340-Mental Health Final Exam Questions
What term should a nurse assessing a response to grieving that includes a sudden physical collapse and paralysis, and which culture group would be associated with this behavior
"Falling out" in the African American Culture
A nursing instructor is teaching about the typical grieving behaviors of Chinese Americans. Which student statement would indicate that more instruction is necessary
"In this culture, the color red is associated with death and is considered bad luck/"
A student nurse asks the instructor, "Which psychiatric disorder is most likely initially diagnosed in the elderly?" Which instructor response gives the student accurate information
"Major depressive disorder is most likely diagnosed later in life."
A child has been diagnosed with an autistic spectrum disorder. The distraught mother cries out, "I'm such a terrible mother. What did I do to cause this?" Which nursing response is most appropriate?
"Poor parenting doesn't cause autistic spectrum disorder. Research has shown that abnormalities in brain structure or function are to blame. This is beyond your control."
A nursing instructor is teaching about reminiscence therapy. What student statement indicates that learning has occurred
"Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution."
A nursing instructor presents a case study in which a three-year-old child is in constant motion and is unable to sit still during story time. She asks a student to evaluate this child's behavior. Which student response indicates an appropriate evaluation of the situation
"This child's behavior must be evaluated according to developmental norms"
A mother questions the decreased effectiveness of methylphenidate (Ritalin) prescribed for her child's ADHD. Which nursing response best addresses the mothers concern
"Your child has probably developed a tolerance to ritalin and may need a higher dosage."
After one week of continuous mental confusion, an older African American client is admitted with preliminary diagnosis of AD. What aspect should the nurse questions with this diagnosis
AD dose not develop suddenly
Chapter 29 Summary
About 1.3 million individuals currently are serving in the U.S. Armed Forces in more than 150 countries around the world. Veterans currently number 19.6 million. Since the beginning of the wars in Afghanistan and Iraq in 2001, more than 2.2 million U.S. military personnel have been deployed in 3 million tours of duty. The military lifestyle offers both positive and negative aspects to those who choose this way of life. To compensate for the extreme mobility, the focus of the military lifestyle turns inward to the military world rather than outward to the local community. In the OEF and OIF campaigns, there has been heavy dependence on the National Guard and Reserves and an escalation in the pace, duration, and number of deployments and redeployments experienced by these individuals. Military families face unique challenges, including frequent moves and many separations. Children and adolescents exhibit a number of problematic behaviors in response to the separation from a deployed parent. The cycle of deployment is described in five distinct stages: predeployment, deployment, sustainment, redeployment, and postdeployment. Special concerns of women in the military include sexual harassment, sexual assault, differential treatment and conditions, and issues related to being a parent. Although the majority do not develop a behavioral health condition, most veterans returning from a combat zone experience feelings and reactions that may contribute to difficulties with their reintegration into civilian life. TBI is a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force to the head. Symptoms of TBI are related to the severity of the injury and the area of the brain that has been injured. The most common long-term sequelae related to TBI include problems with cognition and behavior or mental health. PTSD is the most common mental disorder among veterans returning from military combat. Symptoms of PTSD may occur shortly after the trauma, or they may be delayed, in some instances for years. Depression among military veterans is common, and suicide rates among veterans and service members have continued to rise. Substance use disorder is a common co-occurring condition with PTSD. Nursing care of military families and veterans is presented in the context of the six steps of the nursing process. Treatment modalities for PTSD and TBI include psychosocial therapies, psychopharmacology, complementary therapies, and rehabilitation therapies.
A physician orders methylphenidate (Ritalin) for a child diagnosed with ADHD. Which info about this medication should the nurse provide to the parents
Administer Ritalin to the child after breakfast
A client has recently beep placed in a long-term care facility, because of marked confusion and inability to perform most activities of daily living which nursing intervention is most appropriate to maintain the client's self-esteem
Allow client to choose between two different outfits when dressing for the day
A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of IDD
Altered social interaction R/T non-adherence to social convention.
Chapter 17 Summary
Bipolar disorder is manifested by mood swings from profound depression to extreme elation and euphoria. Genetic influences have been strongly implicated in the development of bipolar disorder. Various other physiological factors, such as biochemical and electrolyte alterations, as well as cerebral structural changes, have been implicated. Side effects of certain medications may also induce symptoms of mania. No single theory can explain the etiology of bipolar disorder, and it is likely that the illness is caused by a combination of factors. Symptoms of mania may be observed on a continuum of three phases, each identified by the degree of severity: phase I, hypomania; phase II, acute mania; and phase III, delirious mania. The symptoms of bipolar disorder may occur in children and adolescents as well as in adults. Treatment of bipolar disorders includes individual therapy, group and family therapy, cognitive therapy, electroconvulsive therapy, and psychopharmacology. For the majority of clients, the most effective treatment appears to be a combination of psychotropic medication and psychosocial therapy. Some clinicians choose a course of therapy based on a model of recovery, somewhat like that which has been used for many years with problems of addiction. The basic premise of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care and to enable a person with a mental health problem to live a meaningful life in a community of choice while striving to achieve his or her full potential. For many years, the pharmacological treatment of choice for bipolar mania was lithium carbonate. A number of other medications are now being used with satisfactory results, including anticonvulsants and antipsychotics. There is a narrow margin between the therapeutic and toxic levels of lithium. Serum lithium levels must be monitored regularly while the client is on maintenance therapy.
Chapter 25 Summary
Care of the aging individual presents one of the greatest challenges for nursing. The growing population of individuals aged 65 and older suggests that the trend will progress well into the 21st century. America is a youth-oriented society. It is not desirable to be old in this culture. In some cultures, the elderly are revered and hold a special place of honor within the society, but in highly industrialized countries such as the United States, status declines with the decrease in productivity and participation in the mainstream of society. Individuals experience many changes as they age. Physical changes occur in virtually every body system. Psychologically, there may be age-related memory deficiencies, particularly for recent events. Intellectual functioning does not decline with age, but length of time required for learning increases. Aging individuals experience many losses, potentially leading to bereavement overload. They are vulnerable to depression and to feelings of low self-worth. The elderly population represents a disproportionately high percentage of individuals who commit suicide. Neurocognitive disorders are the most frequent causes of psychopathology in the elderly. Sleep disorders are very common. The need for sexual expression by the elderly is often misunderstood within our society. Although many physical changes occur at this time of life that alter an individual's sexuality, if he or she has reasonably good health and a willing partner, sexual activity can continue well past the 70s for most people. Retirement has both social and economic implications for elderly individuals. Society often equates an individual's status with occupation, and loss of employment may result in the need for adjustment in the standard of living because retirement income may be reduced by 20 to 40 percent of pre-retirement earnings. Less than 4 percent of the population aged 65 and older live in nursing homes. A profile of the typical elderly nursing home resident is a white woman about 80 years old, widowed, with multiple chronic health conditions. Much stigma is attached to what some still call "rest homes" or "old age homes," and many elderly people still equate them with a place to go to die. The strain of the caregiver role has become a major dilemma in our society. Elder abuse is sometimes inflicted by caregivers for whom the role has become overwhelming and intolerable. There is an intense need to find assistance for these people, who must provide care for their loved ones on a 24-hour basis. Home health care, respite care, support groups, and financial assistance are needed to ease the burden of this role strain. Caring for elderly individuals requires a special kind of inner strength and compassion. The poem on page 694 conveys a vital message for nurses.
A child has been recently diagnosed with mild IDD. What info about this diagnosis should the nurse include when teaching the child's mother
Children with mild IDD develop academic skills up to a sixth-grade level
Chapter 16 Summary
Depression is one of the oldest recognized psychiatric illnesses that is still prevalent today. It is so common that it has been referred to as the "common cold of psychiatric disorders." The cause of depressive disorders is not entirely known. A number of factors, including genetics, biochemical influences, and psychosocial experiences, likely enter into the development of the disorder. Secondary depression occurs in response to other physiological disorders. Symptoms of depression occur along a continuum according to the degree of severity from transient to severe. The disorder occurs at all developmental levels, including childhood, adolescence, senescence, and during the puerperium. Treatment of depression includes individual therapy, group and family therapy, cognitive therapy, electroconvulsive therapy, light therapy, transcranial magnetic stimulation, and psychopharmacology. Nursing care of the depressed client is provided using the six steps of the nursing process.
An older client has met the criteria for a depressive disorder. The client dose not respond to antidepressant meds. Which therapeutic intervention should a nurse anticipate will be ordered for this client
Electroconvulsive therapy
Chapter 24 Summary
Intellectual disability is defined by deficits in general intellectual functioning and adaptive functioning. Four levels of intellectual disability—mild, moderate, severe, and profound—are associated with various behavioral manifestations and abilities. ASD is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation. It is generally accepted that ASD is caused by abnormalities in brain structures or functions. Genetic factors are also thought to play a significant role in ASD. Children with ADHD may exhibit symptoms of inattention or hyperactivity and impulsiveness or a combination of the two. Genetics plays a role in the etiology of ADHD. Neurotransmitters that have been implicated include dopamine, norepinephrine, and serotonin. Maternal smoking during pregnancy has been linked to hyperactive behavior in offspring. CNS stimulants, alpha agonists, atomoxetine, and bupropion are commonly used to treat ADHD. The essential feature of Tourette's disorder is the presence of multiple motor tics and one or more vocal tics. Common medications used with Tourette's disorder include haloperidol, pimozide, clonidine, guanfacine, and atypical antipsychotics such as risperidone, olanzapine, and ziprasidone. ODD is characterized by a pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that occurs more frequently than is usually observed in individuals of comparable age and developmental level. With conduct disorder, there is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. The essential feature of separation anxiety disorder is excessive anxiety concerning separation from the home or from those to whom the person is attached. Children with separation anxiety disorder may have temperamental characteristics present at birth that predispose them to the disorder. General therapeutic approaches for child and adolescent psychiatric disorders include behavior therapy, family therapy, group therapies (including music, art, crafts, play, and psychoeducation), and psychopharmacology.
Chapter 28 Summary
Loss is the experience of separation from something of personal importance. Loss is anything that is perceived as such by the individual. Loss of any concept of value to an individual can trigger the grief response. Elisabeth Kübler-Ross identified five stages that individuals pass through on their way to resolution of a loss: denial, anger, bargaining, depression, and acceptance. John Bowlby described similar stages that he identified in the following manner: stage I, numbness or protest; stage II, disequilibrium; stage III, disorganization and despair; and stage IV, reorganization. George Engel's stages include shock and disbelief, developing awareness, restitution, resolution of the loss, and recovery. J. William Worden, a more contemporary clinician, has proposed that bereaved individuals must accomplish a set of tasks in order to complete the grief process. These four tasks include accepting the reality of the loss, processing the pain of grief, adjusting to a world without the lost entity, and finding an enduring connection with the lost entity in the midst of embarking on a new life. The length of the grief process is highly individual, and it can last for a number of years without being maladaptive. The acute stage of the grief process typically lasts a couple of months, but resolution usually takes much longer. Anticipatory grieving is the experiencing of the feelings and emotions associated with the normal grief process in response to anticipation of the loss. Anticipatory grieving is thought to facilitate the grief process when the actual loss occurs. Three types of pathological grief reactions have been described: Delayed or inhibited grief in which there is absence of evidence of grief when it ordinarily would be expected Distorted or exaggerated grief response in which the individual remains fixed in the anger stage of the grief process and all of the symptoms associated with normal grieving are exaggerated Chronic or prolonged grieving in which the individual is unable to let go of grieving behaviors after an extended period of time and in which behaviors are evident that indicate the bereaved individual is not accepting that the loss has occurred Several authors have identified one crucial difference between normal and maladaptive grieving: the loss of self-esteem. Feelings of worthlessness, feeling that one is a burden to others, suicide ideas, and psychomotor retardation are indicative of clinical depression rather than uncomplicated bereavement. Very young children do not understand death but often react to the emotions of adults by becoming irritable and crying more than usual. They often believe death is reversible. School-aged children understand the finality of death. Grief behaviors may reflect regression or aggression, school phobias, or sometimes a withdrawal into the self. Adolescents are usually able to view death on an adult level. Grieving behaviors may include withdrawal or acting out. Although they understand that their own death is inevitable, the concept is so far-reaching as to be imperceptible. By the time a person reaches the 60s or 70s, he or she has experienced numerous losses. Because grief is cumulative, multiple losses can result in bereavement overload. Depression is a common response. Nurses must be aware of the death rituals and grief behaviors common to various cultures. Some of these rituals associated with African Americans, Asian Americans, Filipino Americans, Jewish Americans, Mexican Americans, and Native Americans were presented in this chapter. Hospice is a program that provides palliative and supportive care to meet the special needs of people who are dying and their families. The term advance directive refers to either a living will or a durable power of attorney for health care. Advance directives allow clients to be in control of decisions at the end of life and spare family and loved ones the burden of making choices without knowing what is most important to the person who is dying.
Which statement accurately differentiates mild NCD from major NCD
Major NCD criteria requires substantial cognitive decline from a previous level of performance and mild NCD requires modest decline
Which is the reason for the proliferation of the diagnosis of NCDs
More people now survive into the high-risk period for neurocognitive disorders
Which statement accurately differentiates NCD from pseudodemntia (depression)
NCD symptoms incude disorientation to time and place, and pseudodemntia dose not
Chapter 13 Summary
Neurocognitive disorders constitute a large and growing public health concern. Delirium is a disturbance of awareness and a change in cognition that develop rapidly over a short period. Level of consciousness is often affected, and psychomotor activity may fluctuate between agitated purposeless movements and a vegetative state resembling catatonic stupor. The symptoms of delirium usually begin quite abruptly and often are reversible and brief. Delirium may be caused by a general medical condition, substance intoxication or withdrawal, or ingestion of a medication or exposure to a toxin. NCD is a syndrome of acquired, persistent intellectual impairment with compromised function in multiple spheres of mental activity, such as memory, language, visuospatial skills, emotion or personality, and cognition. Symptoms of NCD are insidious and develop slowly over time. In most clients, the disorder runs a progressive, irreversible course. NCD may be caused by genetics, cardiovascular disease, infections, neurophysiological disorders, and other general medical conditions. Nursing care of the client with an NCD is presented around the six steps of the nursing process. Objectives of care for the client experiencing an acute syndrome are aimed at eliminating the etiology, promoting client safety, and a return to the highest possible level of functioning. Objectives of care for the client experiencing a chronic, progressive disorder are aimed at preserving the dignity of the individual, promoting deceleration of the symptoms, and maximizing functional capabilities. Nursing interventions are also directed toward helping the client's family or primary caregivers learn about a chronic, progressive neurocognitive disorder. Education is provided about the disease process, expectations of client behavioral changes, methods for facilitating care, and sources of assistance and support as they struggle, both physically and emotionally, with the demands brought on by a disease process that is slowly taking their loved one away from them.
When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette's syndrome
Neuroleptic medication
Which greving behaviors should a nurse anticipate when caring for a Navajo client who lost a child
Not expressing grief openly and reluctance to touch the dead body
Chapter 19 Summary
Posttraumatic stress disorder (PTSD) is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving a personal threat to physical integrity or to the integrity of others. Symptoms may begin within the first 3 months after the trauma, or there may be a delay of several months or even years. The symptoms are associated with events that would be markedly distressing to almost anyone and include reexperiencing the trauma, a sustained high level of anxiety or arousal, or a general numbing of responsiveness. A disorder that is similar in terms of precipitating traumatic events and symptomatology to PTSD is called acute stress disorder. In ASD, the symptoms are time limited, up to 1 month following the trauma. If the symptoms last longer than 1 month, the diagnosis would be PTSD. Theories of etiology in the development of trauma-related disorders include psychosocial theory, learning theory, cognitive theory, and biological theories. Adjustment disorders are relatively common. Some studies indicate they are the most commonly ascribed psychiatric diagnoses. Clinical symptoms associated with adjustment disorders include inability to function socially or occupationally in response to an identifiable stressor. Adjustment disorder is distinguished by the predominant features of the maladaptive response. These include depression, anxiety, mixed anxiety and depression, disturbance of conduct, and mixed disturbance of emotions and conduct. Of the two types of stressors discussed (sudden-shock and continuous), more individuals respond with maladaptive behaviors to long-term, continuous stressors. Treatment modalities for PTSD include cognitive therapy, prolonged exposure therapy, group and family therapy, EMDR, and psychopharmacology. Treatment modalities for adjustment disorders include individual psychotherapy, family therapy, behavior therapy, self-help groups, crisis intervention, and medications to treat anxiety or depression. Nursing care of individuals with trauma- and stressor-related disorders is accomplished using the steps of the nursing process.
A client is diagnosed in stage 7 of AD. To address the client's symptoms, which nursing intervention should take priority
Promote dignity by providing comfort, safety, and self-care measures.
A client diagnosed with AD exhibits progressive memory loss. Diminished cognitive functioning, and verbal aggression upon experiencing frustration. Which nursing intervention is most appropriate
Schedule structured daily routines
An older client has recently moved to a nursing home. The client has trouble concentrating and socially isolates. A physician believes the client will benefit from medication therapy. Which med should the nurse expect the physician to prescribe.
Sertaline (Zoloft)
A nurse assesses a women whose husband died 13 months ago. She isolates herself, screams at her decreased spouse, and is increasingly restless according to bowlby, this widow is in which stage of the grieving process
Stage III: disorganization and despair
Which finding should the nurse expect when assessing a child diagnosed with separation anxiety disorder
The child's mother is diagnosed with an anxiety disorder
Which developmental characteristic should a nurse ID as typical of client with severe intellectual developmental disorder (IDD)
The client communicates wants and needs by "Acting out" behaviors
An older, emaciated client is brought to an emergency department by the client's caregiver. The client has bruises and abrasions on shoulders and back in multiple stages of healing. When directly asked about these symptoms, which type of client response should a nurse anticipate
The client may deny or minimize the injuries
A client diagnosed with vascular neurocognitive disorder (NCD) is discharged to home under the care of his wife. Which information should cause the nurse to questions the client's safety
The client smokes one pack of cigarettes per day
A nurse assigns a client the nursing diagnosis of complicated grieving. According to Bowlby. Which long-term outcome would be most appropriate in the nursing diagnosis
The client will accomplish the reorganization stage of grief by year one
In planning care for a child diagnosed with autistic spectrum disorder, which would be a realistic outcome
The client will establish trust with at least one caregiver by day five
A child diagnosed with severe autistic spectrum disorder has the nursing diagnosis disturbed personal identity. Which outcomes would best address this client diagnosis
The client will name own body parts as separate from other by day five.
A nurse discharges a female client to home after delivering a stillborn infant. The client finds that neighbors have dismantied the nursery that she and her husband planned. According to Worden, how could this intervention affect the women's grieving task completion.
The intervention may hamper the women from continuing a relationship with her infant
A nurse is charting assessment info about a 70-year-old client. According to the U.S. Census bureau, what term would the nurse use to describe this client
The nurse should document using the term elderly
A nurse is caring for an Irish client who has recently lost his wife. The client tells the nurse that he is planning an elaborate wake and funeral. According to George Engel, what purpose would these rituals serve?
To facilitate the acceptance of the loss of the client's wife
A client with depression has just been prescribed the antidepressant phenelzine (Nardil). She says to the nurse, "The doctor says I will need to watch my diet while I'm on this medication. What foods should I avoid?" Which of the following is the correct response by the nurse? Blue cheese, red wine, raisins Black beans, garlic, pears Pork, shellfish, egg yolks Milk, peanuts, tomatoes
a
According to the literature, which of the following is most important for individuals to maintain a healthy, adaptive old age? To remain socially interactive To disengage slowly in preparation of the last stage of life To move in with family To maintain total independence and accept no help from anyone
a
An individual who is diagnosed with Adjustment Disorder with Disturbance of Conduct most likely: Violates the rights of others to feel better. Expresses symptoms that reveal a high level of anxiety. Exhibits severe social isolation and withdrawal. Is experiencing a complicated grieving process.
a
Clara, an 80-year-old woman, says to the nurse, "I'm all alone now. My husband is gone. My best friend is gone. My daughter is busy with her work and family. I might as well just go, too." Which is the best response by the nurse? "Are you thinking that you want to die, Clara?" "You have lots to live for, Clara." "Cheer up, Clara. You have so much to be thankful for." "Tell me about your family, Clara."
a
In group exercise, Mr. B, a 79-year-old man with major depression, becomes tired and short of breath very quickly. Which of the following is the most likely cause? Age-related changes in the cardiovascular system A sedentary lifestyle The effects of pathological depression Medication the physician has prescribed for depression
a
John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regimens would most appropriately be ordered for John? Paroxetine and group therapy Diazepam and implosion therapy Alprazolam and behavior therapy Carbamazepine and cognitive therapy
a
Leon, a veteran of the war in Iraq, has been diagnosed with posttraumatic stress disorder (PTSD). He is a client of a VA outpatient clinic. He tells the nurse that he experiences panic attacks. Which of the following medications may be prescribed for Leon to treat his panic attacks? Alprazolam Lithium Carbamazepine Haldol
a
Mr. B, age 79, is admitted to the psychiatric unit for depression. He has lost weight and has become socially isolated. His wife died 5 years ago, and his son tells the nurse, "He did very well when Mom died. He didn't even cry." Which would be the priority nursing diagnosis for Mr. B? Complicated grieving Imbalanced nutrition: less than body requirements Social isolation Risk for injury
a
The physician orders lithium carbonate 600 mg tid for a client newly diagnosed with Bipolar I Disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. What is the therapeutic range for acute mania? 1.0 to 1.5 mEq/L 10 to 15 mEq/L 0.5 to 1.0 mEq/L 5 to 10 mEq/L
a
The physician orders sertraline (Zoloft) for a client who is hospitalized with Adjustment Disorder with Depressed Mood. What is this medication is intended to do? Increase energy and elevate mood Stimulate the central nervous system Prevent psychotic symptoms Produce a calming effect
a
What is the goal of cognitive therapy with depressed clients? Identify and change dysfunctional patterns of thinking. Resolve the symptoms and initiate or restore adaptive family functioning. Alter the neurotransmitters that are creating the depressed mood. Provide feedback from peers who are having similar experiences.
a
When Frank's wife of 34 years dies, he is very stoic, handles all the funeral arrangements, doesn't cry or appear sad, and comforts all of the other family members in their grief. Two years later, when Frank's best friend dies, Frank has sleep disturbances, difficulty concentrating, loss of weight, and difficulty performing on his job. This is an example of which of the following maladaptive responses to loss? Delayed grieving Distorted grieving Prolonged grieving Exaggerated grieving
a
Which of the following factors is not associated with increased incidence of NCD due to Alzheimer's disease? Multiple small strokes Family history of Alzheimer's disease Head trauma Advanced age
a
Which of the following is a correct statement when attempting to distinguish normal grief from clinical depression? In clinical depression, anhedonia is prevalent. In normal grieving, the person has generalized feelings of guilt. The person who is clinically depressed relates feelings of depression to a specific loss. In normal grieving, there is a persistent state of dysphoria.
a
Which of the following is least likely to predispose a child to Tourette's disorder? Absence of parental bonding Family history of the disorder Abnormalities of brain neurotransmitters. Structural abnormalities of the brain
a
Which of the following is thought to facilitate the grief process? The ability to grieve in anticipation of the loss The ability to grieve alone without interference from others Having recently grieved for another loss Taking personal responsibility for the loss
a
Which of the following nursing diagnoses would be considered the priority in planning care for the child with a severe ASD? Risk for self-mutilation evidenced by banging head against wall Impaired social interaction evidenced by unresponsiveness to people Impaired verbal communication evidenced by absence of verbal expression Disturbed personal identity evidenced by inability to differentiate self from others
a
Which individual is most likely to be below the poverty level in the U.S.
a 70-year-old Hispanic women living along
The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number the diagnoses in order of the appropriate priority. a) Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night b) Risk for injury related to manic hyperactivity c) Impaired social interaction evidenced by manipulation of others d) Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor
a = 3 b = 1 c = 4 d = 2
A client has just been admitted to the psychiatric unit with a diagnosis of Major Depressive Disorder. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply. a) Slumped posture b) Delusional thinking c) Feelings of despair d) Feels best early in the morning and worse as the day progresses e) Anorexia
a, b, c, e
Sally is admitted to the hospital with Major Depressive Disorder and repeatedly makes negative statements about herself. Which of the following interventions is identified as an approach that promotes positive self-esteem in the patient? Select all that apply. Teach assertive communication skills. Make observations to Sally when she completes a goal or task. Instruct Sally that you will not talk with her unless she stops talking negatively about herself. Offer to spend time with Sally using a nonjudgmental, accepting approach.
a, b, d
Trauma-informed care is a philosophical approach that includes which of the following principles? Select all that apply. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of revictimization or retraumatization. Medications need to be given before any other interventions are considered. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client. Trauma-informed care is based on the principle that traumas are not correlated with depression or increased risk for suicide.
a, c
Pam's husband of 1 year left 2 weeks ago for a year-long deployment in Afghanistan. Pam makes an appointment with the psychiatric nurse practitioner at the community mental health clinic. She tells the nurse that she can't sleep, has no appetite, is chronically fatigued, thinks about her husband constantly, and fears for his life. Which of the following might the nurse suggest/prescribe for Pam? Select all that apply. A prescription for sertraline, 50 mg/day Participation in a support group Resume involvement in usual activities Perform regular relaxation exercises
a,b,c,d
Joan's husband, who was deployed to Afghanistan a year ago, is returning home this week. Which of the following postdeployment situations may be likely to occur during the first few months of his return? Select all that apply. A honeymoon period of physical reconnection Resistance from the spouse regarding possible loss of autonomy Rejection by the children for perceived abandonment A period of adjustment to reconnect emotionally
a,b,d
Which of the following medications have been indicated for improvement in cognitive functioning in mild to moderate Alzheimer's disease? Select all that apply. a) Donepezil (Aricept) b) Rivastigmine (Exelon) c) Risperidone (Risperdal) d) Sertraline (Zoloft) e) Galantamine (Razadyne)
a,b,e
Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? Select all that apply. a) Olanzepine (Zyprexa) b) Oxycodone (Oxycontin) c) Carbamazepine (Tegretol) d) Gabapentin (Neurontin) e) Tranylcypromine (Parnate)
a,c,d
Mike, a veteran of combat in Afghanistan, has a diagnosis of mild traumatic brain injury (TBI). The psychiatric home health nurse from the VA medical center is assigned to make home visits to Mike and his wife, Nancy, who is his caregiver. Which of the following would be an appropriate nursing intervention by the home health nurse? Select all that apply. a) Assess for use of substances by Mike or Nancy. b) Encourage Nancy to do everything for Mike to prevent further deterioration in his condition. c) Assess Nancy's level of stress and potential for burnout. d) Encourage Nancy to allow Mike to be as independent as possible. e) Suggest that Nancy ask the physician for a nursing home placement for Mike.
a,c,d
In addition to disturbances in cognition and orientation, individuals with Alzheimer's disease may also show changes in which of the following? Select all that apply. a) Personality b) Vision c) Speech d) Hearing e) Mobility
a,c,e
A client diagnosed with AD has impairments of memory and judgment and is incapable of performing activities of daily living. Which nursing intervention should take priority.
assist with bathing and toileting
A major difference between normal and maladaptive grieving has been identified by which of the following? There are no feelings of depression in normal grieving. There is no loss of self-esteem in normal grieving. Normal grieving lasts no longer than 1 year. In normal grief, the person does not show anger toward the loss.
b
A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for? Fever, sore throat, malaise Tinnitus, severe diarrhea, ataxia Occipital headache, palpitations, chest pain Skin rash, marked rise in blood pressure, bradycardia
b
An acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client? "Do you like exercise?" "Come with me. I will go with you to group therapy." "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?" "Why do you stay in your room all the time?"
b
In an effort to help the child with mild to moderate intellectual developmental disorder develop satisfying relationships with others, which of the following nursing interventions is most appropriate? Interpret the child's behavior for others. Set limits on behavior that is socially inappropriate. Allow the child to behave spontaneously, for he or she has no concept of right or wrong. This child is not capable of forming social relationships.
b
John, a veteran of the war in Iraq, is diagnosed with PTSD. He says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses which of the following in John? Repressed anger Survivor's guilt Intrusive thoughts Spiritual distress
b
Leon, a veteran of the war in Iraq, has been diagnosed with posttraumatic stress disorder (PTSD). He has been hospitalized after swallowing a handful of his antipanic medication. His physical condition has been stabilized in the emergency department, and he has been admitted to the psychiatric unit. In developing his initial plan of care, which is the priority nursing diagnosis that the nurse selects for Leon? Posttrauma syndrome Risk for suicide Complicated grieving Disturbed thought processes
b
Margaret, a 68-year-old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the emergency department by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of which of the following? A delusion of grandeur A delusion of persecution A delusion of reference A delusion of control or influence
b
Margaret, a 68-year-old widow, is brought to the emergency department by her sister-in-law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister-in-law reports that Margaret quit taking her medication a few months ago, thinking she didn't need it anymore. Margaret is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just collapse!" Margaret is admitted to the psychiatric unit. What is the priority nursing diagnosis for Margaret? Imbalanced nutrition: less than body requirements related to not eating Risk for injury related to hyperactivity Disturbed sleep pattern related to agitation Ineffective coping related to denial of depression
b
Mr. Stone is a client in the hospital with a diagnosis of vascular NCD. In explaining this disorder to Mr. Stone's family, which of the following statements by the nurse is correct? "He will probably live longer than if his disorder was of the Alzheimer's type." "Vascular NCD shows stepwise progression. This is why he sometimes seems okay." "Vascular NCD is caused by plaques and tangles that form in the brain." "The cause of vascular NCD is unknown."
b
Mrs. G has been diagnosed with NCD due to Alzheimer's disease. The primary nursing intervention in working with Mrs. G is which of the following? Ensuring that she receives food she likes to prevent hunger Ensuring that the environment is safe to prevent injury Ensuring that she meets the other patients to prevent social isolation Ensuring that she takes care of her own ADLs to prevent dependence
b
Mrs. G, who has NCD due to Alzheimer's disease, says to the nurse, "I have a date tonight. I always have a date on Christmas." Which of the following is the most appropriate response? "Don't be silly. It's not Christmas, Mrs. G." "Today is Tuesday, October 21, Mrs. G. We will have supper soon, and then your daughter will come to visit." "Who is your date with, Mrs. G?" "I think you need some more medication, Mrs. G I'll bring it to you now."
b
Nina recently left her husband of 10 years. She was very dependent on her husband and is having difficulty adjusting to an independent lifestyle. She has been hospitalized with a diagnosis of Adjustment Disorder with Depressed Mood. Which of the following is the priority nursing diagnosis for Nina? Risk-prone health behavior related to loss of dependency Complicated grieving related to breakup of marriage Ineffective communication related to problems with dependency Social isolation related to depressed mood
b
Nina, who is depressed following the breakup of a very stormy marriage, says to the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!" Which is the best response by the nurse? "Cheer up, Nina. You have a lot to be happy about." "You are grieving the loss of your marriage. It's natural for you to feel badly." "Try not to dwell on how you feel. If you don't think about it, you'll feel better." "You did the right thing, Nina. Knowing that should make you feel better."
b
The physician orders sertraline (Zoloft) 50 mg PO bid for Margaret, a 68-year-old woman with Major Depressive Disorder. After 3 days of taking the medication, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? "Cheer up, Margaret. You have so much to be happy about." "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." "I'll report that to the physician, Margaret. Maybe he will order something different." "Try not to dwell on your symptoms, Margaret. Why don't you join the others down in the dayroom?"
b
Which of the following activities would be most appropriate for the child with attention deficit/hyperactivity disorder (ADHD)? Monopoly Volleyball Pool Checkers
b
Which of the following groups is most commonly used for drug management of the child with ADHD? CNS depressants (e.g., diazepam [Valium]) CNS stimulants (e.g., methylphenidate [Ritalin]) Anticonvulsants (e.g., phenytoin [Dilantin]) Major tranquilizers (e.g., haloperidol [Haldol])
b
Which of the following is the leading cause of traumatic brain injury (TBI) in active-duty military personnel in combat? Military vehicle accidents Blasts from explosive devices Falls Blows to the head from falling debris
b
Which of the following medications is used to treat Tourette's disorder? Methylphenidate (Ritalin) Haloperidol (Haldol) Imipramine (Tofranil) Phenytoin (Dilantin)
b
Why is it important for the nurse to check the temperature of the water before an elderly individual gets into the shower? The client may catch cold if the water temperature is too low. The client may burn himself because of a higher pain threshold. Elderly clients have difficulty discriminating between hot and cold. The water must be exactly 98.6°F.
b
In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? Select all that apply. Don't eat chocolate while taking this medication. Keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect. Don't take this medication with the migraine drugs "triptans." Go to the lab each week to have your blood drawn for therapeutic level of this drug. This drug causes a high degree of sedation, so take it just before bedtime.
b, c
The child with ADHD has a nursing diagnosis of impaired social interaction. Which of the following nursing interventions are appropriate for this child? Select all that apply. Socially isolate the child when interactions with others are inappropriate. Set limits with consequences on inappropriate behaviors. Provide rewards for appropriate behaviors. Provide group situations for the child.
b,c,d
Sheila, a nurse, served as a captain in the military and returned from active duty three months ago. She reports experiencing nightmares and headaches since her return but denies being engaged in active combat during her tour of duty. Which of the following should the nurse include the psychosocial assessment? Select all that apply. a) Folstein's mini-mental status exam b) History of sexual trauma c) History of military promotions d) Risks for substance use disorders
b,d
A child with bipolar disorder also has attention deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? No medication would be given for either condition. Medication would be given for both conditions simultaneously. The bipolar condition would be stabilized first before medication for the ADHD would be given. The ADHD would be treated before consideration of the bipolar disorder.
c
A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? Tell the client she cannot wear this outfit while she is in the hospital. Do nothing, and allow her to learn from the responses of her peers. Quietly walk with her back to her room and help her change into something more appropriate. Explain to her that if she wears this outfit, she must remain in her room.
c
A client whose husband died 6 months ago is diagnosed with Major Depressive Disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? "Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer." "I can understand how you must feel." "Those feelings are a normal part of the grief response." "Just think about the good times that you had while he was alive."
c
An elderly client says to the nurse, "I don't want to go to that crafts class. I'm too old to learn anything." Based on knowledge of the aging process, which of the following is a true statement? Memory functioning in the elderly most likely reflects loss of long-term memories of remote events. Intellectual functioning declines with advancing age. Learning ability remains intact, but time required for learning increases with age. Cognitive functioning is rarely affected in aging individuals.
c
Gloria, a recent widow, states, "I'm going to have to learn to pay all the bills. Hank always did that. I don't know if I can handle all of that." This is an example of which of the tasks described by Worden? Task I. Accepting the reality of the loss Task II. Processing the pain of grief Task III. Adjusting to a world without the lost entity Task IV. Finding an enduring connection with the lost entity in the midst of embarking on a new life
c
John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. Which of the following is the nurse's most appropriate initial intervention? Administer alprazolam as ordered prn for anxiety. Call the physician and report the incident. Stay with John and reassure him of his safety. Have John listen to a tape of relaxation exercises.
c
Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with a diagnosis of Major Depressive Disorder. Which of the following is the priority nursing diagnosis for Margaret? Imbalanced nutrition: less than body requirements Complicated grieving Risk for suicide Social isolation
c
Margaret, age 68, is diagnosed with Bipolar I Disorder, current episode manic. She is extremely hyperactive and has lost weight. What is one way to promote adequate nutritional intake for Margaret? Sit with her during meals to ensure that she eats everything on her tray. Have her sister-in-law bring all her food from home because she knows Margaret's likes and dislikes. Provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run." Tell Margaret that she will be on room restriction until she starts gaining weight.
c
Mike was injured during combat in Afghanistan. He has a diagnosis of traumatic brain injury (TBI). Which of the following medications might the physician prescribe to improve Mike's memory and thinking capability? Carbamazepine Duloxetine Donepezil Bupropion
c
Mr. B, age 79, is admitted to the psychiatric unit for depression. He has lost weight and has become socially isolated. His wife died 5 years ago, and he lives alone. A suicide assessment is conducted. Why is Mr. B at high risk for suicide? All depressed people are at high risk for suicide. Mr. B is in the age group in which the highest percentage of suicides occur. Mr. B is a white man, recently bereaved, living alone. His son reports that Mr. B owns a gun.
c
Nancy, who is dying of cancer, says to the nurse, "I just want to see my new grandbaby. If only God will let me live until she is born. Then I'll be ready to go." This is an example of which of Kübler-Ross's stages of grief? Denial Anger Bargaining Acceptance
c
Nina has been hospitalized with Adjustment Disorder with Depressed Mood following the breakup of her marriage. Which of the following is true regarding the diagnosis of adjustment disorder? Nina will require long-term psychotherapy to achieve relief. Nina likely inherited a genetic tendency for the disorder. Nina's symptoms will likely remit once she has accepted the change in her life. Nina probably would not have experienced adjustment disorder if she had a higher level of intelligence.
c
Stanley, age 72, is admitted to the hospital for depression. His son reports that he has periods of confusion and forgetfulness. In her admission assessment, the nurse notices an open sore on Stanley's arm. When she questions him about it he says, "I scraped it on the fence two weeks ago. It's smaller than it was." How might the nurse analyze these data? Consider that Stanley may have been attempting self-harm. The delay in healing may indicate that Stanley has developed skin cancer. A diminished inflammatory response in the elderly increases healing time. Age-related skin changes and distribution of adipose tissue delay healing in the elderly.
c
The child with autism spectrum disorder (ASD) has difficulty with trust. With this in mind, which of the following nursing actions would be most appropriate? Encourage all staff to hold the child as often as possible, conveying trust through touch. Assign a different staff member each day so child will learn that everyone can be trusted. Assign same staff person as often as possible to promote feelings of security and trust. Avoid eye contact, because this is extremely uncomfortable for the child, and may even discourage trust.
c
The night nurse finds Mrs. G, a client with Alzheimer's disease, wandering the hallway at 4 a.m. and trying to open the door to the side yard. Which statement by the nurse probably reflects the most accurate assessment of the situation? "That door leads out to the patio, Mrs. G. It's nighttime. You don't want to go outside now." "You look confused, Mrs. G. What is bothering you?" "This is the patio door, Mrs. G. Are you looking for the bathroom?" "Are you lonely? Perhaps you'd like to go back to your room and talk for a while."
c
The nursing history and assessment of an adolescent with a conduct disorder might reveal all of the following behaviors except: Manipulation of others for fulfillment of own desires. Chronic violation of rules. Feelings of guilt associated with the exploitation of others. Inability to form close peer relationships.
c
Which grief reaction can the nurse anticipate in a 10-year-old child? Statements that the deceased person will soon return Regressive behaviors, such as loss of bladder control A preoccupation with the loss Thinking that he or she may have done something to cause the death
c
Which of the following is not true regarding grieving by an adolescent? Adolescents may not show their true feelings about the death. Adolescents tend to have an immortal attitude. Adolescents do not perceive death as inevitable. Adolescents may exhibit acting out behaviors as part of their grief.
c
An example of a treatable (reversible) form of NCD is one that is caused by which of the following? Select all that apply. Multiple sclerosis Multiple small brain infarcts Electrolyte imbalances HIV disease Folate deficiency
c,e
Which of the following interventions is most appropriate in helping a client with Alzheimer's disease with her ADLs? Select all that apply. Perform ADLs for her while she is in the hospital. Provide her with a written list of activities she is expected to perform. Assist her with step-by-step instructions. Tell her that if her morning care is not completed by 9:00 a.m., it will be performed for her by the nurse's aide so that she can attend group therapy. Encourage her and give her plenty of time to perform as many of her ADLs as possible independently.
c,e
Carol, age 16, has recently been diagnosed with diabetes mellitus. She must watch her diet and take an oral hypoglycemic medication daily. She has become very depressed, and her mother reports that Carol refuses to change her diet and often skips her medication. Carol has been hospitalized for stabilization of her blood sugar. The psychiatric nurse practitioner has been called in as a consult. Which of the following nursing diagnoses by the psychiatric nurse would be a priority for Carol at this time? Anxiety related to hospitalization evidenced by noncompliance Low self-esteem related to feeling different from her peers evidenced by social isolation Risk for suicide related to new diagnosis of diabetes mellitus Risk-prone health behavior related to denial of seriousness of her illness evidenced by refusal to follow diet and take medication
d
Certain family dynamics often predispose adolescents to the development of conduct disorder. Which of the following patterns is thought to be a contributing factor? Parents who are overprotective Parents who have high expectations for their children Parents who consistently set limits on their children's behavior Parents who are alcohol dependent
d
Education for the client who is taking MAOIs should include which of the following? Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification
d
Engel identifies which of the following as successful resolution of the grief process? When the bereaved person can talk about the loss without crying When the bereaved person no longer talks about the lost entity When the bereaved person puts all remembrances of the loss out of sight When the bereaved person can discuss both positive and negative aspects about the lost entity
d
Mr. B, age 79, is admitted to the psychiatric unit for depression. He has lost weight and has become socially isolated. His wife died 5 years ago, and his son tells the nurse, "He did very well when Mom died. He didn't even cry." Which would be the priority nursing intervention for Mr. B? Take blood pressure once each shift. Ensure that Mr. B attends group activities. Encourage Mr. B to eat all of the food on his food tray. Encourage Mr. B to talk about his wife's death.
d
Mrs. G has been diagnosed with NCD due to Alzheimer's disease. The cause of this disorder is which of the following? Multiple small brain infarcts Chronic alcohol abuse Cerebral abscess Unknown
d
Mrs. G, who has NCD due to Alzheimer's disease, has trouble sleeping and wanders around at night. Which of the following nursing actions would be best to promote sleep in Mrs. G? Ask the doctor to prescribe flurazepam (Dalmane). Ensure that Mrs. G gets an afternoon nap so she will not be overtired at bedtime. Make Mrs. G a cup of tea with honey before bedtime. Ensure that Mrs. G gets regular physical exercise during the day.
d
What is the most appropriate way to communicate with an elderly person who is deaf in his right ear? Speak loudly into his left ear. Speak to him from a position on his left side. Speak face-to-face in a high-pitched voice. Speak face-to-face in a low-pitched voice.
d
Which of the following is the most common comorbid condition in children with bipolar disorder? Schizophrenia Substance disorders Oppositional defiant disorder Attention deficit/hyperactivity disorder
d
Which of the following may be influential in the predisposition to PTSD? Unsatisfactory parent-child relationship Excess of the neurotransmitter serotonin Distorted, negative cognitions Severity of the stressor and availability of support systems
d
Which of the following psychosocial therapies has been shown to be helpful for clients with traumatic brain injury (TBI)? Eye movement desensitization Psychoanalysis Reality therapy Cognitive behavioral therapy
d
Which of the following is most likely to initiate a grief response in an individual? Death of a pet dog Being told by her doctor that she has begun menopause Failing an exam A only All of the above
e
