

Ian makes the following statements to you while admitting him. Which statement indicates an increased likelihood of violent behavior? a. "When I get mad, I want to be left alone." b. "Last time I was in here I ended up in seclusion for punching my roommate." c. "My old man was meek and mild, and I've always said I'm not going to be like him." d. "My girlfriend says I yell way too much, and she's threatened to leave me."

b. "Last time I was in here I ended up in seclusion for punching my roommate."

You are caring for a patient who is experiencing a crisis. Which symptoms would indicate that the patient is in the stage of alarm? a. Constricted pupils b. Dry mouth c. Decrease in heart rate d. Sudden drop in blood pressure

b. Dry mouth

Lucas is a nurse on a medical floor caring for Kelly, a 48-year-old patient with newly diagnosed type 2 diabetes. He realizes that depression is a complicating factor in the patient's adjustment to her new diagnosis. What problem has the most potential to arise? a. Development of agoraphobia b. Treatment nonadherence c. Frequent hypoglycemic reactions d. Sleeping rather than checking blood sugar

b. Treatment nonadherence

Intervention(s) appropriate for Evelyn and other hospitalized patients experiencing delirium include which of the following? Select all that apply. a. Immediately placing the patient in restraints if she begins to hallucinate or act irrationally or unsafely b. Ensuring that a clock and a sign indicating the day and date are displayed where the patient can see them easily c. Being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care d. Preventing sensory deprivation by placing the patient near the nurses' station and leaving the television and multiple lights turned on 24 hours per day e. Speaking with the patient frequently for short periods for reassurance, assisting the patient in remaining oriented, and ensuring the patient's safety f. Anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering

b. Ensuring that a clock and a sign indicating the day and date are displayed where the patient can see them easily c. Being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care e. Speaking with the patient frequently for short periods for reassurance, assisting the patient in remaining oriented, and ensuring the patient's safety f. Anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering

Which of the following are true regarding feeding disorders in children? Select all that apply. a. Feeding disorders usually reflect poor parenting. b. Feeding disorders are often manifested in children with developmental delays. c. Feeding disorders are most often treated with a punishment system. d. In many cases, toddler mealtime difficulties spontaneously resolve with no intervention. e. Behavior modification has been found to be effective in treating feeding disorders.

b. Feeding disorders are often manifested in children with developmental delays. d. In many cases, toddler mealtime difficulties spontaneously resolve with no intervention. e. Behavior modification has been found to be effective in treating feeding disorders.

Nathan, a nursing student, is assigned to care for Shawna, who is recovering from injuries received during an episode of domestic violence, the third such assault for which she has received treatment. Nathan left home at age 17 to escape an abusive father. Which statements about Nathan's situation are accurate? Select all that apply. a. He may be prone to blame the patient for her injuries and abuse. b. His personal experiences give him special insight into the needs of this patient. c. His experiences are likely to make him more empathetic towards victims. d. Caring for victims of abuse will help him cope with his own abuse experiences. e. He may experience overwhelming emotions as a result of caring for abuse victims. f. He would likely benefit from clinical supervision related to caring for abuse victims.

b. His personal experiences give him special insight into the needs of this patient. c. His experiences are likely to make him more empathetic towards victims. e. He may experience overwhelming emotions as a result of caring for abuse victims. f. He would likely benefit from clinical supervision related to caring for abuse victims.

A suitable outcome criterion for the nursing diagnosis Ineffective coping related to dependence on pain relievers to treat chronic pain of psychological origin is: a. Patient will participate in self-care with optimal participation. b. Patient will learn and practice effective coping skills. c. Patient will demonstrate improved self-esteem as evidenced by focusing less on weaknesses. d. Patient will replace demanding, manipulative behaviors with more socially acceptable behavior.

b. Patient will learn and practice effective coping skills.

You are caring for Naomi, who has been arrested and is found to be at risk for alcohol and drug dependence/abuse. Which approach is thought to be most useful in treating Naomi? a. Recommend that the patient receive treatment when released from jail b. Provide immediate drug/alcohol treatment plan c. Immediately withdraw all medications d. Isolate the patient until withdrawal from drugs is complete

b. Provide immediate drug/alcohol treatment plan

Evelyn, a 73-year-old woman with pneumonia becomes agitated after being admitted to the intensive care unit through the emergency department. Her vital signs are erratic, and her thinking seems disorganized. During her first 24 hours in ICU, the patient varies from somnolent to agitated and from laughing to angry shouting. Her daughter reports that the patient "was never like this at home." What is the most likely explanation for the situation? a. Pneumonia has worsened the patient's early-stage dementia. b. The patient is experiencing delirium secondary to the pneumonia. c. The patient is sundowning due to the decreased stimulation of the intensive care unit. d. The patient does not want to be in the hospital and is angry that staff will not let her leave.

b. The patient is experiencing delirium secondary to the pneumonia.

Ed, a registered nurse, is planning care for a patient with primary insomnia. What is an appropriate outcome? a. The patient will sleep 12 hours nightly. b. The patient will go to sleep and wake up at consistent times. c. The patient will take one nap daily to restore energy. d. The patient will drink a warm cup of tea before bedtime.

b. The patient will go to sleep and wake up at consistent times.

You are caring for Yolanda, a 67-year-old patient who has been receiving hemodialysis for 3 months. Yolanda reports that she feels angry whenever it is time for her dialysis treatment. You attribute this to: a. Organic changes in Yolanda's brain. b. A flaw in Yolanda's personality. c. A normal response to grief and loss. d. Denial of the reality of a poor prognosis.

c. A normal response to grief and loss.

Which statement about violence and nursing is accurate? a. Unless working in psychiatric mental health settings, nurses are unlikely to experience patient violence. b. To date, no legislation exists that addresses workplace violence against nurses. c. Emergency, psychiatric, and step-down units have the highest rates of violence toward staff. d. Violence primarily affects inexperienced or unskilled staff who cannot calm their patients.

c. Emergency, psychiatric, and step-down units have the highest rates of violence toward staff.

If it is determined that a patient will benefit from guided imagery, what teaching should you provide? a. Focus on a visual object or sound. b. Become acutely aware of your breathing pattern. c. Envision an image of a place that is peaceful. d. Develop deep abdominal breathing.

c. Envision an image of a place that is peaceful.

Which statement regarding forensic nursing is accurate? a. Forensic nurses must all be prepared at the doctoral level. b. Forensic nurses focus on sexual assault examinations as this fits within the scope of practice. c. Forensic psychiatric nurse examiners are prepared to conduct court-ordered evaluations regarding sanity or competency. d. Forensic psychiatric mental health nurses are not permitted to act as hostage negotiators.

c. Forensic psychiatric nurse examiners are prepared to conduct court-ordered evaluations regarding sanity or competency.

The nurse is admitting a patient who weighs 100 pounds, is 66 inches tall, and is below ideal body weight. The patient's blood pressure is 130/80 mmHg, pulse is 72 beats per minute, potassium is 2.5 mmol/L, and ECG is abnormal. Her teeth enamel is eroded, her hands are shaking, and her parotid gland is enlarged. The patient states, "I am really nervous about coming to this unit." What is the priority nursing diagnosis? a. Powerlessness b. Risk for injury c. Imbalanced nutrition: Less than body requirements d. Anxiety

c. Imbalanced nutrition: Less than body requirements

Your 39- year-old patient, Samantha, who was admitted with anxiety, asks you what the stress-relieving technique of mindfulness is. The best response is: a. Mindfulness is focusing on an object and repeating a word or phrase while deep breathing b. Mindfulness is progressively tensing, then relaxing, body muscles c. Mindfulness is focusing on the here and now, not the past or future, and paying attention to what is going on around you d. Mindfulness is a memory system to assist you in short-term memory recall

c. Mindfulness is focusing on the here and now, not the past or future, and paying attention to what is going on around you

Which patient behavior would alert the nurse to a circadian rhythm sleep disorder? a. Excessive sleepiness for at least 1 month, accompanied by prolonged sleep episodes b. Multiple episodes of brief daytime sleeping followed by disturbed nighttime sleep c. Persistent patterns of sleep disruption after traveling for business d. Repeated episodes of upper airway collapse and obstruction that results in sleep fragmentation.

c. Persistent patterns of sleep disruption after traveling for business

Which role does a correctional nurse not fulfill within the corrections setting? a. Nursing assessment b. Maintain proper safety procedures c. Psychotherapist d. Document patient progress

c. Psychotherapist

Tara, a 19-year-old freshmen college student, arrives for a follow-up appointment at the mental health clinic where you work. She had previously been seen in the clinic for crisis intervention three weeks ago after being raped. Tara states, "My mom says I was asking for trouble because of the way I was dressed at the party. She says when girls dress so sexy, men can't help themselves." Your response is guided by the knowledge that: a. Statistics show that women who dress provocatively are more likely to be raped. b. The party setting is more a factor in rape occurrences than what the victim is wearing. c. Rape is an act of violence, aggression, and power, not an expression of sexual needs. d. Tara is exhibiting symptoms of an acute phase of rape-trauma syndrome and will need further counseling sessions.

c. Rape is an act of violence, aggression, and power, not an expression of sexual needs.

Madelyn, a 29-year-old patient recently diagnosed with depression, comes to the mental health clinic complaining of continued difficulty sleeping. One week ago, she was started on a selective serotonin reuptake inhibitor (SRRI), fluoxetine, for her depressive symptoms. When educating Madelyn, your response is guided by the knowledge that: a. SSRIs such as fluoxetine more commonly cause hypersomnolence as opposed to difficulty sleeping. b. The sleep problem is caused by the depression and is unrelated to the medication. c. The neurotransmitters involved in sleep and wakefulness are the same neurotransmitters targeted by many psychiatric medications and the problem may be temporary. d. The medication should be discontinued because sleep is the most important element to her recovery.

c. The neurotransmitters involved in sleep and wakefulness are the same neurotransmitters targeted by many psychiatric medications and the problem may be temporary.

You are caring for Aaron, a 38-year-old patient diagnosed with somatic symptom disorder. When interacting with you, Aaron continues to focus on his severe headaches. In planning care for Aaron, which of the following interventions would be appropriate? a. Call for a family meeting with Aaron in attendance to confront Aaron regarding his diagnosis. b. Educate Aaron on alternative therapies to deal with pain. c. Improve reality testing by telling Aaron that you do not believe that the headaches are real. d. Shift focus from Aaron's somatic concerns to feelings and effective coping skills.

d. Shift focus from Aaron's somatic concerns to feelings and effective coping skills.

You are caring for Malcolm, an 83-year-old African American patient with Alzheimer's disease. Malcolm exhibits agitated behavior at times, especially when he feels he is missing work, and he sometimes attempts to leave the unit to "get to the school where I teach." Which of the following interventions is appropriate for de-escalating Malcolm's agitation? a. Medicate Malcolm with prn medication at regular intervals to prevent agitation. b. Repeatedly explain to Malcolm that he is retired and no longer teaches as the repetition will reinforce the patient's orientation. c. Use validation therapy and ask Malcolm about the school and his job. d. Reduce stimulation in the environment by having Malcolm sit by himself in his room until the agitation passes.

c. Use validation therapy and ask Malcolm about the school and his job.

You are providing teaching for a patient who has been taking a hypnotic medication to sleep. What education is appropriate? a. "You can use this medication for as long as you would like." b. "It would be better to take an over-the-counter medication instead." c. "Melatonin has been shown to be just as effective as hypnotic medications." d. "Be certain to follow up with your care provider regularly while you take this medication."

d. "Be certain to follow up with your care provider regularly while you take this medication."

Mrs. Smith dies at the age of 82. In the 2 months following her death, her husband, aged 84 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate? a. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him. b. Meet with family and support persons to help them accept, anticipate, and prepare for the progression of his stage II dementia. c. Avoid touch and proximity; these are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented. d. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression.

d. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression.

You are discharging Vanessa, a 30-year-old victim of domestic violence, from the emergency department. She has sustained bruises and abrasions but no serious trauma. She is fearful that Children's Services will take custody of her daughter. Her daughter has not been harmed and is safe with Vanessa's mother. Which intervention on your part is indicated? a. Report the assault to the police, because reporting of domestic violence is mandatory. b. Probe Vanessa for information to use as evidence in prosecuting the perpetrator. c. Advise Vanessa to leave her abusive partner and move in with her mother. d. Assist Vanessa to develop a safety plan for rapid escape should abuse happen again.

d. Assist Vanessa to develop a safety plan for rapid escape should abuse happen again.

Which statement about dementia is accurate? a. The majority of people over age 85 are affected by dementia. b. Disorientation is the dominant and most disruptive symptom of dementia. c. People with early dementia do not tend to be distressed by symptoms. d. Hypertension, diminished activity levels, and head injury increase the risk of dementia.

d. Hypertension, diminished activity levels, and head injury increase the risk of dementia.

The information that is least relevant when assessing a patient with a suspected somatization disorder is: a. Understanding coping mechanisms. b. Results of diagnostic workups. c. Limitations in activities of daily living. d. Potential for violence.

d. Potential for violence.

Mindy is the nurse caring for Caitlin, who was raped the night before. Caitlin is considering the morning-after pill to prevent a possible pregnancy that may have resulted from the rape. Caitlin is concerned and states that she does not believe in abortion. Which of the following is the most appropriate action for Mindy to take? a. Examine her own feelings about abortion before discussing this with Caitlin. b. Encourage Caitlin to take more time to consider her options. c. Provide Caitlin with the number to Planned Parenthood. d. Provide Caitlin with medication education.

d. Provide Caitlin with medication education.

A patient states that he only needs 6 hours of sleep per night to feel rested. How should the nurse interpret this statement? a. The patient is not sleeping enough. b. The patient is sleeping too much. c. The patient is not getting enough REM sleep. d. The patient is sleeping according to his own body's needs.

d. The patient is sleeping according to his own body's needs.

In order to determine a patient's legal sanity or competency the psychiatric forensic nurse must assess all of the following, except: a. The patient's ability to distinguish right from wrong regarding the act b. The patient's capacity to understand the nature of the act committed c. The evidence with respect to the defendant's mental state at the time of the act d. The patient's social network

d. The patient's social network