Final exam for mental health

Drugs used in acute violent behavior

(#1) Atavain Xanax and Valium Haldol and Thorazine Risperdal Zyprexia and geodon

medical complications of anorexia

-Bradycardia -Changes in BP/HR -Cardiac arrythmias -Prolonged QT interval -Leukopneia -Lymphocytosis -Elevated Carotene in blood -Hypokalemic Alkalosis -Elevated bicarbonate -Electrolyte imbalances -Osteoporosis -Fatty degeneration of liver -Elevated cholesterol -Hematuria/Proteinuria

illness anxity disorder

Characterized by the preoccupation with disease or illness.

Five Wishes

1) The person I want to make decisions if I cannot 2) The kind of medical treatment I want or don't want 3) How comfortable I want to be 4) How I want people to treat me 5) What I want my loved ones to know

Assessment guidlines for binge eating disorder

1. A thorough physical examination with appropriate blood work has been done 2. Other medical conditions have been identified 3. Call morbid psychiatric diagnosis are presented 4. He careful history of binge triggers, food, and frequency has been collected 5. The patient self-esteem is overly influenced by his or her physical aperient this is over evaluation to tended to be a more difficult recovery.

Assessment guidelines for intermittent explosive disorder

1. Assess history frequency and triggers for violent outburst. 2. Identify times in which the patient was able to maintain control despite being in a situation where the patient might lose control. 3. Explore actual and potential sources of support at home and socially, 3. Assess substance use.

Assessment guidelines for oppositional defiant disorder

1. Identify issues that result in power struggle and trigger for outburst when they begin and how they are handled. 2. Assess the child or adolescence view on his or her behavior and its impact others explore their feelings of empathy or remorse. 3. Explore how the child or adolescent can exercise control and take responsibility.

Assessment guidelines for buliema

1. Medical stabilization is the first priority 2. Monitor laboratory values and through a physical evaluation. Those lab values include electrolyte levels, glucose, thyroid, CBC, and ECG. 3. Psychiatric evaluation is advisable

Assessment guidelines for conduct disorder

1. asses the seriouness, type an intention of destructive behavior and how it's been managed. 2. Assess anxiety, agitation, and anger levels, motivation, inability to control impulses. 3. Assess moral development, problem-solving, belief system, and spirituality. 4. Assess the ability to form therapeutic relationship 5. Assess for substance use.

intermitted explosive disorder

A pattern of behavioral outburst in adults 18 years or older characterized by inability to control aggressive impulses.

Anorexia is

A potential life-threatening eating disorder that includes severe underweight, low blood pressure, pulse, and temperature, as well as dehydration, Losier and potassium, and dysrhythmia.

disenfranchised grief

A situation in which certain people, although they are bereaved, are prevented from mourning publicly by cultural customs or social restrictions.

masked grief

A type of grief reaction when the person experiences symptoms and behavior which causes them difficulty, but they do not see or recognize the fact that these are related to the loss

11. An adolescent client tells the evening-shift nurse that the day-shift nurse promised that she could stay up late to watch a special television program on Netflix. The nurse investigates and finds that no specific instructions/alterations have been indicated anywhere on the patient's chart regarding this issue. The evening nurse does which of the following to maintain the therapeutic milieu?

A. Allows the client to stay up late to promote staff unity B. Encourages client to express feelings about staff disagreement on this issue C. Maintains the same rules for all clients; therefore, refusing client's request D. Uses staying up late as a reward for this client's good behavior Rationale: C According to the American Psychological Association's Dictionary of Psychology, a therapeutic atmosphere is, "an environment of acceptance, empathic understanding, and unconditional positive regard in which persons feel free to verbalize and consider their thoughts, behaviors, and emotions and make constructive changes in their attitudes and reactions." When a person comes into a therapeutic environment, they should have a pleasant, beneficial experience.

For patients diagnosed with serious mental illness, what is the major advantage of case management? a. The case manager can modify traditional psychotherapy. b. With one coordinator of services, resources can be more efficiently used. c. The case manager can focus on social skills training and esteem building. d. Case managers bring groups of patients together to discuss common problems

ANS: B The case manager coordinates the care and multiple referrals that so often confuse the seriously mentally ill patient and the patient's family. Case management promotes efficient use of services. The other options are lesser advantages or are irrelevant.

Assessment of a bulimic patient may show

Enlargement of the paroid gland and dental errosion

Idiopathic daytime hyersommina

Excessive daytime sleepiness

Symptoms in Alzheimer's

Forgetting, disorientation, personality change, depression, motor problems, delusions, speech problems, infections

distorted grief

Normal grief carried to an extreme degree; adoption of deceased person's ailments

Interventions for dementia

Provide clocks and memory aids, photographs, memorabilia, seasonal decorations, familiar objects, orient if necessary. Daily routine, allow for safe pacing and wandering. Assign room closets to nurses station, well lit environment. Restraints as a last resort, COver or remove mirrors to reduce anxiety and frustration. Encourage pt. to talk about good times, break instructions and activities into short timeframes.

6. A 12-year-old has engaged in bullying for several years. The parents say, "We can't believe anything our child says." Recently this child shot a dog with a pellet gun and set fire to a neighbor's trash bin. The child's behaviors support the diagnosis of: A. attention deficit hyperactivity disorder. B. intermittent explosive disorder. C. defiance of authority. D. conduct disorder.

Rathione: D The behaviors mentioned are most consistent with criteria for conduct disorder, for example, aggression against people and animals; destruction of property; deceitfulness; rule violations; and impairment in social, academic, or occupational functioning. Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. The behaviors are not consistent with attention deficit and are more pervasive than defiance of authority. See related audience response question.

. A female client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, Nurse Tonya should plan to.....? Why? A. Severely restrict the client's physical activities B. Weigh the client daily, after the evening meal C. Monitor vital signs, serum electrolyte levels, and acid-base balance D. Instruct the client to keep an accurate record of food and fluid intake

Rational: C. monitor vital signs, serum electrolyte levels, and acid-base balance An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid-base balance is crucial. Option A may worsen anxiety. Option B is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. Option D would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately.

1. For the homeless, health care is usually crisis oriented and sought in emergency departments. The most difficult challenge for nurses treating this vulnerable population is to recognize the client's.........? a. limitations in following treatment protocols. b. limited number of transient treatment facilities. c. transition to persistent poverty. d. use and abuse of tobacco, alcohol, and illicit drugs

Rationale: A Homeless people devote a large portion of their time to just trying to survive. Health care is usually crisis oriented and sought in emergency departments. Those who access health care have a hard time following prescribed treatment regimes such as prescribed diets, purchasing prescriptions, or health-promotion or symptom-relief measures.

2. When caring for a terminally ill client, it is important for the nurse maintain the client's dignity. This can be facilitated by.....? Why did you choose this answer? a. Spending time to let clients share their life experiences b. Decreasing emphasis on attending to the clients' appearance because it only increases their fatigue c. Making decisions for clients so they do not have to make them d. Placing the client in a private room to provide privacy at all times

Rationale: A Spending time to let clients share their life experiences enables the nurse to know clients better. Knowing clients then facilitates choice of therapies that promote client decision making and autonomy, thus promoting a client's self-esteem and dignity.

5. A community health nurse is planning a health fair at a local shopping mall. Which middle-class socioeconomic cultural group should the nurse anticipate would most value preventive medicine and primary health care? Why? a. Northern European Americans b. Native Americans c. Latino Americans d. African Americans

Rationale: A The community health nurse should anticipate that Northern European Americans, especially those who achieve middle-class socioeconomic status, place the most value on preventative medicine and primary health care. This value is most likely related to this group's educational level and financial capability. Many members of the Native American, Latino American, and African American subgroups value folk medicine practices.

14. The 3 main types of eating disorders are anorexia nervosa, bulimia nervosa, and binge-eating disorder. A. True B. False

Rationale: True These disorders are marked by extremes in eating. A person with an eating disorder may greatly cut back on the amount of food he or she eats. Or the person may greatly overeat.

8. A Latin American man refuses to acknowledge responsibility for hitting his wife, stating instead, "It's the man's job to keep his wife in line." Which cultural belief should a nurse associate with this client's behavior? Why? a. Families are male dominated with clear male-female role distinctions. b. Religious tenets support the use of violence in a marital context. c. The nuclear family is female dominated and the mother possesses ultimate authority. d. Marriage dynamics are controlled by dominant females in the family

Rationale: A The nurse should associate the cultural belief that families are male dominated with clear male-female role distinctions with the client's abusive behavior. The father in the Latin American family usually possesses the ultimate authority.

7. A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child might have been physically abused? a. The child shrinks at the approach of adults. b. The child begs or steals food or money. c. The child is frequently absent from school. d. The child is delayed in physical and emotional development.

Rationale: A The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns might be a victim of abuse. Whether or not the adult intended to harm the child, maltreatment should be considered.

8. In the course of an assessment interview, a female client reveals a history of bisexual orientation. Which action should the nurse initially implement when working with this client? a. Self-assess personal attitudes toward homosexuality. b. Review client's possible childhood sexual abuse history. C. Encourage discussion of aversion to heterosexual relationships. d. Explore client's family history of homosexuality.

Rationale: A The nurse should initially self-assess personal attitudes toward homosexuality. The nurse must be able to recognize the potential for negative feelings compromising client care. Unconditional acceptance of each individual is an essential component of compassionate nursing.

11. A patient diagnosed with delirium is experiencing perceptual alterations. Which environmental adjustment should the nurse make for this patient? a. Provide a well-lit room without glare or shadows. Limit noise and stimulation. b. Maintain soft lighting day and night. Keep a radio on low volume continuously. c. Light the room brightly day and night. Awaken the patient hourly to assess mental status. d. Keep the patient by the nurse's desk while awake. Provide rest periods in a room with a television on.

Rationale: A A quiet, shadow-free room offers an environment that produces the fewest sensory perceptual distortions for a patient with cognitive impairment associated with delirium. The other options have the potential to produce increased perceptual alterations.

4. Which of these nursing tasks is best to delegate to the LPN team leaders working in a LTC facility? a. Check for improvement in resident memory after medication therapy is initiated. b. Use the Mini-Mental State Examination to assess residents every 6 months. c. Assist residents to toilet every 2 hours to decrease risk for urinary intolerance. d. Develop individualized activity plans after consulting with residents and family.

Rationale: A LPN education and team leader responsibilities include checking for the therapeutic and adverse effects of medications. Changes in the residents' memory would be communicated to the RN supervisor, who is responsible for overseeing the plan of care for each resident. As the manager in a long-term-care (LTC) facility, you are in charge of developing a standard plan of care for residents with Alzheimer's disease. Assessment for changes on the Mini-Mental State Examination and developing the plan of care are RN responsibilities. Assisting residents with personal care and hygiene would be delegated to nursing assistants working the LTC facility. Focus: Delegation

3. An adolescent with a depressive disorder is more likely than an adult with the same disorder to exhibit..........! Why? A. Negativism and acting out. B. Sadness and crying. C. Suicidal thoughts. D. Weight gain.

Rationale: A Negativism and acting out. Depression is a state of low mood and aversion to activity. It may be a normal reaction to occurring life events or circumstances, a symptom of a medical condition, a side effect of drugs or medical treatments, or a symptom of certain psychiatric syndromes, such as the mood disorders major depressive disorder and dysthymia.

7. Which of the following changes can help create a more inclusive environment for lesbian, gay, bisexual, and transgender (LGBT) pts? Select all that apply! a. explicitly including sexual orientation and gender identity into nondiscrimination policies b. displaying art that reflects LGBT communities c. modifying health care forms to provide opportunities for gender identity and sexual orientation disclosure d. not asking pts about their gender identity and sexual orientation to avoid making them uncomfortable e. ensuring access to unisex or single-stall bathrooms

Rationale: A, B, C, E

10. When planning care for women in abusive relationships, which of the following information is important for the nurse to consider? (Select all that apply). a. It often takes several attempts before a woman leaves an abusive situation. b. Substance abuse is a common factor in abusive relationships. c. Until children reach school age, they are usually not affected by parental discord. d. Women in abusive relationships usually feel isolated and unsupported. e. Economic factors rarely play a role in the decision to stay in abusive relationships.

Rationale: A, B, D When planning care for women who have been victims of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation, that substance abuse is a common factor in abusive relationships, and that women in abusive relationships usually feel isolated and unsupported. Children can be affected by domestic violence from infancy, and economic factors often play a role in the victim's decision to stay.

13. The nursing interventions common in treatment plans for survivors include which of the following? (Select all that apply). a. Establish trust and rapport. b. Identify areas of control. c. Remove the client from home. d. Support the client in the decisions he/she makes. e. Encourage the client to pursue legal action.

Rationale: A, B, D Identifying areas of control empowers the client. Supporting the client in the decisions he/she makes empowers the client and enhances the client's current problem-solving ability. Establishing trust and rapport provides the client with an ally.

4. The school nurse assesses Brook, a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following symptoms are characteristic of the disorder? Select all that apply. Why did you choose your answer(s)? A. Constant fidgeting and squirming B. Excessive fatigue and somatic complaints C. Difficulty paying attention to details D. Easily distracted E. Running away F. Talking constantly, even when inappropriate

Rationale: A, C, D, and F These behaviors are all characteristic of ADHD and indicate that the child is inattentive, hyperactive, and impulsive. Options B and E are signs of emotional distress in a child and could be associated with a number of different psychiatric diagnoses.

13. The healthcare provider is assessing an elderly patient who is disoriented to time and place. Which additional finding would support a diagnosis of delirium? Choose all answers that apply. Why did you choose your answers? a. Sudden onset of symptoms b. Attention is impaired c. Slow and progressive course d. Rambling and incoherent speech e. Stable symptoms over time f. Often linked to an identifiable cause

Rationale: A, B, D, F The healthcare provider will want to distinguish delirium from dementia. Delirium and dementia share some characteristics, but other characteristics are found only in either delirium or dementia. Sudden onset and fluctuation of symptoms are key findings in delirium. Delirium is usually reversible because unlike dementia, delirium is usually due to a problem that can be identified and treated. Speech in a patient diagnosed with delirium is often rambling or incoherent, whereas speech in a patient diagnosed with dementia may be limited or aphasic. Attention in delirium is impaired, whereas attention in dementia is not impaired until late stages of the disease.

4. Which nursing assessment findings are physical signs of sexual abuse in a 6 year-old child (male or female)? (Select all that apply). a. Enuresis/Encopresis b. Red and swollen labia and rectum c. Cigarette burns d. Injuries in different stages of healing e. Vaginal tears f. Lice infestation

Rationale: A, B, E These are all indications that a female child has been the victim of sexual abuse. Options D, E, and F are signs of physical abuse of a child, not sexual abuse.

3. A husband caring for a client in early stage of Alzheimer's asks the nurse what sort of changes he can do at home to keep her wife safe. The nurse enumerates which of the following appropriate actions? Select all that apply. a. Remove excess furniture, throw rugs and clear pathways of clutter. b. Always keep valuables suck as keys, wallets and mobile phones in the same place at home. c. Make sure appointments are scheduled on different dates at different times as possible. d. Ask the doctor if the medications can be given at varying times. e. Reduce the number of mirrors at home f. Allow independence when possible

Rationale: A, B, E, and F These are appropriate suggestions for a caregiver of a client with Alzheimer disease. It is very important to establish routine schedules by setting appointments on the same day at the same time and to request to doctors if they can simplify the client's medication regimen to once-daily dosing with the same schedule.

6. What is often found when female prisoners are interviewed for their health histories? Select all that apply. a. A history of physical and sexual abuse b. Evidence of active tuberculosis c. Extensive tattooing and body piercings d. Personal use of drugs and alcohol e. Positive test results for HIV and hepatitis f. Previous childbirth with living children

Rationale: A, D, F

Kleine-Levin Syndrome

Sleeping beauty syndrome

6. A 15-year-old boy was hospitalized in a psychiatric unit because he initiates frequent fights with peers. Which implementation is most appropriate? A. Anticipate and neutralize potentially explosive situations. B. Ignore minor infractions of rules against fighting. C. Isolate the adolescent from contact with peers. D. Talk to the adolescent each time fighting occurs.

Rationale: A. Anticipate and neutralize potentially explosive situations. The nurse is responsible for maintaining a safe environment; therefore, it would be appropriate to observe for signs that an explosive situation is developing and intervening to neutralize the situation, thereby preventing a fight. Option B: Ignoring minor infractions of rules against fighting in a psychiatric unit would not be a minor infraction and should not be ignored. This could lead to unsafe situations that could escalate out of control. Option C: Isolation and seclusion are methods of intervention that can be used as a last resort after less restrictive means are employed. Option D: Talking to the adolescent each time a fight occurs does not indicate that the nurse is setting and enforcing clear, consistent rules. The nurse needs to maintain safety and would not allow fighting to occur if it could be avoided.

5. Which situation would Nurse Sally identify as placing a client at high risk for caregiver abuse? a Antonia, an adult child, quits her job to move in and care for a parent with severe dementia. b. Mr. Wright, an elderly man with severe heart disease, resides in a personal care home and is frequently visited by his adult child. c. Mrs. Hale, an elderly parent with limited mobility, lives alone and receives help from several adult children. D. Antoinette cares for her husband who is in early stages of Alzheimer's disease and has a network of available support persons.

Rationale: A. Antonia quits her job to move in and care for a parent with severe dementia. In this situation, the adult child has given up her usual role as well as moved her place of residence to care for her parent. Caring for someone with severe dementia is very stressful, requiring almost 24-hour vigilance to ensure safety and meet needs. This situation places the caregiver at high risk for stress and abuse. The caregivers in option B are the staff working in the personal care home; the adult child does not have primary responsibility and, therefore, would not be a high risk for severe stress and abuse. In options C and D, the caregivers are receiving support and no one person has primary responsibility. This will decrease the risk for severe caregiver stress.

Complicated grief

a type of grief that impedes a person's future life, usually because the person clings to sorrow or is buffeted by contradictory emotions

4. A correctional nurse was preparing to give an inmate his psychotropic drug when the prisoner hit the nurse's arm, sending the medication flying, and yelled, "No more. I'm not taking that poison any more!" The prisoner is obviously mentally ill. What should the nurse do? a. Inject the medication rather than debate taking the oral pill with the inmate b. Recognize the prisoner's right to refuse treatment c. Throw the medication away, obtain another pill, and try to persuade the prisoner to take the drug d. With the help of two prison guards, force the medication down the prisoner's throat

Rationale: B

5. When analgesics are ordered for a client with obstructive sleep apnea (OSA) following surgery, the nurse is most concerned about: A. Nonsteroidal anti-inflammatory drugs (NSAIDs) B. Opioids C. Anticonvulsants D. Antidepressants E. Adjuvants.

Rationale: B Clients with obstructive sleep apnea are particularly sensitive to opioids. Thus the risk of respiratory depression is increased. The nurse must recognize that clients with OSA should start out receiving very low doses of opioids

8. Which is an example of an intentional tort? Why did you choose this answer? a. A nurse fails to assess a client's obvious symptoms of neuroleptic malignant syndrome. b. A nurse physically places an irritating client in four-point restraints. c. A nurse makes a medication error and does not report the incident. d. A nurse gives patient information to an unauthorized person.

Rationale: B A tort is a violation of civil law in which an individual has been wronged and can be intentional or unintentional. A nurse who physically places an irritating client in restraints has touched the client without consent and has committed an intentional tort.

12. A client taking a beta adrenergic blockers for HTN can experience interference with sleep patterns such as: A. Nocturia B. Increased daytime sleepiness C. Increased awakening from sleep D. Increased difficulty falling asleep

Rationale: B Beta Blockers can cause nightmares, insomnia, and awakenings from sleep.

11. Which client should a nurse identify as a potential candidate for involuntary commitment? Why? a. A client living under a bridge in a cardboard box b. A client threatening to commit suicide c. A client who never bathes and wears a wool hat in the summer d. A client who eats waste out of a garbage can

Rationale: B The nurse should identify the client threatening to commit suicide as eligible for involuntary commitment. The suicidal client who refuses treatment is a danger to self and requires emergency treatment.

11. Nurse Angela is working in the emergency department of Nurseslabs Medical Center. She is conducting an interview with a victim of spousal abuse. Which step should the nurse take first? a. Contact the appropriate legal services. b. Ensure privacy for interviewing the victim away from the abuser. c. Establish a rapport with the victim and the abuser. d. Request the presence of a security guard.

Rationale: B Privacy. away from the abuser is important. This allows the victim to discuss the problem freely without fear of reprisal from the abuser (especially if she decides to return to the abusive situation). Option A: In this situation. it is not the nurse's responsibility to make the decision to report the abuse. However. whenever the injury is inflicted with a gun, knife, or other weapons, the nurse is obligated to report the abuse. Option C: Although the nurse would want to establish rapport with the victim, her initial concern would not be to establish rapport with the abuser. Option D: The situation does not describe the abuser as currently violent or under the influence of substances; therefore requesting a security presence is inappropriate at this time.

5. A nurse caring to a client with Alzheimer's disease overheard a family member say to the client, "if you pee one more time, I won't give you any more food and drinks". What initial action is best for the nurse to take? a. Take no action because it is the family member saying that to the client b. Talk to the family member and explain that what she/he has said is not appropriate for the client c. Give the family member the number for an Elder Abuse Hot line d. Document what the family member has said

Rationale: B This response is the most direct and immediate. This is a case of potential need for advocacy and patient's rights

10. The nurse teaches the mother of a newborn that in order to prevent sudden infant death syndrome (SIDS) the best position to place the baby after nursing is (select all that apply): 1. Prone 2. Side-lying 3. Supine 4. Fowler's

Rationale: B, C Research demonstrate that the occurrence of SIDS is reduced with these two positions.

9. A nurse attends an interdisciplinary team meeting on an inpatient unit. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? (Select all that apply.) A. Respiratory therapist and psychiatrist B. Occupational therapist and psychologist C. Recreational therapist and art therapist D. Social worker and hospital volunteer E. Mental health technician and chaplain

Rationale: B, C, EThe interdisciplinary treatment team in psychiatry consists of a psychologist, occupational therapist, recreational therapist, art therapist, mental health technician, and chaplain. In addition, a psychiatrist, psychiatric nurse, psychiatric social worker, music therapist, psychodramatist, and dietitian also participate in the interdisciplinary treatment team. Respiratory therapists and hospital volunteers are not included in the interdisciplinary treatment team in psychiatry.

17. Select all that apply to the use of barbiturates in treating insomnia: A. Barbiturates deprive people of NREM sleep B. Barbiturates deprive people of REM sleep C. When the barbiturates are discontinued, the NREM sleep increases. D. When the barbiturates are discontinued, the REM sleep increases. E. Nightmares are often an adverse effect when discontinuing barbiturates.

Rationale: B, D, E Barbiturates deprive people of REM sleep. When the barbiturate is stopped and REM sleep once again occurs, a rebound phenomenon occurs. During this phenomenon, the persons dream time constitutes a larger percentage of the total sleep pattern, and the dreams are often nightmares

7. A family member of a recently deceased patient talks casually with the nurse at the time of the patient ' s death and expresses relief that she will not have to visit at the hospital anymore. What theoretical description of grief best applies to this family member? a. Denial b. Anticipatory grief c. Dysfunctional grief d. Yearning and searching

Rationale: B. Anticipatory griefIf a person has been anticipating a loss for some time, he or she may have already experienced many of the emotions (sadness, shock) commonly associated with death.

4. Which of the following nursing actions best reflects sensitivity to cultural differences related to end-of-life care? a. Practice honesty with everyone, telling patients about their illness, even if the news is not good. b. Ask family members if they prefer to help with the care of the body after death. c. Provide postmortem care at the time of death to relieve family members of this difficult job. d. Value patient self-determination, understanding that each person makes his or her own decisions.

Rationale: B. Ask family members if they prefer to help with the care of the body after death.Giving people options in caregiving allows them to honor their cultural beliefs. Although western health care practices place a high value on honesty, people from some cultural backgrounds regard being told the "truth" as harmful.

15. A nursing intervention directed at the psychological needs of an abused woman is to a. encourage the client to immediately leave the abuser. b. affirm that the client did not deserve or cause the abuse. c. provide a referral to social services for economic problems. d. facilitate contact with law enforcement to take legal action.

Rationale: B. affirm that the client did not deserve or cause the abuse.

13. The nurse is caring for a patient who is terminally ill with lung cancer. Recently, the patient's blood pressure has been decreasing and heart rate increasing. He is experiencing temperature fluctuations and perspires profusely with limited movement. Based on these findings, the patient will most likely die within which time period? a. 1 to 3 months b. 1 to 2 weeks c. Days to hours d. Moments

Rationale: BOne to 2 weeks before death, patients typically exhibit decreased blood pressure, increased heart rate, increased perspiration, and temperature fluctuations; 1 to 3 months before death the patient withdraws from the world: sleep increases and appetite decreases. Days to hours before death, the patient may experience a surge in energy. Very near the time of death, the dying patient is typically not responsive to to

18. During patient teaching, the nurse explains the difference between a sedative and hypnotic by stating: A. "Sedatives are much stronger than hypnotic drugs and should only be used for short periods of time." B. "Sedative drugs induce sleep, whereas hypnotic drugs induce a state of hypnosis." C. "Most drugs produce sedation at low doses and sleep (the hypnotic effect) at higher doses." D. "There really is no difference; the terms are used interchangeably."

Rationale: C Many drugs have both sedative and hypnotic properties, with the sedative properties evident at low doses and the hypnotic properties demonstrated at larger doses.

3. Which of the following is a common, normal emotional response to a stressor? A. Depression B. Fear C. Anxiety D.Panic

Rationale: C Anxiety is a common emotional response to a stressor. Depression is a prolonged feeling of sadness. Fear is a specific, cognitive response to a known threat. Panic is an unreasonable and irrational response to a stressor.

7. An adolescent was arrested for prostitution and assault on a parent. The adolescent says, "I hate my parents. They focus all attention on my brother, who's perfect in their eyes." Which nursing diagnosis is most applicable? A. Disturbed personal identity related to acting out as evidenced by prostitution B. Hopelessness related to achievement of role identity as evidenced by feeling unloved by parents C. Ineffective coping related to inappropriate methods of seeking parental attention as evidenced by acting out D. Impaired parenting related to inequitable feelings toward children as evidenced by showing preference for one child over another

Rationale: C The patient demonstrates a failure to follow age-appropriate social norms and an inability to problem solve by using adaptive behaviors to meet life's demands and roles. The defining characteristics are not present for the other nursing diagnoses. The patient never mentioned hopelessness or disturbed personal identity. The problem relates to the patient's perceptions of parental behavior rather than the actual behavior.

6. A primary care provider's orders indicated that a surgical consent form needs to be signed. Since the nurse was not present when the primary care provider discussed the surgical procedure, which statement "best" illustrates the nurse fulfilling the client advocate role? Why did you choose this answer? a. "The doctor has asked that you sign the consent form." b. "Do you have any questions about the procedure?" c. "What were you told about the procedure you are going to have?" d. "Remember that you can change your mind and cancel the procedure."

Rationale: C This is the best answer because the nurse is assessing the client's level of knowledge as a result of the discussion with the primary care provider. Based on this assessment, the nurse may initiate other actions (call the primary care provider if the client has any questions)

5. Why is the infection rate of HIV, tuberculosis (TB), and hepatitis so high among persons who are incarcerated? Select all that apply. a. Fecal oral transmission because of lack of cleanliness and hygiene among inmates b. Ignorance as to how infectious diseases are transmitted c. Inmates engage in tattooing, drug use, and unprotected sexual intercourse. d. Lack of access to health care while incarcerated e. Overcrowding, poor ventilation, and constant change in the population f. Poor nutrition and lack of exercise while incarcerated

Rationale: C, E

5. Nurse Harry is developing a plan of care for a client with anorexia nervosa. Which action should the nurse include in the plan? Why? A. Restrict visits with the family until the client begins to eat B. Provide privacy during meals C. Set up a strict eating plan for the client D. Encourage the client to exercise, which will reduce her anxiety

Rationale: C. Set up a strict eating plan for the client Establishing a consistent eating plan and monitoring the client's weight are important for this disorder. Option A: The family should be included in the client's care. Option B: The client should be monitored during meals — not given privacy. Option D: Exercise must be limited and supervised.

10. A nurse is caring for a dying patient who is nonresponsive. Which of the following is it important for the nurse to do? a. Be alert to the patient's nonverbal cues. b. Direct explanations about care to family members. c. Tell the patient when the nurse is about to leave the room. d. Sit by the head of the bed when speaking to the patient

Rationale: C. Tell the patient when the nurse is about to leave the room. The nurse should continue to communicate with dying patients even if they are nonresponsive. Research indicates that patients continue to hear even though the level of consciousness is low, sometimes up to the moment of death. Nonverbal actions would not communicate meaning for a patient who is nonresponsive; nor would the patient be aware that the nurse is sitting instead of standing when speaking. The nurse should direct explanations of care to the patient, as always; nurses should not talk about the patient to others in the patient's presence, even when the patient is comatose.

1. During a home visit to a family of three: a mother, father, and their child, The mother tells the community nurse that the father (who is not present) had hit the child on several occasions when he was drinking. The mother further explains that she has talked her husband into going to Alcoholics Anonymous and asks the nurse not to interfere, so her husband won't get angry and refuse treatment. Which of the following is the best response of the nurse? a. The nurse agrees not to interfere if the husband attends an Alcoholics Anonymous meeting that evening. B. The nurse commends the mother's efforts and agrees to let her handle things. c. The nurse commends the mother's efforts and also contacts protective services. d. The nurse confronts the mother's failure to protect the child.

Rationale: C. The nurse commends the mother's efforts and also contacts protective services. The nurse would validate and reinforce the mother's efforts to seek help; however, the nurse must also report the abuse to the appropriate protective services. The priority is to maintain the child's safety. Options A and B are inappropriate; the nurse is failing to provide for the child's safety and is not following legal guidelines. Option D: the nurse, is alienating the mother, as well as failing to follow legal guidelines and ensure the child's safety.

13. An adolescent diagnosed with a conduct disorder stole and wrecked a neighbor's motorcycle. Afterward, the adolescent was confronted about the behavior but expressed no remorse. Which variation in the central nervous system best explains the adolescent's reaction? a. Serotonin dysregulation and increased testosterone activity impair one's capacity for remorse. b. Increased neuron destruction in the hippocampus results in decreased abilities to conform to social rules. c. Reduced gray matter in the cortex and dysfunction of the amygdala results in decreased feelings of empathy. d. Disturbances in the occipital lobe reduce sensations that help an individual clearly visualize the consequences of behavior.

Rationale: CAdolescents with conduct disorder have been found to have significantly reduced gray matter bilaterally in the anterior insulate cortex and the amygdala. This reduction may be related to aggressive behavior and deficits of empathy. The less gray matter in these regions of the brain, the less likely adolescents are to feel remorse for their actions or victims. People with intermittent explosive disorder may have differences in serotonin regulation in the brain and higher levels of testosterone. Neuron destruction in the hippocampus is associated with memory deficits. The occipital lobe is involved with visual stimuli but not the processing of emotions.

6. A patient with fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, "Someone get these bugs off me." What is the nurse's best response? a. "No bugs are on your legs. You are having hallucinations." b. "I will have someone stay here and brush off the bugs for you." c. "Try to relax. The crawling sensation will go away sooner if you can relax." d. "I don't see any bugs, but I can tell you are frightened. I will stay with you."

Rationale: D When hallucinations are present, the nurse should acknowledge the patient's feelings and state the nurse's perception of reality, but not argue. Staying with the patient increases feelings of security, reduces anxiety, offers the opportunity for reinforcing reality, and provides a measure of physical safety. Denying the patient's perception without offering help does not support the patient emotionally. Telling the patient to relax makes the patient responsible for self-soothing. Telling the patient that someone will brush the bugs away supports the perceptual distortions.

11. The nurse is assessing a 19 year-old female client with bulimia. Which of the following laboratory reports would the nurse anticipate? Why do you choose your answer? A. Increased serum glucose B. Increased sodium retention C. Decreased albumin D. Decreased potassium

Rationale: D. In bulimia, loss of electrolytes can occur in addition to signs and symptoms of starvation and dehydration.

1. What are prevailing characteristics of narcolepsy? Select all that apply. A. Involuntary B. Cataplexy C. Hallucinations D. Temporary paralysis E. All are Applicable

Rationale: E The person with narcolepsy experiences a sudden, uncontrollable urge to sleep lasting from seconds to minutes, even though the person sleeps well at night. The person cannot avoid the "sleep attacks" but awakens easily. Narcolepsy is characterized by involuntary episodes of sleepiness, slurred speech, slackening of the facial muscles, a feeling of impending weakness of the knees, paralysis, and hallucinations. Some have other symptoms, such as cataplexy, a sudden loss of muscle tone usually triggered by an emotional event (e.g., laughter, surprise, or anger), but most only have hypersomnia.

13. A person with an eating disorder isn't trying hard enough to eat right. A. True B. False

Rationale: False An eating disorder is a real illness. It is not about lacking the will to eat right.

Oppositional Defiant Disorder

a childhood disorder in which children are repeatedly argumentative and defiant, angry and irritable, and in some cases, vindictive

pyromania

a compulsion to set things on fire

Inhibited grief

a person suppresses feelings of grief and may instead manifest somatic (body) symptoms, such as abdominal pain or heart palpitations

ECT can be used to treat what?

depression and severe manic episodes

Anticipatory grief

grief experienced prior to a loss

Delayed grief

inhibited, suppressed or postponed response to a loss

Anorexia treatment

inpatient

Encopresis

involuntary defecation not attributable to physical defects or illness

enuresis

involuntary urination

Delirium

mental disorder marked by confusion; uncontrolled excitement; ADJ. delirious

conduct disorder

patterns of behavior in which the rights of others or basic social rules are violated

binge eating disorder

significant binge-eating episodes, followed by distress, disgust, or guilt, but without the compensatory purging, fasting, or excessive exercise that marks bulimia nervosa

Medical complications of bulimia

-Sinus bradycardia -Orthostatic changes -Cardiac Murmur -Abnormal Potassium, Sodium values -Russell's Sign (Callused knuckles) -Esophageal Tears -Parotid Swelling -Dental erosion

Thoughts and behaviors associated with anorexia nervosa

-Terror of weight gain -preoccupation with thoughts of food -View of self as fat even when emancipated -particular handling of food like cutting food into small bites -pushing food around the plate -Possible development of a rigorous exercise regimen -possible self-induced vomiting, use of laxatives and diuretics -cognition so disturbed the individual judges self worth by his or her weight

Behaviors associated with bulimia

-binge eating behaviors -self induce vomiting -history of anorexia with signs and symptoms of depression -problems with self concept -increased levels of anxiety and compulsivity -possible chemical dependence -possible impulsive stealing

Assessment Guidelines for sexual dysfunction

1. A sexual assessment should be conducted in a setting that allows privacy and eliminate a distraction 2. Although notetaking may be necessary for the beginning it can be distracting to the patient and interrupt the flow of the interview when taking notes is necessary it should be on the troops and kept at a minimum. 3. The interviewer should be aware of personal bias and attitudes that could walk open discussion or sexual issues. 4. Good eye contact, relax posture, and a friendly facial expression expresses facilitation of patient's comfort and communication openness and receptive body on part of the nurse.

Assessment guideline for somatization disorders

1. Assess for nature, location, onset, characteristics, and duration of the symptoms. 2. explore the past hx of adverse childhood events. 3. identify symptoms of anxiety, depression, and past trauma that may be contributing to the symptoms. 4. Determine the current quality of life, social support, and coping skills, include spirituality. 5. identify and secondary gain that the pt is experiencing symptoms. 6. explore the patient's cognitive and ability to communicate feelings and needs. 7. Assess current psychosocial and biological needs, include overuse and dependance.

Assessment guideline for paraphilic disorder

1. Assess the potential for self harm because the patient may be able to risk for suicide. 2. the main focus should be on the presenting problem 3. Elicit the patient's perception of the impact of the sexual disorder upon the current illness.

Assessment guidelines to anorexia

1. The patient has a medical or psychiatric condition that warrants hospitalization 2. A thorough physical assessment with appropriate blood work has been done 3. Other medical conditions have been ruled out 4. The patient is amenable to receiving or completing appropriate therapy 5. The family and the pt needs further teaching regarding therapy 6. The patient and family desire to participate in a support group 7. The pt has a referral to appropriate therapy

conversion disorder

A rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found.

21. Which of the following diagnoses can be classified as psychophysiological disorders? Select all that apply. a. Coronary artery disease. b. Asthma. c. Cancer. d. Sepsis. e. Upper respiratory tract infection.

A, B, C Rationale: Psychophysiological responses to anxiety are responses in which psychological factors contribute to the initiation or the exacerbation of a physical condition. Research shows that certain personality types (type C personality) are associated with the development of cancer. These clients tend to suppress versus express anxiety. Cancer can be classified as a psychophysiological disorder. Research shows that individuals diagnosed with asthma are characterized as having excessive dependency needs, although no specific personality type has been identified. These individuals share the personality characteristics of fear, emotional lability, increased anxiety, and depression. Asthma can be considered a psychophysiological disorder. Research shows that certain personality types (type A personality) are associated with the development of coronary artery disease. These clients tend to have an excessive competitive drive and a chronic continual sense of time urgency. Coronary artery disease can be classified as an psychophysiological disorder. Viruses, bacteria, fungi, parasites, and the inhalation of foreign bodies directly cause an upper respiratory tract infection. It does not meet the criteria to be considered a psychophysiological disorder. Sepsis is the spread of an infection from its initial site to the bloodstream, initiating a systemic response. Infection is directly caused by viruses, bacteria, fungi, or parasites. It does not meet the criteria to be considered a psychophysiological disorder.

17. What information should the nurse give to the family of a client who has had a dissociative episode? A. Dissociation is a method for coping with severe stress. B. Dissociation suggests the possibility of early dementia. C. Alert family that brief periods of psychotic behavior may occur. D. How to intervene to prevent self-mutilation and suicide attempts.

A. This explanation helps families see the disorder as less "weird" and helps them understand that treatment will be aimed at identifying and developing alternative coping strategies.

11. Mrs. Chatterjee, a 26-year-old patient, attends a clinic in New Delhi, India, with complaints of "fits" for the last 4 years. The "fits" are always sudden in onset and usually last 30 to 60 minutes.A few minutes before a fit begins, she knows that it is imminent, and she usually goes to bed. During the fits she becomes unresponsive and rigid throughout her body, with bizarre and thrashing movements of the extremities. Her eyes close and her jaw is clenched, and she froths at the mouth. She frequently cries and sometimes shouts abuses. She is never incontinent of urine or feces, nor does she bite her tongue. After a "fit" she claims to have no memory of it. These episodes recur about once or twice a month. She functions well between the episodes. Both the patient and her family believe that her "fits" are evidence of a physical illness and are not under her control. However, they recognize that the fits often occur following some stressor such as arguments with family members or friends. . . . She is described by her family as being somewhat immature but "quite social" and good company. She is self-centered, she craves attention from others, and she often reacts with irritability and anger if her wishes are not immediately fulfilled. On physical examination, Mrs. Chatterjee was found to have mild anemia but was otherwise healthy. A mental status examination did not reveal any abnormality . . . and her memory was normal. An electroencephalogram showed no seizure activity. The nurse would determine which diagnosis would be pertinent for this patient. Explain your answer choice!

A. Pain disorder B. Somatoform disorder C. Conversion disorder D. DID

22. A client is diagnosed with hypochondriasis. Which of the following assessment data validate this diagnosis? Select all that apply. a. Physical symptoms are managed by using the defense mechanism of denial. b. Depression and obsessive-compulsive traits are common. c. Social and occupational functioning may be impaired. d. Long history of "doctor shopping." e. Preoccupation with disease processes and organ function

B,C,D, E Rationale: About the correct answer: Preoccupation with disease processes and organ function is common when a client is diagnosed with hypochondriasis. The nurse can differentiate hypochondriasis from somatization disorder because in somatization disorder the complaints are general in nature and cannot be connected to specific disease processes or body systems. A long history of "doctor shopping" is common when a client is diagnosed with hypochondriasis. Doctor shopping occurs because the client with hypochondriasis is convinced that there is a physiological problem and continues to seek assistance for this problem even after confirmation that no actual physiological illness exists. Anxiety and depression are common, and obsessive-compulsive traits frequently are associated with hypochondriasis. Clients diagnosed with hypochondriasis are convinced, and will insist, that their symptoms are related to organic pathology or loss of function. This impairs social and occupational functioning. The client diagnosed with hypochondriasis exaggerates, rather than denies, physical symptoms.

16. Therapeutic intervention for a client with a somatoform disorder would include A. steering conversation away from client feelings. B. conveying interest in the client rather than in symptoms. C. encouraging the client in liberal use of benzodiazepines. D. encouraging the client to refer to the nurse for meeting client needs.

B. Clients with somatoform disorders often have poor self-esteem. They expect to receive attention for their symptoms rather than for themselves. Shifting emphasis from the symptom to the person raises self-esteem and does not reinforce reliance on the symptom as a way of getting emotional needs met.

19. Your patient has had hypochondriasis for 2 years. His wife tells the nurse "It is so difficult! Whenever we make plans to get together with another couple or go on vacation or do anything pleasant, my husband throws a monkey wrench in the works, saying he is too ill, or he needs to make a doctor's appointment. I don't know how much longer I can take it." On the basis of this report, the nurse may wish to explore the nursing diagnosis of A. interrupted family processess. B. decisional conflict. C. risk for caregiver role strain. D. impaired home maintenance.

C. Caregiver role strain is defined as caregiver's felt or expressed difficulty in performing the family caregiver role. The statements "It is so difficult" and "I don't k

15. Dissociative identity disorder is characterized by A. the inability to recall important information. B. sudden unexpected travel away from home and inability to remember the past. C. the existence of two or more subpersonalities, each with its own patterns of thinking. D. recurring feelings of detachment from one's body or mental processes.

C. In dissociative identity disorder, aspects of the self may emerge as distinct personalities, with the individual losing sense of who he or she is. Dissociative identity disorder was previously referred to as multiple personality disorder.

factitious disorder

Condition in which a person acts as if he or she has a physical or mental illness when he or she is not really sick.

18. Which item of data should be routinely gathered during assessment of a client with a somatoform disorder? A. Potential for violence B. Level of confusion C. Dependence on medication D. Personal identity disturbance

D. Many clients with somatoform disorder have received prescription medication for anxiety or pain relief and may have developed dependence. Assess not only for what the client has taken, but also for amounts and length of time over which the drugs have been prescribed.

10. What information should the nurse give to the family of a client who has had a dissociative episode? A. Dissociation is a method for coping with severe stress. B. Dissociation suggests the possibility of early dementia. C. Alert family that brief periods of psychotic behavior may occur. D. How to intervene to prevent self-mutilation and suicide attempts.

Rationale: A. Dissociation is a method for coping with severe stress. This explanation helps families see the disorder as less "weird" and helps them understand that treatment will be aimed at identifying and developing alternative coping strategies.

Chris is a shy, anxious-looking, 31-year-old carpenter who has been hospitalized after making a suicide attempt. . . . He asks to meet with the psychiatrist in a darkened room. He is wearing a baseball cap pulled down over his forehead. Looking down at the floor, Chris says he has no friends, has just been fired from his job, and was recently rejected by his girlfriend. "It's my nose . . . these huge pockmarks on my nose. They're grotesque! I look like a monster. I'm as ugly as the Elephant Man! These marks on my nose are all that I can think about. I've thought about them every day for the past 15 years, and I think that everyone can see them and that they laugh at me because of them. That's why I wear this hat all the time. And that's why I couldn't talk to you in a bright room . . . you'd see how ugly I am." The psychiatrist couldn't see the huge pockmarks that Chris was referring to, even in a brightly lit room. Chris is, in fact, a handsome man with normal-appearing facial pores. [Later Chris says,] "I've pretty much kept this preoccupation a secret because it's so embarrassing. I'm afraid people will think I'm vain. But I've told a few people about it, and they've tried to convince me that the pores really aren't visible. . . . This problem has ruined my life. All I can think about is my face. I spend hours a day looking at the marks in the mirror. . . . I started missing more and more work, and I stopped going out with my friends and my girlfriend . . . staying in the house most of the time. . . ." Chris . . . had seen a dermatologist to request dermabrasion, but was refused the procedure because "there was nothing there." He finally convinced another dermatologist to do the procedure but thought it did not help. Eventually he felt so desperate that he made two suicide attempts. His most recent attempt occurred after he looked in the mirror and was horrified by what he saw . . . "I saw how awful I looked, and I thought, I'm not sure it's worth it to go on living if I have to look like this and think about this all the time." The nurse would determine which diagnosis would be pertinent for this patient. Explain your answer choice! A. Ficticious disorder B. Conversion disorder C. OCD D. BDD

D. BDD

Somatic Disorders

Marked by somatic (bodily) symptoms that cause significant stress or impairment. Somatic Symptom Disorder Illness Anxiety Disorder Conversion Disorder

What is administered before ECT

Muscle relaxers

Pt cues that may show that they are concerned about sexuality

Nonverbal: -showing discomfort -openly engaging in overt sexual behavior Verbal: -telling sexual jokes -making sexual content -asking the nurse inappropriate questions about the nurses sexual activity -discussing sexual exploits -expressing concerns about relationship with partner -expressing concern that sexuality has been diminished -expressing concern over lack of desire -expersing concern about over performance - exprerssing concerns about love life

Interventions for paraphilic disorder

Prevention of socially unacceptable sexual behavior

6. Which nursing action should occur first in order to assist a patient who has a problem of sexual dysfunction or sexual disorder? The nurse should.......? Why? A. develop an understanding of human sexual response. B. assess the patient's sexual functioning and needs. C. acquire knowledge of the patient's sexual roles. D. clarify own personal values about sexuality.

Rationale: D Before one can be helpful to patients with sexual dysfunctions or disorders, the nurse must be aware of his or her own feelings and values about sex and sexuality. Nurses must keep their personal beliefs separate from their patient care in order to remain objective, professional, and effective. Nurses must be comfortable with the idea that patients have a right to their own values and must avoid criticism and censure. The other options are indicated as well, but self-awareness must precede them to provide the best care.

14. A person is brought to the emergency department from a party by a friend. The friend found the patient unconscious in a bedroom. Semen is observed on the patient's underclothes. The priority actions of nursing/staff should be focused on: a. preserving rape evidence. b. obtaining a description of the rape. c. determining what drug was ingested. d. maintaining the patient's airway.

Rationale: D Because the patient is unconscious, the risk for airway obstruction is present. The remaining options are of lower priority than preserving physiological functioning.

What is ECT?

The use of electrical shock current delivered to the brain to induce a seizure that treats depression.

dose a high level of medical care alleviate pts concerns in pts with somatic disorders

Yes

dissocative fugue

characterized by a sudden loss of memory and the assumption of a new identity in a new location

depersonalization disorder

dissociative disorder in which individuals feel detached and disconnected from themselves, their bodies, and their surroundings

nursing assessment in somatic disorders

identify adverse childhood experiences, depression, anxiety, PTSD, and substance use

body dysmorphic disorder

involves excessive preoccupation with an imagined defect in physical appearance

Nursing interventions for paraphilic disorder

medications like medroxyprogesterone and SSRIs

delayed ejaculation disorder

retarded ejaculation, or the inability to ejaculate following a normal sexual excitement phase

Side effects of ECT

temporary memory loss and confusion

erectile disorder

the inability to have or maintain an erection

A patient diagnosed with a serious mental illness lives independently and attends a psychosocial rehabilitation program. The patient presents at the emergency department seeking hospitalization. The patient has no acute symptoms but says, "I have no money to pay my rent or refill my prescription." Select the nurse's best action. a. Involve the patient's case manager to provide crisis intervention. b. Send the patient to a homeless shelter until housing can be arranged. c. Arrange for a short in-patient admission and begin discharge planning. d. Explain that one must have active psychiatric symptoms to be admitted.

ANS: A Impaired stress tolerance and problem-solving abilities can cause persons with SMI to experience relatively minor stressors as crises. This patient has run out of money, and this has overwhelmed her ability to cope, resulting in a crisis for which crisis intervention would be an appropriate response. Inpatient care is not clinically indicated nor is the patient homeless (although she may fear she is). Telling the patient that she is not symptomatic enough to be admitted may prompt malingering.

Select all that apply. An adult patient tells the case manager, "I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends." Where should the nurse refer the patient? a. Psychoeducational classes b. Vocational rehabilitation c. Social skills training d. A homeless shelter e. Crisis intervention

ANS: A, B, C The patient does not understand the illness and need for adherence to the medication regimen. Psychoeducation for the patient (and family) can address this lack of knowledge. The patient, who considers himself friendless, could also profit from social skills training to improve the quality of interpersonal relationships. Many patients with serious mental illness have such poor communication skills that others are uncomfortable interacting with them. Interactional skills can be effectively taught by breaking the skill down into smaller verbal and nonverbal components. Work gives meaning and purpose to life, so vocational rehabilitation can assist with this aspect of care. The nurse case manager will function in the role of crisis stabilizer, so no related referral is needed. The patient presently has a home and does not require a homeless shelter.

Select all that apply. Which statements most clearly indicate the speaker views mental illness with stigma? a. "We are all a little bit crazy." b. "If people with mental illness would go to church, their problems would be solved." c. "Many mental illnesses are genetically transmitted. It's no one's fault that the illness occurs." d. "Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people." e. "People with mental illness are lazy. They get government disability checks instead of working."

ANS: A, B, E Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. It is evidenced in stereotypical statements, by oversimplification, and by multiple other messages of guilt or shame. See related audience response question.

. After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This patient now requires persistent direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of: a. side effects of antipsychotic medications. b. dependency caused by institutionalization. c. cognitive deterioration from schizophrenia. d. stress associated with acclimation to the community.

ANS: B Institutions tend to impede independent functioning; for example, daily activities are planned and directed by staff; others provide meals and only at set times. Over time, patients become dependent on the institution to meet their needs and adapt to being cared for rather than caring for themselves. When these patients return to the community, many continue to demonstrate passive behaviors despite efforts to promote. Cognitive dysfunction and antipsychotic side effects can make planning and carrying out activities more difficult, but the question is more suggestive of adjustment to institutional care and difficulty readjusting to independence instead.

Many persons brought before a criminal court have mental illness, have committed minor offenses, and are off medications. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate? a. "Sometimes a little time in jail makes a person rethink what they've been doing and puts them back on the right track." b. "Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses." c. "Arresting these people helps them in the long run. Sometimes we cannot hospitalize them, but in jail they will get their medication." d. "Research suggests that special mental health courts do not make much difference so far, but outpatient commitment does seem to help."

ANS: B Research supports the use of special mental health courts that can sentence mentally ill persons to treatment instead of jail. Jail exposes vulnerable mentally ill persons to criminals, victimization, and high levels of stimulation and stress. Incarceration can also interrupt eligibility for benefits or lead to the loss of housing and often provides lower-quality mental health treatment in other settings. Recidivism rates for both mentally ill and non-mentally ill offenders are relatively high, so it does not appear that incarceration necessarily leads people to behave more appropriately. In addition, a criminal record can leave them more desperate and with fewer options after release. Research indicates that outpatient commitment is less effective at improving the mental health of mentally ill persons than was expected.

Select all that apply. A person diagnosed with a serious mental illness (SMI) living in the community was punched, pushed to the ground, and robbed of $7 during the day on a public street. Which statements about violence and serious mental illness in general are accurate? a. Persons with SMI are more likely to be violent. b. SMI persons are more likely to commit crimes than to be the victims of crime. c. Impaired judgment and social skills can provoke hostile or assaultive behavior. d. Lower incomes force SMI persons to live in high-crime areas, increasing risk. e. SMI persons experience higher rates of sexual assault and victimization than others. f. Criminals may believe SMI persons are less likely to resist or testify against them.

ANS: C, D, E, F Mentally ill persons are more likely to be victims of crime than perpetrators of criminal acts. They are often victims of criminal behavior, including sexual crimes, at a higher rate than others. When a mentally ill person commits a crime, it is usually nonviolent. Mental illnesses interfere with employment and are associated with poverty, limiting SMI persons to living in inexpensive areas that also tend to be higher-crime areas. SMI persons may inadvertently provoke others because of poor judgment or socially inappropriate behavior, or they may be victimized because they are perceived as passive, less likely to resist, and less likely to be believed as witnesses. See related audience response question.

A homeless individual diagnosed with serious mental illness, anosognosia, and a history of persistent treatment nonadherence is persuaded to come to the day program at a community mental health center. Which intervention should be the team's initial focus? a. Teach appropriate health maintenance and prevention practices. b. Educate the patient about the importance of treatment adherence. c. Help the patient obtain employment in a local sheltered workshop. d. Interact regularly and supportively without trying to change the patient.

ANS: D Given the history of treatment nonadherence and the difficulty achieving other goals until psychiatrically stable and adherent, getting the patient to accept and adhere to treatment is the fundamental goal to address. The intervention most likely to help meet that goal at this stage is developing a trusting relationship with the patient. Interacting regularly, supportively, and without demands is likely to build the necessary trust and relationships that will be the foundation for all other interventions later on. No data here suggest the patient is in crisis, so it is possible to proceed slowly and build this foundation of trust.

A patient diagnosed with schizophrenia has had multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply as the patient transitions from hospital to community? a. Administer a second-generation antipsychotic to help negative symptoms. b. Use a quick-dissolving medication formulation to reduce "cheeking." c. Prescribe a long-acting intramuscular antipsychotic medication. d. Involve the patient in decisions about which medication is best

ANS: D Persons with schizophrenia are at high risk for treatment nonadherence, so the strategy needs primarily to address that risk. Of the options here, involving the patient in the decision is best because it will build trust and help establish a therapeutic alliance with care providers, an essential foundation to adherence. Intramuscular depot medications can be helpful for promoting adherence if other alternatives have been unsuccessful, but IM medications are painful and may jeopardize the patient's acceptance. All of the other strategies also apply but are secondary to trust and bonding with providers.

An outpatient diagnosed with schizophrenia attends programming at a community mental health center. The patient tells the nurse, "I threw away the pills because they keep me from hearing God." Which response by the nurse would most likely to benefit this patient? a. "You need your medicine. Your schizophrenia will get worse without it." b. "Do you want to be hospitalized again? You must take your medication." c. "I would like you to come to the medication education group every Thursday." d. "I noticed that when you take the medicine, you have been able to hold a job you wanted."

ANS: D The patient appears not to understand that he has an illness. He has stopped his medication because it interferes with a symptom that he finds desirable (auditory hallucinations—the voice of God). Connecting medication adherence to one of the patient's goals (the job) can serve to motivate the patient to take the medication and override concerns about losing the hallucinations. Exhorting a patient to take medication because it is needed to control his illness is unlikely to be successful; he does not believe he has an illness. Medication psychoeducation would be appropriate if the cause of nonadherence was a knowledge deficit.

4. A registered nurse arrives at work and is told to "float" to the ICU for the day because the ICU is understaffed and needs an additional nurse to care for the clients. The nurse has never worked in the ICU. Which of the following is the most appropriate nursing action? Why? a. Refuse to float in the ICU b. Call the hospital lawyer c. Call the nursing supervisor d. Report to the ICU and identify tasks that can be safely performed

Answer: D Rationale - floating is acceptable and legal practice. The nurse floated to a unit until will be given orientation; be assigned to care for stable patients or those with conditions similar to her training experience.

Delirium interventions

Assessment -early recognition (must identify the cause!) Treat underlying causes (medications, physiologic alterations, pain) Reality orientation Calm atmosphere Maintain sleep-wake cycle Many times it is sleep deprivation Consider withdrawal as a cause Safety Use caution with medications

11. A victim of a sexual assault that occurred approximately 1 hour ago sits in the emergency department rocking back and forth and repeatedly saying, "I can't believe I've been raped." This behavior is characteristic of: a. the acute phase reaction. b. the angry stage of Rape-trauma syndrome. c. a delayed reaction to Rape-trauma syndrome. d. long term phase of Rape-trauma syndrome.

Rationale: A The victim's response is typical of the acute phase and evidences cognitive, affective, and behavioral disruptions. The response is immediate and does not include a display of behaviors suggestive of the long-term phase, anger, or a delayed reaction.

9. An anorexic client states to a nurse, "My father has recently moved back to town." Since that time the client has experienced insomnia, nightmares, and panic attacks that occur nightly. She has never married or dated and lives alone. What should the nurse suspect? What could you do for this person as a nurse advocate? a. Possible major depressive disorder b. Possible history of childhood incest c. Possible histrionic personality disorder d. Possible history of childhood physical abuse

Rational: B The nurse should suspect that this client might have a history of childhood incest. Adult survivors of incest are at risk for developing posttraumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

8. A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisor's most appropriate reply? Why do you feel your answer is the most appropriate? What are your thoughts? a. "These clients don't know life any other way, and change is not an option until they have improved insight." b. "These clients have limited KEY: Cognitive skills and few vocational abilities to be able to make it on their own." c. "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation." d. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness."

Rational: D The nursing supervisor is accurate when stating that clients in severely abusive relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner for some of the following reasons: for the children, for financial reasons, fear of retaliation, lack of a support network, religious reasons, and/or hopelessness.

10. In planning for the discharge of a client with a cognitive disorder, it is important to assess the client's caregiver support system. Which aspects are the most crucial to assess? Select all that apply. a. Availability of resources for caregiver support. b. Ability to provide the level of care and supervision needed by the client. c. Willingness to transport the client to medical and psychiatric services. d. Interest in engaging the cognitively disordered family member in reminiscence and games. e. Willingness to install door alarms and make other safety changes. f. Understanding the client's abilities and limitations

Rationale ; A, B, C, E, F It is important for a caregiver to have support for herself as well as be able to provide adequate safety, supervision, and medical care to the client. The caregiver must also have realistic expectations of the client, given his abilities and limitations. Reminiscing and engaging the client in games is desirable but not crucial to care.

9. A 90-year-old client diagnosed with major depression is suddenly experiencing sleep disturbances, inability to focus, poor recent memory, altered perceptions, and disorientation to time and place. Lab results indicate the client has a urinary tract infection and dehydration. After explaining the situation and giving the background and assessment data, the nurse should make which of the following recommendations to the client's physician? a. An order to place the client in restraints. b. A reevaluation of the client's mental status. c. The transfer of the client to a medical unit. d. A transfer of the client to a nursing home.

Rationale C. The client is showing symptoms of delirium, a common outcome of UTI in older adults. The nurse can request a transfer to a medical unit for acute medical intervention. The client's symptoms are not just due to a worsening of the depression. There are not indications that the client needs restraints or a transfer to a nursing home at this point.

5. All of the following are benefits of digital photographic documentation, EXCEPT? Why? A. Inability to be altered B. Ability to review images and reshoot C). Ease of distribution during legal proceedings D. Better control of the evidence chain of custody

Rationale: A

16. Health teaching and promotion for a client diagnosed with a sexual disorder is focused on.....? Why? A. identifying triggers that produce depression or anxiety. B. modifying deviant sexual behaviors. C. recognizing the impact of their behavior on others. D. reforming their behaviors into more socially acceptable actions.

Rationale: A Health promotion and teaching is directed toward the individual's health and wellness and so identifying triggers for unhealthy outcomes such as depression and anxiety is the focus

10. A patient who regularly experiences premature ejaculation tells the nurse, "I feel like such a failure. It's so awful for both me and my partner." Select the nurse's most therapeutic response. Why did you choose this? a. "I sense you are feeling frustrated and upset." b. "Tell me more about feeling like a failure." c. "You are too hard on yourself." d. "What do you mean by awful?"

Rationale: A Using reflection and empathy promotes trust and conveys concern to the patient. The distracters do not offer empathy, probe, and offer premature reassurance.

7. A nurse is anxious about assessing the sexual history of a patient who is considerably older than the nurse is. Which statement would be most appropriate for obtaining information about the patient's sexual practices? Why? A. "Some people are not sexually active, others have a partner, and some have several partners. What has been your pattern?" B. "Sexual health can reflect a number of medical problems, so I'd like to ask if you have any sexual problems you think we should know about." C. "It's your own business, of course, but it might be helpful for us to have some information about your sexual history. Could you tell me about that, please?" D. "I would appreciate it if you could share your sexual history with me so I can share it with your health care provider. It might be helpful in planning your treatment."

Rationale: A Explaining that sexual practices vary helps reduce patient anxiety about the topic by normalizing the full range of sexual practices so that whatever his situation, the patient can feel comfortable sharing it. "It's your business of course..." implies the nurse does not have a valid reason to seek the information and in effect suggests that the patient perhaps should not answer the question. "It might be helpful..." makes the information seem less valid or important for the nurse to pursue and, again, could discourage the patient from responding fully. Asking if the patient has any sexual problems that staff should know about is not unprofessional, but it is a very broad question that may increase a patient's uncertainty about what the nurse wants to hear, thus increasing his anxiety. Defining or giving an example of "sexual problem" would make this inquiry more effective.

5. The nurse is meeting with a male patient who experienced a myocardial infarction six months ago. At a follow-up visit, this patient states, "I haven't had much interest in sex since my heart attack. I finished my rehabilitation program, but having sex strains my heart. I don't know if my heart is strong enough." Which nursing diagnosis applies? Why? A. Deficient knowledge related to faulty perception of health status B. Disturbed self-concept related to required lifestyle changes C. Disturbed body image related to treatment side effects D. Sexual dysfunction related to self-esteem disturbance

Rationale: A Patients who have had a myocardial infarction often believe sexual intercourse will cause another heart attack. The patient has completed the rehabilitation, but education is needed regarding sexual activity. These patients should receive information about when sexual activity may begin, positions that conserve energy, and so forth. The scenario does not suggest self-concept or body image disturbance.

1. A 16-year-old diagnosed with a conduct disorder has been in a residential program for 3 months. Which outcome should occur before discharge? Why? A. The adolescent and parents create and agree to a behavioral contract with rules, rewards, and consequences. B. The adolescent identifies friends in the home community who are a positive influence. C. Temporary placement is arranged with a foster family until the parents complete a parenting skills class. D. The adolescent experiences no anger and frustration for 1 week.

Rationale: A The adolescent and the parents must agree on a behavioral contract that clearly outlines rules, expected behaviors, and consequences for misbehavior. It must also include rewards for following the rules. The adolescent will continue to experience anger and frustration. The adolescent and parents must continue with family therapy to work on boundary and communication issues. It is not necessary to separate the adolescent from the family to work on these issues. Separation is detrimental to the healing process. While it is helpful for the adolescent to identify peers who are a positive influence, it's more important for behavior to be managed for an adolescent diagnosed with a conduct disorder.

7. Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse's coworker observes this action but does nothing for fear of repercussion. What is the ethical interpretation of the coworker's lack of involvement? Why did you choose this answer? a. Taking no action is still considered an unethical action by the coworker. b. Taking no action releases the coworker from ethical responsibility. c. Taking no action is advised when potential adverse consequences are foreseen. d. Taking no action is acceptable because the coworker is only a bystander.

Rationale: A The coworker's lack of involvement can be interpreted as an unethical action. The coworker is experiencing an ethical dilemma in which a decision needs to be made between two unfavorable alternatives. The coworker has a responsibility to report any observed unethical actions.

13. A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations? Why did you choose this answer? a. Refusing to give any information to the caller, citing rules of confidentiality b. Refusing to give any information to the caller by hanging up c. Affirming that the person has been seen at the facility but providing no further information d. Suggesting that the caller speak to the client's therapist

Rationale: A The most appropriate action by the nurse is to refuse to give any information to the caller. Admission to the facility would be considered protected health information (PHI) and should not be disclosed by the nurse without prior client consent.

11. A Native American client is admitted to an emergency department (ED) with an ulcerated toe secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate? Why? a. Try to locate a shaman that will agree to come to the ED. b. Explain to the client that "voodoo" medicine will not heal the ulcerated toe. c. Ask the client to explain what the shaman can do that the physician cannot. d. Inform the client that refusing treatment is a client's right.

Rationale: A The most appropriate nursing intervention would be to try to locate a shaman who will agree to come to the ED. The nurse should understand that in the Native American culture, religion and health-care practices are often intertwined. The shaman, a medicine man, may confer with physicians regarding the care of a client. Research supports the importance of both health-care systems in the overall wellness of Native American clients.

8. A parent who is very concerned about his 3-year-old son says, "He likes to play with girls' toys. Do you think he is homosexual or mentally ill?" Which response by the nurse most professionally describes the current understanding of gender identity? Why? How can you help this patient.......? A. "A child's interest in the activities of the opposite gender is not unusual or related to sexuality. Most children do not carry cross-gender interests into adulthood." B. "It's difficult to say for sure because the research is incomplete so far, but chances are that he will grow up to be a normal adult." C. "The research is incomplete, but many boys play with girls' toys and turn out normal as adults." D. "I am sure that whatever happens, he will be a loving son, and you will be a proud parent."

Rationale: A The parent's inquiry is really two questions: (1) whether the child's behavior suggests an increased risk of developing mental illness and (2) what the child's future sexual preference will be. The psychiatric disorder that most directly addresses gender preferences and cross-gender activities is gender identity disorder. Pointing out that cross-gender activities are not necessarily related to gender identity and not likely to be carried into adulthood is supported by current research. Saying the child will grow up to be "normal" implies that to be homosexual is to be abnormal, which reflects a cultural perspective that most professionals would believe to be inappropriate to share in a professional setting. Research provides information about the relationship between cross-gender interests in childhood and adulthood, so a comment that "research is incomplete" is not entirely accurate. Stating that the child is a wonderful boy the father will be proud of, whatever happens, evades the parent's question and suggests that parental bonds should not be affected by gender issues. The nurse has a professional obligation to maintain an objective, therapeutic relationship.

4. To promote self-reliance, how should a psychiatric nurse best conduct medication administration? A. Encourage clients to request their medications at the appropriate times. B. Refuse to administer medications unless clients request them at the appropriate times. C. Allow the clients to determine appropriate medication times. D. Take medications to the clients' bedside at the appropriate times.

Rationale: A The psychiatric nurse promoting self-reliance would encourage clients to request their medications at the appropriate times. Nurses are responsible for the management of medication administration on inpatient psychiatric units, but nurses must work with clients to encourage self-reliance and responsibility, which may result in independent decision-making, leading to medication adherence.

11. You are caring for a client at the end of life. The client tells you that they are grateful for having considered and decided upon some end of life decisions and the appointments of those who they wish to make decisions for them when they are no longer able to do so. During this discussion with the client and the client's wife, the client states that "my wife and I are legally married so I am so glad that she can automatically make all healthcare decisions on my behalf without a legal durable power of attorney when I am no longer able to do so myself" and the wife responds to this statement with, "that is not completely true. I can only make decisions for you and on your behalf when these decisions are not already documented on your advance directive." How should you, as the nurse, respond to and address this conversation between the husband and wife and the end of life? a. You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions. b. You should be aware of the fact that the wife of the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need. c. You should be aware of the fact that the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need. d. You should reinforce the wife's belief that legally married spouses automatically serve for the other spouse's durable power of attorney for health care decisions and that others than the spouse cannot be legally appointed while people are married

Rationale: A You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions. Both the client and the client's spouse have knowledge deficits relating to advance directives. Legally married spouses do not automatically serve for the other spouse's durable power of attorney for health care decisions; others than the spouse can be legally appointed while people are married.

2. Crystal has been seeking treatment for her severe depression for years and has just not responded to any of the medications that have been tried. Crystal has been admitted to the psych unit for the 10th time. At a team conference, staff members recommend electroconvulsive therapy (ECT). When should nursing interventions begin? Why? A. As soon as the patient and her family are presented with this treatment alternative B. The night before ECT scheduled C. Immediately after ECT is administered D. When the patient returns to the unit after ECT therapy

Rationale: A - the nurse is responsible for assessing the patient's and family members' response to electroconvulsive therapy (ECT) and for providing opportunities for communication regarding their feelings and concerns as soon as the treatment is proposed. ECT is rarely an initial treatment for depression; it is used when a patient responds poorly to medication. It involves inducing a seizure in the patient by passing electric current through the brain (seizures are thought to produce changes in neurotransmitters and receptor sites similar to those produced by antidepressant medications). Before the treatment, the patient is given a short-acting barbiturate to induce anesthesia. After the procedure, the patient typically awakens quickly but remains confused and light-headed, necessitating close nursing supervision until these effects subside

13. A patient comes to the hospital for treatment of injuries sustained during a rape. The patient abruptly decides to decline treatment and return home. Before the patient leaves, the nurse should: a. provide written information about physical and emotional reactions that may be experienced. b. tell the patient, "You may not leave until you're given prophylactic sexually transmitted disease treatment." c. give verbal information about legal resources. d. explain the need and importance of HIV testing.

Rationale: A All information given to a patient before leaving the emergency department should be in writing. Patients who are anxious are unable to concentrate and therefore cannot retain much of what is verbally imparted. Written information can be read and referred to at later times. Patients cannot be kept against their will or coerced into receiving medication as a condition of being allowed to leave. This constitutes false imprisonment.

9. A client experiencing lower extremity paralysis is admitted to a medical unit. Extensive tests confirm disability but rule out any underlying organic pathology. The nurse concludes that this is most suggestive of which disorder? a. Conversion disorder b. Hypochondriasis c. Malingering d. Somatization disorder

Rationale: A Conversion Disorder Conversion disorder is a loss or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder. The situation presented in the question describes a conversion disorder.

14. Use of dissociation most closely resembles A. sitting in a lecture and "tuning out." B. developing a headache to avoid an unpleasant task. C. feeling angry with a co-worker who shirks work. D. finding a socially acceptable reason to meet a need.

Rationale: A Dissociation involves having one's thoughts or feelings out of conscious awareness and is similar to, but more drastic than, inattention to a lecture.

18. Which of the following drug regimens are the Centers for Disease Control (CDC)-recommended antibiotic prophylaxis to prevent sexually transmitted disease in a patient who was sexually assaulted? a. One dose of ceftriaxone 125 mg IM plus one dose of metronidazole 2 g PO plus one dose of azithromycin 1 g PO or doxycycline 100 mg PO. b. One dose of ceftriaxone 125 mg IM plus one dose of metronidazole 2 g PO. c. One dose of benzathine penicillin G 2.4 million units. d. Doxycycline 100 mg orally twice daily for 14 days and tetracycline 500 mg four times daily for 14 days

Rationale: A The CDC recommends the following antibiotic prophylaxis: one dose of ceftriaxone 125 mg IM plus one dose of metronidazole 2 g PO plus one dose of azithromycin 1 g PO or doxycycline 100 mg PO. Prophylaxis should be offered to the patient and administered during the examination. This regimen covers a broad spectrum of STDs. Patients should be counseled about the signs and symptoms of STDs as well as incubation periods.

12. A patient in the longterm phase of the Rape-trauma syndrome has experienced intrusive thoughts of the rape and developed a fear of being alone. Which nursing evaluation finding demonstrates the patient has made improvement? The patient............ a. plans coping strategies for fearful situations. b. uses increased activity to reduce fear. c. temporarily withdraws from social situations. d. expresses willingness to be sexual.

Rationale: A The key shows willingness and ability to take personal action to reduce disabling fear. "Expresses willingness to be sexual" relates to sexual functioning rather than fear.

15. A victim of a violent rape has been in the emergency department for 3 hours. Evidence collection is complete and discharge counseling is started. The patient says softly, "I will never be the same again. I can't face my friends. There is no sense of trying to go on." The most perceptive response by the nurse would be: a. "Are you thinking of committing suicide?" b. "It will take time, but you will feel the same." c. "Your friends will understand when you tell them." d. "You will be able to find meaning in this experience as time goes on."

Rationale: A The patient's words suggest hopelessness. Whenever hopelessness is present, so is suicide risk. The nurse should directly address the possibility of suicidal ideation with the patient. The other options attempt to offer reassurance before making an assessment.

7. A patient was abducted and raped at gunpoint by an unknown assailant. Which interventions should the nurse use while caring for the patient in the emergency department? (More than one answer is correct.) a. Allow the patient to talk at a comfortable pace. b. Place the patient in a private room with a caregiver. c. Pose questions in nonjudgmental, empathic ways. d. Reassure the patient that a family member will arrive as soon as possible. e. Invite family members to the examination room and involve them in the history-taking. f. Put an arm around the patient to offer reassurance that the nurse is caring and compassionate.

Rationale: A, B, C Neutral, nonjudgmental care and emotional support are critical to crisis management for the rape victim. The rape victim should have privacy, but not be left alone. Some rape victims prefer not to have family involved. The patient's privacy may be compromised by family presence. The rape victim's anxiety may escalate when touched by a stranger, even when the stranger is a nurse.

23. When providing care for a client who reports to the emergency department immediately after a sexual assault, which nursing actions are appropriate? (Select all that apply). a. Offer a support person or crisis advocate b. Provide appropriate care for injuries c. Make the client sign the exam consent form d. Contact law enforcement e. Determine whether the sexual activity was consensual

Rationale: A, B, D • The nurse should offer an advocate from a local crisis center to provide support, reassurance and resources. The nurse should let the client know that she or he has the right to have a friend or family member present •The nurse should also provide care for and document any injuries and notify local law enforcement. •Law enforcement should be immediately available in case the client chooses to file a report or to transport the evidence collection kit. Some states mandate reporting any sexual assault, while other states only mandate reporting sexual assault for children or elders. •In the emergency room, the nurse is responsible for collecting evidence as well. • A consent must be obtained from the client in order to perform a sexual assault exam. The client should not be forced or pressured to consent to the exam, and adult clients may decline to make a report to law enforcement. • After emotional support is provided, the nurse will assist with exam and collect specimens. The nurse should document all objective evidence, including the client's physical condition and statements. • As a victim of sexual assault, the patient may be in a state of shock or may have feelings of guilt or confusion about the situation. It is never appropriate to question the client about the assault or in any way imply that the client may have been at fault.

12. A nurse assesses a patient diagnosed with pedophilic disorder. Which findings are most likely? Select all that apply. Why did you choose your answer(s)? A. Childhood history of attention deficit hyperactivity disorder (ADHD) B. A poorly managed endocrine disorder C. History of brain injury D. Cognitive distortions E. Grandiosity

Rationale: A, C, D Attention deficit hyperactivity disorder (ADHD) in childhood, substance abuse, phobic disorders, and major depression/dysthymia are strongly associated with paraphilic disorders. Errors in thought make it seem acceptable for deviant and destructive sexual behaviors to occur. Patients who have experienced head trauma with damage to the frontal lobe of the brain may display symptoms of promiscuity, poor judgment, inability to recognize triggers that set off sexual desires, and poor impulse control. Endocrine problems are not associated with pedophilic disorder. Self-confidence is lacking; therefore, grandiosity would not be expected. Pedophilic disorder is characterized by recurrent, intense sexually arousing fantasies, urges, or behaviors involving prepubescent or young adolescents (usually ≤ 13 yr); it is diagnosed only when people are ≥ 16 yr and ≥ 5 yr older than the child who is the target of the fantasies or behaviors. Pedophilia is form of paraphilia that causes harm to others and is thus considered a a paraphilic disorder.

9. The nurse recognizes that a client is experiencing insomnia when the client reports (select all that apply): A. Extended time to fall asleep B. Falling asleep at inappropriate times C. Difficulty staying asleep D. Feeling tired after a night's sleep

Rationale: A, C, D These symptoms are often reported by clients with insomnia. Clients report non-restorative sleep. Arising once at night to urinate (nocturia) is not in and of itself insomnia.

17. When an emergency department nurse teaches a victim of Rape-trauma syndrome about reactions that may be experienced during the long-term phase, which symptoms should be included? (Select all that apply). a. Flashbacks, dreams b. Decreased motor activity c. Development of fears and phobias d. Feelings of numbness e. Syncopal episodes

Rationale: A, C, D These reactions are common to the long-term phase. Victims of rape frequently have a period of increased motor activity rather than decreased motor activity during the long-term reorganization phase. Syncopal episodes would not be expected.

8. When an emergency department nurse teaches a victim of Rape-trauma syndrome about reactions that may be experienced during the long-term phase, which symptoms should be included? (Select all that apply. a. Flashbacks, dreams b. Decreased motor activity c. Development of fears and phobias d. Feelings of numbness e. Syncopal episodes

Rationale: A, C, D These reactions are common to the long-term phase. Victims of rape frequently have a period of increased motor activity rather than decreased motor activity during the long-term reorganization phase. Syncopal episodes would not be expected.

3. Sheila tells the community nurse that her boyfriend has been abusive and she is afraid of him, but she doesn't want to leave. The client asks the nurse for assistance. Which nursing interventions are appropriate in this situation? (Select all that apply). a. Help Sheila to develop a plan to ensure safety, including phone numbers for emergency help. b. Help Sheila to get her boyfriend into an appropriate treatment program. c. Communicate acceptance, avoiding any implication that Sheila is at fault for not leaving. d. Help Sheila to explore available options, including shelters and legal protection. e. Tell Sheila that she should leave because things will not improve. f. Reinforce concern for Sheila's safety and her right to be free of abuse.

Rationale: A, C, D, F These are all appropriate nursing interventions for the victim of domestic violence. The client is not responsible for seeking help for the abuser, and encouraging her to do so may reinforce the client's feeling responsible for the abuse. Advising the client must decide for herself whether to leave, and the nurse must respect any decision the client makes. Making the decision for the client will erode her self-esteem and reinforce her sense of powerlessness.

1. The psychiatric nurse is alert to warning signs of suicide in the adolescent population. From the following list, select those behaviors that are indicative of adolescent suicidal thinking. Select all that apply. Why did you choose your answer(s)? A. Giving away prized possessions B. Associating with friends who are substance abusers C. Sudden withdrawal from friends and family D. Having difficulty concentrating on one thing at a time E. Being easily distracted by environmental events F. Verbal hints or threats about suicide

Rationale: A, C, and F These are all warning signs that an adolescent is having suicidal thoughts. The nurse should directly question any adolescent about suicide intent when these indicators are noted. Option B may indicate that the adolescent has a problem with substance use, but not necessarily suicide. Options D and E are signs of attention deficit hyperactivity disorder, not suicide

12. Mr. Lim who is diagnosed with moderate dementia has frequent catastrophic reactions during shower time. Which of the following interventions should be implemented in the plan of care? Select all that apply. a. Assign consistent staff members to assist the client. b. Accomplish the task quickly, with several staff members assisting. c. Schedule the client's shower at the same time of day. d. Sedate the client 30 minutes prior to showering. e. Tell the client to remain calm while showering. f. Use a calm, supportive, quiet manner when assisting the client.

Rationale: A, C, and F Maintaining a consistent routine with the same staff members will help decrease the client's anxiety that occurs whenever changes are made. A calm, quiet manner will be reassuring to the client, also helping to minimize anxiety. Option B: Moving quickly with several staffs will increase the client's anxiety and may precipitate a catastrophic reaction. Option D: The use of sedation is not indicated and may increase the risk of client injury from the side effect of drowsiness. Option E: Telling the client to remain calm is inappropriate because a client with dementia cannot respond to such a direction.

6. Which activities would be expected in the scope of practice of a sexual assault nurse examiner? (Select all that apply). a. Collecting and preserving evidence b. Requiring HIV testing of a victim c. Providing long-term counseling for rape victims d. Obtaining signed consents for photographs and examinations e. Providing pregnancy and sexually transmitted disease prophylaxis

Rationale: A, D, E HIV testing is not mandatory for a victim of sexual assault. Long-term counseling would be provided by other members of the team. The other activities would be included within this practice role.

18. In clients with disturbed sleep pattern, which of the following are appropriate nursing interventions to manage this issue? Select all that apply: A. Provide soft music or "white noise" B. Provide and evening meal and encourage the client to drink lots of fluids to make herself fell full C. Change bed time schedules D. Restrict daytime sleep as appropriate E. Reduce mental activity late in the day F. Avoid use of continuous restraints

Rationale: A, D, E, and F are independent nursing interventions in managing sleep deprivation. Clients may be provided with evening snack or warm milk prior to bedtime but should be restricted or limited with fluids to decrease the need to get up and use the bathroom in the middle of the night. A regular bedtime schedule should be promoted to establish a regular sleeping pattern.

12. A nurse on an adolescent psychiatric unit assesses a newly admitted 14-year-old. An impulse control disorder is suspected. Which aspects of the patient's history support the suspected diagnosis? Select all that apply. a. Family history of mental illnessb. Allergies to multiple antibioticsc. Long history of severe facial acned. Father with history of alcohol abusee. History of an abusive relationship with one parent

Rationale: A, D, EParents who are abusive, rejecting, or overly controlling cause a child to suffer detrimental effects. Other stressors associated with impulse control disorders can include major disruptions such as placement in foster care, severe marital discord, or a separation of parents. Substance abuse by a parent is common. Acne and allergies are not aspects of the history that relate to the behavior.

15. A client has a diagnosis of primary insomnia. Before assessing this client, the nurse recalls the numerous causes of this disorder (select all that apply). A. Chronic stress B. Severe anxiety C. Generalized pain D. Excessive caffeine E. Chronic depression F. Environmental noise

Rationale: A, D, F Acute or primary insomnia is caused by emotional or physical discomfort not caused by the direct physiologic effects of a substance or a medical condition. Excessive caffeine intake is an example of disruptive sleep hygiene; caffeine is a stimulant that inhibits sleep. Environmental noise causes physical and/or emotional and therefore is related to primary insomnia.

6. During a prenatal assessment, the clinic nurse suspects that her client was abused. Which of the following questions would be most appropriate? a. "Are you being threatened or hurt by your partner?" b. "Are you frightened of your partner?" c. "Is something bothering you?" d. "What happens when you and your partner argue?"

Rationale: A. "Are you being threatened or hurt by your partner?" The use of simple, direct question, asked in an emphatic manner, is best to validate the presence of an abusive situation. Options B, C, and D: The other questions are indirect and may not lead to the discussion of an abusive situation.

14. Which statement made by a parent of a child diagnosed with Tourette's syndrome would be assessed as a risk factor for family violence? a. "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." b. "Our son is really a good little boy, but he needs to be disciplined both at home and in school." c. "We shouldn't be, but we are ashamed of our son's disorder and his inability to control the tics in public." d. "We have become active in the support group but still find the suggestions extremely difficult to put into practice."

Rationale: A. "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs."

3. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment? A. Peer pressure B. Structured programming C. Visitor restrictions D. Mandated activities

Rationale: ANS: B The milieu, or therapeutic community, provides the client with structured programming that may be missing in the home environment. The therapeutic community provides a structured schedule of activities in which interpersonal interaction and communication with others are emphasized. In the milieu, time is also devoted to personal problems and focus groups.

8. David is preoccupied with numerous bodily complaints even after a careful diagnostic workup reveals no physiologic problems. Which nursing intervention would be therapeutic for him? A. Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems. B. Challenge the physical complaints by confronting the client with the normal diagnostic findings. C. Ignore the client's complaints, but request that the client keeps a list of all symptoms. D. Listen to the client's complaints carefully, and question him about specific symptoms.

Rationale: A. Acknowledge that the complaints are real to the client, and refocus the client on other concerns and problems. After physical factors are ruled out, somatic complaints are thought to be expressions of anxiety. The complaints are real to the client, but the nurse should not focus on them. Prompting the client about other concerns will encourage the expression of anxiety and dependency needs.

7. Which outcome is most appropriate for Francis who has a dissociative disorder? A. Francis will deal with uncomfortable emotions on a conscious level. B. Francis will modify stress with the use of relaxation techniques. C. Francis will identify his anxiety responses. D. Francis will use problem-solving strategies when feeling stressed.

Rationale: A. Francis will deal with uncomfortable emotions on a conscious level. Dissociative disorders occur when traumatic events are beyond an individual's recall because these memories have been "blocked" from conscious awareness. Bringing the feelings associated with these events into conscious awareness and coping with these feelings will decrease the need for dissociation.

1. Regarding the request for organ and tissue donation at the time of death, the nurse needs to be aware that......? Why did you choose this answer? a. Specially educated personnel make requests. b. Requests are usually made by the nurse caring for the patient at the time of death. c. Only patients who have given prior instruction regarding donation become donors. d. Professionals need to be very selective in whom they ask for organ and tissue donation.

Rationale: A. Individuals specially trained in requesting organ donations facilitate the process. They are skilled in talking compassionately to people who have suffered a tragic, sudden loss and have answers to many questions that people have regarding the donation process.

2. Nurse Tiffany reinforces the behavioral contract for a child having difficulty controlling aggressive behaviors on the psychiatric unit. Which of the following is the best rationale for this method of treatment? Why? A. It will assist the child to develop more adaptive coping methods. B. It will avoid having the nurse be responsible for setting the rules. C. It will maintain the nurse's role in controlling the child's behavior. D. It will prevent the child from manipulating the nurse.

Rationale: A. It will assist the child to develop more adaptive coping methods. Behavioral therapy is employed for the purpose of developing adaptive behavior that will improve coping. The nurse works to enhance the child's self-functioning and responsibility for his own behavior using appropriate means to develop better coping. Option B: The nurse does not avoid setting rules; it is the responsibility of the nurse to establish and maintain appropriate limits. Options C and D: Although reinforcing behavioral contracts will help prevent manipulative behavior by the child; this is not the best rationale for using behavioral treatment, which aims to improve client behavior.

3. For a female client with anorexia nervosa, Nurse Charles is aware that which goal takes the highest priority? Why? A. The client will establish adequate daily nutritional intake B. The client will make a contract with the nurse that sets a target weight C. The client will identify self-perceptions about body size as unrealistic D. The client will verbalize the possible physiological consequences of self-starvation

Rationale: A. The client will establish adequate daily nutritional intake According to Maslow's hierarchy of needs, all humans need to meet basic physiological needs first. Because a client with anorexia nervosa eats little or nothing, the nurse must first plan to help the client meet this basic, immediate physiological need. Options B, C, and D: The nurse may give lesser priority to goals that address long-term plans, self-perception, and potential complications.

2. The wife of the client with Alzheimer's disease tells the nurse that she forgot to eat the other day and that their phone line was cut because she forgot to pay their bills last month. The nurse noticed that the wife also has dark circles under her eyes and has lost weight since she last saw her. Which of the following should the nurse suggest to the wife of the client? a. Determine available support, resources currently in use and resources in the community. b. Tell the wife that she can lock the client in his room when she goes out to run errands. c. Ask the wife if she can afford to pay home health services. d. Direct the client to the physician for she may also be exhibiting signs of Alzheimer's as well.

Rationale: A. The wife of the client is exhibiting signs of caregiver role strain. Before giving any suggestions, the nurse should first assess the current resources in use so that she can determine which alternate-care resources she can refer the SO to. Locking the client in his room can promote agitation and may endanger the client.

14. An adolescent diagnosed with conduct disorder has aggression, impulsivity, hyperactivity, and mood symptoms. The treatment team believes this adolescent may benefit from medication. The nurse anticipates the health care provider will prescribe which type of medication?a. Second-generation antipsychotic b. Anti-anxiety medication c. Calcium channel blocker d. Beta-blocker

Rationale: AMedications for conduct disorder are directed at problematic behaviors such as aggression, impulsivity, hyperactivity, and mood symptoms. Second-generation antipsychotics are likely to be prescribed. Beta-blocking medications may help to calm individuals with intermittent explosive disorder by slowing the heart rate and reducing blood pressure. Calcium channel blockers reduce blood pressure but are not used for persons with impulse control problems. An anti-anxiety medication will not assist with impulse control.

2. A newly admitted client asks, "Why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest." Which is the most appropriate nursing reply? A. "Group therapy provides the opportunity to learn and practice new coping skills. "B. "Group therapy is mandatory. All clients must attend. "C. "Group therapy is optional. You can go if you find the topic helpful and interesting. "D. "Group therapy is an economical way of providing therapy to many clients concurrently."

Rationale: ANS: A The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping skills. A basic assumption of milieu therapy is that every interaction, including group therapy, is an opportunity for therapeutic intervention.

5. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What should the nurse identify as an appropriate group topic? A. Dream analysis B. Creative cooking C. Paint by number D. Stress management

Rationale: ANS: D The nurse should identify that teaching clients about stress management is an appropriate education group topic. Nurses should be able to perform the role of client teacher in the psychiatric area. Nurses need to be able to assess a client's learning readiness. Other topics for education groups include medical diagnoses, side effects of medications, and the importance of medication compliance.

12. A patient is hospitalized with severe depression after her divorce is finalized. Which type of loss is the patient experiencing? a. Actual b. Perceived c. Physical d. External

Rationale: AThe loss of a relationship is an actual loss. An actual loss is a reality that can be identified by others, not just by the person experiencing it. Perceived loss is internal; it can only be identified by the person experiencing the loss. Physical loss includes injuries, removal of an organ or body part, or loss of function. An external loss is an actual loss of an object.

14. After a patient dies of ovarian cancer, her daughter says to the nurse, "You'll probably think I'm terrible, but I'm glad she can finally rest peacefully." Which response by the nurse is best? a. "Your feelings are a normal response to watching your loved one suffer." b. "It's unusual for family members to be grateful that a loved one has died." c. "Your mother's death has been very hard on you; you should seek counseling." d. "I don't understand what you mean by this comment."

Rationale: AThe nurse should reassure the patient's daughter that her feelings are normal; there is no need for the daughter to seek counseling based on the information provided in this situation. Keep in mind that people can grieve in a dysfunctional manner for which they would benefit from counseling or other mental health support services. By responding, "It's unusual for family members to be grateful that a loved one has died," the nurse is being judgmental. The nurse who states she doesn't understand the family member's comment should at least seek clarification and prompt further exploration of the person's feelings. A comment of this nature can be a discussion starter for the daughter to release feelings and begin the grieving process.

6. Nursing preparations for a client undergoing electroconvulsive therapy (ECT) resembles those used for.......! Why? A. Physical therapy B. Neurologic examination C. General anesthesia D. Cardiac stress testing

Rationale: Answer C. The nurse should prepare a client for ECT in a manner similar to that for general anesthesia. For example, the client should receive nothing by mouth for 8 hours before ECT to reduce the risk of vomiting and aspiration. Also, the nurse should have the client void before treatment to decrease the risk of involuntary voiding during the procedure, remove any full denture, glasses, or jewelry to prevent breakage or loss; and make sure the client is wearing a hospital gown or loose-fitting clothing to allow unrestricted movement. Usually, these preparations aren't indicated for a client undergoing physical therapy, neurologic examination, or cardiac stress testing.

14. The most beneficial nursing intervention directed toward minimizing the discomfort associated with conducting a sexually focused assessment is to.....? Why? A. assure the client that the responses will be kept confidential. B. provide the client with a rationale for asking the questions. C. begin with the most relevant, nonpersonal question. D. project a relaxed, causal demeanor when questioning the client.

Rationale: B Letting the client know why the questions are being asked increases openness and cooperation.

9. A respected school coach was arrested after a student reported the coach attempted to have sexual contact with her. Which nursing action has priority in the period immediately following the coach's arrest? Why? A. Determine the nature and extent of the coach's sexual disorder. B. Assess the coach's potential for suicide or other self-harm. C. Assess the coach's self-perception of problem and needs. D. Determine whether other children were harmed.

Rationale: B Pedophiles and other persons with paraphilic disorders can be at increased risk of self-harm associated with the guilt, shame, and anger they feel about their behavior and its effect on their families, victims, and victims' families. They also face considerable losses, such as the end of their careers or the loss of freedom to imprisonment. Thus, safety is the priority issue for assessment. Determining the nature and extent of the patient's disorder and related patient perceptions would be appropriate but not the highest priority for assessment. Investigating whether other victims exist is a matter for law enforcement rather than health care personnel.

. This 38-year-old married woman, the mother of five children, reports to a mental health clinic with the chief complaint of depression, meeting diagnostic criteria for major depressive disorder. . . . Her marriage has been a chronically unhappy one; her husband is described as an alcoholic with an unstable work history, and there have been frequent arguments revolving around finances, her sexual indifference, and her complaints of pain during intercourse. The history reveals that the patient . . . describes herself as nervous since childhood and as having been continuously sickly beginning in her youth. She experiences chest pain and reportedly has been told by doctors that she has a "nervous heart." She sees physicians frequently for abdominal pain, having been diagnosed on one occasion as having a "spastic colon." In addition to M.D. physicians, she has consulted chiropractors and osteopaths for backaches, pains in her extremities, and a feeling of anesthesia in her fingertips. She was recently admitted to a hospital following complaints of abdominal and chest pain and of vomiting, during which admission she received a hysterectomy. Following the surgery she has been troubled by spells of anxiety, fainting, vomiting, food intolerance, and weakness and fatigue. Physical examinations reveal completely negative findings. The nurse would determine which diagnosis would be pertinent for this patient. Explain your answer choice! A. Hypochondriasis B. Somatization disorder C. Conversion disorder D. DID

Rationale: B The DSM-IV defines hypochondriasis according to the following criteria: A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms. B. The preoccupation persists despite appropriate medical evaluation and reassurance. Somatic symptom disorder (SSD formerly known as "somatization disorder" or "somatoform disorder") is a form of mental illness that causes one or more bodily symptoms, including pain. The symptoms may or may not be traceable to a physical cause including general medical conditions, other mental illnesses, or substance abuse. But regardless, they cause excessive and disproportionate levels of distress. The symptoms can involve one or more different organs and body systems, such as: Pain Neurologic problems Gastrointestinal complaints Sexual symptoms Many people who have SSD will also have an anxiety disorder. People with SSD are not faking their symptoms. The distress they experience from pain and other problems they experience are real, regardless of whether or not a physical explanation can be found. And the distress from symptoms significantly affects daily functioning. Doctors need to perform many tests to rule out other possible causes before diagnosing SSD. The diagnosis of SSD can create a lot of stress and frustration for patients. They may feel unsatisfied if there's no better physical explanation for their symptoms or if they are told their level of distress about a physical illness is excessive. Stress often leads patients to become more worried about their health, and this creates a vicious cycle that can persist for years. Disorders Related to Somatic Symptom Disorder Several conditions related to SSD are now described in psychiatry. These include: Illness Anxiety Disorder (formerly called Hypochondriasis). People with this type are preoccupied with a concern they have a serious disease. They may believe that minor complaints are signs of very serious medical problems. For example, they may believe that a common headache is a sign of a brain tumor. Conversion disorder (also called Functional Neurological Symptom Disorder). This condition is diagnosed when people have neurological symptoms that can't be traced back to a medical cause. For example, patients may have symptoms such as: Weakness or paralysis Abnormal movements (such as tremor, unsteady gait, or seizures) Blindness Hearing loss Loss of sensation or numbness Stress usually makes symptoms of conversion disorder worse. Other Specific Somatic Symptom and Related Disorders. This category describes situations in which somatic symptoms occur for less than six months or may involve a specific condition called pseudocyesis, which is a false belief a woman has that she is pregnant along with other outward signs of pregnancy, including an expanding abdomen; feeling labor pains, nausea, fetal movement; breast changes; and cessation of the menstrual period. Treatment of Somatic Symptom Disorders Patients who experience SSD may cling to the belief that their symptoms have an underlying physical cause despite a lack of evidence for a physical explanation. Or if there is a medical condition causing their symptoms, they may not recognize that the amount of distress they are experiencing or displaying is excessive. Patients may also dismiss any suggestion that psychiatric factors are playing a role in their symptoms. A strong doctor-patient relationship is key to getting help with SSD. Seeing a single health care provider with experience managing SSD can help cut down on unnecessary tests and treatments. The focus of treatment is on improving daily functioning, not on managing symptoms. Stress reduction is often an important part of getting better. Counseling for family and friends may also be useful. Cognitive behavioral therapy may help relieve symptoms associated with SSD. The therapy focuses on correcting: Distorted thoughts Unrealistic beliefs Behaviors that prompt health anxiety Dissociative identity disorder (DID), previously known as multiple personality disorder, is a mental disorder characterized by at least two distinct and relatively enduring personality states. There is often trouble remembering certain events, beyond what would be explained by ordinary forgetfulness.

11. A man who reports frequently experiencing premature ejaculation tells the nurse, "I feel like such a failure. It's so awful for both me and my partner. Can you help me?" Select the nurse's best response. a. "Have you discussed this problem with your partner?" b. "I can refer you to a practitioner who can help you with this problem." c. "Have you asked your health care provider for prescription medication?" d. "There are several techniques described in this pamphlet that might be helpful."

Rationale: B The primary role of the nurse is to perform basic assessment and make appropriate referrals. The other options do not clarify the nurse's role

10. A 13-year-old was placed in a residential program after truancy, running away, and an arrest for theft. At the program, the adolescent refused to join in planned activities and pushed a staff member, causing a fall. Which approach by nursing staff will be most therapeutic? A. Planned ignoring B. Establish firm limits C. Neutrally permit refusals D. Coaxing to gain compliance

Rationale: B Firm limits are necessary to ensure physical safety and emotional security. Limit setting will also protect other patients from the teen's thoughtless or aggressive behavior. Permitting refusals to participate in the treatment plan, ignoring, coaxing, and bargaining are strategies that do not help the patient learn to abide by rules or structure.

1. Most litigation in the hospital comes from the......? Why did you choose this answer? a. Nurse abandoning the clients when going to lunch b. Nurse following an order that is incomplete or incorrect c. Nurse documenting blame on the physician when a mistake is made d. Supervisor watching a new employee check his or her skills level

Rationale: B The nurse is responsible for clarifying all orders that are illegible, unreasonable, unsafe, or incorrect. The failure of the nurse to question the physician about an order creates an area of liability on the nurse's part because this is perceived as a medical action and not the role of the nurse to write orders. Some RNs do have prescriptive privileges based upon advanced degrees and certification. Therefore, the nurse who cannot correct the order must document that the physician was called and clarification or a new order was given to correct the unclear or illegible one that was currently on the chart. Phone calls, follow-up, and lack of follow-up by the physician should also be documented if there is a problem with getting the information in a timely manner. The nurse must show the sequence of events of a situation in a clear manner if there is any conflict or question about any orders or procedures that were not appropriate. Assessments and documentation of the client's status should also be included if there is a potential risk for harm present. Contact of the staff's chain of command should also be specifically stated for the proof of the responsibilities being followed according to hospital policy.

9. When working with clients of a particular culture, which action should a nurse avoid? Why? a. Maintaining eye contact based on cultural norms b. Assuming that all individuals who share a culture or ethnic group are similar c. Supporting the client in participating in cultural and spiritual rituals d. Using an interpreter to clarify communication

Rationale: B The nurse should avoid assuming that all individuals who share a culture or ethnic group are similar. This action constitutes stereotyping and must be avoided. Within each culture, many variations and subcultures exist. Clients should be treated as individuals.

3. An African American youth, growing up in an impoverished neighborhood, seeks affiliation with a black gang. Soon he is engaging in theft and assault. What cultural consideration should a nurse identify as playing a role in this youth's choices? Why? a. Most African American homes are headed by strong, dominant father figures. b. Most African Americans choose to remain within their own social organization. c. Most African Americans are uncomfortable expressing emotions and need group affiliations. d. Most African Americans have limited religious beliefs which contribute to criminal activity.

Rationale: B The nurse should identify that a tendency to remain within one's own social organization may have played a role in this youth's choice to join a black gang. African Americans who have assimilated into the dominant culture are likely to be well educated and future focused. Those who have not assimilated may be unemployed or have low-paying jobs, and view the future as hopeless given their previous encounters with racism and discrimination

6. What is the best rationale for including the client's family in therapy within the inpatient milieu? A. To structure a program of social and work-related activities B. To facilitate discharge from the hospital C. To provide a concrete demonstration of caring D. To encourage the family to model positive behaviors

Rationale: B The nurse should include the client's family in therapy within the inpatient milieu to facilitate discharge from the hospital. Family members are invited to participate in some therapy groups and to share meals with the client in the communal dining room. Family involvement may also serve to prevent the client from becoming too dependent on the therapeutic environment.

10. To effectively care for Asian American clients, a nurse should be aware of which cultural norm? Why did you choose this answer? a. Obesity and alcoholism are common problems. b. Older people maintain positions of authority within the culture. c. "Tai" and "chi" are the fundamental concepts of Asian health practices. d. Asian Americans are likely to seek psychiatric help.

Rationale: B To effectively care for clients of the Asian American culture, the nurse should be aware that older people in this culture maintain positions of authority. Obesity and alcoholism are low among Asian Americans. The balance of "yin" and "yang," not "tai" and "chi," is the fundamental concept of Asian health practices. In the Asian culture, psychiatric illness is often believed to be out-of-control behavior and would be considered shameful to individuals and families.

1. What should the nurse do when planning nursing care for a client with a different cultural background? The nurse should......? Why? a. Allow the family to provide care during the hospital stay so no rituals or customs are broken b. Identify how these cultural variables affect the health problem d. Speak slowly and show pictures to make sure the client always understands e. Explain how the client must adapt to hospital routines to be effectively cared for while in the hospital

Rationale: B Without assessment and identification of the cultural needs, the nurse cannot begin to understand how these might influence the health problem or health care management.

4. Most people respond emotionally to the thought of electric current passing through their brain. When discussing the subject with the patient, the nurse should........ Why? A. Use the term "shock" in a neutral, calm manner B. Refer to the procedure as the patient's "treatment" instead of "shock therapy" C. Refer to it as ECT D. Explain how the convulsions are artificially

Rationale: B - to emphasize the therapeutic value of ECT, the nurse should refer to it as the patient's "treatment." Although "ECT" is medically correct terminology, this term should not be used unless the patient is familiar and comfortable with it; referring to the procedure as ECT may cause the patient to focus on the disturbing elements of this treatment. Such terms as "convulsions" and "shock" tend to increase a patient's anxiety and should therefore be avoided.

1. A rape victim asks an emergency department nurse, "How can I determine if I was at fault for what happened to me?" Which nursing intervention would be therapeutic? a. Reassure the victim that the outcome of the situation will be positive. b. Support the victim to separate issues of vulnerability from blame. c. Pose questions about the rape, helping the patient explore why it happened. d. Make decisions for the victim because of the temporary confusion.

Rationale: B Although the victim may have made choices that increased vulnerability, the victim is not to blame for the rape. This thinking allows the victim to begin to restore a sense of control. This is a positive response to victimization. The remaining options either suggest the use of a nontherapeutic communication technique or do not permit the victim to restore control. No confusion is evident.

10. When a victim of sexual assault is discharged from the emergency department, the nurse should: a. notify the patient's family of the event to seek support for the patient. b. provide referral information verbally and in writing. c. offer to stay with the patient until stability is regained. d. advise the patient to try not to think about the assault.

Rationale: B Immediately after the assault, rape victims are often disorganized and unable to think well or remember what they have been told. Written information acknowledges this fact and provides a solution. The remaining options violate the patient's right to privacy, evidence a rescue fantasy, and offer a platitude that is neither therapeutic nor effective.

9. Which situation would be considered consensual sex rather than rape? a. After coming home intoxicated from a party, a person forces the spouse to have sex. The spouse objects. b. A person's lover pleads to have oral sex. The person gives in but then regrets the decision. c. A person is beaten, robbed, and forcibly subjected to anal penetration by an assailant. d. A dentist gives intravenous anesthesia for a procedure and then has intercourse with an unconscious patient.

Rationale: B Only the answer describes a scenario in which the sexual contact is consensual. Consensual sex is not considered rape if the participants are at least the age of majority.

3. A nurse working a rape telephone hotline should focus communication to: a. provide callers with a sympathetic listener. b. explain immediate steps victims may take. c. arrange long-term patient counseling. d. obtain information to relay to the local police.

Rationale: B The telephone counselor establishes where the victim is and what has happened and provides the necessary information to enable the victim to decide what steps to take immediately. Long-term aftercare is not the focus until immediate problems are resolved. The victim remains anonymous. The remaining options are inappropriate or incorrect because counselors are trained to be empathic rather than sympathetic

20. If a patient who was sexually assaulted does not recall the attack and presents with sensory distortions, hypertension, slurred speech, seizures, and numbness, which of the following is the most likely drug used to facilitate the assault? a. Alcohol b. Ketamine c. GHB d. Rohypnol

Rationale: B These symptoms are characteristic of ketamine ingestion. Ketamine is an anesthetic agent used primarily in veterinary medicine with a very rapid onset of action. Ketamine is produced in liquid and powder form. Victims may also report out-of-body experiences and may exhibit aggressive behavior under the influence of the drug. Motor function is impaired. In some cases, victims remain aware but cannot move or fight back to prevent the assault. In other cases, memory of the event is impaired.

5. The nurse is caring for a client with severe depression. In which conditions would the nurse anticipate the use of electroconvulsive therapy (ECT). Select all that apply. Why did you choose your answer(s)? A. The patient also has dementia. B. The patient is unable to tolerate monoamine oxidase inhibitors (MAOIs). C. The patient has not responded to conventional therapy. D. The patient is undergoing a stressful life change. E. The patient is having acute suicidal thoughts.

Rationale: B, C, E. ECT is used to treat acute depressive illnesses in an attempt to rapidly reverse a life-threatening situation, such as disturbing delusions, agitation, and attempted suicide or when conventional therapies have been unsuccessful. It is also used when the patient can't tolerate antidepressants, since other medication regimens for depression can take weeks to become fully effective. ECT is usually not indicated for situational depression caused by intense stress. Patients with dementia are not given ECT because ECT may further exacerbate cognitive impairment. The decision touse ECT is not based on where the client lives. Test Taking Strategy: Analyze to determine what information the question asks for, which is when to support the use of ECT. "Select All That Apply" questions require considering each option to decide its merit. Recall that the use of ECT is anticipated when the client is experiencing severe mental health problems and traditional therapy is ineffective.

5. After assessing a victim of sexual assault, which terms would the nurse use in the documentation? (Select all that apply). a. Alleged b. Reported c. Penetration d. Intercourse e. Refused f. Declined

Rationale: B, C, F The nurse should refrain from using pejorative language when documenting assessments of victims of sexual assault. "Reported" should be used instead of "alleged." "Penetration" should be used instead of "intercourse." "Declined" should be used instead of "refused."

. A nurse works with an adolescent who was placed in a residential program after multiple episodes of violence at school. Establishing rapport with this adolescent is a priority because: (select all that apply) a. it is a vital component of implementing a behavior modification program.b. a therapeutic alliance is the first step in a nurse's therapeutic use of self.c. the adolescent has demonstrated resistance to other authority figures.d. acceptance and trust convey feelings of security for the adolescent.e. adolescents usually relate better to authority figures than peers.

Rationale: B, DTrust is frequently an issue because the adolescent may never have had a trusting relationship with an adult. Trust promotes feelings of security and is the basis of the nurse's therapeutic use of self. Adolescents value peer relationships over those related to authority. Rewards for appropriate behavior are the main component of behavior modification programs.

10. Which of the following are accurate descriptors of a therapeutic community? (Select all that apply.) A. The unit schedule includes unlimited free time for personal reflection. B. Unit responsibilities are assigned according to client capabilities. C. A flexible schedule is determined by client needs. D. The individual is the sole focus of therapy. E. A democratic form of government exists.

Rationale: B, E In a therapeutic community, the unit responsibilities are assigned according to client capability and a democratic form of government exists. Therapeutic communities are structured and provide therapeutic interventions that focus on communication and relationship-development skills.

11. What are the primary distinguishing factors between the behavior of persons diagnosed with oppositional defiant disorder (ODD) and those with conduct disorder (CD)? Select all that apply. The person diagnosed with: a. ODD relives traumatic events by acting them out. b. ODD tests limits and disobeys authority figures. c. ODD has difficulty separating from loved ones. d. CD uses stereotypical or repetitive language. e. CD often violates the rights of others.

Rationale: B, EPersons diagnosed with ODD are negativistic, disobedient, and defiant toward authority figures without seriously violating the basic rights of others, whereas persons with conduct disorder frequently behave in ways that do violate the rights of others and age-appropriate societal norms. Reliving traumatic events occurs with posttraumatic stress disorder. Stereotypical language behaviors are seen in persons with autism spectrum disorders.

10. The nurse is assessing a client with a body mass index of 35. The nurse would suspect this client to be at risk for which of the following conditions? Select all that apply. Why did you chose your answers? A. Hypoglycemia. B. Hyperlipidemia. C. Rheumatoid arthritis. D. Respiratory insufficiency. E. Angina.

Rationale: B,D,E Clients with a body mass index (BMI) of 30 or greater are classified as obese. It is important to learn the complications of obesity because, based on the World Health Organization guidelines, half of all Americans are obese. Workload on the heart is increased in obese clients, and this often leads to symptoms of angina. Workload on the lungs is increased in obese clients, and this often leads to symptoms of respiratory insufficiency. Obese clients often present with hyperlipidemia, particularly elevated triglyceride and cholesterol levels. Obese clients commonly have hyperglycemia, not hypoglycemia, and are at risk for developing diabetes mellitus. Osteoarthritis, not rheumatoid arthritis, results from trauma to weight-bearing joints and is commonly seen in obese clients.

19. Carina, a student nurse on rotation in the emergency department, is assigned to care for Daniel, who was brought in from the local prison with suspected appendicitis. Daniel is in prison for child rape. Carina's niece was recently sexually abused, and Carina feels this type of crime is reprehensible. She begins feeling very upset and disgusted with Daniel because of his crime and doesn't know how she can care for him without letting her feelings show. Carina's best course of action is to......? Why? A. Refuse the assignment because her personal feelings will prevent her from giving good care. B. Talk with her faculty member or an experienced nurse in the emergency department. C. Perform the activities of care but not engage in conversation with the patient. D. Tell Daniel honestly how she feels and let him choose to request a different nurse.

Rationale: B. Nurses may experience distress when providing care for someone who engages in what they view as objectionable, or even reprehensible, acts. This is sometimes compounded by knowing someone who was a victim or having been victimized ourselves. Talking with a faculty member, a nurse mentor, or someone at a mental health clinic can be helpful and important and may even result in better personal understanding and coping. Refusing an assignment is not an option. Performing the activities of care but not engaging in conversation does not appropriately or fully care for the patient. Telling the patient how she feels would be unprofessional and inappropriate, and is putting the burden of our own feelings onto the patient.

. Which nursing diagnosis should be investigated for clients with somatoform disorders? A. Deficient fluid volume B. Self-care deficit C. Disturbed personal identity D. Delayed growth and development

Rationale: B. Clients with somatoform disorders may be unable to meet certain self-care needs because of pain, paralysis, weakness, and fatigue.

2. The nurse notes that a woman who recently began cancer treatment appears quiet and withdrawn, states that she does not believe the treatments will make any difference, does not ask about her progress, and missed two chemotherapy sessions. Based on the above assessment data, the nurse gathers more information to consider making which of the following nursing diagnoses? Why did you choose this diagnosis? a. Anxiety b. Hopelessness c. Spiritual distress d. Complicated grieving

Rationale: B. HopelessnessThe patient exhibits signs and symptoms of hopelessness. Manifestations of hopelessness include withdrawing, not following through with recommended treatment, and losing confidence that anything she does will be of help.

8. Martin Sanchez is a nine (9)-year-old child admitted to a psychiatric treatment unit accompanied by Mr. and Mrs. Sanchez. To establish trust and position of neutrality, which action would the nurse take? A. Encourage Mr. and Mrs. Sanchez to leave while Martin is being interviewed.B. Interview Martin with his parents together, observing their interaction.C. Provide diversion for Martin, and interview Mr. and Mrs. Sanchez alone.D. Review the clinical record prior to interviewing Mr. and Mrs. Sanchez.

Rationale: B. Interview Martin with his parents together, observing their interaction. It is important for the nurse to be seen as a neutral person who is interested in the family as an adaptive functioning unit. By conducting the admission interview with the parents and child together, the nurse establishes this neutral role from the beginning. The responses on options A and C separate the parents and the child, and thus the nurse does not have an opportunity to establish a position of neutrality. Option D: Although the nurse would review the clinical record, this does not demonstrate to the family that she is an advocate for both parents and the child.

7. Which goal is a priority for a client with a DSM-IV-TR diagnosis of delirium and the nursing diagnosis Acute confusion related to recent surgery secondary to traumatic hip fracture? a. The client will complete activities of daily living. b. The client will maintain safety. c. The client will remain oriented. d. The client will understand communication.

Rationale: B. Maintaining safety is the priority goal for an acutely confused client who recently had surgery. All measures to promote physiologic safety and psychosocial wellbeing would be implemented.

7. A nurse is providing postmortem care. Which action is the priority? a. Locating the patient's clothing b. Providing culturally and religiously sensitive care in body preparation c. Transporting the body to the morgue as soon as possible to prevent body decomposition D. Providing all postmortem care to protect the family of the deceased from having to see the body

Rationale: B. Providing culturally and religiously sensitive care in body preparationAt the end of life religious and cultural expectations are important for the lasting memories held by the family about the way their loved one's death occurred. Sensitive care contributes to feelings of closure, appropriateness of the death rituals, and fulfilled family obligations.

17. You are interviewing Lance, a 31-year-old patient who has been referred to the sexual disorders clinic by his primary care provider. When describing his problem, Lance states, "I can have an orgasm, no problem. It just happens way too soon." You find that you feel uncomfortable talking with Lance about his sexual problem. Which of the following actions you could take would be appropriate? Why? A. Ask another nurse to take over the interview so you don't project your feelings onto the patient. B. Pause the interview and take time to gather your thoughts and do positive self-talk. C. Continue the interview using an appropriate professional tone and matter-of-fact approach. D. Ask Lance whether he would feel more comfortable speaking with a physician about his problem.

Rationale: C Remembering your position as a professional and addressing the topics in a tone and manner appropriate of a professional will increase your comfort, along with the patient's. The response in the first option would be confusing to the patient and does not address your feelings or work to resolve them. Pausing the interview would not be appropriate because self-assessment is best done before patient interaction. Asking the patient whether he would feel more comfortable speaking with a physician projects your feelings of being uncomfortable onto the patient and does not carry out your professional role and responsibility.

15. A client with paraphilia tendencies tells the nurse that "I'm disgusted with my lifestyle." The nurse most appropriately assesses the patient by.....? Why? A. assures him that his condition responds well to treatment. B. tells him that the first step to managing his behavior is recognizing it as unhealthy. C. assesses him for the existence of suicidal ideations. D. recommends inpatient behavioral modification therapy.

Rationale: C Such clients may be severely depressed and have suicidal ideations that must be recognized immediately.

5. The nurse notes that an advance directive is in the client's medical record. Which of the following statements represents the best description of guidelines a nurse would follow in this case? Why did you choose this answer? a. A durable power of attorney for health care is invoked only when the client has a terminal condition or is in a persistent vegetative state b. A living will allows an appointed person to make health care decisions when the client is in an incapacitated state. c. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. d. The client cannot make changes in the advance directive once the client is admitted into the hospital.

Rationale: C A living will direct the client's healthcare in the event of a terminal illness or condition. A durable power of attorney is invoked when the client is no longer able to make decisions on his or her own behalf. The client may change an advance directive at any time.

6. When photo documenting forensic evidence, it is considered good practice to capture.....? Why? A. one image of each finding. B. two images of each finding. C. four images of each finding. D. at least 10 images of each finding.

Rationale: C COLLECTION AND DOCUMENTATION OF EVIDENCE Photo documentation will typically proceed along with the physical examination and the collection of evidence. When an injury or other evidence (e.g., fluids, fibers) is found, it should be photographed. It is considered good practice to capture four images of each finding [9]. One should be an overall shot of the body and should include a clear anatomical reference (e.g., arm, hand, leg, foot), another should be a medium shot, and there should be two detailed shots of the finding. The wide and medium shots can be used to document multiple findings. Detailed shots of each finding should be taken before evidence collection, during manipulation, and after the evidence is swabbed or removed. If a lifesaving measure may disturb evidence, it is ideal to photograph the site/finding beforehand, if possible.

3. Shortly after the parents announced that they were divorcing, a 15-year-old became truant from school and assaulted a friend. The adolescent told the school nurse, "I'd rather stay in my room and listen to music. It's easier than thinking about what is happening in my family." Which nursing diagnosis is most applicable? Why? A. Chronic low self-esteem related to role within the family B. Decisional conflict related to compliance with school requirements C. Ineffective coping related to adjustment to changes in family relationships D. Disturbed personal identity related to self-perceptions of changing family dynamics

Rationale: C Depression is often associated with impulse control disorder. The correct nursing diagnosis refers to the patient's dysfunctional management of feelings associated with upcoming changes to the family. The teen displays self-imposed isolation. The distracters are not supported by data in the scenario.

2. Whenever possible, it is good practice to conduct the interview of the forensic patient in the presence of......? Why did you choose this answer? A. the perpetrator. B. family members. C. a law enforcement investigator. D. a supervisor and facility administrator.

Rationale: C Examination of the forensic patient is conducted in a thorough head-to-toe or toe-to-head manner, with the intent of documenting every indication of injury related to the incident (no matter how insignificant and involving every part of the body) using a body-map or wound chart. The entire body surface should be palpitated to identify areas of bruising that may not yet be visible. Documentation and collection of evidence typically occurs at the same time as the physical exam—as evidence is detected it should be collected. During the exam, vital signs should be taken and any urgent medical needs should be addressed.

4. An adolescent acts out in disruptive ways. When this adolescent threatens to throw a pool ball at another adolescent, which comment by the nurse would set appropriate limits? Why? A. "Attention everyone: we are all going to the craft room." B. "You will be taken to seclusion if you throw that ball." C. "Do not throw the ball. Put it back on the pool table." D. "Please do not lose control of your emotions."

Rationale: C Setting limits uses clear, sharp statements about prohibited behavior and guidance for performing a behavior that is expected. The incorrect options represent a threat, use of restructuring (which would be inappropriate in this instance), and a direct appeal to the child's developing self-control that may be ineffective.

3. A client who had a "Do Not Resuscitate" order passed away. After verifying there is no pulse or respirations, the nurse should next.....? Why did you choose this answer? a. Have family members say goodbye to the deceased b. Call the transplant team to retrieve vital organs c. Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately. d. Call the funeral director to come and get the body

Rationale: C The body of the deceased should be prepared before the family comes in to view and say their goodbyes. This includes removing all equipment, tubes, supplies, and dirty linens according to protocol, bathing the client, applying clean sheets, and removing trash from the room.

5. An 11-year-old diagnosed with oppositional defiant disorder becomes angry over the rules at a residential treatment program and begins cursing at the nurse. Select the best method for the nurse to defuse the situation. Why did you choose this answer? A. Ignore the child's behavior. B. Send the child to time-out. C. Accompany the child to the gym and shoot baskets. D. Role-play a more appropriate behavior with the child.

Rationale: C The child's behavior warrants an active response. Redirecting the expression of feelings into nondestructive age-appropriate behaviors, such as a physical activity, helps defuse the situation here and now. This response helps the child learn how to modulate the expression of feelings and exert self-control. This is the least restrictive alternative and should be tried before resorting to a more restrictive measure. Role-playing is appropriate after the child's anger is defused.

1 . The first step in preserving evidence is.......? Why did you choose this answer? A. contacting law enforcement. B. thoroughly cleaning the victim's skin. C. identifying the nature and origin of the injuries. D. drying and placing the victim's clothing in an individual evidence bag.

Rationale: C The emergency department or trauma nurse is often the first to interact with assault victims and their families, and the ability to quickly recognize forensic patients is a valuable skill to possess. This is considered as vital as providing medical treatment. The U.S. Department of Justice recommends that forensic patients be given priority as emergency cases. Although lifesaving measures take precedence over evidence preservation, it should be recognized that quality of life can be significantly diminished for those whose assailant is not brought to justice. A high-quality medical forensic exam performed in a timely manner can minimize psychologic trauma, promote healing, and help ameliorate patients' concerns.

4. Northern European Americans value punctuality, hard work, and the acquisition of material possessions and status. A nurse should recognize that these values may contribute to which form of psychopathology? Why did you choose this answer? a. Dissociative disorders B. Alzheimer's dementia c. Stress-related disorders d. Schizophrenia-spectrum disorders

Rationale: C The nurse should correlate Northern European American values, such as punctuality, hard work, and acquisition of material possessions, with stress-related disorders. Psychopathology (mental distress or the manifestation of behaviors and experiences which may be indicative of mental illness or psychological impairment) may occur when individuals fail to meet the expectations of the culture.

7. A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to have influenced this client's decision? Why did you choose this answer? a. Future orientation causes the client to devalue assertiveness skills. b. Decreased emotional expression makes it difficult to be assertive. c. Assertiveness techniques may not be aligned with the client's definition of the female role. d. Religious prohibitions prevent the client's participation in assertiveness training.

Rationale: C The nurse should identify that the Latin American woman's refusal to participate in an assertiveness training group may be influenced by the Latin American cultural definition of the female role. Latin Americans place a high value on the family which is male dominated. The father usually possesses the ultimate authority.

6. The nurse finds a client sleep walking down the unit hallway. An appropriate intervention the nurse implements is: A. Asking the client what he or she is doing and call for help B. Quietly approaching the client and then loudly calling his or her name C. Lightly tapping the client on the shoulder and leading him or her back to bed D. Blocking the hallway with chairs and seating the client

Rationale: C The nurse should not startle the client but should gently awaken the client and lead him or her back to bed.

12. A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes? Why? a. When the client makes inappropriate sexual innuendos to a staff member B. When the client constantly demands inappropriate attention from the nurse c. When the client physically attacks another client after being confronted in group therapy d. When the client refuses to bathe or perform hygienic activities

Rationale: C The nurse would have the right to medicate a client against his or her wishes if the client physically attacks another client. This client poses a significant risk to safety and is incapable of making rational choices. The client's refusal to accept treatment can be challenged because the client is endangering the safety of others.

4. A rape victim tells the emergency room nurse, "I feel so dirty. Please let me take a shower before the doctor examines me." The nurse should: a. arrange for the patient to shower. b. give the patient a basin of hot water and towels. c. explain that washing would destroy evidence. d. explain that bathing facilities are not available in the emergency department

Rationale: C No matter how uncomfortable, the patient should not bathe until the physician's examination is completed. The collection of evidence is critical if the patient is to be successful in court. The remaining options would result in destruction of evidence or are untrue.

21. Which of the following statements is the BEST approach to use with a female patient who denies a sexual assault and refuses the sexual assault examination but exhibits bite marks and bruises suggestive of sexual assault? a. "You can help to make sure other women are not assaulted." b. "You could become pregnant or develop a sexually transmitted disease. c. "I can provide you with medications to help prevent sexually transmitted diseases and pregnancy." d. "I need to collect evidence as soon as possible after an assault."

Rationale: C The best approach to use with a patient who has suffered a probable sexual assault is to point out services that benefit the patient, such as prophylaxis to prevent STDs and pregnancy. In the aftermath of an assault, patients are often frightened, confused, and concerned with themselves more than other potential victims, so pressuring them to protect others or trying to frighten them more by suggesting they might be pregnant or develop an STD is a negative approach that may be counterproductive.

11. When assessing a client for obstructive sleep apnea (OSA), the nurse understands the most common symptom is: A. Headache B. Early awakening C. Impaired reasoning D. Excessive daytime sleepiness

Rationale: D Excessive daytime sleepiness is the most common complaint of people with OSA. Persons with severe OSA may report taking daytime naps and experiencing a disruption in their daily activities because of sleepiness.

12. A community nurse conducts a primary prevention, home-visit assessment for a newborn and mother. Mrs. Smith has three other children. the oldest of whom is age 12. She tells the nurse that her 12-year-old daughter is expected to prepare family meals, to look after the young children. and to clean the house once a week. Which of the following is the most appropriate nursing diagnosis for this family situation? a. Delayed growth and development, related to performance expectations of the child. b. Anxiety (moderate), related to difficulty managing the home situation. c. Impaired parenting, related to the role reversal of mother and child. d. Social isolation, related to lack of extended family assistance.

Rationale: C The role of a 12-year-old child in a family should not be that of a parent. In this situation. the child and mother have reversed roles. Options A. B. and D: There is no evidence that the child has delayed growth or development. the mother in this situation is not demonstrating signs of anxiety. and there is no evidence in this situation that the family is socially isolated.

22. Which of the following is the MOST important when preparing a homeless victim of sexual assault for discharge? a. Specific directions for medication or treatments, including side effects. b. Information sheets outlining signs for all risk factors. c. List of safe shelters and assistance in applying for welfare assistance or Social Security. d. Follow-up appointment dates, with physicians, labs, or other healthcare providers.

Rationale: C While all of these are important, patients who are homeless require further assistance with discharge, because compliance with treatment and follow-up appointments is poor in the homeless population. Interventions that are most important include: Lists of safe shelters and places they can go to bathe, eat, and get mail. Assistance in applying for welfare assistance or Social Security. Discharge planning should begin on admission and must be a joint effort so that the transfer and discharge documents provide the information that the individual needs.

14. A female client verbalizes that she has been having trouble sleeping and feels wide awake as soon as getting into bed. The nurse recognizes that there are many interventions the promote sleep (check all that apply). A. Eat a heavy snack before bedtime B. Read in bed before shutting out the light C. Leave the bedroom if you are unable to sleep D. Drink a cup of warm tea with milk at bedtime E. Exercise in the afternoon rather than the evening F. Count backwards from 100 to 0 when your mind is racing.

Rationale: C, E, F Lying in bed when one is unable to sleep increases frustration and anxiety which further impede sleep; other activities, such as reading or watching television, should not be conducted in bed. Counting backwards requires minimal concentration but it is enough to interfere with thoughts that distract a person from falling asleep.

8. To assist an adult client to sleep better the nurse recommends which of the following? (Select all that apply.) A. Drinking a glass of wine just before retiring to bed B. Eating a large meal 1 hour before bedtime C. Consuming a small glass of warm milk or herbal tea at bedtime B. Performing mild exercises 30 minutes before going to bed

Rationale: C. A small glass of milk or cup of herbal tea (non-caffienated) relaxes the body and promotes sleep.

16. A hospitalized client is prescribed chloral hydrate (Noctec). The nurse includes which action in the plan of care? A. Monitor apical heart rate every 2 hours B. Monitor blood pressure every 4 hours C. Instruct the client to call for ambulation assistance D. Clear a path to the bathroom at bedtime.

Rationale: C. Chloral hydrate is a sedative. This medication does not affect cardiac function. Blood pressure changes are not significant with the use of this medication. A client should call for assistance to the bathroom at night. Additionally, the client may experience residual daytime sedation; therefore, the nurse should instruct the client to call for ambulation assistance during the daytime hours.

7. Which of the following medications are the safest to administer to adults needing assistance in falling asleep? A. Sedatives B. Hypnotics C. Benzodiazepines D. Anti-anxiety agents

Rationale: C. The group of drugs that are the safest are the benzodiazepines. They facilitate the action of the neurons in the central nervous system (CNS) that suppress responsiveness to stimulation, therefore decreasing levels of arousal.

6. A 14-year-old client was brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. Nurse Kris conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa? Why? A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader." B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." D. "I do diet around my periods; otherwise, I just get so bloated."

Rationale: C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get down to a "desirable weight" is characteristic of the disorder. Feeling inadequate when compared to peers indicates poor self-esteem. Option A: Most clients with anorexia nervosa don't like the way they look, and their self- perception may be distorted. A girl with cachexia may perceive herself to be overweight when she looks in the mirror. Option B: Preferring fast food over healthy food is common in this age-group. Option D: Because of the absence of body fat necessary for proper hormone production, amenorrhea is common for a client with anorexia nervosa.

5. A nurse is preparing to care for a 5-year-old who has been placed in traction following a fracture of the femur. The nurse plans care, knowing that which of the following is the most appropriate activity for this child? A) Large picture books B) A radio C) Crayons and coloring book D) A sports video

Rationale: C. Crayons & Coloring Book In the preschooler, play is simple and imaginative and includes activities such as crayons and coloring books, puppets, felt and magnetic boards, and Play-Doh. Large picture books are most appropriate for the infant. A radio and a sports video are most appropriate for the adolescent.

7. Nurse Penny is aware that the following medical condition is commonly found in clients with bulimia nervosa? Why did you choose your answer? A. Allergies B. Cancer C. Diabetes mellitus D. Hepatitis A

Rationale: C. Diabetes mellitus Bulimia nervosa can lead to many complications, including diabetes, heart disease, and hypertension. Options A, B, and D: The eating disorder isn't typically associated with allergies, cancer, or hepatitis A.

1. Nurse Tamara is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to...? Why? A. Avoid shopping for large amounts of food B. Control eating impulses C. Identify anxiety-causing situations D. Eat only three meals per day

Rationale: C. Identify anxiety-causing situations Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Option A: Controlling shopping for large amounts of food isn't a goal early in treatment. Option B: Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the plan of care after initially addressing stress and underlying issues. Option D: Eating three meals per day isn't a realistic goal early in treatment.

4. Nurse Mary is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important? Why? A. Fill out the client's menu and make sure she eats at least half of what is on her tray. B. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal D. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count.

Rationale: C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal Allowing the client to select her own food from the menu will help her feel some sense of control Option A: She must then eat 100% of what she selected. Option B: Remaining with the client for at least 1 hour after eating will prevent purging. Option D: Bulimic clients should only be allowed to eat food provided by the dietary department

6. Which approach to helping grieving people is most consistent with postmodern grief theories? a. Help the patient identify the tasks to be accomplished during his or her grief. b. Encourage people to recognize stages of grieving in anticipation of what is to come. c. Listen carefully to a person's story of how his or her grief experience is unfolding. d. Offer general grief timelines to help the person know when a phase will pass.

Rationale: C. Listen carefully to a person's story of how his or her grief experience is unfolding.Postmodern grief interventions focus on the uniqueness of the patient's story that unfolds and "writes" itself as the person lives through the experience of loss.

8. When caring for the client diagnosed with delirium, which condition is the most important for the nurse to investigate? a. Cancer of any kind. b. Impaired hearing. c. Prescription drug intoxication. d. Heart failure.

Rationale: C. Polypharmacy is much more common in the elderly. Drug interactions increase the incidence of intoxication from prescribed medications, especially with combinations of analgesics, digoxin, diuretics, and anticholinergics. With drug intoxication, the onset of the delirium typically is quick. Although cancer, impaired hearing, and heart failure could lead to delirium in the elderly, the onset would be more gradual.

1. A mother expresses concern because her three-year-old son has been fondling his penis. This mother does not know the best approach for the child's behavior. What is the nurses response to the mother? Why? A. "this is a strong sign that he is ready for toilet training" B. "you should just discourage this behavior now before it worsens as he gets older" C. "this this normal behavior for a child of his age" D. "we should obtain a urine sample to assess for an infection"

Rationale: C: "this is normal behavior for a child of the age" Children ages 1 to 3 enjoyed fondling their genitals. Punishment for genital fondling may lead to guilt and shame regarding sexual behavior later in life.

4. A female patient experienced a pelvic fracture in a motor vehicle accident several months earlier and her recovery has been slow. Among the challenges presented by the event is the fact that sexual activity now causes a dull ache in her pelvis. What diagnosis is most important for this patient? Why did you choose this answer and what could you do, as a nurse, to help this patient? A. Disturbed body image B. Sexual dysfunction: Dyspareunia C. Alteration in comfort: Pain D. Altered sexuality patterns: Change in sexual expression

Rationale: C: alteration in comfort: pain The patient's change in sexual behavior is directly attributable to the pain of her injury. There is no evidence of alterations and her sexual expression or a disturbed body image. Dyspareunia involves genital, rather than skeletal, pain.

2. During hospitalization for a suicide attempt, the patient informs the nurse that she does not want to return to work because her boss expects sexual favors each week before he gives her a paycheck. The patient informs the nurse that she needs this job but is embarrassed that she has to perform these favors. The nurse informs the patient that is his illegal behavior and is called........? What else could you tell this patient to assist her? A. environmental harassment B. fetishism C. quid pro quo harassment D. hostile environment harassment

Rationale: C: quid pro quo harassment quid pro quo means that something is given or withheld in exchange for something else. It generally occurs with a person in a position of authority offers either direct or indirect reward or punishment based on the granting of sexual favors. Environmental harassment and hostile environment harassment are the situation and occur when workplace behaviors of a sexual nature create a hostile, intimidating environment that interferes with a person's work performance. Fetishism is sexual arousal with the aid of an inanimate object not generally associated with sexual activity.

7. How does a democratic form of self-government in the milieu contribute to client therapy? A. By setting punishments for clients who violate the community rules B. By dealing with inappropriate behaviors as they occur C. By setting community expectations wherein all clients are treated on an equal basis D. By interacting with professional staff members to learn about therapeutic interventions

Rationale: CA democratic form of self-government in the milieu contributes to client therapy by setting the expectation that all clients should be treated on an equal basis. Clients participate in the decision-making and problem-solving aspects that affect treatment setting. The norms, rules, and behavioral limits are established by the staff and clients. All individuals have input.

16. A nurse cares for a rape victim who was given flunitrazepam (Rohypnol) by the assailant. Which intervention has priority? Monitoring for: a. coma. b. seizures. c. hypotonia. d. respiratory depression.

Rationale: D Monitoring for respiratory depression takes priority over hypotonia, seizures, or coma.

2. An adolescent was arrested for prostitution and assault on a parent. The adolescent says, "I hate my parents. They focus all attention on my brother, who's perfect in their eyes." Which nursing diagnosis is most applicable? a. Disturbed personal identity related to acting out as evidenced by prostitutionb. Hopelessness related to achievement of role identity as evidenced by feeling unloved by parentsc. Ineffective coping related to inappropriate methods of seeking parental attention as evidenced by acting outd. Impaired parenting related to inequitable feelings toward children as evidenced by showing preference for one child over another

Rationale: CThe patient demonstrates a failure to follow age-appropriate social norms and an inability to problem solve by using adaptive behaviors to meet life's demands and roles. The defining characteristics are not present for the other nursing diagnoses. The patient never mentioned hopelessness or disturbed personal identity. The problem relates to the patient's perceptions of parental behavior rather than the actual behavior.

13. An older female client reports symptoms of chronic vaginal dryness and symptoms suggesting a sexual arousal disorder. The nurse appropriately assesses this client for a possible cause by asking.....? Why? A. "When did the problem first occur?" B. "Is there a specific time of the month when this problem occurs?" C. "Are you allergic to any particular foods?" D. "Do you take any antihistamine medications?"

Rationale: D Causes of vaginal dryness range from physiological factors, such as hormonal changes or medication side effects, to emotional and psychological issues, like a lack of desire or even anxiety. The first step in treating vaginal dryness is figuring out the source of the discomfort, especially if a dry vagina is causing painful sex. A number of conditions can lead to a lack of vaginal lubrication: Changes in hormones. One of the most common causes of vaginal dryness is a decrease in estrogen levels during menopause or perimenopause, after childbirth, or during breastfeeding, according to the American Congress of Obstetricians and Gynecologists (ACOG). Cancer treatments such as chemotherapy and radiation to the pelvis can also lead to low estrogen and a decrease in vaginal lubrication. "The vagina depends on estrogen for health," says Irwin Goldstein, MD, director of Sexual Medicine at Alvarado Hospital and San Diego Sexual Medicine in California. Medications. Allergy and cold medications containing antihistamines as well as asthma medications can have a drying effect inside the body and cause reduced vaginal lubrication, according to Dr. Goldstein. Insufficient arousal. In some cases, vaginal dryness may be caused by a low libido or sexual problems with a partner. "If a partner has poor performance and early ejaculation, it can contribute to vaginal dryness," Goldstein says. Irritants. The chemicals in soaps, hygiene products, dyes, and perfumes may cause problems. "Many women have allergies to detergents and soaps," Goldstein says. "There can be irritants on things like underwear or towels." Other allergens can actually include lubricants and objects that may be placed in the vagina, he adds. Anxiety. Psychological and emotional factors like stress and anxiety can also interfere with sexual desire and lead to vaginal dryness when normal vaginal lubrication does not occur. "When a woman is anxious, there is insufficient blood flow," Goldstein says, "so she will have dryness." How to Prevent and Treat Vaginal Dryness Treatment for vaginal dryness depends on the cause. Women who experience problems with vaginal lubrication because of hormonal changes can often benefit from estrogen therapy. In addition to estrogen-based therapies, other approaches that may bring relief, especially from painful sex, include: Lubricants. "There are a plethora of lubricants that can help vaginal dryness," They include silicone-based, oil-based, and water-based products, according to ACOG. Lubricants are usually used to make sex less uncomfortable rather than for long-term vaginal lubrication. Moisturizers. Over-the-counter vaginal moisturizers can be an effective way to minimize vaginal dryness over several days with one application. Moisturizing agents help introduce water into the tissue of the vagina."

12. A client with an eating disorder is admitted to the acute admission unit of the psychiatric hospital. The nurse is scheduling the weights for Monday and Thursday mornings. In order to obtain an accurate weight, the nurse should do which of the following? Why? A. Weigh the client at the same time between breakfast and lunch. B. Allow the client to go to the bathroom unattended before the procedure. C. Have the client wear the same type of underwear with each weight. D. Observe for attempts to put weights into clothing or body.

Rationale: D Prior to weighing the client, the nurse observes for attempts to add weight such as putting items in clothing or on the body. The client is weighed at the same time each week before breakfast, and wearing minimal clothing (usually just underwear) to prevent hiding of weighted items in clothing to increase weight. The nurse does not allow the client to go to the bathroom unattended prior to weighing, or the client may attempt to drink a large amount of water to increase water weight.

10. Collection of evidence from bite marks is particularly useful in....? Why? A. identifying motive. B. creating a solid legal case. C. determining the assault timeframe. D. perpetrator identification through DNA-tested saliva.

Rationale: D Bite marks are a feature in many types of crimes, including assaults, homicides, and child abuse. They are typically found on the arms, breasts, and neck in cases of sexual assault; on the arms, legs, and breasts in cases of homicide; and over many body surfaces in child abuse cases [9]. Although the science behind bite mark analysis (for perpetrator identification) is dubious, the presence of bite marks is particularly useful for guiding saliva collection, which can be used to both tie the victim to the suspect (self-defense biting) and the suspect to the victim (attack biting). Therefore, bite injuries should be given special attention and, whenever possible, should be examined by a forensic odontologist

7. When documenting gunshot wounds, nurses should....? Why? A. identify the caliber of bullet. B. attempt to identify entrance or exit wounds. C. remove gunshot powder residue with a clean, damp cotton swab. D. remove bullets or fragments with plastic-shielded forceps and handle as little as possible.

Rationale: D COLLECTION AND DOCUMENTATION OF EVIDENCE Bullets (or bullet fragments) are a vital piece of evidence in cases of gun violence. It is recommended that when these are removed from victims, they should be extracted with plastic-shielded forceps and handled as little as possible. After they are removed, they should be immediately wrapped in gauze, placed in an evidence envelope, and the envelope marked with contents, name of person who extracted bullet, date and time of extraction, and name of the patient. Additionally, when documenting gunshot wounds, healthcare professionals should not attempt to identify entrance or exit wounds unless recording the patient's statement. The caliber of the bullet should also not be guessed, as this can create a disagreement between the medical-forensic report and the law enforcement report.

9. Which of the following areas sustains the most injury during a sexual assault involving penile penetration only? A. Cervix B. Perineum C. Vaginal walls D. Posterior fourchette

Rationale: D COLLECTION AND DOCUMENTATION OF EVIDENCE During the exam, crusted secretions or other attached material should be clipped out of the pubic hair and placed into evidence. Approximately 20 to 30 samples of the patient's own pubic hair should be plucked and kept separate as a control. A Wood's lamp should be used in the collection of semen samples from the external genital area, and again, enough swabs should be used to completely remove all visible traces. Following collection, a magnification device should be employed to further examine the area for microtrauma. A gynecologic colposcope is recommended for its sufficient lighting, magnification, and photographic capability. The labia minora, posterior fourchette, and fossa navicularis typically sustain the most injury during an assault involving penile penetration only, while assaults involving digital penetration cause damage to the aforementioned sites and the vaginal walls, the cervix, and perineum (due to fingernails).

8. When indicated by forcible oral copulation (or its attempt) or uncertain patient history, the nurse examiner should obtain two swabs of A. the tongue. B. the tonsillar fossae. C. behind the buccal sulci. D. All of the above

Rationale: D COLLECTION AND DOCUMENTATION OF EVIDENCE The nurse examiner should then move to the oral cavity and carefully observe every surface for injury from forced entry, a hand or gag over the mouth, or other insult. Two swabs each are usually taken from the tongue, the tonsilar fossae, behind the buccal sulci, and behind the upper incisors when indicated by forcible oral copulation (or its attempt) or uncertain patient history (e.g., if the patient was drugged or unconscious).

8. A 15-year-old ran away from home six times and was arrested for shoplifting. The parents told the court, "We can't manage our teenager." The adolescent is physically abusive to the mother and defiant with the father. Which diagnosis is supported by this adolescent's behavior? A. Attention deficit hyperactivity disorder (ADHD) B. Posttraumatic stress disorder (PTSD) C. Intermittent explosive disorder D. Conduct disorder

Rationale: D Conduct disorders are manifested by a persistent pattern of behavior in which the rights of others and age-appropriate societal norms are violated. Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. Criteria for ADHD and PTSD are not met in the scenario.

3. Which of the following types of fluids are useful for DNA collection? Why did you choose this? A. Blood B. Saliva C. Semen D. All of the above

Rationale: D In the case of sex crimes, it should be determined if the examination was initiated by law enforcement or if the assault has yet to be reported. Healthcare professionals have the duty to report cases of assault/abuse to officials. If law enforcement has already been involved, certain questions that would cause undue stress should not be asked during the exam if they have already been asked by investigators (e.g., description of the suspect), but obviously, certain questions that pertain to the medical-forensic exam must be addressed. Questions that will be asked by investigators included.

2. A nurse in community health conducts quarterly mental health-promotion and depression-screening programs at the local senior center. The nurse is aware that older adults are at increased risk for developing depression. Using such an intervention also addresses the older adults'.......? a. dependence on their primary care provider. b. normal sensory losses. c. reduced social contacts. d. underutilization of the mental health system.

Rationale: D Older adults, because they may depend on others for care, are at risk for abuse and neglect. Healthy aging activities such as physical activity and establishing social networks improve the mental health of older adults. Older adults underutilize the mental health system and are more likely to be seen in primary care or to be the recipient of care in institutions. The nurse can reach them by organizing health-promotion programs through senior settings or other community-based settings.

2. .Depression, hyperthyroidism, hypothyroidism, pain, and sleep apnea are examples of: A. Disorders that are provoked by sleep. B. Conditions known as parasomnias. C. Conditions that cause secondary sleep disorders. D. Disorders associated with narcolepsy.

Rationale: D Secondary sleep disorders occur when a disease causes alterations in sleep stages or in quantity of sleep. Depressed people may spend more time in bed; however, in general, they have difficulty falling asleep, experience less slow-wave (deep) sleep, spend less time in REM sleep, awaken early, and have less total sleep time. An increase in thyroid secretion causes an increase in stage III and IV sleep. Hypothyroidism causes a decrease in those stages. Hyperthyroidism creates increased metabolic rate, making it difficult to fall asleep. Acute pain and chronic pain interfere with sleep. They inhibit sleep, increase arousals during sleep, and cause longer awake intervals during the night. During periods of sleep apnea, O2 level in the blood drops, and the CO2 level rises, causing the person to wake up frequently.

4. The nurse in the hospital has a prescription to administer medication at 0400 to Mrs. Giovanni. Mrs. Giovanni is asleep when the nurse enters the room. She is difficult to arouse and confused. Identify the stage of sleep Mrs. Giovanni was likely in when the nurse awakened her. A. Stage I B. Stage II C. Stage III D. Stage IV

Rationale: D Stage IV is the deepest sleep and the most restorative. REM Sleep. In this stage, the delta waves are highest in amplitude, slowest in frequency, and highly synchronized. The body, mind, and muscles are very relaxed. It is difficult to awaken someone in stage IV sleep, and if awakened, the person may appear confused and react slowly.

13. A nursing measure to promote sleep in school-age children is to: A. Make sure the room is dark and quiet B. Encourage evening exercise C. Encourage television watching D. Encourage quiet activities prior to bed time.

Rationale: D The amount of sleep needed during the school years is individualized because of varying states of activities and levels of health. A 6-year old averages 11-12 hours of sleep nightly, whereas an 11-year old sleeps about 9-10 hours. The 6- or 7-year old can usually be persuaded to go to bed by encouraging quiet activities.

3. A nurse is caring for a 64-year-old homeless woman with a chronic respiratory disease in the local community-based clinic. The nurse realizes that the client is at risk of experiencing exacerbation of the disease process related to.....? a. Poor attire and cleanliness practices b. The client's lack of education and ability to read c. The individual's lack of concern about the disease d. The client's lack of a storage site for medication and the inability to obtain nutritious meals

Rationale: D The homeless person's lack of a storage site for medication and inability to obtain nutritious meals are factors that contribute to poor management of chronic disease. Homeless people are often stereotyped as having a lack of concern for their situations. Poor attire and lack of hygiene are not causes of chronic illness exacerbation. They are signs of the client's status as a member of an at-risk population. It is incorrect for the nurse to assume that the client lacks education and the ability to read.

8. In the role of milieu manager, which activity should the nurse prioritize? A. Setting the schedule for the daily unit activities B. Evaluating clients for medication effectiveness C. Conducting therapeutic group sessions D. Searching newly admitted clients for hazardous objects

Rationale: D The milieu manager should search newly admitted clients for hazardous objects. Safety of the client and others is the priority. Nurses are responsible for ensuring that the client's safety and physiological needs are met within the milieu.

9. An involuntarily committed client is verbally abusive to the staff and repeatedly threatening to sue. The client records the full names and phone numbers of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit? Why? a. Verbally redirect the client, and then limit one-on-one interaction. B. Involve the hospital's security division as soon as possible. c. Notify the client that documenting personal staff information is against hospital policy. d. Continue professional attempts to establish a positive working relationship with the client.

Rationale: D The most appropriate nursing action is to continue professional attempts to establish a positive working relationship with the client. The involuntarily committed client should be respected and has the right to assert grievances if rights are infringed.

1. A client on an inpatient unit angrily states to a nurse, "Peter is not cleaning up after himself in the community bathroom. You need to address this problem." Which is the appropriate nursing response? A. "I'll talk to Peter and present your concerns." B. "Why are you overreacting to this issue? "C. "You should bring this to the attention of your treatment team. "D. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns."

Rationale: D The most appropriate nursing response involves restating the client's feeling and developing a plan with the client to solve the problem. According to Skinner, every interaction in the therapeutic milieu is an opportunity for therapeutic intervention to improve communication and relationship-development skills.

10. Which statement should a nurse identify as correct regarding a client's right to refuse treatment? Why did you choose this answer? a. Clients can refuse pharmacological but not psychological treatment. b. Clients can refuse any treatment at any time. c. Clients can refuse only electroconvulsive therapy (ECT). d. Professionals can override treatment refusal if the client is actively suicidal or homicidal.

Rationale: D The nurse should understand that health-care professionals can override treatment refusal when a client is actively suicidal or homicidal. A suicidal or homicidal client who refuses treatment may be a danger to self or others. This situation should be treated as an emergency, and treatment may be performed without informed consent

12. When planning client care for a Latino American, the nurse should be aware of which cultural influence that may impact access to health care? Why? a. The root doctor may be the first contact made when illness is encountered. b. The "yin" and "yang" practitioner may be the first contact made when illness is encountered. c. The shaman may be the first contact made when illness is encountered. d. The curandero may be the first contact made when illness is encountered.

Rationale: D The nurse should understand that some Latin Americans may initially contact a curandero when illness is encountered. The curandero is the folk healer who is believed to have a gift from God for healing the sick. Treatments often include supernatural rituals, prayers, magic, practical advice, and indigenous herbs.

6. Which rationale by a nursing instructor best explains why it is challenging to globally classify the Asian American culture? Why did you choose this answer? a. Extremes of emotional expression prevent accurate assessment of this culture. b. Suspicion of Western civilization has resulted in minimal cultural research. c. The small size of this subpopulation makes research virtually impossible. d. The Asian American culture includes individuals from many different countries.

Rationale: D The nursing instructor's best explanation is that the Asian American culture is difficult to classify globally due to the number of countries that identify with this culture. The Asian American culture includes peoples and descendants from Japan, China, Vietnam, the Philippines, Thailand, Cambodia, Korea, Laos, India, and the Pacific Islands. Within this culture there are vast differences in values, religious practices, languages, and attitudes.

2. Which statement would best explain the role of the nurse when planning care for a culturally diverse population? The nurse will plan care to......? Why? a. Include care that is culturally congruent with the staff from predetermined criteria b. Focus only on the needs of the client, ignoring the nurse's beliefs and practices c. Blend the values of the nurse that are for the good of the client and minimize the client's individual values and beliefs during care d. Provide care while aware of one's own bias, focusing on the client's individual needs rather than the staff's practices

Rationale: D Without understanding one's own beliefs and values, a bias or preconceived belief by the nurse could create an unexpected conflict or an area of neglect in the plan of care for a client (who might be expecting something totally different from the care). During assessment values, beliefs, practices should be identified by the nurse and used as a guide to identify the choices by the nurse to meet specific needs/outcomes of that client. Therefore, identification of values, beliefs, and practices allows for planning meaningful and beneficial care specific for this client.

4. Which of the following is NOT one of the components of forensic documentation? Why? A. Photography B. Written documentation C). Diagrammatic documentation D). Scanning with a Wood's lamp

Rationale: D Wood lamps are used to identify fungal infections.

19. Which of the following techniques should be used when collecting a saliva swab for evidence under bite mark guidelines? a. Use one dry swab only, but avoid air-drying. b. Use one wet swab only, air-drying for 60 seconds after swabbing. c. Use a wet swab followed by a dry swab, but avoid air-drying. d. Use a wet swab followed by a dry swab, air-drying both for 60 seconds after swabbing.

Rationale: D A two-swab technique should be used to collect saliva according to bite mark guidelines. The first swab should be moistened with water, and the saliva is collected by rolling the tip of the swab over the skin in a circular motion and then allowing the swab to air dry for 60 seconds. The second swabbing is done in the same manner except the swab is dry. The second swab should also be air dried for 60 seconds, and both are placed together in a sealed envelope.

2. The nursing diagnosis Rape-trauma syndrome is established for a rape victim in the emergency department. Which outcome should be achieved by the time the patient is discharged? a. The patient will state, "I feel safe and entirely relaxed." b. The memory of the rape will be less vivid and less frightening. c. Physical symptoms of pain and discomfort are no longer present. d. The patient agrees to keep a follow-up appointment with the rape victim advocate.

Rationale: D Agreeing to keep a follow-up appointment is a realistic short-term outcome. The remaining options are unlikely to be met during the limited time the victim is in the emergency department.

8. A patient has been in the dying process for about 10 days. His wife has left his side only for very short periods during that time, and she looks pale and exhausted. The nurse, realizing the wife has not eaten much, suggests that she take a break to eat and rest. The woman refuses, saying, "I don't want to leave him. I won't have him much longer, and I don't want him to go when I'm gone." What should the nurse do? a. Explain that she will be of more help to her husband if she is rested and well. b. Tell the wife that it is safe to leave her husband for an hour or two because he won't die that soon. c. Call the primary care provider to come and try to persuade her to take physical care of herself. d. Arrange for a cot for her at the bedside and arrange to have food brought to her.

Rationale: D Arrange for a cot for her at the bedside and arrange to have food brought to her.The nurse was correct to suggest that the woman needs to eat and rest. However, this is primarily for the woman's well-being, not because she needs to be of more help to her husband. The nurse should not assure her that her husband will not die in an hour or two, because she does not know exactly when he will die. It would be inappropriate to ask anyone else to try to persuade her to change her mind; the nurse should support the wife's decisions in a therapeutic manner and not try to change them. The nurse should not rely on the physician to encourage basic care and comfort for the family. She should make the wife as comfortable as possible if she does not wish to leave the room. This would include arranging for her to rest in the patient's room and having food and drink brought to the room.

2. During postprandial (after a meal) monitoring, a female client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you had sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response? Why? A. "I trust you not to purge." B. "How are you purging and when do you do it?" C. "Don't worry. I won't allow you to purge today." D. "I understand it's important for you to feel in control, but I'm still going to sit with and monitor you for 90 minutes after you eat."

Rationale: D. "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat." This response acknowledges that the client is testing limits and that the nurse is setting them by performing postprandial monitoring to prevent self-induced emesis. Clients with bulimia nervosa need to feel in control of the diet because they feel they lack control over all other aspects of their lives. Option A: Because their therapeutic relationships with caregivers are less important than their need to purge, they don't fear betraying the nurse's trust by engaging in the activity. They commonly plot to purge and rarely share their secrets about it. Options B and C: An authoritarian or challenging response may trigger a power struggle between the nurse and client.

9. A patient has been in the dying process for about 10 days. His wife has left his side only for very short periods during that time, and she looks pale and exhausted. The nurse, realizing the wife has not eaten much, suggests that she take a break to eat and rest. The woman refuses, saying, "I don't want to leave him. I won't have him much longer, and I don't want him to go when I'm gone." What should the nurse do? a. Explain that she will be of more help to her husband if she is rested and well. b. Tell the wife that it is safe to leave her husband for an hour or two because he won't die that soon. c. Call the primary care provider to come and try to persuade her to take physical care of herself. d. Arrange for a cot for her at the bedside and arrange to have food brought to her.

Rationale: D. Arrange for a cot for her at the bedside and arrange to have food brought to her. The nurse was correct to suggest that the woman needs to eat and rest. However, this is primarily for the woman's well-being, not because she needs to be of more help to her husband. The nurse should not assure her that her husband will not die in an hour or two, because she does not know exactly when he will die. It would be inappropriate to ask anyone else to try to persuade her to change her mind; the nurse should support the wife's decisions in a therapeutic manner and not try to change them. The nurse should not rely on the physician to encourage basic care and comfort for the family. She should make the wife as comfortable as possible if she does not wish to leave the room. This would include arranging for her to rest in the patient's room and having food and drink brought to the room.

3. A family member asks a home care nurse what he should do if the patient's serious chronic illness worsens even with increased medical interventions. How does the nurse best begin a conversation about the goals of care at the end of life? a. Encourage the family member to think more positively about the patient's new therapy b. Avoid the discussion because it has to do with medical, not nursing, diagnoses c. Initiate a discussion about advance directives with the patient, family, and health care team d. Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is present

Rationale: D. Begin the discussion by asking the patient to identify his or her beliefs about the goals of care while the family member is presentIf you ask the patient first what he or she believes is best, you know how to discuss that option in more detail and give realistic ways of reaching that desired goal. Discussing other possible options after the patient's preference helps family members know and understand the patient's wishes.

6. A woman experiences the loss of a very early-term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can "always try again." The woman feels confusion over her sadness and stops talking about it with others. What type of grief response is she most likely experiencing? a. Delayed b. Anticipated c. Exaggerated d. Disenfranchised

Rationale: D. DisenfranchisedThis woman's friends are not fully acknowledging the value of her pregnancy because of the short length of time the woman was pregnant or because, by comparison, the loss seems less than losing a child after birth. The loss does not seem "legitimate." Thus the woman does not experience sympathy from others and feels disenfranchised

1. The 57-year old client with Alzheimer's disease is brought to the ER with vaginal excoriation, UTI and severe dehydration. The nurse also notes that the client's hair is unkempt and looks like she has not had a shower in a while and is dehydrated. Which of the following is not an appropriate action of the nurse? a. Stay with the client and place her in a safe and non-threatening environment. b. Assess and treat any physical injuries. c. Report a possible case of client neglect to the social worker. d. Wait for the caregiver to arrive to interview him on how this had happened.

Rationale: D. In this situation the client should be treated appropriately and the nurse should place her in a safe environment. Since she shows signs and symptoms of elderly neglect, the nurse should adhere to the state and hospital's policy in reporting such incidences. She should also notify the caseworker or the social worker so that it can be investigated and a follow-up can occur.

9. Nurse Martinez, a school nurse, is meeting with the school and health treatment team about a child who has been receiving methylphenidate (Ritalin) for two (2) months. The meeting is to evaluate the results of the child's medication use. Which behavior change noted by the teacher will help determine the medication's effectiveness. A. Decrease repetitive behaviors B. Decreased signs of anxiety C. Increased depressed mood D. Increased ability to concentrate on tasks

Rationale: D. Increased ability to concentrate on tasks Methylphenidate (Ritalin) is used as a method of treatment of ADHD. Evidence of increased ability to concentrate on tasks while taking this medication would establish the drug's effectiveness.

5. A young man is diagnosed with a serious, life-changing illness. His conversations during his first 2 days of hospitalization are abrupt, superficial, and unrelated to his illness. What understanding about communication enhances your therapeutic communication with this patient? a. Younger patients are usually less talkative about their diagnosis. b. All patients benefit by talking about their feelings with another person. c. Avoid discussing illness-related topics with quiet patients. d. Remain alert for signals that the patient wants to discuss his illness

Rationale: D. Remain alert for signals that the patient wants to discuss his illness.Make no presumptions about this patient other than the fact that he is not yet ready to talk about his situation. However, stay alert for a time when he might want to talk to you. Some people do not work through their problems by talking to others.

7. A 15-year-old patient arrives at the emergency department with nonspecific complaints. The patient's temperature is 100.8°F (38.2°C), pulse rate and blood pressure are elevated, and pupils are dilated with decreased reaction to light. Two days ago, the patient began taking sertraline (Zoloft) 50 mg daily for treatment of depression. The patient has a history of substance use and stated that marijuana had been smoked one week ago. The diagnosis is.......? Why? A. alcohol withdrawal. B. infection affecting the central nervous system. C. neuroleptic malignant syndrome. D. serotonin syndrome.

Rationale: D. Serotonin Syndrome. The most serious drug-related adverse effect of SSRIs is the potential to produce serotonin syndrome. Commonly prescribed SSRIs include sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), and fluvoxamine (Luvox). (See Etiology, Presentation, and Workup.) Serotonin syndrome, characterized by mental status changes, neuromuscular dysfunction, and autonomic instability, is thought to be secondary to excessive serotonin activity in the spinal cord and brain.

3. The nurse cares for a client after an electroconvulsive therapy (ECT) treatment. The nurse should report which uncommon observation to the client's physician? Why? A. Headache. B. Disruption in short- and long-term memory. C. Transient confusional state. D. Backache.

Rationale: D. Strategy: You are looking for something unexpected. (A) expected effect (B) expected effect (C) expected effect (D) correct-client undergoing ECT needs to be instructed about what s/he could experience during and after ECT; expected effects include headache, disrupted memory (short- and long-term), and general confused state; backache is not a usual effect; thorough description of the pain in relation to severity, duration, location, and what makes pain better needs to be assessed and reported to the physician. Common Side Effects Which You Might Encounter The common side effects of electroconvulsive therapy include: Headache - You can have mild to moderate headache after the session and it can last from few minutes to hours. Confusion - You can remain confused for few minutes after the session is over. You will overcome it after few minutes. Delirium - It lasts for few minutes only when the patient is recovering from anesthesia.It is more pronounced after the initial treatment sessions and in those patients who have other neurological disorder as well or in those patients who undergo bilateral ECT. Patient recovery varies from few minutes to days and few weeks at the maximum in minority of patients. High Confusion - May be seen in about 10% of the patients and the condition lasts for about 30 minutes after the seizures. Benzodiazepines and barbiturates can be used for the treatment of marked confusion. Memory Impairment - the most concerned adverse effect of ECT is the memory impairment. Around 75% of all the patients who undergo ECT say that memory loss is the most troubling side effect. During the course of treatment memory impairment does occur but the good thing is that it is not a permanent damage. After 6 months of the treatment all patients return to their normal thinking levels. However, a small percentage of the patients may develop persistent memory problems. An example of memory loss can be that a patient might not remember what happened when he went for hospital admission and ECT. The extent to which the memory is affected during the treatment and the time it takes to come back to normal depends on the magnitude of electrical current used during treatment. Moreover, those patients who do not show much improvement with ECT complain more of memory loss. Can Side Effect Of Electroconvulsive Therapy Cause Permanent Damage To Your Brain? The good news is this although ECT causes effects on the memory there is no evidence of brain damage caused due to electroconvulsive therapy. Possibility of brain damage due to ECT was a huge concern and a number of research studies were conducted using various brain imaging techniques to determine whether there was any evidence of brain damage. Luckily, all the studies showed that there is no permanent brain damage as a result of ECT. There is a common agreement between the epilepsy experts and neurologists that the seizures which have duration less than thirty minutes are not associated with permanent damage to the brain. More Side Effects Of Electroconvulsive Therapy Which You Might Encounter Fractures- used to occur in the olden days but they should not occur these days. Fractures of the vertebrae or long bones can be avoided by the use of proper muscle relaxants during the procedure. Backache And Tooth Injury - Due the contraction of the muscles during the procedure, you may experience pain in the back. Someone may get a tooth broken as well due to the contractions. Necessary precautionary measures for e.g. use of mouth piece, should be taken. Pain In The Muscles Or Muscle Soreness - You may experience muscle soreness after the first few sessions of ECT. This is due to the effect of succinylcholine which causes depolarization of the muscle. Nausea, vomiting and headache may be experienced in minority of patients after undergoing electroconvulsive therapy. Nausea and vomiting can be cured by taking anti-vomiting medicine as needed. Commonly used anti vomiting medicines are Tab Gravinate (dimenhydrinate) 50mg, Tab Maxolon (metoclopramide) 10mg and Tab Motilium (domeperidone) 10mg. Anyone of the these can be taken. However if nausea or vomiting persists it is better to see your doctor. Remedies For The Side Effects Of Electroconvulsive Therapy Headache Simple headaches which occur as a side effect of electroconvulsive therapy can be treated by the use of NSAIDS (Non steroidal anti inflammatory drugs) for e.g acetaminophen (comes under brand name Tylenol, check brand name in your country). It may be given when the patient is recovering from the effects of ECT. Ibuprofen is also a pain killer (NSAIDS) and helps in post ECT headaches. Pretreatment with Ibuprofen decreases post ECT headaches Take 600mg of ibuprofen 90 minutes before the ECT session and it will decrease the frequency and the severity of the post ECT headaches. You will have fewer headaches after the ECT and if you have headache it will be of lesser intensity. Severe headaches - If you experience severe headaches after undergoing ECT, then pretreatment with intravenous ketorolac (NSAID) will be helpful to you. There are other agents as well like propoxyphene (check brand name in your country), tramadol and opioid derivaties which can be used alone or in combination for the management of severe headaches. Migrainous headaches - Electoconvulsive therapy may cause migraine like headaches in certain people. In this case along with the agents mentioned above, specific agents for the treatment of migraine can be added. For e.g sumatriptan (check brand name in your country) 25 mg by mouth or 6 mg subcutaneous can be helpful. Another agent used for the treatment of migraine is the ergot derivatives. However, these agents should not be used as a pretreatment of ECT because they can significantly affect the cardiovascular changes which occur during ECT. Muscle Soreness - It can be treated by the use of simple painkillers for e.g. NSAIDS Nausea and Vomiting - It can be treated by the use of antiemetic drugs before the start of ECT. For e.g. metoclopramide 10 mg intravenous or intravenous 10 mg of prochlorperazine. If there is a chance of adverse effect with these agents ( dopamine receptor antagonists) then alternative drug like ondansetron can be used. Fractures - These days fractures can be easily avoided by the use of muscle relaxants as a pretreatment to ECT.

2. Nurse Meredith is observing 8-year-old Anna during a community visit. Which of the following findings would lead the nurse to suspect that Anna is a victim of sexual abuse? a. The child is fearful of the caregiver and other adults. b. The child has a lack of peer relationships. c. The child has self-injurious behavior. d. The child has an interest in things of a sexual nature.

Rationale: D. The child has an interest in things of a sexual nature. An 8-year-old child is in the latency phase of development; in this stage, the child's interest in peers, activities, and school is the priority. Interest in sex and things of a sexual nature would occur appropriately during the age of puberty, not at this time. A child who is the victim of sexual abuse, however, may show an unusual interest in sex. The assessments in the other answer choices may indicate abuse, but not necessarily sexual abuse.

10. The nurse is assessing a 16-year-old female who is admitted to the eating disorders unit with a history of weight fluctuation, abdominal pain, teeth erosion, receding gums, and bad breath. She states that her health has been a problem but there are no other concerns in her life. Which of the following assessments will be the least useful as the nurse develops the care plan? A. Information regarding recent mood changes. B. Family functioning using a genogram. C. Ability to socialize with peers. D. Whether she has a sexual relationship with a boyfriend.

Rationale: D. Whether she has a sexual relationship with a boyfriend. This is not the most appropriate or pertinent question to ask about her sexual relationships. Most who have an eating disorder also have a body image disturbance and may not even be in a relationship. At this time, we are most worried about her safety, health and reasons why she is experiencing an eating disorder (causal factors). Option A: Information about mood changes is important to assess, as bulimia is often associated with affective disorders. Option B: Family functioning is the most essential point to assess, as it reveals if binge eating is triggered by conflict within the family. Option C: Information about the ability to socialize with peers is important to assess, as it is possible the problem initiated with peer relationships.

9. A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which nursing response is most appropriate? Why? A. "Thanks for checking in." B. "I'll stand outside your door to give you privacy." C. "Let me know when you get back to the day room." D. "I will accompany you to the bathroom."

Rationale: D: The response, "I will accompany you to the bathroom," is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior. The response, "Thanks for checking in," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom. The response, "Let me know when you get back to the day room," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom. The response, "I'll stand outside your door to give you privacy," does not address the nurse's responsibility to deter the self-induced vomiting done by clients diagnosed with bulimia nervosa. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits.

3. An elderly couple who have just relocated to a long-term care facility have been unable to obtain a shared room. A staff member at the facility states that this should not be a concern and implies that sexual activity between the couple likely ceased many years ago. How should the nurse to best respond to this individual's assertion? Why? A. Resource as shown the nature of sexual activity changes with age but that it actually becomes more frequent. B. That's true, but it's important for us to give them the teaching they need in order to resume this part of their relationship. C. It's true that they probably stopped having sexual activity, but it's important for them to have companionship. D. Actually it's not true that older people always stop having sexual activity when they get older.

Rationale: D: actually it is not ture that older people always stop having sexual activity when they get older. Sexual activity need not be hindered by age. There's no evidence, however, that it becomes increasingly frequent and late adulthood.

15. About the same number of boys and girls get anorexia nervosa. A. True B. False

Rationale: False Girls are much more likely than boys to get anorexia. Three out of four preteens with anorexia are girls. But binge-eating disorder affects boys and girls about equally.

18. Like those with anorexia, people with bulimia become very thin. A. True B. False

Rationale: False People with bulimia usually are of normal weight. Like those with anorexia, people with bulimia are afraid of gaining weight. They feel very unhappy with their body. They may use diet pills and laxatives to lose weight. But they don't lose a great deal of weight because they overeat (binge) and then purge. Purging may be vomiting food on purpose to get rid of it.

16. Older adults are more likely than teens to get an eating disorder. A. True B. False

Rationale: False Teens and young adults are more likely to get an eating disorder than children or older adults.

20. People with eating disorders often don't know they are ill or they hide their condition. A. True B. False

Rationale: True Because of this, they may not get treatment. Family members or close friends who see the problem can encourage the person to get help. They can offer support during treatment. Treatment for anorexia includes restoring the lost weight and easing the psychological distress that often caused the weight loss. This distress includes low self-esteem, poor body image, and problems interacting with others. Treatment for bulimia and binge-eating disorder includes eating regular meals and getting nutrition advice. Doctors can also treat any underlying mood or anxiety disorders. People with binge-eating disorder or bulimia may need to take medicine.

19. People with binge-eating disorder feel out of control during a binge episode. A. True B. False

Rationale: True Binge-eating means eating a large amount of food within a certain period of time. Many binge-eaters eat alone because they are embarrassed at how much food they are eating. They eat even when they are not hungry. They often eat until uncomfortably full. Binge-eaters do not purge after overeating. They tend to be overweight.

17. People with anorexia nervosa see themselves as overweight even though they are dangerously thin. A. True B. False

Rationale: True People with anorexia are obsessed with being thin. They often develop peculiar eating habits. They may pick out just a few foods to eat. Or they may eat foods in small quantities or carefully weigh foods. They may use diet pills and laxatives to lose weight. They check their weight over and over again. They often exercise more than normal to control their weight.

Briquet's Syndrome

Somatization disorder Psychological: multiple physical complaints without physical pathology

somatization disorder

Somatoform disorder where a person experiences a variety of physical symptoms over an extended period of time. The person needs to have many somatic symptoms (pain, GI stress, sexual stress, and neurological)

Pharmacologic interventions for somatic disorders

TCA and SSRIs

18. Lance asks you what medication is usually used for premature ejaculation. You educate him regarding a class of medications that are used for treatment but have to be monitored for the possibility of dosage reduction or change related to the possibility of causing sexual side effects. (A) Which of the following is the class of medications you are educating Lance about? (B) What education could you provide Lance with about your answer? A. MAO inhibitors B. Tricyclic antidepressants C. Atypical antipsychotics D. SSRI antidepressants

Treatments include antidepressants in the selective serotonin reuptake inhibitor (SSRI) category. Conversely, pharmacotherapy may cause erectile dysfunction, and medications may need to be evaluated for change or dose reduction. The other options are not used for premature ejaculation. No drug is specifically approved by the US Food and Drug Administration (FDA) for the treatment of premature (early) ejaculation. However, various agents have been safely and effectively used for this purpose. Selective serotonin reuptake inhibitors (SSRIs) and antidepressants with SSRI-like effects have been the most successful. Desensitizing creams containing local anesthetics can also be useful in some cases; though not FDA-approved, they are believed to be of at least some efficacy and carry minimal risk. Selective Serotonin Reuptake Inhibitors Adverse effects of long-term SSRI use are a significant concern and should be considered by both the physician and the patient. These adverse effects include psychiatric and neurologic sequelae, dermatologic reactions, anticholinergic effects, fluctuation in body weight, cognitive impairment, drug interactions, and sexual side effects other than delayed ejaculation (eg, erectile dysfunction or loss of libido. Paroxetine (Paxil, Pexeva) Paroxetine is a potent SSRI used to treat premature ejaculation. Improvement may not be evident until at least 3 weeks after the initiation of treatment. If there is no beneficial effect on premature ejaculation after 6 weeks or if adverse effects become troublesome, it should be discontinued in favor of an alternative treatment. Sertraline (Zoloft) Sertraline is a potent SSRI used to treat premature ejaculation. Improvement may not be evident until at least 3 weeks after the initiation of treatment. If there is no beneficial effect on premature ejaculation after 6 weeks or if adverse effects become troublesome, it should be discontinued in favor of an alternative treatment. Citalopram (Celexa) Citalopram is a potent SSRI used to treat premature ejaculation. Improvement may not be evident until at least 3 weeks after the initiation of treatment. If there is no beneficial effect on premature ejaculation after 6 weeks or if adverse effects become troublesome, it should be discontinued in favor of an alternative treatment. Fluoxetine (Prozac) Fluoxetine is a potent SSRI used to treat premature ejaculation. Improvement may not be evident until at least 3 weeks after the initiation of treatment. If there is no beneficial effect on premature ejaculation after 6 weeks or if adverse effects become troublesome, it should be discontinued in favor of an alternative treatment.

Interventions for sexual counseling

Use of an interactive helping process focusing on the need to make adjustments in sexual practice or to enhance with sexual events or disorder.

What are somatic symptoms

a combination of distressing symptoms and excessive or maladaptive response or associated health concerns without significant physical findings and medical diagnosis

premature ejaculation

a condition in which the male reaches climax too soon, usually before, or shortly after, penetration of the female

female sexual interest/arousal disorder

a female dysfunction marked by a persistent reduction or lack of interest in sex and low sexual activity, as well as, in some cases, limited excitement and few sexual sensations during sexual activity

male hypoactive sexual desire disorder

a male dysfunction marked by a persistent reduction or lack of interest in sex and hence a low level of sexual activity

sexual dysfunction

a problem that consistently impairs sexual arousal or functioning

genito-pelvic pain/penetration disorder

a sexual dysfunction characterized by significant physical discomfort during intercourse

hypochondriasis

a somatoform disorder in which a person interprets normal physical sensations as symptoms of a disease