EAQ PSYCH

A victim of rape is diagnosed with rape-trauma syndrome. Which signs and symptoms does the nurse find in the victim? Select all that apply. 1 Anxiety 2 Aggression 3 Nightmares 4 Low alertness 5 Relaxed muscles

1,2,3 anxiety, aggression, nightmares A rape victim may develop rape-trauma syndrome which is a sustained and maladaptive response to the event of rape. It is characterized by experiencing nightmares. The victim may appear anxious, and may be angry and aggressive. Low alertness and relaxed muscles are not the manifestations of rape-trauma syndrome. Patients of rape-trauma syndrome are hyperalert. They also have increased muscle tension.

What is the focus for the acute phase of treatment for anorexia nervosa? 1 Weight restoration 2 Improving interpersonal skills 3 Learning effective coping methods 4 Changing family interaction patterns

1 Weight restoration is the priority goal of treatment for the patient with anorexia nervosa because health is threatened seriously by the underweight status.

What guideline for nursing care should the nurse implement when caring for a patient with schizoid personality disorder? 1 Avoid being too nice or friendly. 2 Teach and role model assertiveness. 3 Maintain strict adherence to schedules. 4 Respect the patient's need for social isolation.

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

9. In a therapy group, the nurse is using existential theory by focusing on the here and now experience to enhance the members' awareness of feelings and their meanings. What statement is an example of a here and now activation? 1 "You have been sitting quietly. What are your thoughts or feelings?" 2 "You were in tears last week. Can you discuss it with the group now?" 3 "You looked upset when another member spoke. Why were you upset?" 4 "You looked disturbed when they spoke. Did it bring up something from your past?"

1 When the nurse notices a member is sitting quietly and asks about the member's thoughts or feelings, the statement focuses on the member's current behavior which is the essence of here-and-now activation. When the nurse asks if the member wants to discuss the reason for the member's behavior during a previous meeting, the statement requires recall of an incident in the past and its explanation in retrospect. The immediacy of here-and-now experience is not there. When the nurse notices a particular behavior and asks the reason for it, the statement asks for an explanation of the "why" of a behavior. Existential theory focuses on "what" rather than the "why" of a behavior. When the nurse notices the member's behavior and asks how it relates to the past, the statement probes into the member's past experiences rather than focusing on here-and-now experiences.

When the nurse finishes addressing a group of college women about rape, the following comments are heard during the discussion period. Which comment calls for additional teaching by the nurse? 1 "So if you dress conservatively, your risk of being raped is small." 2 "Who would have guessed that most rape victims know the rapist?" 3 "It makes sense that rape is a crime of violence, not a crime of sex." 4 "I always thought rapes happened at night, but now I know that isn't true."so if you dress conservatively, your risk being raped is small

1 Rapes have little to do with whether the victim dresses seductively because rape is a crime of violence rather than a crime of sex.

A student nurse interacts with the sexual assault nurse examiner (SANE) during internship. The student nurse asks the SANE to share an experience while caring for victims of sexual assault. Which response given by the SANE is appropriate? 1 "I have seen rape victims from 6 months to 90 years old." 2 "I noticed that most rapes are impulsive acts of the rapists." 3 "I feel that patients get severe injuries when they try to escape." 4 "I overlook my feelings toward sexual assault before caring for the patient."

1 "I have seen rape victims from 6 months to 90 years old." The student nurse should know the facts and interact with experienced professionals to give the best care to the sexual assault victims. The response "I have seen rape victims from 6 months to 90 years old" indicates that any person from 6 months to 90 years old can be the victim of rape. The statement that the nurse overlooks the feelings and reactions toward sexual assault before caring for the patient indicates that the nurse has sympathy for the patient. The nurse should care for the patient with personal feelings and reactions. It helps to show empathy toward the patient to give an effective treatment. There is no evidence that patients get severe injuries when trying to escape. Rape is not an impulsive act. It is a planned act; more than 50% involve a weapon.

An abuse victim tearfully tells the nurse in the emergency department, "Don't tell my husband that you know he beats me because if he thinks anyone knows, he will beat me again." Based on this information, what is the most appropriate nursing diagnosis? 1 Fear 2 Chronic pain 3 Post-trauma syndrome 4 Risk for self-directed violence

1 Fear The patient is expressing fear based on a known threat.

Which drug associated with date rape has the shortest duration? 1 Ketamine 2 Clonazepam 3 Flunitrazepam 4 G-hydroxybutyric acid (GHB)

1 Ketamine The duration of ketamine is only 30 to 60 minutes. The duration of clonazepam, flunitrazepam, and GHB is up to 12 hours.

Which statement reflects a truth about rape? 1 Most rapes are planned. 2 Some women want to be raped. 3 Most charges of rape are unfounded. 4 Most women are raped by strangers.

1 Most rapes are planned Many myths about rape exist. Most rapes are not impulsive, spur-of-the-moment acts, but are carefully planned and orchestrated. Some women want to be raped, most charges of rape are unfounded, and most women are raped by strangers are not true statements.

The nurse is teaching a class on strategies to prevent the occurrence of abuse, such as reducing stress in the home. This is an example of which type of prevention? 1 Primary 2 Tertiary 3 Primordial 4 Secondary

1 Primary Primary prevention includes measures taken to prevent the occurrence of abuse, such as reducing stress. Tertiary prevention involves counseling and support for individuals who are survivors of violence. Secondary prevention involves screening programs for high-risk individuals. Primordial prevention is preventing the risk factors in social and environmental conditions.

A sexual assault victim asks to be given "the morning-after pill" to prevent conception. The nurse does not believe in abortion. What action should the nurse take? 1 Report and document the request. 2 Refer the woman for social services counseling. 3 Ask the supervising nurse to reassign the patient. 4 Ask the patient to reevaluate her request after 24 hours.

1 Report and document the request The nurse's ethical beliefs should never interfere with patient rights. The nurse should report and document the patient's request. If the drug is prescribed, however, the nurse can request that another nurse administer the drug.

During the immediate post-rape period what verbal nursing intervention would best lower patient anxiety and increase feelings of safety? 1 "You are safe here. I will stay with you while you have your examination." 2 "I know you feel confused. We will make all the necessary decisions for you." 3 "Please tell me as much about the details of the rape as you can remember." 4 "When you leave you will be given follow-up appointments for pregnancy and sexually transmitted disease screening."

1 You are safe here. I will stay with you while you have your examination." The presence of the nurse is reassuring, especially when the patient is experiencing disorganization and the environment is confusing.

When counseling a woman who has been in an abusive relationship for 5 years, the nurse facilitates the woman's sense of empowerment when the nurse does which of the following? 1 Assisting the woman in developing a plan to assure her safety 2 Suggesting that the woman needs to leave the abuser immediately 3 Asking the woman to identify behaviors that trigger her partner's violence 4 Offering the woman several different suggestions regarding how to stop the abuse

1 assisting the women in developing a plan to assure her safety Empowerment is fostered when the nurse and the woman work together to end the abuse. Acting as the expert and providing options is an example of the paternalist model of care rather than the empowerment model. Suggesting that the woman is responsible for the violence is not empowering.

12. A nurse is teaching a group of nursing students about the phases of critical incident stress debriefing. Prioritize the order of events taking place during the critical incident stress debriefing sessions. 1. Brief explanation and discussion of the debriefing process 2. Discussion of painful experiences related to the crisis incident 3. Discussion of the emotional and behavioral experiences of the incident 4. Acknowledgement and review of the material discussed earlier

1,2,3,4 Critical incident stress debriefing is a type of tertiary care that is directed to a group that has experienced a crisis. It has seven phases. The first phase of this intervention includes a brief introduction about the debriefing process. This is followed by a discussion about the painful experiences related to the crisis incident among participants. Then there is interaction about the physical, emotional, and behavioral experiences during the incident. This facilitates the collection of various ideas from the participants. Finally, the proposed ideas are acknowledged and reviewed by the participants and members of the healthcare team.

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

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

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

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

Which assessment question focuses on the characteristic behaviors of a patient diagnosed with borderline personality disorder? Select all that apply. 1 Have you ever attempted suicide? 2 Have you ever been told you are sarcastic? 3 Over a few hours can your mood shift dramatically? 4 Do you experience visual or auditory hallucinations? 5 How would you describe your romantic relationships?

1,2,3,5 Areas of assessment related to borderline personality disorder typically include history of mood shifts, tendencies toward sarcasm and anger, as well as intense, unstable romantic relationships and suicidal behaviors. Hallucinations are not characteristic of this disorder.

Which statement demonstrates a risk for abusive parenting? Select all that apply. 1 "I can't remember ever being told I was loved." 2 "Drinking a beer or two helps me to calm down." 3 "It's been really hard since the divorce became final." 4 "We've gone to counseling but nothing seems to help." 5 "If the children would only listen to me things would be okay."

1,2,3,5 Characteristics of abusive parents include a history of abuse, neglect, or emotional deprivation as a child, a history of drug or alcohol abuse, involvement in a crisis situation: unemployment, divorce, financial difficulties, projection of blame onto the child for parents' "troubles," and the inability to seek help from others.

Which statement demonstrates that a patient understands good sleep hygiene techniques? Select all that apply. 1 "I drink water or milk in the evenings." 2 "I get up between 7:30 and 8:00 AM every morning." 3 "Don't telephone after 10:00 PM because I'll be in bed." 4 "Napping in the afternoon is a personal indulgence of mine." 5 "My television is a flat screen model on the living room wall."

1,2,3,5 Good sleep hygiene guidelines include limiting caffeinated beverages to one or two a day and none in the evening, maintaining a regular sleep/wake schedule, avoiding daytime napping, and reserving the bedroom for sleep and a place for intimacy.

A patient diagnosed with anorexia nervosa presents to the clinic with a body mass index (BMI) of 15 kg/m2. Based on BMI, which level of severity does the nurse document? 1 Mild 2 Severe 3 Extreme 4 Moderate

2 A BMI of 15 to 15.99 kg/m2 is considered severe. A BMI of 16 to 16.99 kg/m2 is moderate. A BMI of less than 15 is extreme. A BMI of 17kg/m2 or more is mild.

8. The nurse is assessing a patient who attempted suicide once. Which method used by the patient in the previous suicide attempt would put the patient at higher risk? 1 Slashing the wrists 2 Staging a car crash 3 Inhaling natural gas 4 Ingesting sleeping pills

2 A method can be considered high or low risk based on the lethality, that is, how quickly a person can die using that particular method. Therefore, staging a car crash would put the patient at higher risk. Ingesting pills, inhaling natural gas, and slashing one's wrists are considered low-risk methods. If the patient uses these methods to commit suicide, there may be time to rescue the patient from dying.

8. A patient on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." The nurse should 1 Leave the patient's room and wait outside in the hall 2 Say "I understand" and allow the patient to close the door 3 Keep the door open, but step to the side out of the patient's view 4 Say "For your safety I can be no more than an arm's length away"

4 This level of suicide watch does not make adjustments based on patient preference. The explanation quoting the protocol and the reason (the patient's safety) is appropriate.

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

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

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

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

A patient who was raped one year ago talks with the nurse. Which comment by the patient indicates a successful resolution of this traumatic event? 1 "Sometimes I wonder if I secretly wanted to be raped." 2 "Now I realize what I did that caused this assault to happen." 3 "I'm emotionally stable but now I have frequent headaches and stomach pain." 4 "Although I have a nightmare once in a while, most of the time I sleep soundly."

4 "Although I have a nightmare once in a while, most of the time I sleep soundly." Signs of recovery after sexual assault include sleeping well with occasional nightmares or broken sleep, eating as one did before the rape, feeling calm or only mildly suspicious, fearful, or restless, getting support from family and friends, generally positive self-regard, absent or mild somatic reactions, and returning to pre-rape sexual functioning. "Sometimes I wonder if I secretly wanted to be raped," "Now I realize what I did that caused this assault to happen," and I'm emotionally stable but now I have frequent headaches and stomach pain" show guilt, significant somatization, and self-reprisal.

10. According to the U.S. Patient Self-Determination Act (PSDA), who may decide whether or not to refuse life-sustaining or life-prolonging treatments? Select all that apply. 1 Nurses 2 Doctors 3 Institutions 4 Individual patients 5 Designated patient surrogates

4,5 According the PSDA, an individual patient or designated surrogate can decide whether or not to refuse life-sustaining or life-prolonging treatments. Nurses, doctors, and institutions may play a role in educating patients and surrogates to make informed decisions in these cases, but they will not make the final decision.

9. While several different neurotransmitters are involved in mood stabilization, which are considered the main regulators? Select all that apply. 1 Acetylcholine 2 Dopamine 3 Glutamate 4 Norepinephrine 5 Serotonin

4,5 Two main neurotransmitters involved in mood are serotonin (5-hydroxytryptamine [5-HT]) and norepinephrine. Research suggests that depression results from the dysregulation of a number of neurotransmitter systems beyond serotonin and norepinephrine. The dopamine, acetylcholine, and glutamate also are believed to be involved in the pathophysiology of a major depressive episode.

1. The nurse is checking on a patient who is under 24-hour observation for suicide risk. The nurse checked the meal tray and found that there was no glass or silverware. The nurse then gave the patient medication and saw the patient swallow it. The nurse also gave the patient instructions about the things to be done the next day. After some time the patient went to sleep and the nurse later found that the patient was in a deep sleep, with hands and legs under the covers. Which observation or measure taken by the nurse needs to be addressed or corrected? 1 Observing the patient's hands under the covers 2 Observing the patient swallowing his medication 3 Absence of any glass or silverware on the meal tray 4 Telling the patient about things to be done the next day

1 A patient with suicidal ideation under 24-hour observation should be checked regularly by the attending nurse. The patient may hide any material used for suicide using his or her hands. The nurse should make sure that when the patient is sleeping, the hands are never under the covers. The nurse also needs to observe the patient swallowing each dose of medication and not retaining it in the mouth. The nurse should make sure that there are no glasses or silverware in meal trays with which the patient could injure him- or herself. The nurse should also explain the next day's schedule and document it in a chart to make the patient prepared for the next day's schedule.

3. At the first family therapy session the family tells the therapist that "We wouldn't have to be here if our younger son wasn't such a brat. He seems so different from our other son. We never had difficulty with him misbehaving." The other sibling offers, "He gets upset pretty easily." The nurse should suspect that the younger son is doing what? 1 Being scapegoated 2 Resisting boundaries 3 Experiencing multigenerational transition 4 Assuming the family management function

1 A scapegoat is the person others blame for the family's distress. Those blaming the scapegoat are usually trying to keep the focus off their own painful issues and problems. The parents seem to be scapegoating the younger son.

A patient is suspected of having insomnia. Which investigation does the nurse anticipate to be prescribed for this patient? 1 Actigraphy 2 Hypnogram 3 Polysomnography (PSG) 4 Multiple sleep latency test (MSLT)

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

The nurse explains to a patient with a borderline personality disorder that the patient's former psychiatrist resigned and a new psychiatrist has been hired. Which patient reaction is most likely? 1 Rage 2 Silence 3 Anxiety 4 Withdrawal

1 An individual with a borderline personality disorder tends to experience anger or rage when feeling rejected or ignored. Silence, withdrawal, and anxiety are not expected reactions.

Chapter 12 A patient with schizophrenia was prescribed antipsychotics. After daily observation, the nurse finds the patient's blood pressure has decreased. What is the most appropriate action by a nurse before administering the prescribed drug to the patient? 1 The nurse should tell the patient to rise slowly. 2 The nurse should tell the patient to avoid taking fluids. 3 The nurse should avoid administering the drug for the day. 4 The nurse should give an adrenergic agonist to raise the blood pressure.

1 Antipsychotics block the α2-receptor, which may cause hypotension. The nurse can give advice to the patient to rise slowly from the bed because the patient may feel dizzy as a result of reduced blood pressure. The nurse cannot administer the adrenergic agonist but can report to the health care provider if the patient's diastolic pressure falls below 80 mm Hg. The nurse should not stop administering the drug because that may worsen the schizophrenic symptoms. The nurse should not advise the patient to avoid fluid intake, because the patient may feel dehydrated and the total pressure exerted on the blood vessels maybe reduced.

12. A patient says to the nurse, "Since my spouse died, I'm having trouble concentrating. I want to stay home alone all the time but I know it would help me to be with others." Which group should the nurse suggest? 1 Bereavement 2 An internet support group 3 Co-Dependents Anonymous 4 National Alliance on Mental Illness (NAMI) family support group

1 Bereavement groups provide support for those who have experienced the loss of a loved one. An internet support group may provide support but it may not be specific to grief and would not engage the patient in face-to-face interactions as well as a bereavement group. Co-Dependents Anonymous is a twelve-step self-help group. NAMI groups provide patient and family support, education, and advocacy.

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

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

An adult complains, "I fall asleep as soon as I go to bed but wake up between 3 and 4 AM every morning; then, I can't go back to sleep. It's causing me problems concentrating at work and I don't have enough energy to take care of my family." Which nursing diagnosis applies to this scenario? 1 Insomnia 2 Impaired comfort 3 Sleep deprivation 4 Disturbed sleep pattern

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

What is a coping mechanism used excessively by patients with anorexia nervosa? 1 Denial 2 Humor 3 Altruism 4 Projection

1 Denial of excessive thinness is the mainstay of the patient with anorexia nervosa.

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

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

Chapters 26,35 The nurse is conducting group therapy for patients with antisocial personality disorder. During group therapy, a patient is found to be aggressive and bullies other members of the group. How should a nurse respond to change the behavior of the patient? 1 "I feel you should stop bullying other members of the group." 2 "It is not good to be aggressive and bully others during therapy." 3 "Please try to control your anger and be friendly with the group members." 4 "You seem to be aggressive; what is making you aggressive during therapy?"

1 During group therapy, the patients may become aggressive and bully others due to their illness. The nurse makes them acknowledge their behavior by using the response, "I feel you should stop bullying other members of the group." It helps the patient to control his or her anger. The nurse avoids a response which starts with 'you' such as "You seem to be so aggressive; what is making you aggressive during the therapy?" The patients may feel rejected and may behave more aggressively. The response, "Please try to control your anger and be friendly with the group members," is not appropriate. It may make patients feel that the nurse is not concerned about their feelings and emotions. The response, "It is not good to be aggressive and bully others during therapy," is not appropriate. The nurse avoids directly reporting the patient's behavior as good or bad, as it may cause withdrawal of the patient.

2. What role should the nurse play in supporting patients making end-of-life care decisions? 1 Encouraging patients to complete paperwork to support their wishes 2 Making decisions for the patient based on the nurse's professional opinion 3 Suggesting patients avoid discussing these matters with family to limit stress 4 Explaining that the nurse may not take part in discussing end-of-life care without an attorney present

1 Encouraging patients to talk about end-of-life issues and complete paperwork to support their wishes is an important intervention for basic-level registered nurses. The nurse should not make these decisions for the patient or suggest patients avoid discussing these matters with family. Having an attorney present is not required when having these discussions.

10. The leader opens the discussion at the first meeting of a new group. Which comment would be appropriate for this phase? 1 "Let's begin by establishing the ground rules for our group." 2 "Let's start by asking each person here to define his or her problems." 3 "I would like each person to explain why you are attending this group." 4 "Bringing family members to our group will help us achieve our goals."

1 Establishing ground rules helps to build trust in a group and set the group's norms and expectations. This is an appropriate leader behavior in the orientation phase. Members of a new group have not established trust and would be unwilling to define their problems. Visitors would alter the group's identity and jeopardize trust.

5. A teenage patient was admitted several weeks ago after a suicide attempt. Despite family therapy, one of the parents is still struggling to cope with the child's behavior. Which teaching point would be most beneficial for the parents? 1 Depression is beyond voluntary control, but it can be managed. 2 The patient needs to be able to express anger directly at the parents. 3 The parents should also seek therapeutic help because depression is hereditary. 4 The patient should stop taking prescribed medicines if the patient mentions suicide.

1 Family support is key to improving the prognosis for depressed teenagers. Crucial to this is the parents' understanding that depression is involuntary but can be managed. The patient should not stop taking prescribed medications without consulting the doctor. The patient does need to find ways to express feelings, but expressing anger is not always a solution. Depression can be hereditary, but this does not address the parent's concern.

10. Following the death of a loved one, what term describes a person's reaction to the loss? 1 Grief 2 Mourning 3 Depression 4 Bereavement

1 Following the death of a loved one, a person's reaction to the loss is grief. Mourning refers to things people do to cope with grief, including shared social expressions of grief such as viewing hours, funerals, and bereavement groups. A diagnosis of clinical depression should be carefully distinguished from characteristics of the normal grieving process. Bereavement, derived from the Old English word berafian meaning, "to rob," is the period of grieving after a death.

7. Which is a model of care that supports and cares for patients facing death regardless of age, diagnosis, or the ability to pay? 1 Hospice 2 Medicare 3 Kübler-Ross 4 Dual process

1 Hospice is a model of care that supports and cares for patients facing death regardless of age, diagnosis, or the ability to pay. Medicare is the federal government's national program that provides health insurance for older adults. The Kübler-Ross model describes the phases of responding to a terminal illness. Dual process is a model of coping and bereavement.

A patient diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." The best response for the nurse would be, 1 "I will be continuing to follow the care plan for the patient." 2 "Your eye for perfection extends even to my nursing interventions." 3 "That patient's care is really of no concern to you or to other patients." 4 "I see you are trying to control that patient's therapy as well as your own."

1 Obsessive-compulsive personality disorder has the key factor of perfectionism, with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a patient with obsessive-compulsive disorder.

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

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

11. In a persistent vegetative state, damage to what part of the brain eliminates cognitive function? 1 Cortex 2 Hypothalamus 3 Medullary brainstem 4 Reticular activating system

1 In a persistent vegetative state, the cortex is severely damaged, eliminating cognitive function. The hypothalamus and medullary brainstem remain intact to support cardiorespiratory and autonomic functions. The reticular activating system remains functional, making wakefulness possible.

7. What is the group leader's responsibility in the termination phase? 1 Encouraging group members to reflect on progress made. 2 Removing him- or herself from the group so they can function independently. 3 Allowing members to exchange contact information so they may remain as a support for each other. 4 Encouraging group members to fill out evaluation forms so the group leader can further improve his or her therapeutic technique.

1 In the termination phase, the group leader's role is to encourage members to reflect on progress they have made and identify post termination goals. Contact with other members in the group outside of the group is not therapeutic and usually is discouraged. The group leader does not remove him- or herself from the group process. Group members do not fill out evaluation forms in group therapy.

What nursing diagnosis would be most appropriate for a patient who reports disruption in the amount and quality of sleep? 1 Insomnia 2 Sleep deprivation 3 Disturbed sleep pattern 4 Readiness for enhanced sleep

1 Insomnia is the disturbance in both quality and quantity of sleep that causes impaired functioning. Sleep deprivation refers to long periods without sleep. Disturbed sleep pattern occurs when changes in sleep routine cause impaired functioning. Readiness for enhanced sleep is a pattern of periodic suspension of consciousness that provides rest and sustains a desired lifestyle.

A person diagnosed with obsessive-compulsive personality disorder is consistently late for appointments and says, "I have to check the safety features and fluid levels on my car six times before I leave home." Which nursing diagnosis has the highest priority? 1 Anxiety 2 Altered family processes 3 Altered role performance 4 Impaired social interaction

1 Internally, this person is fearful of imminent catastrophe. This fear produces anxiety. Persons diagnosed with obsessive-compulsive personality disorder try to control the environment through perfectionism and orderliness. Traits include compulsivity, oppositionality, lack of emotional expressiveness, and perfectionism. Social interactions, family processes, and role performance for this individual will improve after the anxiety is reduced; therefore, these diagnoses have a lower priority.

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

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

5. A nurse on an inpatient unit administers medication to a patient who is currently on suicide precautions. Which action by the nurse is most important? 1 Verify that the patient swallowed the entire dose of the medication. 2 Document the patient's willingness to take the medication voluntarily. 3 Inform the patient of the name, action, and side effects of the medication. 4 Teach the patient about delays associated with the drug's peak effectiveness.

1 Mouth checks may be used to be sure a patient is not saving (hoarding) medications in the hospital. In the community, provision of a limited-day supply or family supervision is required. Documenting the patient's willingness to take the medication voluntarily, informing the patient of the name, action, and side effects of the medication, and teaching the patient about delays associated with the drug's peak effectiveness offer appropriate nursing actions but are not the most important.

Chapter13,14 A young adult patient is being evaluated for mental illness. What risk factor would most likely result in a diagnosis of depression? 1 Neuroticism 2 Parents' divorce 3 Optimal physical health 4 A cousin with depression

1 Neuroticism is a negative personality trait often seen in patients with major depressive disorder. Family history generally only extends to first-degree family members. Physical health would be a factor if the patient was in poor health. A divorce of the parents may have an impact on a child, but it is less of a risk factor than neuroticism.

2. Which suicide intervention has the greatest impact on a patient's safety? 1 One-on-one observation by the staff. 2 Educating visitors about potentially dangerous gifts. 3 Removal of personal items that might prove harmful. 4 Restricting the patient from potentially dangerous areas of the unit.

1 One-on-one observation allows for constant supervision, which minimizes the patient's opportunities to cause self-harm. Although educating visitors about potentially dangerous gifts, restricting the patient from potentially dangerous areas of the unit, and removal of personal items that might prove harmful are appropriate, they do not have the impact that one-on-one observation has.

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

1 Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression.

The nurse is caring for a patient with antisocial behavior. The patient is aggressive, exploits the group members during any group activities, and lacks sympathy toward others. What appropriate action should the nurse take while caring for the patient? 1 Note signs of aggression in the patient. 2 Administer morphine to calm the patient. 3 Stop involving the patient in group tasks. 4 Make the patient feel guilty for exploiting others during group activities.

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

9. A patient with diagnoses of borderline personality disorder, depression, and a high risk of suicide is stabilized and is getting discharged. The nurse interacts with this patient. Which response by the patient indicates effective treatment? 1 "I promise you I will lead a happy life." 2 "Sorry, I don't feel like talking with you." 3 "I can help myself; I don't need your assistance." 4 "Let me get discharged; I will put an end to everything."

1 Patients with borderline personality disorder, depression, and suicidal ideation are at risk of suicide and injury to self or others. The treatment outcomes include the patient would remain free from injury, have a will to live, and would refrain from attempting suicide. In the statement that the patient promises to lead a happy life, the patient expresses the will to live. The statement suggests that the treatment is effective. The patient doesn't feel like talking to the nurse indicates that the patient is still depressed and prefers to be isolated. The statement suggests that treatment is not effective. In the statement that the patient does not need the nurse's assistance, the patient is denying the help. It indicates that the patient prefers to be alone and believes that no one would be able to help. The statement that the patient would put an end to everything once discharged is a covert statement. The patient is having suicide ideation, and the treatment is ineffective.

A patient diagnosed with hypersomnolence asks the nurse what medication likely will be prescribed. The nurse's response is based on what fact? 1 The patient may be prescribed a stimulant. 2 Medication therapy with benzodiazepines may be initiated. 3 The patient will likely be started on an anticholinesterase inhibitor. 4 There is no effective medication treatment for hypersomnolence disorder.

1 Pharmacotherapy with long-acting amphetamine-based stimulants such as methylphenidate and non-amphetamine-based stimulants such as modafinil are helpful in hypersomnolence disorder. There is effective medication treatment, benzodiazepines are sedating and addictive, and anticholinesterase inhibitors are used for the treatment of dementia.

What should the nurse instruct the patient who is taking Qsymia for the management of binge eating disorder? 1 "Use birth control." 2 "Eat at regular intervals." 3 "Measure your weight weekly." 4 "Review the nutritional content of foods you consume."

1 Qsymia is a combination of two drugs: topiramate and phentermine. It is used in the treatment of binge eating disorder; however, it should be used cautiously because it can cause birth defects. Female patients prescribed this medication should be instructed to use birth control. All patients diagnosed with binge eating disorder are advised to eat at regular intervals because abstinence from food can result in a rebound of binge eating. All patients diagnosed with binge eating disorder are advised to weigh themselves on a weekly basis since there is minimal daily weight loss, which can discourage the patient. In order to eat a balanced diet, any patient diagnosed with binge eating disorder should be advised to review the nutritional content of the foods they consume.

4. Which task is most likely to give terminally ill patients a sense of meaning about life in general? 1 Recognition of a transcendent realm 2 Transmission of knowledge and wisdom 3 Transfer of fiscal, legal, and formal social responsibilities 4 Expression of regret, forgiveness, and gratitude to family and friends

1 Recognition of a transcendent realm is most likely to give terminally ill patients a sense of meaning about life in general. Transmission of knowledge and wisdom is most likely to give terminally ill patients a sense of meaning about one's individual life. The transfer of fiscal, legal, and formal social responsibilities is most likely to give terminally ill patients a sense of completion with worldly affairs. Expression of regret, forgiveness, and gratitude to family and friends is most likely to give terminally ill patients a sense of completion in relationships with family and friends.

1. What is an important means of promoting good self-esteem in children? 1 To communicate validation of individual worth 2 To establish closed boundaries to provide structure 3 For the mother to assume the role of placater to avoid family confrontations 4 To tightly define roles and establish individual responsibility for most functions

1 Self-esteem develops when an individual is made to feel good about him- or herself and his or her role in the family. Parents should offer praise when a child has done well. They should discipline the child without making him or her feel bad about him- or herself; rather, they should help the child recognize that the action was wrong, not that he or she is bad. The mother assuming the role as placater, tightly defining roles, and establishing closed boundaries are much less effective in promoting healthy self-esteem it children.

2. The nurse teaches the parents of an adolescent who was diagnosed with schizophrenia about comorbidity. What does the nurse include in the teaching? 1 "Watch your child for signs of substance abuse." 2 "Make sure your child does not become dehydrated." 3 "With schizophrenia, your child will not experience any depression." 4 "Contact the healthcare provider immediately if your child has anxiety."

1 Substance use disorders involving alcohol, marijuana, and nicotine occur in nearly half of the people who are diagnosed with schizophrenia. Substance use is linked to higher rates of treatment nonadherence. Schizophrenia may cause polydipsia, which is a compulsive drinking of excess fluids, not dehydration. Depression frequently co-occurs in individuals with schizophrenia. Anxiety co-occurs with schizophrenia, but it is not necessary to contact the healthcare provider immediately if these symptoms present.

5. The nurse is performing crisis intervention for a patient who recently lost a spouse. The patient shows depressive and impulsive behavior, and sometimes gets aggressive. Which assessment tool should the nurse use to evaluate the effectiveness of crisis intervention? 1 Likert scale 2 SAD PERSONS scale 3 Hamilton rating scale 4 Cognition rating scale

1 The Likert scale is used to assess the effectiveness of the crisis intervention. It contains five points, and based on the patient's symptoms, a rating is given. The SAD PERSONS scale is used to assess the suicidal behavior of a patient. The rating is given on 10 points based on 10 different criteria. Hamilton rating scale is used to rate the anxiety and depression in a patient and contains 17 items on which the rating is given. Cognition rating scale is used to evaluate the functioning ability in schizophrenic patients.

3. A patient tells the nurse that he or she believes his or her situation is intolerable. The nurse assesses that the patient is isolating socially. A nursing diagnosis that should be considered is 1 Hopelessness 2 Deficient knowledge 3 Chronic low self-esteem 4 Compromised family coping

1 The defining characteristics are present for the nursing diagnosis of hopelessness.

4. A high school student tells the school nurse, "I just failed my chemistry test. I'm going to shoot myself." What is the most critical question for the nurse to ask this student? 1 "Do you have access to a gun?" 2 "Why do you want to kill yourself?" 3 "Have you failed any other subjects?" 4 "Did something happen with your parents?"

1 The evaluation of a suicide plan is important in determining the degree of suicidal risk. Three main elements that must be considered when evaluating lethality are whether there is a specific plan with details (in this scenario, a self-inflicted gunshot wound), how lethal is the proposed method (guns are high lethality methods of suicide), and whether there is access to the planned method (does the patient have a gun). People who have definite plans for the time, place, and means are at high risk. "Why" questions are probing, nontherapeutic communication techniques. "Have you failed any other subjects?" and "Did something happen with your parents?" are yes/no questions that do not encourage the patient's self-disclosure.

The nurse cares for a patient with chronic pain. A regular dose of analgesic medication is ineffective in reducing the patient's pain. What does the nurse expect is the cause for the patient's response? 1 The patient is showing signs of tolerance. 2 The patient is showing signs of withdrawal. 3 The patient is showing signs of intoxication. 4 The patient is showing signs of hyperreactivity.

1 The nurse expects that the patient is showing signs of tolerance because the regular dose of an analgesic drug is ineffective in reducing the patient's pain. Tolerance is the phenomenon in which a patient may need increased amounts of a drug to produce the desired effects, or a constant drug dose may cause diminished effects over time. Withdrawal symptoms are seen when the drug concentration in the blood is reduced. Analgesic drugs generally do not cause significant withdrawal symptoms. The excessive usage of a drug results in intoxication. Analgesic drugs do not cause intoxication. Generally, stimulant drugs cause hyperreactivity. Analgesic drugs do not cause hyperreactivity.

The nurse is assessing a patient with binge eating disorder. What diagnosis should the nurse consider when the patient shows feelings of inadequacy? 1 Anxiety 2 Ineffective coping 3 Imbalanced nutrition 4 Disturbed body image

1 The nursing diagnosis of anxiety is made when the patient shows feelings of discomfort or inadequacy. Ineffective coping is noted if the patient uses eating as a coping method. Imbalanced nutrition is diagnosed when the patient shows irregular eating patterns and is overweight. Disturbed body image is noted when the patient shows embarrassment due to weight gain.

A patient diagnosed with borderline personality disorder tells the charge nurse, "I only want that one nurse taking care of me. All the other nurses are horrible and don't care about their patients." What coping behavior is the patient displaying? 1 Splitting 2 Emotional lability 3 Separation individuation 4 Emotional dysregulation

1 The patient is displaying splitting, an unusual feature of borderline personality disorder, which is characterized by the inability to view both positive and negative aspects of others as part of a whole. Emotional lability is the rapid movement of one emotional extreme to another. Separation individuation occurs in infants. Separation refers to the development of limits, the differentiation between the infant and the mother, whereas individuation refers to the infant's ability to recognize distinctness from the mother. Emotional dysregulation is a term that describes poorly modulated mood characterized by mood swings.

After assessment, the nurse finds that a patient has difficulty sleeping, most probably caused by impaired circadian rhythm. The nurse learns that the patient has a fear of hospitals. Which assessment tool would be helpful in arriving at the diagnosis? 1 Actigraphy 2 Polysomnography 3 Multiple sleep latency test 4 Maintenance of wakefulness test

1 There are four methods of diagnosis of sleep disorders based on the type and severity of the disorder. Actigraphy is the diagnostic procedure used to diagnose circadian rhythm disorders. It involves a watchlike device used for recording the sleep pattern. It is a simple method and does not require sophisticated equipment and facilitated sleep rooms. Polysomnography, the multiple sleep latency test, and the maintenance of wakefulness test are not used to diagnose circadian rhythm disorders. Polysomnography and the multiple sleep latency tests are used to diagnose patients suspected of narcolepsy. The maintenance of wakefulness test is used to detect a patient's ability to stay awake in an environment conducive to sleep. Because these procedures require sophisticated equipment, they are not used for patients who have fear of hospitalization.

A patient gets excessively anxious in group activities such as playing an indoor game and is hypersensitive to negative evaluation. What interventions should the nurse perform while caring for this patient? Select all that apply. 1 The nurse has a friendly approach toward the patient. 2 The nurse assigns the patient to another group activity. 3 The nurse insists the patient participate in group activates. 4 The nurse avoids having a friendly approach with the patient. 5 The nurse accepts the patient's request to not be involved in group activities.

1, 5 Patients with avoidant personality disorder get excessively anxious in social situations and group activities. Therefore, the nurse should have a friendly, reassuring, and accepting approach while caring for these patients. The nurse should respect the patient's decision to not be involved in group activities because they can increase the patient's anxiety. Even if the patient refuses to participate, the nurse should have a friendly approach toward the patient. The nurse should not insist the patient participate in group activities but should provide encouragement to help the patient manage the anxiety and participate in group activities. Changing the group activity does not help in reducing anxiety.

The nurse is attending to a patient with sleep deprivation. While interviewing the patient the nurse learns that the patient became obese during periods of sleep deprivation. What does the nurse analyze as the reasons for the patient's obesity? Select all that apply. 1 Changes in leptin levels 2 Changes in ghrelin levels 3 Changes in interleukin levels 4 Changes in C-reactive protein levels 5 Changes in tumor necrosis factor levels

1,2 Sleep deprivation is known to dysregulate the levels of leptin and ghrelin, which may cause obesity. Leptin is a hormone that regulates satiety or feelings of fullness. Ghrelin is a hormone that regulates hunger. Sleep deprivation also changes the levels of proinflammatory markers such as tumor necrosis factor, C-reactive protein, and interleukin, which promote inflammation. They do not cause obesity.

9. A registered nurse was appointed in charge of a psychiatric ward. What appropriate actions does the nurse take to keep patients safe in the ward? Select all that apply. 1 Count the kitchen utensils daily 2 Lock the utility rooms, kitchen, and office 3 Install unbreakable shower rods in the bathroom 4 Ensure that the windows remain open in the morning 5 Decorate the ward with flowers in beautiful glass vases

1,2 The nurse should lock the utility rooms, kitchen, and offices and instruct all the staff members to do so. The nurse should count the number of utensils daily to ensure that the patients don't take harmful objects from the kitchen. The ward must be kept free of harmful objects, like glass vases and nails. The nurse should close the windows to prevent the patients from escaping. The bathrooms must be made jump-proof and hanging-proof by installing breakaway showers.

8. What information will be included in medication education for a patient prescribed an antidepressant? Select all that apply. 1 The goal of antidepressant therapy is the remission of symptoms. 2 It generally takes one to three weeks of antidepressant therapy for mood to improve. 3 It may require a change in prescription to identify the most effective antidepressant. 4 Antidepressant therapy is contraindicated in individuals diagnosed with bipolar disorder. 5 Antidepressant therapy may trigger psychosis in patients diagnosed with schizophrenia.

1,2 ,3,5 A drawback of antidepressant drugs is that improvement in mood may take one to three weeks or longer. The goal of antidepressant therapy is the complete remission of symptoms. Often, the first antidepressant prescribed is not the one that ultimately will bring about remission. Antidepressants may precipitate a psychotic episode in a person with schizophrenia. Patients with bipolar disorder often receive a mood stabilizing drug along with an antidepressant.

A nurse is assessing emotional trauma in a patient who was sexually assaulted. What action does the nurse take while performing the assessment? Select all that apply. 1 The nurse encourages the patient to talk at a comfortable pace. 2 The nurse asks the patient, "Are you having any suicidal intentions?" 3 The nurse says to the patient, "It is very painful to be in a situation like this." 4 The nurse asks the family about the patient's behavior before the incident. 5 The nurse says to the patient, "Are you considering yourself responsible for this?"

1,2 The nurse encourages the patient to talk at a comfortable pace. The nurse asks the patient, "Are you having any suicidal intentions?" The patient who has been sexually assaulted may have extreme emotional trauma, so the nurse should assess the emotional state of the patient. The nurse should encourage the patient to talk at a comfortable pace. It helps the patient to state all the details of the incident without getting agitated or depressed. The nurse should assess the presence of suicidal intentions in the patient. The nurse should ask the questions directly, like, "Are you having any suicidal intentions?" It helps the nurse to plan interventions to enhance the patient's self-esteem. The nurse should avoid showing sympathy to the patient by saying, "It is very painful to be in a situation like this." It makes the patient feel depressed and worthless. The nurse should assess only the details of assault while taking the history of the patient. It helps to identify the immediate physical and psychological needs of the patient. Asking about the patient's family behavior before the incident is not required for the immediate treatment. Patients who are the victims of assault blame themselves. The nurse should reassure the patients that they are not responsible for the event. The nurse should not ask the patient directly if the patient feels responsible for the incident; this can make the patient feel rejected.

A nurse is planning management for patients suffering from insomnia. What positive outcomes should the nurse plan for? Select all that apply. 1 Proper sleep induction 2 Consistent sleep pattern 3 Adequate hours of sleep 4 Appropriate hours of sleep 5 Feeling refreshed after sleep

1,2, 4 Insomnia refers to a sleep disorder characterized by difficulty in falling asleep or staying asleep as desired. Proper sleep induction is important for patients with insomnia because they may have difficulty falling asleep. Consistent sleep pattern is essential to maintain sleep throughout the night with minimal awakening. Appropriate hours of sleep should be managed according to the patient's schedule, and daytime sleeping should be avoided. Adequate hours of sleep are essential in the case of patients with sleep deprivation. Feeling refreshed after sleep is important for patients with sleep deprivation and disturbed sleep pattern.

Which patient statement supports the diagnosis of histrionic personality disorder? Select all that apply. 1 "I like being the center of attention." 2 "My husband left because he said I flirt way too much." 3 "I'm here because I got so depressed after my last divorce." 4 "I try really hard but I can never seem to please my husband." 5 "I think I'd feel better if I could just cry and let him know how I feel."

1,2,3 Histrionic personality disorder is characterized by emotional attention-seeking behaviors including self-centeredness, low frustration tolerance, and excessive emotionality. The person with histrionic personality disorder often is impulsive and melodramatic and may act flirtatious or provocative. Relationships do not last, because the partner often feels smothered or reacts to the insensitivity of the histrionic person. The individual with histrionic personality disorder does not have insight into his or her role in breaking up relationships and may seek treatment for depression or other comorbid condition.

2. Based upon current information regarding successful suicide attempts among the male population, which factor is relevant? Select all that apply. 1 Access to firearms 2 75 years of age and older 3 History of alcohol consumption 4 American Indian and Alaskan natives 5 History of antidepressant medication therapy

1,2,3,4 The National Violent Death Reporting System examined toxicology tests of those who committed suicide in 16 states: 33.3% tested positive for alcohol and 20% for opiates or prescription pain killers. Among males, adults aged 75 years and older have the highest rate of suicide (nearly 36.1 per 100,000 population). Firearms are the most commonly used method of suicide among males (approximately 55.7%). Among American Indians and Alaska natives aged 15 to 34 years, suicide is the second-leading cause of death. Antidepressants are not noted often.

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

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

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

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

What is the psychosocial assessment focus for a patient diagnosed with antisocial personality disorder? Select all that apply. 1 Anxiety level 2 Substance abuse 3 Current stressors 4 Homicidal ideations 5 Chronic medical issues

1,2,3,4 The nurse should assess this patient for current stressors, history of past and current substance abuse, current anxiety level, and any homicidal or suicidal ideations. Currently there is no research to associate this disorder with physiologic causes.

Which mental health disorder has been identified as a comorbid disorder associated with childhood abuse that can last the child's entire life? Select all that apply. 1 Anxiety 2 Suicidal ideations 3 Chronic depression 4 Post-traumatic stress disorder (PTSD) 5 Obsessive-compulsive disorder (OCD)

1,2,3,4 The secondary effects of abuse, such as anxiety, depression, and suicidal ideation, are health care issues that can last a lifetime. Depression and PTSD are two of the most prevalent disorders resulting from childhood trauma. OCD is not associated with abuse as frequently.

3. Which statement is true regarding nonsuicidal self-injury? Select all that apply. 1 Homosexuality may be a trigger for these behaviors. 2 The injuries can be a self-inflected means of punishment. 3 Cutting and biting are common manifestations of this disorder. 4 The patient generally has more than one method to inflict injury. 5 The peak for this type of behavior is between 25-29 years of age.

1,2,3,4 These behaviors most commonly consist of cutting/carving, burning, scraping/scratching skin, biting, hitting, skin picking, and interfering with wound healing. Half of self-injurers report multiple methods. These actions can be used to punish themselves, to connect with others, to get attention, to escape a responsibility, or to avoid a situation. Risk factors for nonsuicidal self-injury include depression in either parent, non-heterosexual orientation, and depression. Non-suicidal self-injury begins between 10 and 15 years of age, peaking in the late teens. Hospital admission data confirms a decline in the behavior between 25 to 29 years of age.

Which information is considered a part of the general nursing assessment of a victim who has experienced a physical assault? Select all that apply. 1 Level of anxiety 2 Coping mechanisms 3 Indications of physical trauma 4 Indications of emotional trauma 5 The value of existing physical evidence

1,2,3,4 Level of anxiety, Coping mechanisms, Indications of physical trauma, Indications of emotional trauma The nurse assesses the survivor's (1) level of anxiety, (2) coping mechanisms, (3) available support systems, (4) signs and symptoms of emotional trauma, and (5) signs and symptoms of physical trauma. Information obtained from the assessment is then analyzed, and nursing diagnoses are formulated. Existing physical evidence is collected, but the nurse is not responsible for assessing its legal value.

The nurse is teaching the family of a patient with a personality disorder that psychological problems often are due to a disruption in the normal separation-individuation of the child from the mother. Identify the correct order of the different stages of this process as described by Margaret Mahler and her colleagues. 1. Normal autism 2. Symbiosis 3. Differentiation 4. Practicing 5. Rapprochement 6. Object constancy

1,2,3,4,5,6 In the normal autism stage, which lasts from birth to 1 month, the infant spends most of his or her time sleeping. Between 1 and 5 months, the infant is in the symbiosis stage and perceives the mother-infant as a single entity. When the infant is 5 to 10 months old, he or she starts differentiating between self and mother and the infant's attention is drawn toward the outer world. At 11 to 18 months, the toddler starts learning to walk and explore, and there is a great increase in the toddler's sense of separateness. In the rapprochement stage, which is from 18 to 24 months, the toddler moves away from the mother and comes back again; there are alternating periods of helplessness and independence. At 2 to 5 years, the individuation process is complete with object constancy, where the child understands that the mother is permanent even when she is not in the presence of the child.

When conducting an assessment interview the nurse is prompted to inquire about the existence of a dysfunctional sleep disorder when the patient reports being prescribed which classification of medications? Select all that apply. 1 Antihistamine 2 Anticonvulsant 3 Antidepressant 4 Broad-spectrum antibiotics 5 Second-generation antipsychotics

1,2,3,5 Many patients use medication to address their sleep problems. Many antidepressants, anticonvulsants, antihistamines, and second-generation antipsychotics are also used off-label (without specific approval from the Food and Drug Administration) for their sedative properties in the treatment of insomnia disorder. Antibiotics are not prescribed for their hypnotic/sedative properties.

. Which intervention is required when a patient is being observed one-to-one to prevent a suicide attempt? Select all that apply. 1 Staff must remain within arm's length of the patient at all times 2 Assure that the patient has no access to glass or metal objects. 3 Assess the patient's mouth after each medication administration. 4 The patient's hands must be visible at all times except when sleeping. 5 Documentation should include the patient's verbatim statements.

1,2,3,5 Nursing staff responsibilities when a patient is prescribed one-to-one observation include remaining within arm's reach of the patient at all times, charting the patient's verbatim statements, ensuring the patient has no access to glass or metal objects, and assuring that the patient is swallowing medication and not "cheeking" it for the purpose of overdosing. Even when asleep, the patient's hands must always be visible.

12. At which sites may hospice care be provided? Select all that apply. 1 Homes 2 Hospitals 3 Nursing homes 4 Doctors' offices 5 Treatment centers 6 Freestanding hospice centers

1,2,3,6 Hospice care may be provided in homes, hospitals, nursing homes, or freestanding hospice centers. Generally, doctors' offices and treatment centers are not sites of hospice care, as the patient must choose hospice care rather than curative treatments.

A nurse is assessing a patient with anorexia nervosa. Which clinical findings does the nurse expect? Select all that apply. 1 Dry skin 2 Emaciation 3 High blood pressure 4 Decreased urine output 5 Decreased urinary concentration

1,2,4 Anorexia nervosa causes imbalance in nutrition leading to dehydration and dry skin. It can also lead to emaciation. In some patients, fluid intake is also decreased leading to decreased urine output. Patients with anorexia nervosa usually have low blood pressure due to deficiency of proteins. The low urinary output results in increased concentration of urine.

Which action is considered a nursing responsibility related to the abuse of a patient? Select all that apply. 1 Reporting is a legal obligation. 2 Abuse need only be suspected. 3 Most states require a report within 24 hours. 4 The nurse is required to display a neutral attitude. 5 The report needs support by another healthcare provider.

1,2,4 Nurses are mandated legally to report suspected or actual cases of child and vulnerable adult abuse. Nurses must attempt to maintain both an appropriate level of suspicion and a neutral, objective attitude. Each state has specific guidelines for reporting, including whether the report can be oral, written, or both, and within what time period the suspected abuse or neglect must be reported (immediately, within 24 hours, or within 48 hours). No collaboration by another nurse is required.

Which instruction will the nurse include when educating a patient regarding the principles of stimulus control to improve sleep? Select all that apply. 1 Go to bed when you feel sleepy. 2 Get out of bed if falling asleep is difficult. 3 Keep the bedroom warm to maximize sleepiness. 4 Reserve the bedroom for sleeping and intimacy only. 5 Daytime naps should not exceed 60 minutes in length.

1,2,4 Stimulus control involves adherence to basic principles that include going to bed only when sleepy, using the bed or bedroom only for sleep and intimacy, getting out of bed if unable to sleep and engaging in a quiet-time activity, and maintaining a regular sleep/wake schedule, with getting up at the same time each day being the most important factor, along with avoiding daytime napping. If napping is necessary to avoid accident or injury, it should be limited to 20 to 30 minutes. The temperature of the bedroom should be determined by the patient's perception of comfort.

While assessing the blood glucose levels of a pregnant patient, the nurse suspects that the patient has been physically abused. What appropriate action should the nurse take to support and protect the patient? Select all that apply. 1 Suggest to the patient to be admitted to the hospital. 2 Take a photograph of the patient's wounds as evidence. 3 Insist that the patient undergo a whole body examination. 4 Listen effectively to the patient while conducting the interview. 5 Ask the panel of healthcare professionals to interact with the patient.

1,2,4 The nurse should identify the patients at risk of abuse and those who are being abused. The nurse should suggest to the patient to be admitted to the hospital for further investigation. The nurse should listen effectively to the victim to know the cause of the abuse. This would help the nurse give suitable advice to the patient. The nurse should document the evidence by taking photographs with the patient's consent and by using assessment tools. The nurse should interact with the patient in complete privacy, not with a panel of health care professionals. Patients should not be forced to undergo a full-body examination as some of them may feel shy.

11. What is an advantage of group therapy sessions? Select all that apply. 1 Feedback is provided by a variety of sources. 2 Patients are provided with a sense of belonging. 3 Private issues are often the topic of group discussion. 4 Several patients can be involved in treatment simultaneously. 5 Inclusion into a group is not dependent on stability of one's condition.

1,2,4 There are advantages and disadvantages of group approaches in the care of psychiatric patients. Advantages include the following: engaging multiple patients in treatment at the same time, thereby saving resources; participants benefit not only from the feedback of the nurse leader but also that of peers who may possess a unique understanding of the issues; and promoting a feeling of belonging. Until symptoms are stabilized, persons who are acutely psychotic, acutely manic, or intoxicated have difficulty interacting effectively in groups and may interfere with other members' ability to remain safely focused on group goals and progress. Disadvantages of group therapy sessions include concerns that private issues may be shared outside the group.

Screening for which personality disorder should be focused on the male population? Select all that apply. 1 Paranoid 2 Antisocial 3 Borderline 4 Dependent 5 Schizotypal

1,2,5 Statistically more men than women are diagnosed with antisocial, paranoid, and schizotypal personality disorders. More women than men are diagnosed with borderline and dependent personality disorders.

A nurse prepares the case report of a patient who was sexually abused. What information does the nurse record in the patient's case report? Select all that apply. 1 Nightmares 2 Feelings of guilt 3 Untreated diseases 4 Excessive masturbation 5 Inadequate immunization

1,2,4 Nightmares Feelings of guilt Excessive masturbation Sexually abused patients often indulge in excessive masturbation. Masturbation is a sexualized behavior commonly seen in sexually abused children in response to the traumatic event. The sexually abused patients may exhibit post-traumatic stress disorder, which is characterized by nightmares and feelings of guilt. Inadequate immunization and untreated diseases are seen in neglected patients due to inadequate medical care.

What is commonly the result of abuse in childhood? Select all that apply. 1 Running away 2 The onset of clinical depression 3 Confrontation with family members 4 Posttraumatic stress disorder (PTSD) 5 Faster physical and social development

1,2,4 Running away, The onset of clinical depression, Posttraumatic stress disorder (PTSD) Abuse during childhood may manifest in depression later in life. The patient may have low self-esteem and feelings of worthlessness. Posttraumatic stress disorder (PTSD) develops from a trauma that the patient experienced. Violence is ofent seen in childhood histories of runaways, juvenile offenders, and prostitutes. Those who face abuse in childhood have slower physical and mental development as the energy needed for developmental tasks tends to be spent on coping with abuse. Abuse in childhood does not lead to confrontation with the family. Rather, the abused person is more likely to become withdrawn and avoid confrontation.

8. Which statement made by the nurse leader is associated with issues addressed during the orientation phase of group development? Select all that apply. 1 "We will all be respectful of each other's opinions." 2 "We are expected to talk to each other, not at the group's leader." 3 "Let's focus on problems that substance abuse has caused in your life." 4 "Trusting each other is extremely important to the success of this group." 5 "What is expressed here in the group will not be discussed outside the group."

1,2,4,5 All groups go through developmental phases. In the orientation phase, the group is forming. The group leader's role is to structure an atmosphere of respect, confidentiality, and trust. The purpose of the group is stated, and members are encouraged to get to know one another and to establish trust with one another. Therapeutic interaction is supported when the group leader encourages the group to talk directly to each other rather than to the leader, and reminds members about ground rules for respectful, meaningful interaction. Actual problem solving does not occur in this phase.

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

1,2,4,5 It is important for all nurses, regardless of their practice area, to develop an understanding of the disease of addiction. Nursing curricula should include the content and practicing the skills necessary for addiction screening, early detection, and referral to appropriate treatment. Without an accurate assessment for substance use and other mental health disorders, individuals will be unable to receive comprehensive treatment planning and quality care. The education of nurses is not the responsibility of hospitals but rather schools of nursing.

Which assessment finding supports the diagnosis of anorexia nervosa in a teenage female? Select all that apply. 1 Bradycardia 2 Amenorrhea 3 Hypertension 4 Hypothyroid function 5 Prolonged QT interval

1,2,4,5 Medical complications associated with anorexia nervosa include bradycardia, prolonged QT interval, and ST-T wave abnormalities, symptomatic hypotension, amenorrhea, and abnormal thyroid functioning resulting in hypothyroidism.

7. Which statement regarding bipolar I is true? Select all that apply. 1 The median age for onset is 18 years. 2 The disorder tends to begin with a depressive episode. 3 The disorder is more common among women than men. 4 Severe postpartum depression increases the risk for developing the disorder. 5 The episodes tend to increase in number and severity during the course of the illness.

1,2,4,5 The median age of onset for bipolar I is 18 years. Bipolar I tends to begin with a depressive episode in both women and men. The episodes tend to increase in number and severity during the course of the illness. Women who experience a severe postpartum psychosis within 2 weeks of giving birth have a four times greater chance of subsequent conversion to bipolar disorder. Bipolar I disorder seems to be somewhat more common among men.

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

1,2,4,5 Withdrawal symptoms the nurse can anticipate include rhinorrhea, yawning, lacrimation, and piloerection. Nystagmus occurs in patients experiencing phencyclidine intoxication.

10. A patient's history includes depression, anxiety, and self-medication with alcohol and marijuana. The patient has been admitted for inpatient evaluation. Which therapeutic groups might best help this patient? Select all that apply. 1 Dual diagnosis group 2 Support and self-help 3 Psychoeducational group 4 Dialectical behavior treatment 5 Therapeutic community meetings

1,2,5 A patient with comorbid depression, anxiety, and substance abuse has a dual diagnosis. Therapeutic community meetings can also help a patient with a dual diagnosis, as there are often several groups that a patient might attend during an inpatient stay. Support and self-help groups may begin in the hospital and are easily transferrable due to their prolific nature to outpatient settings. Psychoeducational groups do not specifically target substance use or abuse issues. Dialectical behavior treatment is not as appropriate for this scenario.

2. Which functions represent informal individual roles by members of a group? Select all that apply. 1 Dominator 2 Help seeker 3 Standard setter 4 Information seeker 5 Recognition seeker

1,2,5 Informal roles group members often assume may or may not be helpful to group development. Individual roles do not help the group but instead relate to specific personalities, personal agendas, and desires for having needs met by shifting the group's focus to them. Dominator, help seeker, and recognition seeker are examples of individual roles. Maintenance roles, such as the standard setter, keep the group together, help each person feel worthwhile and included, and create a sense of group cohesion. Task roles, such as the information seeker, keep the group focused on its main purpose and get the work done.

2. Which are appropriate actions for the nurse providing end-of-life care for patients with dementia? Select all that apply. 1 Proactively manage issues such as pain and depression. 2 Eliminate medications that may detract from safety or quality of life. 3 Catheterize the patient who is unable to communicate his or her need to urinate. 4 Address irritable and uncooperative behaviors with medication to sedate the patient. 5 Identify the patient's goals for care, and educate the family to minimize aggressive medical interventions.

1,2,5 The nurse providing end-of-life care for patients with dementia should proactively manage issues such as pain and depression; eliminate medications that may detract from safety or quality of life; and identify the patient's goals for care, educating the family to minimize aggressive medical interventions. The patient who is unable to communicate his or her need to urinate is unlikely to require catheterization; the nurse should anticipate this need and provide assistance accordingly. Difficult behaviors, such as irritability or refusal to cooperate with care, are often forms of communication indicating discomfort in body, mind, or spirit. When caregivers use an anticipatory approach to care, they can frequently prevent or reduce behaviors that result when a person with dementia is unable to communicate important unmet needs.

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

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

6. What are the side effects of transcranial magnetic stimulation? Select all that apply. 1 Seizures 2 Dementia 3 Headache 4 Hallucinations 5 Unconsciousness

1,3 Patients who have undergone transcranial magnetic stimulation may have side effects, such as headache and mild seizures, due to the feeling of contraction of the scalp and a slight tapping sensation in the head. Neurological effects like dementia, hallucinations, and unconsciousness are not the associated side effects of transcranial magnetic stimulation.

4. Which situation is supportive of the laissez-faire leadership style? Select all that apply. 1 Group objectives allow for a variety of strategies. 2 Group effectiveness depends on group interaction. 3 Group dynamics present with a self-directed group. 4 Group focus is that of supporting individual creativity. 5 Group members are of varying cognitive functioning levels.

1,3,4 There are three main styles of group leadership, and a leader selects the style that is best suited to the therapeutic needs of a particular group. A laissez-faire leader allows the group members to behave in any way they choose and does not attempt to control the direction of the group. In a creative group, such as an art or horticulture group, the leader may choose a flexible laissez-faire style, directing minimally to allow for a variety of responses. The autocratic leader exerts control over the group and does not encourage much interaction among members. Staff leading a meeting with a fixed, time-limited agenda may tend to be more autocratic. In contrast, the democratic leader supports extensive group interaction in the process of problem solving.

When the nurse suspects abuse of a newborn, what should a community health nurse include during the home assessment? Select all that apply. 1 Responsiveness to infant's signals 2 Presence of weapon in the house 3 Playfulness of caregiver with infant 4 Caregiver's history of abuse as a child 5 Any acute disease noted in the child

1,3,4 Responsiveness to infant's signals, Playfulness of caregiver with infant, Caregiver's history of abuse as a child The caregiver's facial expression as a response to the infant's signals indicates the emotional bonding established between the infant and the caregiver. Playfulness of the caregiver with the infant shows a healthy relationship. People who faced abuse as a child may grow up to be child abusers themselves. So, it is important to find out about the caregiver's history of being abused as a child. Presence of weapons in the house is assessed in a case of family violence and when there is a potential for homicide in the house, but is not an indicator of abuse. Whether or not the child develops a disease can be irrelevant. However, if the disease is chronic, it may lead to abuse in the future.

Which area will the nurse focus on when evaluating whether a patient has experienced improved sleep quality? Select all that apply. 1 Daytime sleepiness is lessened. 2 Fewer dreams are experienced each night. 3 The time it takes to fall asleep is decreased. 4 There are fewer awakenings during the night. 5 The time it takes to fall back to sleep after awakening is decreased.

1,3,4,5 Evaluation is based on whether or not the patient experiences improved sleep quality as evidenced by decreased sleep latency, fewer nighttime awakenings, a shorter time to get back to sleep after awakening, and improvement in daytime symptoms of sleepiness. Dream monitoring is not a factor in this evaluation.

12. When creating a suicide prevention plan for males, which intervention will be included? Select all that apply. 1 Minimizing access to firearms 2 Focus depression screenings on the 25- to 40-year-old age group 3 Publicizing community-based suicide prevention service facilities 4 Providing community educational focusing on the identification of warning signs 5 Identify strategies to minimize the stigma attached to seeking mental health services

1,3,4,5 Goals for suicide prevention include developing and implementing strategies to reduce the stigma associated with substance abuse, being a consumer of mental health, and suicide-prevention services; promoting efforts to reduce access to lethal means and methods of self-harm (males use firearms quite frequently to commit suicide); implementing training for recognition of at-risk behaviors; and improving access to mental health and substance abuse services. Screening should include all males, but teens and males over 75 are at high risk.

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

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

Which patient statement supports the diagnosis of mania? Select all that apply. 1 "I really don't need much sleep; two hours a night is enough." 2 "I really enjoy cooking and eating all sorts of expensive foods." 3 "My mother says this outfit is way too sexy but I like it and wear it all the time." 4 "I've telephoned everyone I know and talked for hours; my husband will be mad." 5 "My family is really upset with me but it's just because they're jealous of all I do."

1,3,4,5 When in full-blown mania, a person constantly goes from one activity, place, or project to another with little or no regard for sleep or food. Inactivity is impossible, even for the shortest period of time. Flowery and lengthy letters are written, and excessive phone calls are made. The behaviors often alienate family, friends, employers, health care providers, and others. Modes of dress often reflect the person's grandiose yet tenuous grasp of reality. Dress may be described as outlandish, bizarre, colorful, and noticeably inappropriate. The statement regarding cooking and eating is not supportive of manic behavior.

Which medical complication is associated with the diagnosis of bulimia nervosa? Select all that apply. 1 Russell's sign 2 Hyperkalemia 3 Hypochloremia 4 Positive Babinski sign 5 Parotid gland enlargement

1,3,5 Medical complications of bulimia nervosa include Russell's sign (callus on knuckles from self-induced vomiting), parotid gland enlargement associated with elevated serum amylase levels, hypochloremia, and hypokalemia. A positive Babinski sign is not associated with bulimia nervosa.

Which disease process has been associated with obstructive sleep apnea? Select all that apply. 1 Diabetes 2 Peptic ulcer 3 Hypertension 4 Migraine headache 5 Cardiovascular disease

1,3,5 Obstructive sleep apnea has been associated with hypertension, diabetes, cardiovascular disease, and stroke. Research does not confirm the association of peptic ulcers and migraine headaches with obstructive sleep apnea.

11. Which situation is considered a protective factor against suicide? Select all that apply. 1 The patient is 5 months pregnant. 2 The patient is economically secure. 3 The patient has strong religious beliefs. 4 The patient has a college-level education. 5 The patient has coped with the loss of a loved one.

1,3,5 Protective factors against suicide include pregnancy, religious beliefs, and effective coping skills. Education and financial security are not protective factors in this situation.

A nurse plans to give secondary prevention to a patient who was sexually abused. Which action by the nurse indicates effective nursing practice? Select all that apply. 1 The nurse treats the injuries of the patient. 2 The nurse identifies families at high risk for abuse. 3 The nurse teaches mindfulness techniques to the patient. 4 The nurse arranges a housekeeper for the patient's family. 5 The nurse arranges a legal advocacy program for the patient.

1,4 Secondary prevention involves interventions to reduce the long-term effects of abuse in the patient. Patients who are victims of sexual abuse get depressed and fearful, so the nurse should teach them mindfulness techniques. This helps to reduce the stress in the patient. The nurse should treat the physical injuries of the patient to reduce the risk of infection. Such patients have feelings of hopelessness and suicidal intentions. Patients who are victims of sexual abuse develop suicidal intentions, so constant monitoring of the patient must be done. Caregiving becomes a burden to the patient's family members so the nurse should arrange a housekeeper to reduce the burden. Mindfulness-based stress reduction and legal advocacy programs are arranged for the survivors of abuse in tertiary prevention. Identifying families at high risk for abuse is part of primary prevention of abuse.

The community health nurse is teaching about prevention of abuse. Which are examples of tertiary prevention? Select all that apply. 1 Support groups for survivors 2 Reduction of stress for the abuser 3 Teaching of coping skills to the abuser 4 Legal advocacy programs for survivors 5 Screening programs for high-risk individuals

1,4 Tertiary prevention involves treating survivors of abuse, for example with support groups and legal advocacy programs. Reducing stress for the abuser and increasing his or her coping skills are strategies for primary prevention of abuse. Screening programs for high-risk individuals are examples of secondary prevention of abuse.

7. A pregnant woman seeks counseling after losing a parent. She informs the nurse that she has lost her job a few days ago and is aware of her responsibility for her family. Which factors put her at greater risk of suicide? Select all that apply. 1 Losing a job 2 Being pregnant 3 Accessing health care 4 The death of her parent 5 Being responsible for her family

1,4 The nurse should know about the risk factors of suicide. Unemployment and death of a loved one are two of the risk factors. However, pregnancy, access to health care, and a sense of responsibility for the family are protective factors for suicide.

Which personality disorders are categorized as cluster C? Select all that apply. 1 Avoidant 2 Paranoid 3 Antisocial 4 Dependent 5 Obsessive-compulsive

1,4,5 Avoidant, dependent, and obsessive-compulsive disorders are cluster C personality disorders. Paranoid personality disorder is in cluster A. Antisocial personality disorder is in cluster B.

12. Which antidepressant drug can be prescribed to depressed patients who also suffer from narrow-angle glaucoma? Select all that apply. 1 Bupropion 2 Amitriptyline 3 Desipramine 4 Isocarboxazid 5 Tranylcypromine

1,4,5 Bupropion is a norepinephrine dopamine reuptake inhibitor that can be prescribed to treat depression in patients with narrow angle glaucoma. It blocks the synaptic reuptake of norepinephrine and dopamine instead of the muscarinic receptors. Isocarboxazid is a monoamine oxidase inhibitor that inhibits the monoamine oxidase enzyme. It does not antagonize the muscarinic actions, so it can be prescribed to patients with narrow angle glaucoma. Tranylcypromine is a monoamine oxidase inhibitor. It does not cause side effects like blurred vision, so it is safe to be prescribed. Tricyclic antidepressants such as desipramine and amitriptyline must be avoided in depressed patients with narrow angle glaucoma. Tricyclic antidepressants are muscarinic receptor antagonists and thus cause blurred vision. These drugs would worsen the condition of narrow angle glaucoma.

A patient refuses to keep a sleep diary because he or she already knows it is difficult to sleep at night. What should the nurse tell the patient about these diaries? Select all that apply. 1 The diary will also include time spent napping. 2 The diary should be kept only when prescribed a sedative. 3 The patient cannot be treated without self-reporting of sleep loss. 4 The diary will show what habits may be contributing to the lack of sleep. 5 The patient may find there are less sleep issues when reviewing the diary.

1,4,5 Maintaining a sleep diary serves several purposes. Often patients are surprised to find they have fewer sleep issues than they initially thought. A comprehensive diary will include things that are known to distract from sleep such as caffeinated drinks. The diary also should include any naps. A diary may be kept with or without a prescription. Although the diary is important, many physicians do prescribe medication without these logs.

Which patient statement supports the diagnosis of dependent personality disorder? Select all that apply. 1 "It's hard but I pay for the rent, all the utilities, and all the food." 2 "It's been so hard with my husband away so much for his work." 3 "I've lived alone before but moved back home when my mom died." 4 "My mother didn't like it so I never spent the night at a friend's house." 5 "I was sick a lot as a child and so my family was always there for me."

1,4,5 Persons with dependent personality disorder have a high need to be taken care of, which can lead to patterns of submissiveness with fears of separation and abandonment by others. This may create problems for the person by leaving them more vulnerable to exploitation by others because of their passive and submissive nature. Persons with dependent personality disorder are thought to have early and profound learning experiences during childhood in which disordered attachment and dependency develop on the caretaker. Dependent personality disorder may be the result of chronic physical illness or punishment of independent behavior in childhood. Moving back to the family home and expressing how difficult separation has been are not statements that are supportive of a dependent personality disorder.

8. When evaluating members of a therapeutic group, what statement by a member does the nurse identify as being consistent with monopolizing behavior? 1 "No, I do not have anything to say at the moment." 2 "Please keep quiet and just listen to what I am saying." 3 "My headache is irritating and simply refuses to go away." 4 "What makes you believe that I should listen to your advice?"

2 A monopolizing member does not give anybody else a chance to be heard. Such a member is extremely talkative. In an attempt to deal with anxiety, the person may monopolize the group with one's own compulsive speech. A complaining member may continually bring somatic problems such as a nagging headache to the group and still reject any help. A silent member prefers to stay silent and observe others during any group discussions. A demoralizing member may talk angrily to the leader and show no concern for others. Such a member shows hostile behavior.

Which is the best treatment method for the patient who speaks of several failed relationships and appears arrogant and lacks empathy for others? 1 Psychotherapy 2 Cognitive-behavioral therapy 3 Administration of citalopram 4 Administration of venlafaxine

2 A patient who appears arrogant and lacks empathy for others tells about several failed relationships. These are signs and symptoms of narcissistic personality disorder. The best treatment for narcissistic personality disorder is cognitive-behavioral therapy. The patient is taught to replace narcissistic thoughts that have formed irrational core beliefs with more appropriate thoughts and beliefs. Psychotherapy is effective in managing patients with histrionic personality disorder. Citalopram is a selective serotonin reuptake inhibitor that effectively treats avoidant personality disorder. Selective norepinephrine reuptake inhibitors such as venlafaxine are also effective in treating avoidant personality disorder.

A nurse manages care for an individual diagnosed with avoidant personality disorder. Select the appropriate outcome for this patient. The patient will 1 Refrain from aggressive behavior toward others within 5 days 2 Demonstrate use of assertive communication within 3 months 3 Establish an intimate relationship with another adult within 2 weeks 4 Make a permanent commitment never to self-mutilate within 1 week

2 A person diagnosed with avoidant personality disorder is excessively anxious in social situations and hypersensitive to negative evaluation but desires social interaction. Assertiveness training is intended to assist this person in self-expression. Outcome achievement for any of the personality disorders is slow because personality is a deeply ingrained characteristic. It is likely to take months or years to achieve desired outcomes. Persons diagnosed with avoidant personality disorder seldom self-mutilate or demonstrate aggression toward others.

The nurse is assessing a patient for a possible personality disorder. What behavior does the nurse identify as feature of paranoid personality disorder? 1 Excessive emotionality 2 Reluctance to answer any questions 3 Defers questions to his or her mother 4 Dichotomous thinking

2 A person with paranoid personality disorder generally views others with suspicion and may be reluctant to answer any questions. People with histrionic personality disorder may exhibit excessive emotionality to the extent of being considered melodramatic. A person with dependent personality disorder may have low self-esteem and may be dependent on others for minor issues. For instance, the person may ask a family member to answer questions during an interview. A person with borderline personality disorder may have dichotomous thinking. This is due to splitting or an inability to view both the positive and negative aspects of a person as a part of the whole.

Which statement made by a patient illustrates a primary coping style of persons with borderline personality disorder (BPD)? 1 "My health care provider says I might get out of here tomorrow. Do you think I'm ready to go?" 2 "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." 3 "I will never again speak to any of my messed up family members. I know that this will help me be more functional." 4 "I promise I am not feeling suicidal. I won't hurt myself."

2 A primary coping style used by patients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person. The statements "My health care provider says I might get out of here tomorrow. Do you think I'm ready to go?", "I will never again speak to any of my messed up family members. I know that this will help me be more functional," and "I promise I am not feeling suicidal. I won't hurt myself" do not describe splitting, which is a primary coping style of patients with BPD.

12. The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill patient who has been diagnosed with schizophrenia is early detection of 1 Acute dystonia 2 Tardive dyskinesia 3 Cholestatic jaundice 4 Pseudoparkinsonim

2 An AIMS assessment should be performed periodically on patients who are being treated with antipsychotic medication known to cause tardive dyskinesia.

4. A patient who has been receiving antipsychotic medication for 6 weeks tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the patient reports flulike symptoms, including a fever and a very sore throat, the nurse should 1 Consider recommending a change of antipsychotic medication 2 Arrange for the patient to have blood drawn for a white blood cell count 3 Suggest that the patient take something for his or her fever and get extra rest 4 Advise the health care provider that the patient should be admitted to the hospital

2 Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms. Agranulocytosis with infection could be life threatening, so recommending rest does not address the underlying problem. The patient may not need to be admitted to the hospital but should have blood drawn to guide the next step. A nurse would not recommend a change of medication. The medication has been effective and might not need to be changed.

A nurse is assessing a patient experiencing anorexia nervosa. What diagnosis should the nurse consider when the patient exhibits destructive behavior towards self? 1 Powerlessness 2 Ineffective coping 3 Imbalanced nutrition 4 Disturbed body image

2 Ineffective coping is presented as destructive behavior toward oneself or inability to meet expectations. Powerlessness is presented by indecisive behavior or a feeling of shame. Imbalanced nutrition is diagnosed when there are signs of emaciation or decreased urine output. Disturbed body image is noted when there is excessive self-monitoring regarding body image.

4. The nurse provides care to a suicidal patient with bipolar manic episodes. The patient's family expresses concern regarding pharmacologic interventions and the side effects they cause. Which medication does the nurse expect to be prescribed to the patient? 1 Fluoxetine 2 Clozapine 3 Haloperidol 4 Diazepam

2 Antipsychotics may be prescribed to suicidal patients who experience psychotic or bipolar manic episodes. Since the patient's family expressed concern regarding side effects, the patient is most likely to be prescribed a second-generation antipsychotic, such as clozapine, with a lower risk of side effects than first-generation antipsychotics. Fluoxetine is an antidepressant, which would not be prescribed to this patient. Haloperidol is a first-generation antipsychotic with a greater risk for adverse side effects. Diazepam is an antianxiety medication, which would not be prescribed to this patient.

5. As a terminally ill patient becomes less able to take in sustenance, what is the most important information for the nurse to share with the family? 1 "We will start giving intravenous fluids to stave off dehydration." 2 "Difficulty taking in water or food means the illness is progressing." 3 "Dehydration is a common cause of death in terminally ill patients." 4 "Lack of food is a common cause of death in terminally ill patients."

2 As a terminally ill patient becomes less able to take in sustenance, one important distinction to keep in mind is that the patient is not dying of dehydration or lack of food but rather from the illness. The nurse should encourage families to offer water orally rather than intravenously as often as their actively dying loved one desires and is able to swallow. Dehydration and a lack of food are not the causes of death in terminally ill patients.

A nurse is educating a patient newly diagnosed with anorexia nervosa about the medication dosage and side effects. The patient becomes upset and tearful, stating, "No! I will not take that medication!" What is the most likely reason for the patient's feelings? 1 The patient is resistant because of a need to control. 2 The patient is upset about the possible side effect of weight gain. 3 The patient feels embarrassed about taking psychiatric medication. 4 The patient is worried about the common adverse effect of sexual problems.

2 Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain, but are not well accepted by patients who are frightened by the side effect of weight gain. There is nothing in the scenario to suggest the patient is embarrassed. Sexual side effects are more common with selective serotonin reuptake inhibitor (SRRI) medication than with atypical antipsychotics. The patient may have a need to control, which is typical of patients with anorexia; however, during medication education it is more likely for the patient to be upset over the possibility of a side effect.

What positive outcome does the nurse plan when managing a patient with sleep deprivation? 1 Proper sleep induction 2 Work and sleep balance 3 Consistent sleep pattern 4 Appropriate hours of sleep

2 Balance between work and sleep should be the outcome of treatment for sleep deprivation. Sleep deprivation is caused by an imbalance between the hours of sleep required and the hours of sleep obtained. Proper sleep induction, consistent sleep pattern, and appropriate hours of sleep should be the outcomes to treatment for insomnia. Insomnia causes difficulty in falling asleep or staying asleep. Proper sleep induction overcomes the difficulty in falling asleep. Consistent sleep pattern maintains sleep throughout the night with minimal awakening. Managing appropriate hours of sleep such as avoiding daytime sleeping or unnecessary sleeping helps in sleep maintenance and gives refreshing sleep.

The nurse recognizes bariatric surgery as a treatment for which disorder? 1 Rumination 2 Binge eating 3 Bulimia nervosa 4 Anorexia nervosa

2 Bariatric surgery is an option to treat binge eating disorder as the patients are obese due to overeating, with no compensatory activities such as exercise. Patients with anorexia nervosa are underweight as they starve themselves due to fear of weight gain. They do not need bariatric surgery. Patients with bulimia nervosa tend to overeat, which is followed by compensatory behaviors, such as excessive exercise or misuse of laxatives. They are usually normal in weight or close to ideal weight and they do not need bariatric surgery. In rumination disorder the patient regurgitates the food, which is followed by rechewing and reswallowing or spitting. It does not cause obesity and bariatric surgery is not necessary.

12. A patient who has come for flu treatment is found to have agranulocytosis and myocarditis on assessment. He has taken acetaminophen and cetirizine for flu. The patient is also a known diabetic and has schizophrenia. He is taking metformin for diabetes and clozapine for schizophrenia. Which of these drugs could have caused agranulocytosis and myocarditis? 1 Metformin 2 Clozapine 3 Cetirizine 4 Acetaminophen

2 Clozapine decreases the risk of suicide in patients with schizophrenia. However, these patients should be regularly monitored for severe side effects of clozapine, like agranulocytosis, myocarditis, and altered glucose metabolism. A common side effect of metformin is gastrointestinal disturbance; cetirizine can cause drowsiness; and paracetamol in large amounts can lead to liver toxicity.

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

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

Chapter 18,19 Which assessment finding is most likely to occur in a patient diagnosed with bulimia nervosa? 1 Lymphocytosis 2 Dental erosion 3 Osteoporosis 4 Muscle wasting

2 Dental erosion is most likely to occur in patients diagnosed with bulimia nervosa due to chronic self-induced vomiting. Lymphocytosis, osteoporosis, and muscle wasting are conditions that are more likely to occur as a result of anorexia nervosa, not bulimia nervosa.

1. In which phase of the Kübler-Ross model is the patient attempting to deal with overwhelming feelings of vulnerability and helplessness? 1 Anger 2 Bargaining 3 Acceptance 4 Denial and isolation

2 In the bargaining phase, as the patient attempts to deal with overwhelming feelings of vulnerability and helplessness, he or she may secretly try to make deals with a higher power to prolong his or her life. The anger phase typically surfaces when the patient is ready to come to terms with the fact that he or she is in fact seriously ill and becomes pessimistic and unhappy. The acceptance phase is a final time for resting, free of pain and struggle. The patient may wish for solitude and may not be as talkative. Denial is typically a brief reaction in which the patient is in disbelief or shock about the situation.

2. A nurse is planning a diet chart for a manic patient who is on lithium therapy. Which instruction should be included in the diet chart? 1 Reduce sodium intake. 2 Take lithium with meals. 3 Take lithium before breakfast. 4 Avoid taking lithium before going to bed.

2 Lithium should be given with meals because lithium causes irritation of the stomach lining. Patients on lithium therapy should ensure they have adequate salt in their diets because lithium decreases sodium reabsorption, leading to a possible deficiency of sodium. Lithium should not be taken on an empty stomach before breakfast because it causes irritation of the stomach lining. Lithium intake should not affect the patient's sleep patterns.

5. Which change in neurotransmission is associated with suicidal thinking? 1 Increased norepinephrine reserves in the thalamus and pons. 2 Decreased serotonin activity in the brainstem and prefrontal cortex. 3 Increased gamma-aminobutyric acid (GABA) activity in the hypothalamus. 4 Decreased numbers of dopamine and glutamate receptors in the temporal lobes.

2 Low serotonin levels are related to depressed mood and depression is commonly associated with suicide. Postmortem examinations of individuals who complete suicide also reveal a low level of serotonin in the brainstem or the frontal cortex. GABA is associated with anxiety. Increased norepinephrine is associated with stimulation of the sympathetic nervous system.

11. Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? 1 Dopamine 2 Serotonin 3 Acetylcholine 4 γ-aminobutyric acid

2 Low serotonin levels have been noted among individuals who have committed suicide. While γ-aminobutyric acid, dopamine and acetylcholine are neurotransmitters they are not believed to be associated with suicidal ideations.

A nurse sees trazedone 50 mg at bedtime on the medication administration record of a patient diagnosed with multiple sclerosis. The nurse's drug reference indicates 50 mg is a low dose for this antidepressant. Which analysis is correct? 1 Antidepressant medications are more effective when given in the evening. 2 A low dose of trazedone has been prescribed to improve the patient's sleep. 3 A lower dose is needed because of the neurologic changes associated with multiple sclerosis. 4 An error on the medication administration record is likely. Recheck the health care provider's prescription.

2 Many antidepressants, anticonvulsants, antihistamines, and second-generation antipsychotics are used off-label for their sedative properties in the treatment of insomnia. Trazedone is an antidepressant medication commonly administered to improve sleep; however, it is not Food and Drug Administration approved for use as a hypnotic. When used for sleep, it usually is administered at a lower dose than when used as an antidepressant.

What is true about medications used to treat insomnia? 1 They have a short half-life. 2 They include benzodiazepines. 3 They are all controlled medications. 4 They are only prescribed for one week.

2 Medications used to treat insomnia include benzodiazepines, nonbenzodiazepines, melatonin receptor agonists, orexin receptor antagonists, and certain tricyclic antidepressants. They are generally prescribed for two weeks, not one week. Although benzodiazepines are control level IV, not all of them are controlled. Some medications have long half-lives, resulting in a "hangover effect" the next morning when the patient awakens.

8. Following the death of a loved one, what term describes the things people do to cope, including the funeral and bereavement groups? 1 Grief 2 Mourning 3 Depression 4 Bereavement

2 Mourning refers to things people do to cope with grief including shared social expressions of grief such as viewing hours, funerals, and bereavement groups. Following the death of a loved one, a person's reaction to the loss is grief. A diagnosis of clinical depression should be carefully distinguished from characteristics of the normal grieving process. Bereavement, derived from the Old English word berafian meaning, "to rob," is the period of grieving after a death.

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

2 Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. Improving mood, preventing flashbacks, and helping one to sleep do not describe accurately the action of naltrexone.

Which behaviors are demonstrated characteristically by a patient diagnosed with narcissism? 1 Perfectionism and preoccupation with detail 2 Grandiose, exploitive, and rage-filled behavior 3 Angry, highly suspicious, aloof, and withdrawn behavior 4 A dramatic expression of emotion, while easily being led

2 Narcissistic patients give the impression of being invulnerable and superior to others to protect their fragile self-esteem. A dramatic expression of emotion while easily being led, perfectionism and preoccupation with detail, and angry, highly suspicious, aloof, and withdrawn behavior are not generally associated with narcissism.

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

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

2. The nurse is concerned that a depressed male patient may be displaying a nonverbal suicidal threat when he presents another patient with his favorite shirt as a "gift." What is the nurse's initial intervention? 1 Place the patient on suicide precautions, including 15-minute checks. 2 Ask the patient if he is experiencing suicidal ideations with a plan to hurt himself. 3 Support the patient by telling him that he will need the shirt when he's discharged. 4 Document that the patient has shown behaviors that are likely subtle suicide threats.

2 Nonverbal suicide threats are generally indirect actions that a person is planning to take his or her own life, such as giving away prized possessions. Assessing the individual in a direct manner is the initial intervention in managing the risk for personal harm. Placing the patient on suicide precautions is appropriate once the behavior has been identified as a suicide threat. Telling the patient that he will need his shirt does not help identify whether the gesture is truly a suicide threat. Documentation is appropriate after the behavior has been identified as a suicide threat. The documentation as it is stated in the option is nonconclusive and subjective.

3. Which drug can be used to treat alogia, avolition, and anhedonia in schizophrenic patients? 1 Molindone 2 Olanzapine 3 Thiothixene 4 Thioridazine

2 Olanzapine is a second-generation antipsychotic. It is prescribed to treat both positive symptoms, like hallucination and delusion, and negative symptoms, like alogia, avolition, and anhedonia. Thiothixene is a high-potency first-generation antipsychotic. It is prescribed to treat positive symptoms like hallucination and delusion. Molindone is a medium-potency first-generation antipsychotic. It does not treat alogia, avolition, or anhedonia. Thioridazine is a low-potency first-generation antipsychotic used to treat positive symptoms of schizophrenia.

7. An adult with a 6-year history of schizophrenia begins a community rehabilitation program. Select the most appropriate initial outcome for this patient. The patient will 1 Lead the morning exercise group 2 Participate actively in scheduled programming 3 Apply for employment in a local sheltered workshop 4 Report that no auditory hallucinations have occurred

2 Participation in scheduled activities of the program should occur first. After the patient is accustomed to the program, he or she might lead a group or apply for employment. Hallucinations commonly continue to occur in patients diagnosed with schizophrenia.

11. The nurse is addressing a primary symptom of schizophrenia when 1 Arranging for the patient to attend stress management classes 2 Reinforcing the patient's ability to interrupt intrusive paranoid thoughts 3 Working with the patient to arrive at a budget that allows him or her to live independently 4 Supporting the patient in his or her attempts to stop using alcohol to cope with hallucinations

2 Primary symptoms are ones that are directly caused by the mental illness, such as paranoid thoughts. Stress is a secondary symptom of schizophrenia resulting from stressors related to coping with the illness. A need for assistance while living independently is a secondary symptom of schizophrenia resulting from stressors created by the illness. Alcohol abuse is a secondary symptom of schizophrenia resulting from the use of alcohol to manage the stress of the hallucinations (a primary symptom).

6. A nurse is preparing the care plan of a patient who has rape-trauma syndrome. What should the nurse include as an outcome measure for this patient in the care plan? 1 The patient will take frequent short naps. 2 The patient will be able to control impulses. 3 The patient will suppress feelings of self-harm. 4 The patient will report feelings of stress and anxiety.

2 Rape-trauma syndrome is characterized by hypervigilance, insomnia, and suicidal thoughts. The outcomes of an effective crisis management will include that the patient will control impulsive behavior. After an effective crisis intervention, the patient ideally should not have feelings related to self-harm and certainly will not suppress such feelings as that is not an effective coping strategy. If the patient has insomnia, an important outcome goal should be that the patient is able to sleep for a longer duration of time rather than just taking short naps. Another important goal for this patient should be that the patient will not have any symptoms of anxiety or stress after the interventions.

Therapeutic nutrition is initiated for a patient hospitalized with anorexia nervosa. Two days later, the nurse notes that the patient has developed peripheral edema. What is the nurse's correct analysis of this situation? 1 The patient's electrolyte balance has improved. 2 The patient may be experiencing refeeding syndrome. 3 Peripheral edema is the consequence of preexisting low bone density. 4 The therapeutic nutrition program has improved the patient's hydration.

2 Refeeding syndrome is a potential complication of initiation of therapeutic nutrition for patients diagnosed with anorexia nervosa. An assessment finding associated with this problem is peripheral edema. Serum electrolytes, particularly sodium and potassium, are likely to be abnormal in this situation. Low bone density is an assessment finding associated with estrogen deficiency or low calcium intake. Peripheral edema is not a finding associated with normal hydration.

A person is treated for a severe back injury resulting from domestic abuse. What is the key question that a nurse should ask to assess if the victim needs any further intervention? 1 If the patient reports feeling anxious or depressed 2 If the patient has any desire to kill the perpetrator 3 If the patient would like to follow further treatment 4 If the patient wants to get the perpetrator arrested

2 Safety always comes first. Therefore, the nurse assesses the patient's homicide potential. If a victim has any desire to kill the perpetrator, an intervention is needed so that any such possibility can be prevented. For anxiety or depression, counseling can be done and the patient can be referred to a proper care facility. If the patient wants further treatment, based on the patient's condition, a psychiatric inpatient care facility or an outpatient facility can be referred. After knowing about the abuse, the nurse mandatorily reports to the police. The patient can take legal action and the health care record of abuse will be helpful in legal proceedings.

6. A patient with schizophrenia was prescribed perphenazine. During the follow-up visit after 12 weeks on the medication, the nurse suggests that the patient go on bed rest and follow a diet rich in proteins and carbohydrates. Which is the most appropriate reason for the nurse to give this suggestion? 1 The patient has the symptoms of agranulocytosis. 2 The patient has the symptoms of cholestatic jaundice. 3 The patient has the symptoms of postural hypotension. 4 The patient has the symptoms of autonomic dysfunction.

2 Schizophrenic patients taking perphenazine, a first-generation antipsychotic drug, may have toxic effects as a result of long-term therapy. The nurse should identify the signs and symptoms of the toxic effects, like cholestatic jaundice, which is due to collection of bile juice in the gallbladder. The patient should be instructed to go on bed rest and consume a diet rich in proteins and carbohydrates. Postural hypotension is characterized by a drop in blood pressure with a change in position. It cannot be managed by a protein-rich diet. Agranulocytosis is characterized by dangerously low levels of white blood cells; this condition is not related to bed rest and diet changes. Autonomic nervous system controls involuntary actions of the body. An autonomic dysfunction is not treated by bed rest and diet changes.

4. A 21-year-old college student undergoes a depression screening at the student health center. The student says, "I know I'm gay but I can't tell my family or straight friends." Which statement is accurate regarding this student's suicide risk? 1 This student's sexual preference has no bearing on suicide risk. 2 This student has a higher suicide risk than his or her heterosexual peers. 3 This student's suicide risk will decline if the family is informed of his or her sexual preferences. 4 This student's suicide risk is lower than that of heterosexual students because there is an identified gay and lesbian support community.

2 Suicide is the third leading cause of death among lesbian, gay, bisexual, and transgender (LGBT) youth in the United States. Informing the family may or may not change the risk. LGBT youth are more likely to attempt suicide than their heterosexual peers.

9. A patient who has no family is admitted to the hospital for treatment of bronchial carcinoma. The nurse finds that though the patient is in pain, the patient is improving. The patient says to the nurse, "I won't be a problem much longer." What should the nurse understand from this? 1 The patient will be discharged soon. 2 The patient is contemplating suicide. 3 The patient is happy with the treatment. 4 The patient does not require treatment anymore.

2 The factors that put this patient at higher risk of suicide include age, gender, lack of social support, lack of spouse, and a chronic medical condition. When such a patient makes a covert statement like "I won't be a problem much longer," the nurse should understand that the patient is contemplating suicide. In such situations, the nurse should ask the patient directly about suicidal ideation and whether he or she has thoughts of suicide or has developed a plan. The patient is in pain and thus would not be in a happy mood. The patient has not fully recovered yet and may not be discharged soon. Further treatment is required for the patient unless the patient has fully recovered.

A nurse is assessing a patient with major injuries. The nurse suspects that the patient was physically abused by his or her intimate partner. The patient is unable to interact due to a language barrier. What appropriate action should the nurse take while documenting the clinical report of abuse? 1 Immediately report against the patient's partner in the community health department. 2 Maintain a balance of suspicion and a neutral, objective attitude. 3 Ask the patient's family member to translate the conversation. 4 Give the patient some time, and conduct the interview after 72 hours.

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

The patient says to the nurse, "Why do we have to have family therapy sessions? This is my problem, not theirs." What is the nurse's best response? 1 "Family therapy allows for everyone to share their feelings." 2 "Family therapy is used to strengthen the functioning of the family." 3 "Family therapy allows us to assess your family members' coping skills." 4 "Family therapy allows for us to assess the cohesiveness in your family."

2 The nurse's best response is, "Family therapy is used to strengthen the functioning of the family." The two major aims of family therapy are to strengthen the functioning of the family and improve the skills of the individual members. Not everyone in the family may be open to sharing their feelings. Assessing family cohesiveness and coping skills are strategies for the assessment of family functioning, but not the purpose of family therapy.

9. A schizophrenic patient is aggressive and says, "I want to kill myself with a gun." What appropriate action should the nurse take while caring for the patient? 1 Instruct the staff to stay away from the patient. 2 Instruct the staff to observe the patient 24 hours a day. 3 Instruct the staff to let the patient interact with other patients. 4 Instruct the staff to chart the patient's whereabouts and record mood every 5 hours.

2 The patient is clearly communicating suicidal intentions. The staff should observe the patient 24 hours a day. The nurse should be around the patient and record his or her mood and behavior every 15-30 minutes. One-to-one nursing interaction must be done with the patient 24 hours a day. The patient should not be allowed to mingle with other patients as the patient can harm them. The nurse is supposed to chart the patient's whereabouts and record the mood and behavior every 15-30 minutes, not every 5 hours.

Chapters 22 The nurse is planning care management for a patient with alcohol misuse. What intervention does the nurse plan for rehabilitation of this patient? 1 Avoid repeated counseling. 2 Develop motivation and self-help skills. 3 Refrain from assessing alcohol consumption. 4 Avoid discussing the effects of alcohol intake.

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

8. In a clinical interview conducted at a community health care center, the nurses observe that a patient with schizophrenia is very sensitive and feels extremely guilty about previous actions. What is the appropriate nursing diagnosis? 1 The patient is a victim of child abuse. 2 The patient has risk for self-directed violence. 3 The patient has impaired verbal communication. 4 The patient is showing positive symptoms of schizophrenia.

2 The patient with schizophrenia shows negative symptoms such as self-blaming, guilt, and becoming sensitive. It indicates that the patient is at risk for self-directed violence and can do self-harm. Impaired verbal communication is characterized by dissociative ideas. Positive symptoms of schizophrenia include hallucination and associative looseness. Feeling guilty and being sensitive are negative symptoms of schizophrenia. Schizophrenia is not associated with a history of child abuse.

5. A nurse has been instructed to give group therapy to patients with intellectual disabilities. The nurse follows a laissez-faire style of leadership and asks the patients to paint scenery during group therapy. Which appropriate action does the nurse follow while conducting the group therapy? 1 The nurse gives clear directions to the patients while painting. 2 The nurse allows the patients to paint anything during group therapy. 3 The nurse advises the patients to interact with others to share their ideas. 4 The nurse checks that the patients do not interact during the group therapy.

2 The three leadership styles a nurse can choose while conducting group therapy are autocratic leader, democratic leader, or laissez-faire leader. The laissez-faire leadership style is followed during group therapy which involves art. The nurse allows the patients to paint as they wish. It helps to explore their thoughts, perceptions, and feelings and effectively design the treatment. The nurse avoids giving directions to the patients during the therapy, as the patient may feel rejected and resist portraying feelings and perceptions. In democratic leadership, the nurse encourages the patients to interact with one another and share their feelings. In autocratic leadership, the nurse controls the patients and does not allow them to interact with one another. During group therapy like painting, the patients must not be advised and restricted from interacting with others. The nurse allows the patients to behave as they wish and the nurse must observe and document the patients' feelings and interpersonal skills.

Review the following information. Which assessment question best demonstrates the implementation of the suggested evidence-based practice intervention for a patient diagnosed with depression? 1 "How much sleep do you get each night?" 2 "How is your depression affected when you are sleeping well?" 3 "Describe for me why you believe you have problems sleeping." 4 "Do you believe your mental health problem is related to a sleep disorder?"

2 This study highlights the prevalence of sleep disruption among patients with serious mental illness and calls for better assessment, monitoring, and management of sleep complaints in this population to improve clinical outcomes and reduce the use of resources, such as hospitalization and emergency department use. Asking the patient to describe how the depression is affected by effective sleep patterns best addresses the need for assessment techniques that focus on the effect of sleep on depression as well as the effect of depression on the sleep. Comanagement of sleep disturbance may result in improved symptom management, improved quality of life, and a return to baseline levels of functioning. Asking "How much sleep do you get each night?", "Describe for me why you believe you have problems sleeping?", and "Do you believe your mental health problem is related to a sleep disorder?" focus on the sleep patterns exclusively.

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

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

7. Which task is most likely to give terminally ill patients a sense of meaning about one's individual life? 1 Recognition of a transcendent realm 2 Transmission of knowledge and wisdom 3 Transfer of fiscal, legal, and formal social responsibilities 4 Expression of regret, forgiveness, and gratitude to family and friends

2 Transmission of knowledge and wisdom is most likely to give terminally ill patients a sense of meaning about one's individual life. Recognition of a transcendent realm is most likely to give terminally ill patients a sense of meaning about life in general. The transfer of fiscal, legal, and formal social responsibilities is most likely to give terminally ill patients a sense of completion with worldly affairs. Expression of regret, forgiveness, and gratitude to family and friends is most likely to give terminally ill patients a sense of completion in relationships with family and friends.

A patient reveals that he or she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to reveal which of the following? 1 Tachycardia 2 Hypokalemia 3 Hypolipidemia 4 Hypercalcemia

2 Vomiting causes loss of potassium, leading to hypokalemia.

3. A nurse leads a community meeting on an inpatient unit. What is the nurse's goal for this meeting? 1 Teaching patients about ways to express anger 2 Promoting and maintaining a therapeutic milieu 3 Helping patients to express and resolve intrapersonal conflicts 4 Teaching patients about the purpose and side effects of medication

2 With the promotion of patient rights and advocacy, a common group consistently held on inpatient units is the therapeutic community meeting. As every interaction occurring on an inpatient milieu has the potential to be therapeutic, the community meeting is the essential venue at which unit happenings are processed and integrated into treatment. Helping a patient express and resolve intrapersonal conflicts is the goal of individual psychotherapy. Teaching patients about medication or ways to express anger are goals of a psychoeducational group.

The nurse is providing discharge teaching to a patient who was recently raped. What should the nurse say regarding the psychological effects of the assault? 1 "You may feel hyperactive and notice an increased surge of energy." 2 "It is normal to experience depression after being sexually assaulted." 3 "People often report the need to be social after a sexual assault incident." 4 "Let the healthcare provider know immediately if you feel scared or worried."

2 "It is normal to experience depression after being sexually assaulted." After a sexual assault, people may experience depression, low self-esteem, anxiety, and fear. The patient should be taught that these feelings are normal and to be expected. The patient does not have to contact the healthcare provider immediately if feeling scared. The patient may feel depressed and lethargic, not hyperactive. The patient might want to be alone rather than around other people in social settings.

An elderly patient pays the bills because the patient fears that his or her family will make him or her live elsewhere if the patient doesn't "help out." The nurse assesses this as what? 1 Neglect 2 Economic abuse 3 Physical violence 4 Psychological abuse

2 Economic abuse Economic abuse occurs when the perpetrator takes financial advantage of the elderly person, often through the use of subtle threats of what unpleasant or frightening outcome will occur if the elder patient does not supply funds. Neglect, physical violence, and psychological abuse lack the financial component.

The nurse performing the assessment of a wheelchair-bound patient suspects that the spouse's explanation of how the patient sustained facial contusions and a broken nose may not be entirely truthful. What should the nurse do? 1 Report the patient's injuries to the police and ask for a confidential investigation. 2 Have the spouse stay in the waiting room so the patient can be interviewed in private. 3 Confront the spouse with the suspicion that the patient's injuries are the result of abuse. 4 Document the suspicion and follow a policy of "wait and see" whether the patient returns again.

2 Have the spouse stay in the waiting room so the patient can be interviewed in private The initial intervention is the assessment interview, and suspected victims of abuse should always be interviewed in private. If the perpetrator is in the room, the victim cannot speak freely. Confronting the spouse, reporting the injuries to the police, or waiting to see if the patient returns again are not appropriate options; the assessment interview is the initial intervention.

Chapters 28,29 A nurse is caring for a pediatric patient who has severe injuries on his or her face and neck. The nurse says to the nurse manager, "I empathize with the patient; I wish I could make this patient happy by resolving all the problems." What response does the nurse have to the patient? 1 Confusion 2 Helplessness 3 Embarrassment 4 Discouragement

2 Helplessness The nurse caring for a victim of violence often develops common responses, such as helplessness. The nurse wishes to do more for the patient and resolving all the patient's problems to make him or her feel happy. The nurse's statement does not indicate embarrassment, confusion, or discouragement. Embarrassment is a feeling of shame or awkwardness. Confusion is the state of being bewildered or unclear in one's mind about something. The nurse does not seem to be confused about the patient's condition. When the patient doesn't respond to long-term treatment, the nurse feels discouraged or disappointed.

A woman in the sixth month of pregnancy presents in the emergency department with complaints of a severe headache. Her partner answers the assessment questions, even though they are directed to the woman. The woman has a depressed affect and slumped shoulders. The nurse recognizes the need for further assessment related to which of the following? 1 Potential neurologic infection 2 The risk of intimate partner violence 3 The possibility of a hypertensive crisis 4 Development of a major depressive episode

2 The risk of intimate partner violence Pregnancy is a high-risk period for development or escalation of intimate partner violence. In this instance, the partner is trying to control the interview, which is another indicator of possible abuse. Potential neurologic infection, the possibility of a hypertensive crisis, and development of a major depressive episode are possibilities but less likely options.

The nurse is preparing a safety plan for a victim of family violence. How does a safety plan help the victim? 1 The victim can call the nurse if there is any suicidal ideation. 2 The victim can identify signs of occurrence of violence and leave. 3 The victim can call law enforcement to intervene in a crisis situation. 4 The victim can stay calm and relaxed during an episode of violence.

2 The victim can identify signs of occurrence of violence and leave. The safety plan helps the patient to identify signs of abuse and to escape the situation by leaving. The patient should be prepared by packing essential items and keeping a packed bag in a secret place. There should be a plan for a destination and transportation. The victim can call the police if the situation warrants and it is not possible for the victim to escape. The victim can call the nurse if there is a suicidal feeling. Staying calm and relaxed does not help the victim avoid a violent situation.

A sexual assault victim tells the nurse, "I should have tried to fight him off! But I was so terrified that I could not move. I should have tried harder." What would be a supportive response from the nurse? 1 "Try not to think about it. Put it out of your mind." 2 "The way you behaved was the right thing to do at the time." 3 "Do you think others will think badly of you for not trying to fight?" 4 "We each behave in characteristic ways in a crisis. That was your way."

2"The way you behaved was the right thing to do at the time." The victim should always be told that staying alive was the priority and that whatever he or she did to that end was the right thing to do.

The nurse is assessing a patient with rape-trauma syndrome. The patient killed the perpetrator in an attempt to save herself. The patient tells the nurse, "I am a murderer. I killed that man. I should have tried to run away. Why did I have to kill the man?" What should be the response given by the nurse to the patient? 1 "Please calm down and start thinking logically." 2 "You have done the correct thing to save your life." 3 "I don't think that the law enforcement would take actions against you." 4 "Running away would have been a better solution to save yourself."

2"You have done the correct thing to save your life." The rape victim killed the perpetrator in an attempt to save herself. Therefore, the nurse should reassure the patient by saying that the patient did the right thing to save her life. This will reduce the feelings of guilt and self-blame. The nurse should listen to the patient when the patient tries to explain her feelings. Asking the patient to calm down and start thinking logically would not reassure the patient. Saying that the law enforcement would not take actions against the patient indicates that the nurse is being judgmental about the patient's actions. Telling the patient that running away would have been a better option indicates that the nurse does not feel that the patient has done the right thing. This will increase the feelings of guilt in the patient and should be avoided.

What appropriate symptoms should the nurse asses to identify borderline personality disorder when interviewing patients? Select all that apply. 1 Extent of happiness 2 Feelings of emptiness 3 Frequency of mood shifts 4 Tendency toward sarcasm 5 Inclination toward group activities

2,3,4 The nurse can assess borderline personality disorder by evaluating the tendency of sarcasm, anger, and bitterness in the patient. The nurse should assess feelings of emptiness and loneliness. A patient with borderline personality disorder experiences extreme mood shifts. The nurse should asses the frequency of extreme mood shifts that occur in an hour or days. Patients with borderline personality do not engage in group activities because of anxiety. Extent of happiness doesn't help in identifying borderline personality disorder because the patient has mood swings.

1. A nurse is giving postvention to the wife of a depressive patient who committed suicide. What statements indicate that the nurse understands postvention? Select all that apply. 1 "You should be strong for your family." 2 "Don't be afraid to talk about your husband." 3 "Donating your husband's belongings may help you let go." 4 "I can't allow you to meet your husband's primary health care provider." 5 "Why didn't you admit your husband immediately for treatment of his depression?"

2,3 Postvention or tertiary intervention refers to counseling given to the relatives and family of a person who has committed suicide. The nurse should have an understanding of grief and loss counseling, such as the need for the family to talk about the loss openly. Families often keep the belongings of the patient, which can prevent them from overcoming their loss and grief. The nurse should suggest donating all the belongings of the patient as part of the process of letting go. The nurse should not blame or interrogate the family, as it can make them feel rejected. The nurse should allow the family to meet the primary health care provider if they have questions about the patient's condition before the suicide. They may gain a better understanding, which will help them move through the grieving process. Stating that the wife should be strong for her family is not appropriate or helpful because it dismisses her grief.

A nurse interacts with a patient who was physically abused. The nurse diagnoses the patient as in the serious battering phase. Which signs and symptoms does the nurse find in the patient? Select all that apply. 1 The patient begins to indulge in self-harm. 2 The patient tries to cover up injuries with a scarf. 3 The patient requests to be rescued from the abuser. 4 The patient accepts the blame for being physically abused. 5 The patient believes that the partner will stop physical abuse.

2,3 The cycle of abuse consists of three stages, the tension-building phase, the serious battering phase, and the honeymoon phase. In the serious battering phase, the patient has serious injuries and tries to cover them up with a cloth or scarf. The patient wants to escape from the abuser and asks for help from the nurse and others. In the tension-building phase, the patient blames himself or herself for the partner's abusive behavior. In the honeymoon phase, the patient develops feelings of trust and hope toward the abuser. The abuser shows love and care toward the victim and showers the victim with gifts and flowers, so the patient hopes that the partner will stop physically abusing. Patients who are suicidal or manic are usually found to indulge in self-harm.

Which interview question will support the possible ingestion of the date rape drug flunitrazepam? Select all that apply. 1 "Do you remember your drink tasting salty?" 2 "How much, if any, alcohol did you have to drink?" 3 "Is it possible something was added to your drink?" 4 "Are you sure you were unconscious for 90 minutes?" 5 "Do you remember seeing things that weren't really there?"

2,3 "How much, if any, alcohol did you have to drink?" "Is it possible something was added to your drink?" Flunitrazepam is a pill that dissolves in liquids. Impact is within 10 to 30 minutes and lasts 2 to 12 hours. It is more potent when combined with alcohol, causing sedation, psychomotor slowing, muscle relaxation, and amnesia. Ketamine comes as a liquid or a white powder. Onset is within 30 seconds intravenously and 20 minutes orally; duration is only 30 to 60 minutes. The victim may become confused, paranoid, delirious, and combative, with drooling and hallucinations. Gamma-hydroxybutyric acid (GHB) comes in liquid, white powder, or pill form and presents with a salty taste.

A person comes to the healthcare facility with a bleeding head injury and some bruises to both hands. What signs would indicate this person is a victim of domestic abuse? Select all that apply. 1 The patient makes direct eye contact. 2 The patient gives hesitant explanations. 3 The patient's explanation is inconsistent. 4 The patient minimizes the seriousness of the injury. 5 The patient exaggerates the seriousness of the injury.

2,3,4 If the patient comes with a bleeding injury, especially to head or face, the nurse should suspect abuse. If the explanation does not match with the injury seen, the nurse should ask the patient direct questions in a nonthreatening way to determine if the injury is caused by some person in the family. If the patient minimizes the seriousness of the injury, the nurse should suspect abuse. The nonverbal responses should be documented. Examples include if the patient hesitates, does not make eye contact, or if the explanation is inconsistent. Good eye contact and a consistent explanation do not reveal any underlying abuse. The patient may minimize, not exaggerate, the seriousness of an injury.

3. What information regarding lithium carbonate is true? Select all that apply. 1 It is effective for patients with a history of rapid cycling. 2 It demonstrates effectiveness in the treatment of bipolar I. 3 Indefinite maintenance dosing is required for many patients. 4 Manic behaviors generally show improvement in 10 to 21 days. 5 Associated hypersexual behavior is well managed with the medication.

2,3,4 Lithium is effective in the treatment of bipolar I acute and recurrent manic and depressive episodes. Lithium inhibits about 80% of acute manic and hypomanic episodes within 10 to 21 days. It can help reduce hypersexuality but to a lesser degree than for other symptomology. Lithium is less effective in those with rapid cycling. Many patients receive lithium for maintenance indefinitely and experience manic and depressive episodes if the drug is discontinued.

10. Which principles related to crisis resolution direct the care provided by a crisis intervention nurse? Select all that apply. 1 The nurse must be willing to take a passive and nondirective role in the care. 2 Early intervention probably increases the chances for coping that is effective. 3 During a crisis, people often are more receptive than usual to outside intervention. 4 The goal of crisis intervention is for the patient to regain pre-crisis-level functioning. 5 The patient employs previously used problem-solving methods to regain pre-crisis function.

2,3,4 The goal of crisis intervention is to return the patient to at least the pre-crisis-level of functioning. During a crisis, people often are more receptive than usual to outside intervention. With intervention, the patient can learn different adaptive means of problem solving to correct inadequate solutions. The nurse must be willing to take an active, even directive, role in intervention. Early intervention probably increases the chances for a good prognosis.

Which factor is of least importance as a victim of spousal abuse constructs a safety plan? 1 Where the victim will go to be safe 2 How the victim will arrange for transportation 3 How the victim will explain the decision to leave 4 What the victim will need to take when he or she leaves

3 How the victim will explain the decision to leave Having a destination and transportation, plus important items to bring are important aspects of a safety plan. Having an explanation for the decision to leave is not of great importance.

What measures should the nurse take while assessing a rape victim? Select all that apply. 1 Make use of "why" questions. 2 Ask questions using descriptive terms. 3 Ask questions in a nonjudgmental tone. 4 Ask the patient to talk at a comfortable pace. 5 Ask the patient to explain the assault in detail.

2,3,4 Ask questions using descriptive terms. Ask questions in a nonjudgmental tone. Ask the patient to talk at a comfortable pace. While assessing a rape victim, the nurse should ask questions using descriptive terms to avoid any confusion in the patient. The nurse should always ask questions in a nonjudgmental manner to avoid making the patient feel embarrassed and uncomfortable. The nurse should ask the patient to speak in a comfortable pace since the patient has undergone trauma. Asking "why" questions would indicate that the nurse wants a detailed explanation of the incident. The nurse determines only the details of the assault that will be helpful in addressing immediate physical and psychological needs of the patient. Asking the patient to explain the assault in full detail as this can make the patient feel more embarrassed and traumatized.

Which diagnostic laboratory test is considered pertinent to the assessment of a patient suspected of having bulimia nervosa? Select all that apply. 1 Liver function 2 Glucose level 3 Thyroid function 4 Electrolyte levels 5 Complete blood count

2,3,4,5 Medical evaluation usually includes a thorough physical examination, as well as pertinent laboratory testing, including: electrolyte levels, glucose level, thyroid function tests, and complete blood count. Although it may be appropriate in some cases, liver function testing is not considered pertinent to the assessment process.

Which statement is a myth concerning sexual assaults? Select all that apply. 1 Most rapes occur in the home. 2 Most women are raped by strangers. 3 Most rapes occur for the purpose of sex. 4 Sexual assaults are generally impulsive, unplanned acts. 5 Fighting back will only result in additional physical injuries.

2,3,4,5 Most women are raped by strangers. Most rapes occur for the purpose of sex. Sexual assaults are generally impulsive, unplanned acts. Fighting back will only result in additional physical injuries. The majority (69%) of rape victims are raped by someone they know. Sex is used as an instrument of violence in rape. Rape is an act of aggression, anger, or power. Most rapes are planned; over 50% involve a weapon. There are no verifiable data to substantiate the theory that a victim will be injured if he or she tries to get away. Over 50% of all rapes occur in the home, not in dark alleys.

8. According to Elisabeth Kübler-Ross, which phases occur in people's responses to terminal illness? Select all that apply. 1 Guilt 2 Anger 3 Bargaining 4 Depression 5 Acceptance 6 Denial and isolation

2,3,4,5,6 According to Elisabeth Kübler-Ross, when responding to terminal illness, people experience the phases of anger, bargaining, depression, acceptance, and denial and isolation. Guilt is not included among these phases.

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

2,3,5 Clinical features of fetal alcohol syndrome include short stature, microcephaly, and craniofacial malformations. Spina bifida and renal agenesis are not associated with fetal alcohol syndrome.

In the tertiary prevention method, what measures are taken to assist the survivors of abuse in the healing process? Select all that apply. 1 Counsel the survivors to hate and stay away from the perpetrator. 2 Counsel the individuals and families for healing and rehabilitation. 3 Assist in dealing with the legal proceedings against the perpetrator. 4 Support the survivors to remain in social isolation and avoid interaction. 5 Assist the survivors of violence to achieve safety, health, and well-being.

2,3,5 Counsel the individuals and families for healing and rehabilitation. Assist in dealing with the legal proceedings against the perpetrator. Assist the survivors of violence to achieve safety, health, and well-being. In the tertiary prevention method, the nurse provides care to the individuals or groups of survivors of family abuse. The measures are taken to support the healing process through counseling. A legal advocacy program can be in place to advise the survivors on legal proceedings. Overall assistance is given to the survivors to achieve an optimal level of safety, health, and well-being. Negative thoughts against the perpetrator are addressed and reduced. Support groups are in place to provide social supports and group interactions to decrease isolation behavior.

10. What notation in the patient's medical record supports the diagnosis of mania? Select all that apply. 1 Patient demonstrates ritual behaviors. 2 Patient reports, "God talks directly to me." 3 Patient is disheveled and in need of a bath. 4 Patient reports, "I haven't slept in 4 days; don't need to." 5 Patient presents with a happy, near euphoric demeanor.

2,4,5 People with mania are the happiest, most excited, and most optimistic people one could meet. They feel euphoric and energized; they don't sleep or eat and talk constantly. Because they feel so important and powerful, they take horrific chances and do foolish things. As the disorder intensifies, psychosis ensues and people with mania begin to hear voices, sometimes the voice of God. Being disheveled or demonstrating ritualistic behavior are not classic characteristics of mania.

What are the personality traits associated with borderline personality disorder? Select all that apply. 1 Shyness 2 Impulsivity 3 Disinhibition 4 Hypersensitivity 5 Aggressive disregard 6 Emotional dysregulation

2,4,6 Borderline personality disorder is highly associated with impulsivity, hypersensitivity, and emotional dysregulation. People with this disorder act quickly and impulsively in response to their emotions, without considering the consequences. Because of their hypersensitive trait, they exhibit separation anxiety. The emotional dysregulation trait is indicated by frequent mood swings. The genetic trait of shyness predisposes people to schizoid personality disorder. People with the disinhibition trait show a lack of concern for the consequences of their actions. They are predisposed to antisocial personality disorder. People with an aggressive disregard trait who exhibit violent tendencies with no concern for others often have an antisocial personality disorder.

7. Which statement concerning a crisis is true? Select all that apply. 1 A crisis is defined based on the event that occurred. 2 Adaptation to the results of the crisis is vital to recovery. 3 A crisis is chronic in its nature and unlimited in its duration. 4 Normal coping mechanisms are sufficient to deal with a crisis. 5 A crisis involves a struggle to regain one's emotional equilibrium.

2,5 Crisis is defined by the struggle for equilibrium and adaptation in its aftermath. Crisis is not defined by the experience itself. Normal coping mechanisms fail to deal with this distress, resulting in an inability to function as usual. Crises are acute and time limited, usually lasting 4 to 6 weeks.

11. At what point in the end-of-life process does anticipatory grief occur? 1 Immediately following the death of a loved one 2 When curative efforts for a serious illness begins 3 Once a life-threatening diagnosis has been received 4 For several months following the death of a loved one

3 Once a life-threatening diagnosis has been received or curative efforts are stopped, individuals begin a period of grieving called anticipatory grief or anticipatory mourning. This type of grief is anticipatory in the sense that a future loss is being mourned in advance. Anticipatory grief typically does not occur when curative efforts for a serious illness begins, as patients and family members may have hope for recovery at this point. The grief that occurs immediately and for several months following the death of a loved one is not considered anticipatory.

6. The nurse recognizes that which of the following describes a closed group? 1 Will demonstrate cohesiveness 2 Will discuss topics that will be restricted 3 Will not add new members once it is formed 4 Has a membership that is limited to one gender

3 A closed group is one to which no members are added once the group has begun. Discussing topics that will be restricted, having a membership that is limited to one gender, and demonstrating cohesiveness may or may not be characteristics of the group.

10. A patient diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as 1 Blocking 2 A delusion 3 A neologism 4 Clang association

3 A neologism is a newly coined word that has meaning only for the patient. Clang association is choosing a word with similar sound like "click, clack, clutch." Blocking is related to thoughts and a stop or reduction in thoughts often related to interruptions caused by hallucinations. Delusions are false beliefs.

Chapter 24 A patient diagnosed with antisocial personality disorder with impaired social interaction and defensive coping receives psychotherapy treatment. Which response of the patient indicates to the nurse the treatment has been effective? 1 The patient ridicules a manic patient in the psychiatric unit. 2 The patient requests the nurse excuse him or her from a particular task. 3 The patient plays a leading role in a group activity assigned by the nurse. 4 The patient declares the government to be responsible for his or her condition.

3 A patient with antisocial personality disorder shows impaired social interaction and defensive coping. A patient who plays a leading role in a group activity indicates improvement of the symptoms, which may be the result of effective treatment. This is because the patient cooperates with others and interacts well. Psychotherapy aims to help patients take responsibility for their own actions in order to improve their conditions. The patient declaring the government to be responsible does not indicate effective treatment. A request to be excused from a therapy task doesn't indicate progress or effective treatment. Psychotherapy aims to make the patient interact with others and develop sensitivity toward others. Ridiculing another patient shows that the patient with antisocial personality disorder is not sensitive and does show empathy for others.

A patient was diagnosed with narcissistic personality disorder. Which aspect of the nursing assessment is most important? 1 Pain rating 2 Level of anxiety 3 Nutritional status 4 Attention span, hyperactivity

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

The nurse is assessing a patient reporting problems with sleep. What symptoms in the patient help the nurse to analyze the disorder as disturbed sleep pattern? 1 Lethargy 2 Agitation 3 Acute confusion 4 Not feeling well rested

4 Disturbed sleep pattern is caused by changes in the normal sleep pattern that decreases the functional ability. The patient with disturbed sleep pattern has no difficulty falling asleep but is dissatisfied with sleep and does not feel well rested as a result of changes in the sleep routines. Acute confusion, lethargy, and agitation are the symptoms of sleep deprivation. Sleep deprivation is caused by an imbalance between the hours of sleep required and the hours of sleep obtained.

4. The nurse is assessing a single-parent family consisting of a parent and an adolescent. The parent recently lost a job and the adolescent is in high school. The adolescent tells the nurse that he wants to help the parent. Which nursing intervention would be helpful in preventing the family from having diffuse boundaries? 1 Arrange for some financial resources for the family 2 Ask the adolescent to go and obtain a full-time job 3 Suggest resources that help the parent to get a job 4 Ask the parent to stay away from the child for some time

3 As the parent has lost a job, there is a high possibility that the adolescent would take up the responsibilities of the family. This would be indicative of diffuse family boundaries. The nurse should define the roles of the family members. The nurse should ideally help the parent to get a new job and look after financial aspects of the family. Arranging for monetary sources may make the family dependent on external sources for the money over time and thus it should be prevented. The adolescent is in school and is too young to take up a vocation. In this situation, the family members would need each other's support, and thus the nurse should not ask the parent to stay away from the child.

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

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

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

3 Cocaine exerts a stimulant effect on metabolism.

How can the nurse working with patients diagnosed with eating disorders help families develop effective coping mechanisms? 1 Stressing the need to suppress overt conflict within the family 2 Urging the family to demonstrate greater caring for the patient 3 Teaching the family about the disorder and the patient's behaviors 4 Encouraging the family to use their usual social behaviors at meals

3 Families need information about specific eating disorders and the behaviors often seen in patients with these disorders. This information can serve as a basis for additional learning about how to support the family member.

9. Group therapy is a mainstay of inpatient psychiatric treatment. Which statement best describes how this approach came to be used? 1 Group therapy was initiated to contain costs. 2 Group therapy assures patient confidentiality. 3 Group therapy was initially used to treat veterans. 4 Group therapy was initially used for patients in drug treatment programs.

3 Group therapy was initially used to maximize the number of patients who could be treated at one time as the result of veterans returning from the First and Second World Wars. Group therapy may affect cost as it requires fewer healthcare professionals to manage, but this was not the main reason it began. Group therapy is a staple in drug treatment programs, but this was not the first population treated with it. One of the potential drawbacks to group therapy is the lack of confidentiality among members of the group.

4. The nursing diagnosis risk for self-directed violence has been added to the care plan of a suicidal patient. The most appropriate short-term goal would be that while hospitalized, the patient will 1 Participate in a self-help group 2 Name three personal strengths 3 Seek help when feeling self-destructive 4 Reclaim any prized possessions that were given away

3 Having the patient cope with self-destructive impulses in a healthy way is the only appropriate short-term goal here.

A patient diagnosed with anorexia nervosa and which assessment finding meets the criteria for hospitalization? 1 Oral temperature 98.1°F 2 Heart rate 56 beats per minute 3 Serum potassium level 2.6 mEq/L 4 Systolic blood pressure 88 mm Hg

3 Hypokalemia (less than 3 mEq/L) or other electrolyte disturbances warrant hospitalization because of risks regarding cardiac regulation. Other criteria for hospitalization include severe hypothermia (temperature lower than 36°C or 96.8°F), heart rate less than 40 beats per minute and systolic blood pressure less than 70 mm Hg.

A nurse assesses personality traits of a patient with an eating disorder. Which comment by the patient indicates bulimia nervosa rather than anorexia nervosa? 1 "I feel good. I feel just fine. I don't have any problems." 2 "I try to do what my parents want, but I usually don't get things right." 3 "If I want to do something, I just do it. I don't like to analyze things too much." 4 "I don't look as good as most of my friends. That's why I don't have many dates."

3 Impulsivity is characteristic of bulimia nervosa. The other options indicate low self-esteem, feelings of ineffectiveness, and alexithymia, which are findings in all eating disorders.

5. In children, grief is considered to be persistent if it lasts longer than how many months? 1 2 Months 2 4 Months 3 6 Months 4 12 Months

3 In children, grief is considered to be persistent if it lasts longer than 6 months. Grief lasting 2 or 4 months in adults or children not considered to be persistent. In adults, grief is considered to be persistent if it lasts longer than 12 months.

Chapters 25, 30 1. The nurse observes the meal tray about to be served to a suicidal patient. Which item should be removed from the tray? 1 Plastic plate 2 Cloth napkin 3 Metal utensils 4 Styrofoam cup

3 In most health care agencies, suicidal patients receive plastic dinnerware on their meal trays.

6. What is the physician's role in physician-assisted suicide? 1 Convincing the patient to end his or her life 2 Administering medication to end the patient's life 3 Providing the patient with the means to end his or her own life 4 Advocating for the patient's legal right to end his or her own life

3 In physician-assisted suicide, the physician provides the patient with the means to end his or her own life, often in the form of medication and administration instructions. The physician may educate or counsel the patient about his or prognosis but should not attempt to convince the patient to end his or her life. Unlike euthanasia, in physician-assisted suicide, the physician makes the means of death available but does not act as the direct agent of death, such as by administering medication to end the patient's life. The physician may choose to advocate for patients' legal rights to end their own lives, but this is not the physician's role in physician-assisted suicide itself.

1. A divorced woman is treated with antidepressants in an inpatient setting. The patient expresses to the nurse, "My depression is gone. I feel very energetic today. Soon everything will be fine." What would be the most appropriate response for the nurse? 1 "Yes, I will surely plan for your discharge." 2 "Congrats! You seem to have recovered well." 3 "Do you have any sort of suicidal ideas or plans?" 4 "I am happy to see you recover from depression."

3 It is important for the nurse to be aware of verbal and nonverbal hints of suicide by a patient to prevent suicide. When there is a sudden rise in the mood and energy of a depressed patient, the nurse should understand that the patient may have suicidal ideation. These behavioral changes may be the patient's attempt to mask suicidal intent. In such situations, the nurse should ask the patient directly about suicidal ideation. The patient should not be discharged as the patient is not safe. The patient should not be congratulated for recovery from depression because the patient is still not mentally stable. The patient does not seem to have recovered from depression. Therefore the nurse should not express satisfaction with the patient's recovery.

What information is important for the nurse to understand when initiating the use of naltrexone prescribed for alcohol relapse prevention? 1 The tablets will be taken three times a day. 2 Medication can begin on the fifth day of abstinence from alcohol. 3 The patient needs to be opiate-free for 10 days before starting the medication. 4 The patient must avoid all alcohol and substances such as cough syrup and mouthwash containing alcohol.

3 It is important that the nurse ensure the patient is opiate-free for 10 days before starting naltrexone for alcohol relapse prevention. Acamprosate calcium tablets are taken three times a day and initiated on the fifth day of abstinence from alcohol. The patient prescribed disulfiram should avoid all alcohol and substances such as cough syrup and mouthwash containing alcohol.

11. A patient is prescribed tricyclic antidepressants. What should the nurse check for in the patient's case history before administering the drug? 1 Suicidal ideation 2 Loss of appetite 3 Oral contraceptive use 4 Insomnia

3 Medications such as oral contraceptives, antihypertensive reagents, monoamine oxidase inhibitors and anticoagulants may react with tricyclic antidepressants. It can cause potent side effects due to drug interaction. The nurse should check for their administration in the patient's case history and inform the primary healthcare provider. Suicidal ideation, loss of appetite, and insomnia are common symptoms of depression.

During assessment of a patient with anorexia nervosa, it is not likely that the nurse would note indications of which of the following? 1 Introversion 2 Social isolation 3 High self-esteem 4 Obsessive-compulsive tendencies

3 Most patients with eating disorders have low self-esteem.

The nurse is caring for a rheumatoid arthritis patient with borderline personality disorder. Which behavior does the nurse find in the patient compared with other patients in the ward? 1 The patient is always calm and depressed. 2 The patient abuses peers and hospital staff. 3 The patient shows extreme fluctuating emotions. 4 The patient feels uncomfortable with the nurse's attention.

3 Patients with borderline personality disorder have unstable moods. Such patients exhibit rapid emotional shifts. They may be extremely aggressive and suddenly become extremely calm. They have a history of violence and impulsivity. They are not always aggressive but they are emotionally unstable and may exhibit a range of emotions. The patients have attention-seeking behavior and may try to attract the attention of the nurse.

Which of the following statements is true of bulimia? 1 Patients with bulimia have lanugo. 2 Patients with bulimia severely restrict their food intake. 3 Patients with bulimia often appear to have a normal weight. 4 Patients with bulimia binge eat but do not engage in compensatory measures.

3 Patients with bulimia are often at or close to ideal body weight and do not appear physically ill. Not engaging in compensatory measures, severely restricting food, and lanugo do not refer to bulimia but rather refer to signs of binge eating disorder and anorexia nervosa.

A patient reports symptomology that supports the diagnosis of sleep paralysis. The nurse effectively assesses the patient by asking, 1 "Do you ever have nightmares?" 2 "Is it difficult for you to fall asleep?" 3 "Have you ever fallen asleep while driving?" 4 "Do you have a history of obsessive-compulsive behavior?"

3 Patients with sleep paralysis often also exhibit symptoms of narcolepsy, such as extreme sleepiness, resulting in falling asleep at inappropriate times.

What type of dialectical behavior therapy (DBT) for borderline personality disorder aims at reducing the person's destructive behavior? 1 Aftercare therapy 2 Inpatient treatment 3 Outpatient skills group 4 Intensive outpatient treatment

4 During the intensive outpatient treatment phase of DBT, the aim is to reduce the patient's destructive behaviors, such as property damage. During inpatient treatment, the goal is primarily to reduce the risk of suicide. DBT provided in the outpatient skills group aims at helping the patient stabilize, acquire skills for behavioral function, and become more functional. Aftercare therapy helps the person improve quality of life skills and reinforces adaptive behaviors.

A patient experiences extreme anxiety in social situations and seems to have some intellectual and perceptual distortions but can be made aware of the misinterpretations of reality. What is the patient likely to be suffering from? 1 Schizoid personality disorder 2 Paranoid personality disorder 3 Schizotypal personality disorder 4 Obsessive-compulsive personality disorder

3 People with schizotypal personality disorder have severe social and interpersonal deficits. They experience anxiety in social situations. They may have some intellectual and perceptual distortions but can be made aware of reality, unlike those with schizophrenia. Schizoid personality disorder can be a precursor to schizophrenia or delusional disorder. People with this disorder are emotionally detached loners who do not seek out or enjoy close relationships. People with paranoid personality disorder tend to be afraid that others will harm or deceive them. Therefore, they are hostile and view others with suspicion. People with obsessive-compulsive disorder have a fear of imminent catastrophe. They tend to rehearse over and over how they will respond in a social circumstance.

A nurse caring for a patient who has been diagnosed with a personality disorder should expect that the patient will exhibit which behavior? 1 Abnormal ego functioning 2 Frequent episodes of psychosis 3 Inflexible and maladaptive responses to stress 4 Constant involvement with the needs of significant others

3 Personality patterns persist unmodified over long periods. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder. Psychosis, abnormal ego functioning, and caregiving tendencies generally are not characteristic of personality disorders.

3. Which is an example of an event that may cause grief as a result of public tragedy? 1 Stillborn child 2 Sudden death of a parent 3 Assassination of a president 4 Death resulting from a violent crime

3 Public tragedies involve a loss with an impact that is felt broadly across a community or the general public. Entire communities and nations are shocked by genocide, war, assassinations, natural disasters, and school shootings. A stillborn child, death of a parent, and death resulting from violent crime do not specifically indicate public tragedy.

A non-habit-forming melatonin receptor agonist often prescribed for insomnia is 1 Zaleplon 2 Zolpidem 3 Ramelteon 4 Eszopiclone

3 Ramelteon is a short-acting melatonin receptor agonist that has been approved by the Food and Drug Administration for insomnia and is not habit forming.

Assessment of a patient suspected of experiencing bulimia nervosa calls for the nurse to perform which of the following? 1 Body fat analysis 2 Inspection of body cavities 3 Inspection of the oral cavity 4 A range of motion assessment

3 Repeated vomiting often causes dental erosions and caries.

3. A nurse is caring for a patient with schizophrenia. Which type of intervention should the nurse plan to ensure the safety of the patient? 1 Primary intervention 2 Tertiary intervention 3 Secondary intervention 4 Critical incident stress debriefing

3 Secondary intervention includes coping strategies from acute crisis and prolonged anxiety levels. The prime theme of secondary intervention is to ensure the safety of the patient. It includes the assessment systems, support systems, and coping strategies. Primary interventions include psychotherapeutic crisis interventions. Tertiary interventions include coping for patients with a disabling mental state. Critical incident stress debriefing is a form of tertiary intervention.

The nurse is learning about treatment measures for different sleep disorders. Which appropriate treatment measure is needed for rapid eye movement sleep behavior disorder? 1 Reassurance 2 Reducing obesity 3 Sleep partner safety 4 Lifestyle management

3 Sleep partner safety is a treatment measure in the case of rapid eye movement sleep behavior disorder. These patients show elaborate motor activity and they act out their dreams with actions such as shouting, thrashing, and hitting. These activities may harm the patient's sleep partner. Reassurance and lifestyle management are needed in patients having confusional arousals. Confusional arousals are characterized by a confused state on waking up from sleep. Reassurance is required when the patient has an episode of waking up confused. Lifestyle management such as maintaining proper sleep hygiene, stress reduction, limiting alcohol, and obtaining sufficient sleep reduces confusional arousals. Reducing obesity is more helpful in treating obstructive sleep apnea hypopnea syndrome, because obesity is an important risk factor for obstructive sleep apnea.

The nurse is learning about sleep-related hypoventilation. Sleep-related hypoventilation is most commonly seen in patients having which disease? 1 Neurologic disorders 2 Advanced cardiac disease 3 Lung parenchymal disease 4 Advanced pulmonary disease

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

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

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

12. When several group members always sit together and nod or smirk as others are talking, the leader assesses this behavior as which of the following? 1 Altruistic 2 Universality 3 Subgrouping 4 Contingency seeking

3 Subgrouping involves formation of a splinter group within the larger group. Members of the subgroup show more loyalty to each other than to the larger group.

5. What causes the "death rattle" that may accompany the dying process? 1 Slowing heartbeat 2 Cheyne-Stokes respirations 3 Pooling of saliva in the upper airway 4 Speaking in a state of agitation and delirium

3 The "death rattle" that may accompany the dying process is caused by pooling of saliva in the upper airway. It is not caused by a slowing heartbeat, Cheyne-Stokes respirations, or speaking in a state of agitation and delirium.

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

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

Which hormone regulates hunger? 1 Leptin 2 Insulin 3 Ghrelin 4 Melatonin

3 The hormone ghrelin regulates hunger. Leptin is a hormone that causes feelings of fullness, thereby acting as a satiety hormone. Insulin regulates blood sugar levels. Melatonin regulates sleep.

A patient is withdrawn and suspicious and states he or she has always preferred to be alone. The patient describes him- or herself as having "special powers" and states, "I believe we can all read each other's thoughts at times." Based on this presentation, the nurse suspects which personality disorder? 1 Avoidant 2 Narcissistic 3 Schizotypal (STPD) 4 Obsessive-compulsive

3 The main traits that describe STPD are psychoticism, such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obsessive-compulsive personality disorder the main pathologic personality traits are rigidity and inflexible standards of self and others, along with persistence to goals long after it is necessary, even if it is self-defeating or negatively affects relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people.

10. A nurse interacts with a depressive patient. The patient says, "Can you get me carbon monoxide tomorrow? I want to kill myself." What conclusion should the nurse make from the patient's response? 1 The patient has delusions. 2 The patient is socially withdrawn. 3 The patient is at higher risk of suicide. 4 The patient can cause harm to others.

3 The nurse should appropriately evaluate the suicide plan of the patient. Patients with definite intention and time are at high risk. Based on the method of lethality, patients can be classified as higher risk and lower risk. Carbon monoxide poisoning, using a gun, jumping off a high place, or car crash indicate high risk. Depressive patients normally feel rejected and avoid social gatherings. The statement by the nurse does not indicate that the client is socially withdrawn. Although delusions are not a high risk of suicide, they can result in suicide. The patient does not have manifestations of delusions. The patient is depressed and sad but not aggressive, so there is no harm to others.

Which benzodiazepine drug should the nurse expect to be prescribed for treating insomnia? 1 Trazodone 2 Ramelteon 3 Quazepam 4 Doxylamine

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

7. The time of death used on the death certificate is identified at what point? 1 When the medical examiner releases the patient. 2 When the funeral home arrives to move the patient's body. 3 When the nurse observes the patient has been without a heartbeat or breath for two minutes. 4 When the family member or other person present identifies the patient has stopped breathing.

3 The time of death used on the death certificate is identified when the nurse observes the patient has been without a heartbeat or breath for 2 minutes. The time of death is not identified when the medical examiner releases the patient, when the funeral home arrives to move the patient's body, or when the family member or other person present identifies the patient has stopped breathing.

3. Which statement is true concerning the act of suicide? 1 More women than men commit suicide. 2 Native Americans and Alaskan Natives have low suicide rates. 3 Suicide is the second leading cause of death in the United States. 4 A patient with schizophrenia is at great risk for attempting suicide.

4 Individuals with schizophrenia are 50 times more likely to attempt suicide than the general public. More women attempt suicide, but more men are successful. Suicide is the tenth leading cause of death in the United States. Native Americans and Alaskan Natives have high suicide rates.

7. Which task is most likely to give terminally ill patients a sense of completion with worldly affairs? 1 Recognition of a transcendent realm 2 Transmission of knowledge and wisdom 3 Transfer of fiscal, legal, and formal social responsibilities 4 Expression of regret, forgiveness, and gratitude to family and friends

3 The transfer of fiscal, legal, and formal social responsibilities is most likely to give terminally ill patients a sense of completion with worldly affairs. Recognition of a transcendent realm is most likely to give terminally ill patients a sense of meaning about life in general. Transmission of knowledge and wisdom is most likely to give terminally ill patients a sense of meaning about one's individual life. Expression of regret, forgiveness, and gratitude to family and friends is most likely to give terminally ill patients a sense of completion in relationships with family and friends.

8. The nurse is giving information about different theories of suicide. When does a person usually commit copycat suicide? 1 After a person loses his or her job 2 After a person loses his or her self-esteem 3 After a highly publicized suicide of a public figure 4 After losing freedom due to imminent incarceration

3 Theories of suicide have recently focused on a combination of suicidal fantasies with loss of job, rage, guilt, or identification with an individual who has committed suicide. A person commits copycat suicide after a highly publicized suicide of a public figure or an idol or a peer in the community. Losing a job, losing self-esteem due to various reasons, and feeling trapped in a jail may also be reasons for committing suicide, but they are not the reasons for a copycat suicide.

9. A patient diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be 1 "The voices are wrong about the hospital food. It is not contaminated." 2 "You are safe here in the hospital; nothing bad will happen to you." 3 "I understand that the voices are very real to you, but I do not hear them." 4 "Other people are eating the food, and nothing is happening to them."

3 This reply acknowledges the patient's reality but offers the nurse's perception that he or she is not experiencing the same thing.

11. A patient is at very high risk of suicide, and assessment shows that the patient will most likely follow a plan of self-harm. How often should the nurse chart the patient's whereabouts and record mood, verbatim statements, and behavior? 1 Every other day 2 Three times a day 3 Every 15-30 minutes 4 Every 60-120 minutes

3 When patients are at high risk of suicide and assessment shows that they may follow a plan of self-harm, the nurse should keep them under 24-hour surveillance. The nurse should chart the patient's whereabouts and record his or her mood, verbatim statements, and behavior every 15-30 minutes. The patients may cause self-harm if the interval between two checks is large, such as thrice a day, every 60-120 minutes, or every other day.

The nurse is assessing an adolescent patient who has been raped by a stranger. What question should the nurse ask the patient to assess the likelihood of pregnancy? 1 "Do you have nausea and vomiting?" 2 "Why do you think you might be pregnant?" 3 "What is the date of your last menstrual period?" 4 "Would you please describe the incident of rape?"

3 "What is the date of your last menstrual period?" In order to assess the probability of the patient becoming pregnant due to the rape, the nurse should ask the patient about her last menstrual period. By knowing this, the nurse can calculate the approximate date of ovulation. If the time of the rape incident coincides with or is close to the approximate date of ovulation, there is a greater chance that the patient may become pregnant. Morning sickness characterized by nausea and vomiting occurs later in pregnancy. Thus, the nurse should not ask this question to a victim who has been raped recently. The nurse should not ask questions that start with "why" as they are inherently evaluative. The nurse should never ask the patient to describe the rape. Such questions may make the patient feel uncomfortable and embarrassed.

A rape victim experiences intrusive dreams, flashbacks, and recurring images of the incident since it occurred 3 weeks ago. What is the possible nursing diagnosis of the rape victim? 1 Anxiety 2 Depression 3 Acute stress disorder 4 Post-traumatic stress disorder

3 Acute stress disorder The symptoms of intrusive dreams, flashbacks, and recurring images of the event for 3 weeks indicate acute stress disorder. The symptoms are in response to the traumatic event of rape and the duration of the symptoms is 3 weeks. The rape victims' symptoms are not suggestive of anxiety or depression. The symptoms are similar to post-traumatic stress disorder (PTSD); however, the duration in PTSD is more than a month.

What is the most appropriate statement about the victims of abuse? 1 Elder abuse is uncommon. 2 Children face physical abuse more than any other abuse. 3 Females face intimate partner abuse more often than males. 4 Girls facing child abuse die at a slightly higher rate than boys.

3 Females face intimate partner abuse more often than males. In intimate partner abuse, four out of five victims are women. Elders commonly face abuse both in domestic and institutional settings, and it is reported that 1 out of every 10 adults older than age 60 are victims of abuse. Neglect is the most common form of child abuse. It is followed by physical abuse. Girls are slightly more likely to be abused but boys die at a slightly higher rate than girls.

When there is reason to suspect that a child is being abused, what is the nurse's initial action? 1 Call the local police to report it. 2 Confront the parent or parents. 3 Follow agency policy for reporting. 4 Interrogate the child to obtain proof.

3 Follow agency policy for reporting. Nurses are mandated reporters of child abuse. They must follow the rules set forth by the state regarding the steps to take to report child abuse.

In the emergency department, a rape victim is examined and evidence is collected. How will this care be reimbursed? 1 Private foundations pay for the care. 2 The victim's insurance will pay for the care. 3 Government or tribal resources pay for the care. 4 The hospital writes off the expense as community service.

3 Government or tribal resources pay for the care. States and tribal governments are required to pay or reimburse for sexual assault exams. Failure to comply with this mandate results in loss of funding from the Violence Against Women grant initiatives. This mandate is patient-centered and gives control back to individuals who should be the primary decision makers in personal health and legal matters. Payment by private foundations, the victims' insurance, or the hospital are incorrect.

A person with a history of abusing an intimate partner says, "When my partner leaves home, I think it's because she's meeting someone she likes better than me." Which emotion is most evident by this comment? 1 Guilt 2 Anxiety 3 Jealousy 4 Remorse

3 Jealousy Extreme pathological jealousy is characteristic of an abuser. Many refuse to allow their partners to work outside the home; others demand that their partners work in the same place as they do, so they can monitor activities and friendships. Many accompany their partners to and from all activities and forbid them to have friends or participate in recreational activities outside the home. Anxiety is possible, but jealousy is more specific to the patient's comment. There is no evidence of remorse or guilt, which would signify regret of the abuse.

Which of the following is the best description of completed rape? 1 Sexual desire satisfied inappropriately 2 An act prompted by early childhood neglect 3 Penetration without the consent of the victim 4 Assault by a stranger on an unsuspecting victim

3 Penetration without the consent of the victim Completed rape is defined by the FBI as "penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim." Assault by a stranger on an unsuspecting victim, sexual desire satisfied inappropriately, and an act prompted by early childhood neglect are not accurate definitions of completed rape.

A married couple that has had a violent marriage decides to participate in family or marital therapy. What are the expected outcomes of family psychotherapy for the perpetrator? 1 To become temperamental and handle a crisis situation impulsively 2 To express anger and disappointment to the members of the family 3 To recognize destructive patterns of behavior and learn alternative responses 4 To develop reclusive behavior and isolate one's self from others in the family

3 To recognize destructive patterns of behavior and learn alternative responses The perpetrator should also be included in the plan of care. The person should undergo individual therapy and then, if it is successful and some changes are noticed, the person can undergo family psychotherapy. The expected therapy outcome is that the person should learn to recognize the destructive patterns of behavior and can use alternative responses to refrain from abuse. The perpetrator should learn to control impulses and should not be temperamental in a crisis. The person should learn alternative ways to express anger, disappointment, and frustration and should not just vent to the members of the family. The person should learn to interact in a healthy way with other members of the family so that trust can be established, and openness and directness can help stop the violence.

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

3,4,5 A term that people commonly use to describe substance use disorders is addiction. The most current definition of addiction states that it is a "primary, chronic disease of brain reward, motivation, memory, and related circuitry." It is a disease of dysregulation in the hedonic (pleasure seeking) or reward pathway of the brain. When people are in the process of using a substance to excess they are said be experiencing intoxication.

What are the elementary causes for a perpetrator to use violence? Select all that apply. 1 Effect of peer pressure 2 Feeling of hopelessness 3 Ineffective impulse control 4 Lack of any support system 5 Lack of problem-solving skills

3,4,5 The perpetrators of violence have problems with impulse control. They are unable to think before they act and may even repent their act later. They do not have any healthy support systems which could prevent them from resorting to violence. They do not have problem-solving abilities and break down under stress. Peer pressure does not force them to become violent. They may live in social isolation and, with an inability to make friends, they have ineffective coping during crisis situations. A victim of abuse rather than the perpetrator feels hopeless and powerless.

A patient diagnosed with an antisocial personality disorder becomes frustrated and angry when unable to get connected to the internet. The patient then curses loudly, disrupting, frightening, and disturbing others. Which nursing actions are therapeutic? Select all that apply. 1 Seclude the patient for 1 hour to allow for deescalation. 2 Say to the patient, "Step aside and I will get you connected to the internet." 3 Ask the patient, "How were you feeling when you were having this difficulty?" 4 Encourage the patient to recognize signs of mounting tension and seek assistance. 5 Tell the patient, "Further outbursts will result in suspension of your computer privileges."

3,4,5 Therapeutic responses by the nurse include exploring the situation, encouraging description, setting limits on and expectations of the patient's behavior, suggesting other means of coping, and identifying results of inappropriate behavior. The nurse should assist the patient to identify the source of anger as well as the function that anger, frustration, and rage serve. It is inappropriate to seclude this patient because criteria for seclusion are not met. This scenario provides an opportunity for a therapeutic encounter, so the nurse should process it with the patient rather than completing the task for the patient.

A student was examined by the school nurse for a stomach ache. During the exam, it was revealed that the student is a victim of abuse by a parent. What are the various strategies of secondary prevention in this case? Select all that apply. 1 Give a referral to the legal advocacy program. 2 Provide referral information for family therapy 3 Provide the victim immediate physical care. 4 Help increase the coping skills of the parent. 5 Teach the parent different ways to express anger.

3,4,5 Provide the victim immediate physical care. Help increase the coping skills of the parent. Teach the parent different ways to express anger. Secondary prevention involves early intervention to reduce the disabling or long-term effects of the abuse. The nurse should take care of the victim's immediate health needs. Support is given to the parent to increase coping skills to help in a crisis. The parent may be referred to a counseling program to learn alternative ways to express anger and frustration. Family therapy is required for the perpetrator who has completed individual therapy and developed some positive changes. In the tertiary prevention method, the legal advocacy program is needed.

1. The nurse meets with a patient who was a victim of sexual assault. Which statements made by the patient indicate recovery? Select all that apply. 1 "I try not to think about the night that I was raped." 2 "I realize that I am hopeless about trusting others." 3 "I feel comfortable hanging out with my male friends." 4 "I manage the really dark days by going to a gym class." 5 "All of my bruises have healed, and I can wear tank tops again."

3,4,5"I feel comfortable hanging out with my male friends." "I manage the really dark days by going to a gym class." "All of my bruises have healed, and I can wear tank tops again." Indicators of sexual abuse recovery include showing comfort in relationships, healing physical injuries, and managing anger in nondestructive, health-promoting ways. The statement about being hopeless in trusting others does not show improvement. The statement about not trying to think about the night of the incident does not show improvement.

Which statements are true of antisocial personality disorder (APD)? Select all that apply. 1 Persons with APD display magical thinking. 2 It is the least studied of the personality disorders. 3 Frontal lobe dysfunction is a brain change identified in APD. 4 Persons with APD are concerned with personal pleasure and power. 5 It is characterized by rigidity and inflexible standards of self and others. 6 It is characterized by deceitfulness, disregard for others, and manipulation. 7 Persons with APD usually present for treatment because of awareness of how their behavior is affecting others.

3,4,6 APD is the most studied and researched personality disorder with characteristics that include personal pleasure-seeking and deceitful disregard for others that is associated with a frontal lobe dysfunction. Rigidity and inflexible standards describes obsessive-compulsive personality disorder. Magical thinking describes schizotypal personality disorder. People with APD usually present with depression or because of the consequences of their behaviors, not because they care about the effects of their actions on others.

6. A primary health care provider prescribes a tricyclic antidepressant to treat a depressive patient who is being held for psychiatric observation. The nurse observes that the patient is expressing suicidal thoughts and intentions. What should the nurse do while caring for the patient? Select all that apply. 1 Hand over the complete course of medication to the patient. 2 Suggest that the patient take a larger dose of the medication. 3 Check the patient's mouth after providing doses of the medication. 4 Give a reduced dose of the prescribed medication to prevent risk of overdose. 5 Advise the patient's family to closely monitor the medication if the dose is taken at home.

3,5 A tricyclic antidepressant, such as desipramine, can be prescribed to treat depressed patients but the doses should be carefully monitored in suicidal patients. Overdosing on a tricyclic antidepressant can be fatal due to its potent side effects and many suicidal patients attempt suicide by overdose of pills. The nurse should ensure that the patient swallows the tablet by checking the mouth. This will ensure that patients are not hoarding doses of medication with the intention to overdose later. The patient must be given medication only under the supervision of the nurse or the family to avoid overdose. Suggesting the patient increase the dose is not an acceptable option because dosage can only be changed by the primary health care provider and this is not necessarily an action to prevent suicide. The nurse should not give the complete course of medication at one time to the patient as the patient could abuse the drug. Patients must be given a limited day supply of medication so that they cannot consume all the tablets at a time. The nurse should not reduce the dose unless the primary health care provider prescribes it.

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

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

5. A patient with schizophrenia reports to the nurse, "At night my business rival came to the hospital to kill me for my property." What is the most appropriate response of the nurse while handling such a patient? 1 "Next time when you see him, call me." 2 "Oh, really! Let's file a police complaint." 3 "No one can come to the hospital in the night." 4 "Because of your illness you are having hallucinations. No one can hurt you."

4 A patient with schizophrenia often has hallucinations. The nurse should try to persuade the patient to focus on reality by convincing him that these visions are part of the illness. This assurance makes the patient confident and does not support the illness. A nurse also should not neglect the patient's hallucinations because this can make the patient feel rejected and be at risk for withdrawing. It is advisable that the nurse does not encourage the patient's hallucination by saying that the patient should call her the next time he sees the business rival. This can worsen the patient's condition.

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

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

A nurse is teaching a patient with bulimia nervosa about scheduling healthy, balanced meals. Why does a nurse consider providing this patient education important? 1 To identify trigger foods 2 To realize health effects 3 To include forbidden foods 4 To avoid binge-purge cycles

4 Learning about scheduled balanced meals can help the patient to maintain a steady dietary regimen and avoid binge-purge cycles. Identifying trigger foods can be done by encouraging the patient to explore ideas about trigger foods. Including forbidden foods can be achieved by discussing the patient's irrational thoughts regarding those foods. Health effects of purging can be taught by educating the patient about the ill effects of induced vomiting.

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

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

A patient diagnosed with a borderline personality disorder shows the nurse multiple new, shallow self-inflicted cuts. Select the nurse's therapeutic response. 1 "I will not be caught up or manipulated by your attention-seeking behavior." 2 "This suicide attempts scare me. I am placing you on suicide precautions immediately." 3 "These are shallow wounds that do not need attention. It's time for you to go to group now." 4 "I will care for your wounds, and then you should write down what you were thinking and feeling when this happened. We will discuss it later."

4 An approach useful for patients with borderline personality disorder relates to responses to superficial self-destructive behaviors. The nurse should remain neutral and provide wound care in a matter-of-fact manner. Then the patient is instructed to write down the sequence of events leading up to the injury, as well as the consequences, before staff will discuss the event. This cognitive exercise encourages the patient to think independently about his or her behavior instead of merely ventilating feelings. It facilitates the discussion with staff about alternative actions. It is not therapeutic to deny the seriousness of the wounds or confront the patient with the behavior. Instituting suicide precautions reinforces the behavior.

What statement about histrionic personality disorder is most appropriate? 1 The child is afraid of retaliation by the opposite-sex parent. 2 Antidepressants are the treatment of choice for this disorder. 3 The disorder begins when the person is in the mid-teenage years. 4 People who are egocentric by birth are predisposed to the disorder.

4 Certain inborn traits predispose people to histrionic personality disorder. Those showing egocentricity or emotional expressiveness are predisposed to this disorder. The psychodynamic etiology begins when the person is 3 to 5 years old. The child is excessively attached to the opposite-sex parent. Psychotherapy is the treatment of choice. Antidepressants may be given to reduce symptoms of the disorder.

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

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

Chapter 34,35 A patient with tenacious suicidal behavior has been advised dialectical behavioral treatment (DBT). What does the nurse need to know about DBT? 1 The patient is encouraged to observe others in the group. 2 The patient is seen by the therapist for DBT once every day. 3 Treatment can be provided by a basic-level registered nurse. 4 Emotional skills can be improved, leading to reduced risk of self-destructive behavior.

4 DBT improves interpersonal, behavioral, cognitive, and emotional skills, and reduces self-destructive behaviors. The patient is seen for DBT every week rather than once every day. The patients are discouraged from making observations about others in the group. Instead, they are encouraged to consider everything that is presented in the group in terms of their own use of skills, emotional challenges, and areas of growth. The treatment is provided by those with specialized training and advanced education such as advanced practice registered nurses. Basic-level nurses do not lead such psychotherapy groups.

10. What term describes emotional withdrawal, which the terminally ill patient may experience as he or she accepts the finality of life? 1 Cathexis 2 Cachexia 3 Decubitus 4 Decathexis

4 Decathexis describes emotional withdrawal, which the terminally ill patient may experience as he or she accepts the finality of life. Cathexis describes an emotional connection, which the terminally ill patient may experience as he or she accepts the finality of life. Cachexia describes severe weight loss, also known as wasting syndrome. Patients confined to bed may have decubitus ulcers, also known as bedsores.

A patient with borderline personality disorder has suicidal intentions. The nurse plans to teach mindfulness and emotion regulation to improve interpersonal effectiveness skills in the patient. Which therapy does the nurse follow to effectively work with the patient? 1 Family therapy 2 Schema-focused therapy 3 Supportive psychotherapy 4 Dialectical behavior therapy

4 Dialectical behavior therapy is used in patients with borderline personality disorder who have chronic suicidal intentions. The therapy includes cognitive and behavioral techniques like mindfulness and emotion regulation. It helps to improve interpersonal effectiveness skills in patients. Schema-focused therapy helps patients change their view about themselves. It helps in evaluating the behavior of people in stressful conditions. In supportive psychotherapy, the nurse encourages the patient to participate in activities. It helps to enhance the patient's ability to cope with stressors. In family therapy, the family members of the patient are taught how to assist the patient in handling stress.

11. A therapeutic group is in its working phase. What does the nurse identify as the most appropriate role of the group leader during this phase of the group development? 1 Point out similarities between the members 2 Encourage members to get to know each other 3 Help members to identify post termination goals 4 Help members to gain confidence in problem-solving

4 During the working phase, the group leader encourages the members to focus on problem solving, and guides and supports them in conflict resolution. Through successful conflict resolution, the members gain confidence in problem-solving activities. In the orientation phase, the members may be excessively silent or overbearing because they are yet to establish trust with one another. The leader encourages them to get to know each other by pointing out the similarities between the members. In the termination phase, the leader encourages members to reflect upon the progress of the group and helps the members to identify the post termination goals.

9. Which task is most likely to give terminally ill patients a sense of completion in relationships with family and friends? 1 Recognition of a transcendent realm 2 Transmission of knowledge and wisdom 3 Transfer of fiscal, legal, and formal social responsibilities 4 Expression of regret, forgiveness, and gratitude to family and friends

4 Expression of regret, forgiveness, and gratitude to family and friends is most likely to give terminally ill patients a sense of completion in relationships with family and friends. Recognition of a transcendent realm is most likely to give terminally ill patients a sense of meaning about life in general. Transmission of knowledge and wisdom is most likely to give terminally ill patients a sense of meaning about one's individual life. The transfer of fiscal, legal, and formal social responsibilities is most likely to give terminally ill patients a sense of completion with worldly affairs.

11. The group goals are to learn to express feelings comfortably rather than keep them covert. When a group member shares with the group how expressing these feelings make him or her feel, the patient is engaging in which of the following? 1 Subgrouping 2 Confrontation 3 Group content 4 Providing feedback

4 Feedback includes letting the group know how they and the comments made in group make the individual feel. This is the only option that accurately describes the sharing of expressed feelings; group content, confrontation, and subgrouping are incorrect.

A nurse who is idealized by a patient is at risk for 1 Developing a prejudicial, blaming orientation 2 Stringent enforcement of boundaries and limits 3 Becoming indecisive about planned interventions 4 Becoming overinvolved and being protective and indulgent

4 Finding an approach for helping patients with personality disorders who have enormous needs can be overwhelming for caregivers. For example, a female patient with borderline personality disorder may briefly idealize her male nurse on the inpatient unit, telling staff and patients alike that she is "the luckiest patient because she has the best nurse in the hospital." The rest of the team initially realizes that this behavior is an exaggeration, and they have a neutral response. But after days of constant dramatic praise, some members of the team may start to feel inadequate and jealous of the nurse. They begin to make critical remarks about minor events to prove that the nurse is not perfect. Open communication in staff meetings and ongoing clinical supervision are important aspects of self-care for the nurse working with these patients to maintain objectivity.

2. If a suicidal patient is to be treated outside the hospital, which intervention would be of highest priority? 1 Arrange for a police visit every 24 hours. 2 Provide a one-week supply of antidepressant medication. 3 Make sure the patient has food enough to last for two to three days. 4 Have the patient identify three people to call if the patient is overwhelmed by hopelessness.

4 For suicidal patients treated in the community, establishing a network of individuals to whom the patient may turn if the suicidal urge becomes great is important.

6. In a persistent vegetative state, what part of the brain remains functional, making wakefulness possible? 1 Cortex 2 Hypothalamus 3 Medullary brainstem 4 Reticular activating system.

4 In a persistent vegetative state, the reticular activating system remains functional, making wakefulness possible. The cortex is severely damaged, eliminating cognitive function. The hypothalamus and medullary brainstem remain intact to support cardiorespiratory and autonomic functions.

3. In adults, grief is considered to be persistent if it lasts longer than how many months? 1 2 Months 2 4 Months 3 6 Months 4 12 Months

4 In adults, grief is considered to be persistent if it lasts longer than 12 months. Grief lasting 2 or 4 months is not considered persistent. In children, grief is considered to be persistent if it lasts longer than 6 months.

6. Which criterion must be met in order for a patient to be eligible for hospice care? 1 The patient must be age 65 years or older. 2 The patient must demonstrate financial need. 3 The patient's diagnosis cannot be related to substance abuse. 4 A physician must certify the patient with a life expectancy of 6 months or less.

4 In order to be eligible for hospice care, a physician must certify the patient with a life expectancy of 6 months or less. Hospice care supports and cares for patients facing death regardless of age, income, or diagnosis.

During an interview, the nurse asks a patient with borderline personality disorder about childhood experiences. What findings about the patient's childhood may relate to the patient's borderline personality disorder? 1 Sleeping most of the time at the age of 0 to 1 month 2 Starting to explore their environment at the age of 11 to 18 months 3 Getting emotional support from their parents at the age of 2 to 5 years 4 Seeking emotional support from their mother at the age of 18 to 24 months

4 Patients with borderline personality disorder may have disrupted childhoods, which means that there is a lack of attachment with the primary caregiver. At the age of 18 to 24 months, a child moves away from the mother and tries to become independent. The child does not require emotional support but comes back to the mother for emotional refueling. This phase is called rapprochement. Disruption or the lack of attachment in this phase can be crucial for causing personality disorders. The child learns to walk and starts exploring things between 11 to 18 months of age. When the child reaches the ages of 2 to 5 years, the child becomes an individual and does not seek emotional support from the mother. However, the child is confident to get support from his or her mother whenever needed. At the age of 0 to 1 month the infant spends most of his or her time sleeping.

2. A nurse is caring for a patient with gallbladder cancer. The patient says, "Though my family is very supportive, I feel like a burden on my family." What appropriate diagnosis should the nurse make from the patient's response? 1 Social Isolation 2 Disabled family coping 3 Impaired social interaction 4 Situational low self-esteem

4 Patients with situational low self-esteem have feelings of worthlessness and being a burden on family and others. Disabled family coping is characterized by ineffective communication with the family and unavailability of the family. Patients with impaired social interaction have few supportive groups and don't interact with others. Intense feeling of isolation, deprivation, and lack of love can be seen in patients with social isolation.

6. A patient reports lethargy, decreased appetite, and generalized body aches. The nurse finds out that the patient's teenaged child committed suicide a year ago. How should the nurse respond to this finding? 1 Avoid talking about the incident with the patient. 2 Do not ask further questions about the deceased child. 3 Ask the patient not to think about her daughter anymore. 4 Ask the patient open-ended questions about the incident.

4 Risk of suicide in a family member of a person who has committed suicide is 4.5 times higher than in the general population. Therefore, it is important to ask open-ended questions about the incident and review the current situation of the patient. Mentioning or talking about the daughter can reduce hurt, stigma, and isolation in the patient. Survivors always want their loved ones to be remembered, so it would be inappropriate to ask the patient not to think about his or her child anymore. The nurse should always encourage the patient to express feelings about the traumatic event. This will make the patient feel comforted.

4. Which statement best describes the functional role of "self-confessor"? 1 Seeks attention by discussing achievements 2 Tries to connect various ideas and suggestions 3 Provides facts or shares experience as an authority figure 4 Verbalizes feelings or observations beyond the group topic

4 Self-confessors share their own feelings and thoughts beyond that which is being discussed in a group. The coordinator tries to connect various ideas and suggestions. The information giver provides facts or shares experience as an authority figure. The recognition-seeker seeks attentions by discussing achievements.

The nurse appropriately assesses an obese, hypertensive patient with type 2 diabetes for sleep disorders when asking, 1 "Do you snore when you sleep?" 2 "Do you regularly have nightmares?" 3 "Is getting to sleep a problem for you?" 4 "How much sleep do you usually get each night?"

4 Short sleep duration has been associated with obesity, cardiovascular disease, hypertension, and diabetes.

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

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

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

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

How is the behavior of a cluster B personality disorder described? 1 Odd or eccentric 2 Anxious or fearful 3 Aggressive or destructive 4 Dramatic, emotional, or erratic

4 The behavior of a cluster B personality disorder is described as dramatic, emotional, or erratic. The behaviors in a cluster A personality disorder are described as odd or eccentric. Anxious or fearful behavior is descriptive of a cluster C personality disorder. Aggressive or destructive behaviors are not descriptive of any cluster of personality disorders.

2. A patient has been enrolled in group psychotherapy. What feature about the group is appropriate? 1 Therapeutic groups manage patient governance and advocacy matters. 2 Basic-level registered nurses can be leaders of such therapeutic groups. 3 Group psychotherapy is helpful when individual psychotherapy is unsuccessful. 4 The purpose of group psychotherapy is to treat those with psychiatric disorders.

4 The main aim of group psychotherapy is to treat those with psychiatric disorders. Patient governance and advocacy matters are managed in therapeutic community meetings. Basic-level registered nurses cannot become leaders of such groups. Since this group is used to bring about personality changes, only a trained leader (often an advanced practice nurse) can lead such a group. Group psychotherapy is conducted concurrently with individual psychotherapy.

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

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

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

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

What should the nurse expect to be the cause of edema found next to the ear in a patient diagnosed with bulimia nervosa? 1 Electrolyte imbalance 2 Self-induced vomiting 3 Hydrochloric acid reflux 4 Increased serum amylase levels

4 The patient diagnosed with bulimia nervosa has a parotid swelling, which can be caused by increased serum amylase levels. An electrolyte imbalance can cause many body manifestations, none of which are indicative of swelling in front of the ear. Patients diagnosed with bulimia nervosa generally induce vomiting by sticking their fingers down their throats, causing finger calluses but not swelling by the ear. Dental caries and enamel erosion occur in patients with diagnosed bulimia nervosa due to hydrochloric acid reflux.

2. A new member has joined the group after being part of another therapeutic group. The patient is very quiet for the first few meetings. How should the nurse manage this silence? 1 Ignore the patient until he or she decides to speak. 2 Keep questioning the patient about his or her reluctance to share. 3 Ask the patient bluntly how he or she expects to improve with no input. 4 Consider giving a writing assignment for everyone in the group to share.

4 The patient's silence may mean that the patient is determining the safety of this new group. Asking everyone to answer the same question or write on the same topic can encourage participation from a new member. Ignoring a patient is not only unhelpful, it's unethical. Some people do advocate confrontation as a communication technique, but that is generally helpful only if a level of trust has been established. Repeated questioning will likewise yield no better results.

7. Which approaches to family therapy would the nurse take to provide support and give information to the family that is coping with a family member diagnosed with a serious illness? 1 Behavioral family therapy 2 Insight-oriented family therapy 3 Multigenerational family therapy 4 Psychoeducational family therapy

4 The primary goal of psychoeducational family therapy is the sharing of mental health care information. This helps family members better understand their member's illness, prodromal symptoms (symptoms that may appear before a full relapse), medications needed to help reduce the symptoms, and more. Psychoeducational family meetings allow feelings to be shared and strategies for dealing with these feelings to be developed. Insight-oriented therapy focuses on developing increased self-awareness, other awareness, and family awareness among family members. Behavioral family therapy focuses on changing behaviors of family members to influence overall patterns of family interactions. Multigenerational family therapy is incorrect.

The nurse is providing community teaching to a group of adolescents about ways to prevent rape. Which statement made by the adolescent indicates further teaching must occur? 1 "Rape can occur in the home." 2 "Women do not want to be raped." 3 "Rape is not always done for the purpose of sex." 4 "It isn't rape if the participants are in a relationship."

4 "It isn't rape if the participants are in a relationship." Intimate partner violence is common in rape cases, and the adolescent should be taught that regardless of the participants' relationship to one another, if consent is not obtained, this is considered rape. The statements that women do not want to be raped, that rape can occur at home, and that sex is not the primary motivation for rape indicate effective teaching.

A school nurse interviews a student who has vague somatic complaints. Which assessment finding alerts the nurse to a high risk for sexual abuse? 1 Both parents work in a factory. 2 The parents are of Asian heritage. 3 Neither parent completed high school. 4 Both parents were sexual abuse victims.

4 Both parents were sexual abuse victims. Victims of sexual abuse are at high risk to become perpetrators. Abuse is uncommon among persons of Asian descent. Abuse occurs in families from a variety of economic and educational backgrounds.

The nurse is counseling a victim of family violence. What key idea does the nurse need to emphasize to the victim during crisis intervention? 1 An abuser can be changed when the abuser learns coping skills. 2 Skills to manage a stressful situation can help in preventing a crisis. 3 People can turn to support groups to manage a stressful situation. 4 People have a right to live without fear of violence, physical harm, or assault.

4 People have a right to live without fear of violence, physical harm, or assault. As a key to crisis intervention, the nurse needs to emphasize that no one has the right to harm anyone and that people have a right to live without fear of violence, physical harm, or assault. Understanding this is the first step for the victim to be able to resist abuse and seek help if needed. An abuser should also be treated and counseled about using appropriate social and coping skills in a stressful situation but this is not a step for immediate crisis intervention. Various social skills are learned by the patient and planning is done to avoid a crisis situation. The nurse can support the victim by counseling about safety and providing other resources to prevent further crisis. Along with counseling, people are given referrals to various support groups to help treatment.

What is the role of the advanced practice nurse in the management of a rape victim? 1 Provide legal consultation. 2 Be an expert witness in court. 3 Conduct the medical evaluation. 4 Provide individual psychotherapy.

4 Provide individual psychotherapy. The advanced practice nurse provides individual and group psychotherapy to rape victims. This will help them to cope with the physical and psychological symptoms related to the rape. The Sexual Assault Nurse Examiners are responsible for conducting medical and legal evaluations, and serve as expert witnesses in the court.

A female patient is raped by her husband frequently. What psychological effect would the nurse observe in this patient? 1 Fear 2 Anxiety 3 Aggression 4 Sexual distress

4 Sexual distress The psychological effects in a rape victim depend on the relationship of the victim with the perpetrator. If the patient is raped by the spouse, it is most likely that the patient has sexual distress. If the patient has been raped by a stranger, the most likely effect would be that of fear and anxiety. Aggression is usually not a common psychological response to rape.

Which response illustrates the best practice in giving care to a patient who has just been sexually assaulted? 1 Assertive: "Let's talk about new coping skills you can use." 2 Sympathetic: "I'm so sorry for what you have been through." 3 Reassuring: "Don't worry. It's hard now, but everything will be alright." 4 Supportive: "I am going to stay with you. We can talk as long as you want to."

4 Supportive: "I am going to stay with you. We can talk as long as you want to." The most effective approach for counseling in the emergency department or crisis center is to provide nonjudgmental care and optimal emotional support. Sympathy is not a therapeutic response and does not focus on the patient. Telling the patient not to worry is false reassurance. It is too soon to try to learn new coping skills because the patient is in an acute stress phase.

A nurse is performing the clinical assessment of a patient who was sexually abused during a date. What appropriate actions does the nurse take during assessment? 1 The nurse avoids interacting with the patient's friends. 2 The nurse asks, "Why didn't you try to escape from the situation?" 3 The nurse considers only the verbal statements made by the patient. 4 The nurse assesses the usefulness of the patient's social support system.

4 The nurse assesses the usefulness of the patient's social support system. The nurse should assess the availability and usefulness of the patient's social support system. Most of the time a patient's family and friends fail to support the patient, as they don't understand the patient's feelings. They are not considered the best support available to the patient. The nurse should carefully consider both verbal and nonverbal clues given by the patient; it helps to document the evidence properly. It also reflects the moral support that the patient has from the support groups. The nurse should not ask the patient questions starting with "Why." The patient may feel rejected and assume that the nurse is insensitive to the situation. The nurse should interact with the patient's family and friends and other health care providers to effectively document the patient's clinical history and case history.

Three weeks after a patient was raped she tells the nurse, "I am going crazy. I have nightmares and wake up screaming. Then during the day all sorts of thoughts about the rape intrude into whatever I am concentrating on. I can't get anything done at work." How should the nurse reply? 1 "Is becoming mentally ill a frightening thought for you?" 2 "Would it help if you took some time off from work and stayed home?" 3 "You are right to be concerned. I can give you a referral for treatment." 4 "These are normal responses to stress and will decrease with time and therapy."

4 These are normal responses to stress and will decrease with time and therapy. These symptoms are part of the response to rape trauma and parallel symptoms experienced by other victims of post-traumatic stress disorder.

When can a victim of abuse expect the abuse to worsen? 1 When the perpetrator feels he or she is in complete control 2 When the perpetrator is feeling remorseful for being abusive 3 When the victim submits to the domination of the perpetrator 4 When the victim moves toward independence from the abuser

4 when the victim moves toward independence from the abuser When the abuser thinks he or she is losing control over the victim, the violence escalates. Remorse by the perpetrator and submission by the victim have not been shown to increase violence.