EAQ 6: Coping and Stress Tolerance

Which assessment data are the most important to obtain from a client in crisis? 1 The client's work, recreational, and leisure time habits 2 Any significant physical, surgical, or medication health data 3 A history of emotional or mental health problems in the family 4 The client's perception of the circumstances related to the crisis

4 Knowing the client's perception of the circumstances surrounding the crisis helps the nurse determine what the situation means to the client. Work and lifestyle habits, health information, and family history should be included in a later assessment.

The nurse finds that an adolescent has episodes of binge eating followed by self-induced vomiting and strenuous exercise. Which condition is the adolescent likely to have? 1 Bulimia 2 Anorexia 3 Orthorexia 4 Binge behavior

1 Bulimia is a disorder characterized by repeated episodes of binge eating followed by inappropriate compensatory behavior, such as self-induced vomiting and/or strenuous exercise. Anorexia is an eating disorder characterized by low body weight. Orthorexia is a disorder in which the individual avoids certain foods, believing them to be harmful. Binge behavior is consumption of large amounts of foods in a brief time but without the subsequent compensatory behavior.

Which finding would indicate that a client needs to be evaluated by the health care provider for Alzheimer disease (AD)? Select all that apply. One, some, or all responses may be correct. 1 Forgets home address 2 Has difficulty multitasking 3 Unable to find food in freezer 4 Neglects balancing checkbook 5 Wears pajama bottoms to store

1 Clients with early-onset AD may forget their home address or be unable to navigate themselves home. Information overload can cause clients to struggle with multitasking, but it is not indicative of AD. Being unable to locate food in the freezer could indicate that the client is experiencing disorganization, but this is not a specific indicator of AD. Neglecting to balance one's checkbook is a fairly common oversight and does not suggest that the client has AD. Wearing pajama bottoms to run a quick errand is common and does not suggest AD.

Which condition would be a contraindication to electroconvulsive therapy (ECT)? 1 Brain tumor 2 Type 1 diabetes 3 Hypothyroid disorder 4 Urinary tract infection

1 ECT is contraindicated in the presence of a brain tumor, because the treatment causes an increase in intracranial pressure. ECT is not contraindicated in the presence of diabetes, hypothyroidism, or urinary tract infection.

Which age group of hospitalized children will have the most difficulty with separation anxiety? 1 6 to 30 months 2 36 to 59 months 3 5 to 11 years 4 12 to 18 years

1 Infants and toddlers ages 6 to 30 months experience separation anxiety. Separation anxiety occurs in preschool and young school-aged children, but it is less obvious and less serious than it is in the toddler. The school-aged child is more accustomed to periods of separation from parents. Adolescents when hospitalized are often ambivalent about whether they want their parents with them. Peer group separation may pose more anxiety for the adolescent.

Which antidepressant may be prescribed to a new mother diagnosed with depression? 1 Sertraline 2 Fluoxetine 3 Amphetamine 4 Carbamazepine

1 Sertraline is considered safe in lactating females. Dosing immediately after breast-feeding can reduce the risk for excretion of the medication in the breast milk by the next feeding time. Fluoxetine and amphetamine are not recommended for breast-feeding clients. Carbamazepine is not used to treat depression.

Although the health care provider has explained the scheduled head and neck surgery, the client still has moderate to severe anxiety. Which action would the nurse take? 1 Attempt to discover the client's concerns. 2 Elaborate on what the health care provider has already said about the surgery. 3 Teach the client to use the suction equipment. 4 Plan for the client's postoperative communication with a tracheostomy in place.

1 Various aspects of hospitalization and diagnosis may cause the client to become anxious. The nurse would identify what concerns the client the most. Anxiety interferes with learning, and it is the health care provider's responsibility to explain the surgery. Teaching the client to use the suction equipment preoperatively may cause the client unnecessary anxiety. A tracheostomy may not be performed; it depends on the type of surgery.

The nurse is preparing to administer methylphenidate to an older adult with apathy and depression. Which would the nurse include in the assessment to monitor for complications? Select all that apply. One, some, or all responses may be correct. 1 Vision 2 Weight 3 Heart rate 4 Skin turgor 5 Bowel sounds

1, 2, 3 When methylphenidate is administered to older adults, the nurse will monitor the client's vision for signs of glaucoma, as well as their weight, heart rate, and blood pressure. Skin turgor and bowel sounds are not affected by methylphenidate.

The nurse is working with a group of clients in a mental health facility. The nurse would assess risk for suicide in clients with which conditions? Select all that apply. One, some, or all responses may be correct. 1 Anxiety 2 Alcohol abuse 3 Schizophrenia 4 Bipolar disorder 5 Attention deficit disorder

1, 2, 3, 4 Certain mental health disorders increase a person's risk for suicide. These include anxiety, alcohol abuse, schizophrenia, and bipolar disorder. Attention deficit disorder does not increase a person's risk for suicide.

Which would the nurse do when a disaster survivor receives a high score on one of the Impact of Event Scale-Revised (IES-R) subscales? 1 Repeat the test. 2 Refer for further evaluation. 3 Nothing because this is an expected score. 4 Assess for a history of abuse or neglect.

2 A high score on any IES-R subscale indicates a need for further evaluation. The test does not need to be repeated. A high score is not an expected score. A high score on all subscales requires evaluation for current or past trauma such as abuse or neglect.

A client with hepatic cirrhosis begins to exhibit slurred speech, confusion, drowsiness, and a flapping tremor. Based upon this assessment, which prescribed diet would the nurse anticipate? 1 No protein 2 Moderate protein 3 High protein 4 Strict protein restriction

2 Because the liver is unable to detoxify ammonia to urea and the client is experiencing clinical manifestations leading to an impending hepatic encephalopathy coma, protein intake should be moderate. Strict protein and no-protein restrictions are not required because the client needs protein for healing. The hepatic encephalopathy diagnosis contradicts high-protein intake because protein breaks down into ammonia.

According to Piaget, which statement describes the concrete operation stage? 1 During this stage, children have egocentric thoughts. 2 During this stage, children are able to perform mental operations. 3 During this stage, children learn to think with the use of symbols and mental images. 4 During this stage, children develop an action pattern for dealing with the environment.

2 During the concrete operation stage, children are able to perform mental operations. During the formal operations stage, there is prevalence of egocentric thoughts. During the preoperational stage, children learn to think with the use of symbols and mental images. During the sensorimotor stage, children develop an action pattern for dealing with the environment.

According to Piaget's theory, which period describes a child's stage of egocentrism? 1 Sensorimotor 2 Preoperational 3 Formal operations 4 Concrete operations

2 During the preoperational period, children learn to think with the use of symbols and mental images. They exhibit egocentrism where they see all objects and persons as their own. The sensorimotor period occurs between birth and 2 years of age. During this period, infants develop an action pattern for dealing with the environment. The formal operations period lasts from 11 years of age into adulthood. During this period, the person is self-conscious and thinks he or she is invulnerable and tends to show risk-taking behaviors. The concrete operations period occurs between 7 to 11 years of age. During this period, children are able to perform mental operations.

A 5-year-old girl is undergoing a course of chemotherapy. One day the nurse sees the child crying. The child tells the nurse, "All my hair is gone, and everyone stares at me." Which is the best response by the nurse? 1 "Let's take the hair off your doll so you two will look alike." 2 "Let's ask your mother to bring in a hat for you to wear until your hair grows back." 3 "You just think that everyone is staring at you because you feel funny without your hair." 4 "You shouldn't have to look at yourself without hair, so I'm going to take this mirror out of your room."

2 Having the child wear a hat until her hair regrows meets her current needs while assuring her that her hair loss is temporary. Removing the doll's hair demeans the child's feelings. Denying the child's feelings by stating that she just thinks that everyone is staring at her is not the best response. Taking the mirror out of the room demeans the child's feelings and implies that the hair loss is unsightly.

Which class of medications would the nurse identify as used to reduce tremors caused by lithium therapy? 1 Diuretics 2 Beta blockers 3 Anticholinergics 4 Nonsteroidal anti-inflammatory drugs

2 Lithium can cause fine hand tremors that can interfere with motor skills. Tremors can be reduced by using a beta blocker such as propranolol. Diuretics lead to accumulation of lithium levels by promoting the loss of sodium. Because they cause urinary hesitancy, medications with anticholinergic actions may intensify discomfort associated with lithium-induced diuresis. Some nonsteroidal anti-inflammatory drugs can increase the renal reabsorption of lithium, thereby causing lithium levels to rise.

A client with a diagnosis of schizophrenia is prescribed an antipsychotic medication. The nurse understands which side effect of antipsychotic medications may be irreversible? 1 Akathisia 2 Tardive dyskinesia 3 Parkinsonian syndrome 4 Acute dystonic reaction

2 Tardive dyskinesia, an extrapyramidal response characterized by vermicular movements and protrusion of the tongue, chewing and puckering movements of the mouth, and puffing of the cheeks, is often irreversible, even when the antipsychotic medication is withdrawn. Akathisia (motor restlessness), parkinsonian syndrome (a disorder featuring signs and symptoms of Parkinson's disease such as resting tremors, muscle weakness, reduced movement, and festinating gait), and dystonia (impairment of muscle tonus) usually can be treated with antiparkinsonian or anticholinergic medications while the antipsychotic medication is continued.

Which type of delusion is a client displaying when he proclaims, "I am the second son of God"? 1 Influence 2 Religious 3 Reference 4 Persecutory

2 The client is expressing a religious delusion: a belief that one is favored by a higher being or is an instrument of that being. An influence delusion is a fixed false belief that one has the power to control the thoughts of another. A reference delusion is a fixed false belief that casual incidents and external events have direct personal references, such as the television is sending special messages. A persecutory delusion is a fixed false belief that one is being mistreated by others.

In light of a nurse hearing a depressed client telling another client, "I'll be feeling better soon," which initial parameter would the nurse assess for in the depressed client? 1 Ability to sleep 2 Suicidal thinking 3 Current feelings of depression 4 Subjective ideas about treatment progress

2 The nurse would assess the client's suicidal thinking. The client's comment reflects the possibility of suicide; further assessment and protection of the client are necessary. Although sleep is affected by depression, the overheard comment does not make this a priority at this time. Although feelings of depression could be getting better and subjective ideas about treatment progress could be improving, neither is the priority at this time. These assessments can be addressed after the assessment for suicide.

Which communication pattern is defined as confabulation? 1 The flow of thoughts is interrupted. 2 Imagination is used to fill in memory gaps. 3 Speech flits from one topic to another. 4 Statements are too loose to understand.

2 Using imagination to fill in memory gaps is the definition of confabulation; it is a defense mechanism used by people experiencing memory deficits. Interruption of the flow of thoughts is the definition of thought blocking. Flitting from one topic to another with no apparent meaning is the definition of flight of ideas. In associative looseness, the connections between statements are so loose that only the speaker understands them.

Which characteristics are commonly associated with adolescent depression? Select all that apply. One, some, or all responses may be correct. 1 Exercising daily 2 Having suicidal ideation 3 Exhibiting tearfulness 4 Having poor muscle tone 5 Avoiding previously enjoyed activities and relationships

2, 3, 5 Having suicidal ideation, exhibiting tearfulness, and avoiding previously enjoyed activities and relationships are characteristic features of depression. Having poor muscle tone and performing physical exercise routines are uncommon in depressed adolescents.

A client tells the nursing assistant "I am so worried about the results of the biopsy they took today." The nurse overhears the nursing assistant reply, "Don't worry. I'm sure everything will come out all right." Which conclusion would the nurse make about the nursing assistant's answer? 1 It shows empathy. 2 It uses distraction. 3 It gives false reassurance. 4 It makes a value judgment.

3 A person cannot know the results of the biopsy until it is examined under a microscope. The response does not allow the client to voice concerns, shuts off communication, and provides reassurance that may not be accurate. This answer does not empathize with the client; it minimizes the client's concerns. This response is not a form of distraction; it minimizes the client's concern and shuts off communication. This response does not contain any value statements.

Which period of Piaget's theory marks the end of cognitive development? 1 Sensorimotor 2 Preoperational 3 Formal operations 4 Concrete operations

3 According to Piaget's theory, the formal operations period marks the end of cognitive development. During this period, adolescents have the capacity to reason with respect to possibilities. The sensorimotor period is the first period when a newborn develops a schema or pattern for dealing with the environment. The second period is the preoperational period when a child develops egocentrism and animism. During the concrete operations period, children are able to perform mental operations.

A coworker's mother died 16 months ago, and she now cries whenever someone uses "mother" in casual conversation. Which conclusion would the nurse make about this behavior? 1 Crying is an expected response to death. 2 Excessive crying is an attention-seeking behavior. 3 The coworker may need help with grieving. 4 The coworker was extremely attached to her mother.

3 Crying is a release, but effective coping mechanisms should have developed. The coworker may need help with the grieving process. At 16 months after the death of a loved one, excessive crying is not an expected response. The nurse would not conclude that the coworker is seeking attention without conducting additional assessment. Concluding that the coworker was extremely attached to the mother is an unvalidated assumption.

When working with a client who has a phobia of black cats, which problem would the nurse anticipate for this client? 1 Denying that the phobia exists 2 Anger toward the feared object 3 Anxiety when discussing the phobia 4 Distortion of reality when completing daily routines

3 Discussion of the feared object triggers anxiety and an emotional response to the object. People with phobias generally acknowledge their existence. Extreme fear is more of a problem than anger. Although the client may avoid situations to avoid black cats, distortion of reality (psychosis) related to the daily routine usually is not a problem for a person with a phobia.

A client has been receiving lithium for the past 2 weeks for the treatment of bipolar disorder, manic phase. Which information will the nurse include in the teaching plan for this client? 1 A diuretic is necessary for anyone taking lithium. 2 Lithium must be taken for the rest of the client's life. 3 The blood level of lithium must be checked every month. 4 A low-sodium diet must be followed while lithium is being taken.

3 Lithium's therapeutic window is very narrow, and a toxic level may accumulate in the body unless routine checks of the medication's concentration in the blood are performed. During the acute phase of mania, the therapeutic blood level of lithium should be between 1.0 and 1.5 mEq/L (1.0-1.5 mmol/L); the maintenance therapeutic blood level of lithium ranges from 0.5 and 1.2 mEq/L (0.5-1.2 mmol/L). Diuretics reduce sodium and should be avoided; lithium is not excreted when the sodium level is decreased, resulting in toxicity. Lithium may or may not need to be taken for the rest of a client's life. A low-sodium diet can lead to hyponatremia, which must be avoided because it limits the excretion of lithium, resulting in toxicity.

Which type of crisis has occurred when a sudden terrorist act causes the deaths of thousands of adults and children and negatively affects their families, friends, communities, and the nation? 1 Situation-maturational 2 Situational 3 Maturational 4 Adventitious

4 An adventitious crisis is a crisis or disaster that is unplanned and accidental; its subcategories include natural disasters, national disasters, and crimes of violence. A situational-maturational crisis is not a typical category in crisis theory. If 2 events occurred around the same time—for example, retirement (maturational crisis) and the unexpected death of a spouse (situational crisis)—the client would have to deal with both issues. A situational crisis results from an external source and the loss is often unexpected. A maturational crisis occurs as an individual moves into a new stage of development and prior coping styles are no longer effective; maturational crises are usually predictable.

The nurse hears a child who was not invited to a sleepover say, "I have better things to do than go to that sleepover." Which defense mechanism would the nurse conclude the child is using? 1 Denial 2 Projection 3 Regression 4 Rationalization

4 Rationalization is the offering of an explanation to one's self or others to allay anxiety. Denial involves avoiding the reality of a situation; the child is not avoiding the reality of the sleepover. Projection is blaming others for one's shortcomings; the child is not blaming others for not being invited to the sleepover. Regression is returning to an earlier more familiar mode of behavior; the child is not regressing.

Which action would be difficult for a client who has borderline personality disorder to complete during the orientation phase of a therapeutic relationship? 1 Controlling anxiety 2 Terminating the session on time 3 Accepting the psychiatric diagnosis 4 Setting mutual goals for the relationship

4 Setting mutual goals for the relationship would be difficult for clients with borderline personality disorder during the orientation phase. Clients with borderline personality disorder often demonstrate a pattern of unstable interpersonal relationships, impulsiveness, affective instability, and frantic efforts to avoid abandonment; these behaviors usually create great difficulty in establishing mutual goals. Controlling anxiety would not be difficult until the client is in the working phase of the relationship. Terminating the session on time would be difficult in the termination phase of the relationship. During the orientation phase of the relationship, accepting the psychiatric diagnosis would not be the issue.

Which intervention is the most important for a young female client who was raped 3 days ago and continually talks about the trauma of being sexually assaulted? 1 Getting her involved with a rape therapy group 2 Remaining available and supportive to limit destructive anger 3 Exploring her feelings about men to promote future relationships 4 Providing a safe environment that permits the ventilation of feelings

4 The client needs to be able to express her current feelings in a safe environment. It is too soon after the assault to discuss this topic in a group. Although the nurse should be available and supportive, feelings of anger are usually not the initial response. It is too soon after the assault to discuss her feelings about men and future relationships.

Which toxic effect would the nurse find in a client who has overdosed on isocarboxazid? 1 Mydriasis 2 Bradycardia 3 Hypothermia 4 Circulatory collapse

4 The clinical symptoms of monoamine oxidase inhibitors (MAOIs) generally appear after 12 hours of ingestion. Circulatory collapse is associated with MAOI toxicity. Mydriasis, bradycardia, and hyperthermia are not associated with an isocarboxazid overdose.