mental health chapter questions exam three
a nurse is discussing normal grief with a client who recently lost a child. which of the following statements made by the client indicates understanding? (SATA) a. "I may experience feelings of resentment" b. "I will probably withdrawal from others" c. "I can expect to experience changes in sleep" d. "Is it possible that I will experience suicidal thoughts" e. "it is expected that I will have a loss of self-esteem"
a, b, c rationale on incorrect: suicidal ideations are associated with complicated grieving. the client who is experiencing distorted or exaggerated grief response can direct anger towards themselves. Assess and monitor the client for thoughts of suicide or self-injury (d); a client who is experiencing complicated grief response commonly experiences a loss of self-esteem and a sense of worthlessness. These findings are not associated with normal grief (e)
Which actions are associated with addressing the needs of health care providers who are frequently involved in the compassionate care of grieving clients? (Select all that apply.) a. Consciously making the effort to encourage staff members b. Advocating for facility-sponsored exercise program c. Attending the weekly scheduled debriefing and support session d. Changing unit assignments on a regular basis e. Earning a certification associated with grief counseling
a, b, d, e To balance a work life that centers on others, create habits that reconnect you with your own life, your well-being, your commitment to work, and your enjoyment of the larger world. Find people you can trust at work and support each other. Accept each other's failings, successes, vulnerabilities, and intentions. Work for systemic changes at your place of employment that will enhance self-care, such as exercise programs and periodic debriefings and memorials when patients die. Continue to increase your knowledge base and seek professional certifications. Ask your supervisor to email inspiring or appreciative messages to the staff. Take a few moments to thank and appreciate each other. Changing units is appropriate only in the event that burnout and compassion fatigue are unavoidable. The timing and frequency of these interventions vary from person-to-person.
a nurse is working with a client who has recently lost a guardian. the nurse recognizes that which of the following factors influence a client's grief and coping ability (SATA) a. interpersonal relationships b. culture c. birth order d. religious beliefs e. prior experience with loss
a, b, d, e rationale on incorrect: birth order is not a factor that influences grief and ability to cope (c)
On the sixth anniversary of her spouse's death, a widow says, "Sometimes life does not seem worth living anymore. I wish I could go to sleep and never wake up." Which response by the nurse has priority? a. "Are you considering suicide?" b. "You still have so much to live for." c. "Grief can sometimes last for many years." d. "Why do you continue to grieve something from long ago?"
a. "Are you considering suicide?" The nurse should always take an individual very seriously if he or she mentions some form of suicidal ideation and ask directly about suicide.
Grief therapy was prescribed for a client who recently experienced tremendous grief upon the death of a parent. Which statement best demonstrates that a client is moving toward the healthy resolution of that grief? a. "I've enjoyed going to the book club my sister suggested." b. "My mother would want me to get back to living my life again." c. "I'm going to stop being sad and rely on my faith to support me." d. "I'm considering it's time to go back to work."
a. "I've enjoyed going to the book club my sister suggested." Ongoing evaluation will be performed until the crisis has resolved sufficiently to allow a return to normal pre-crisis functioning. As the patient's anxiety level reduces from severe to moderate to mild through successful interventions, the patient will need less support and return to independence. The correct option demonstrates independence, social engagement, and a return of enjoyment to one's life. The remaining options demonstrate consideration associated with returning to the familiar life situations (work, faith-based comfort).
a nurse is caring for a client who lost a guardian to cancer last month. the client states, "I'd still have my guardian if the doctor would have made a diagnosis sooner." which of the following responses should the nurse make? a. "you sound angry. anger is a normal feeling associated with loss" b. "I think you would feel better if you talked about your feelings with a support group" c. "I understand just how you feel. I felt the same when my guardian died" d. "do other members of your family also feel this way"
a. "you sound angry. anger is a normal feeling associated with loss" rationale on correct: this is a therapeutic response for the nurse to make. this response acknowledges the clients emotion and provides education on the normal grief response
A physician informed an adult of the results of diagnostic tests that showed lung cancer. Later in the day, the patient says to the nurse, "My doctor said I have breathing problems, right?" Which nursing diagnosis is applicable? a. Denial related to acceptance of new diagnosis b. Spiritual distress related to unresolved life conflicts c. Situational low self-esteem related to stress of new diagnosis d. Acute confusion related to metastatic changes to cerebral function
a. Denial related to acceptance of new diagnosis Although emotional responses to grief vary from one individual to the next, a common first response is that of denial. The person is emotionally unable to accept his or her painful loss. Denial functions as a buffer against intolerable pain and allows the person to acknowledge the reality of a loss slowly.
When considering the lethality of a client's suicide plan, what is the basic principle the nurse will consider? a. If the action is reversible, the plan is less lethal. b. A gun can easily deliver a fatal wound. c. Ingesting pills is a slow method of self-harm. d. Any suicide plan has the potential to be lethal.
a. If the action is reversible, the plan is less lethal. A plan that doesn't allow for a last minute reversal of the action is consider more lethal. While all suicide plans should be taken seriously, not all plans are considered lethal. The remaining options are true statements but not the guiding principle concerning determining a plan's lethality.
A patient who had a stroke 3 days ago tearfully tells the nurse, "What's the use in living? I'm no good to anybody like this." Which action should the nurse employ first when caring for a patient demonstrating hopelessness? a. Implement the institutional protocol for suicide risk. b. Support the patient to clarify and express feelings of grief. c. Educate the patient about the success of stroke rehabilitation. d. Offer the patient an opportunity to confer with the pastoral counselor.
a. Implement the institutional protocol for suicide risk. The patient's comment suggests hopelessness, helplessness, and worthlessness. Physical illnesses play a role in increasing suicide risk. Suicide precautions should be initiated.
Sixteen years ago, a toddler died in a tragic accident. Once a year, the parents place flowers at the accident site. How would the nurse characterize the parents' behavior? a. Mourning b. Bereavement c. Complicated grief d. Disenfranchised grief
a. Mourning Mourning refers to all of the ways in which a person outwardly expresses grief and the efforts taken to manage grief. It does not have a designated time frame and may continue for many years. A once-a-year ritual is an adaptive coping technique to recognize the parents' loss.
While entering the building, an elementary school nurse observes a person in the distance emerging from a forest and approaching the school. The person is dressed in black from head to toe; wearing a backpack; and carrying a long, narrow, dark object. Which action should the nurse take first? a. Move to a secure location. b. Observe the intruder's features. c. Take note of the intruder's location. d. Activate the school code for an intruder.
a. Move to a secure location. This scenario presents a potential adventitious crisis in phase 1. The nurse must first consider safety. After moving to a secure location, the nurse can activate the school's code for an intruder and describe the intruder to law enforcement.
Three weeks after being assaulted by a patient, a nurse develops headaches, insomnia, and gastrointestinal problems. The nurse has had four absences from work over a 2-week period. Which action should the nursing supervisor employ? a. Refer the nurse for counseling and support. b. Ask the nurse about current personal problems. c. Direct the nurse to take paid vacation for the following week. d. Schedule the nurse for administrative tasks rather than patient care.
a. Refer the nurse for counseling and support. Nurses need to monitor their thoughts and feelings and learn to recognize when they need self-care, support, or professional help. This is especially true in the aftermath of violence. Nurses often suppress their own feelings in order to effectively handle the immediate situation and react later with anxiety.
A client is engaged in short-term therapy to assist in resolving complicated grieving over the loss of a child. Which intervention is directed toward encouraging the parent to fully express emotions regarding the child's death? a. Role-playing in order to describe how much the loss has affected life b. Talking to a friend about how life has changed since the loss c. Engaging in a discussion about the changes that losing a child will create d. Identifying strategies to help manage life without her child
a. Role-playing in order to describe how much the loss has affected life Encouragement of full expression of emotions and effect may include writing letters to deceased, role-playing, and looking at pictures. The remaining options, while appropriate, are focused on education and achieving peace in the post-death life of the client.
The nurse recognizes the influence of a dysfunctional hypothalamus when including which intervention for a specific client? a. Sleep hygiene measures for a 40 year old diagnosed with acute depression b. Frequent re-orientation to time and place for a 79 year old diagnosed with dementia c. Staff to accompany a 30 year old diagnosed with anorexia nervosa to the bathroom d. Limit setting for a 14 year old diagnosed with oppositional defiance disorder (ODD
a. Sleep hygiene measures for a 40 year old diagnosed with acute depression The hypothalamus maintains homeostasis. It regulates temperature, blood pressure, perspiration, libido, hunger, thirst, and circadian rhythms, such as sleep and wakefulness. Sleep hygiene is appropriate in this scenario. None of the remaining options are directly associated with the hypothalamus.
The nurse is completing a care plan for a patient who is exhibiting poor coping after receiving a serious medical diagnosis. Which interventions would the nurse consider? Select all that apply. a. Recommend a glass of wine before dinner each night for relaxation. b. Compile a list of activities that are of interest to the patient. c. Review pamphlets about treatment options with the patient. d. Identify positive aspects of the illness, such as the chance to spend more time with family. e. Reinforce the fact that the medical team can make treatment decisions, so the patient does not need to worry.
b, c, d Interventions that develop an action plan (activities that the patient is still able to do), education about the illness (review of treatment options), and changing how the patient views some aspect of the illness (have more time with family members) are all interventions that help coping skills. Recommending the use of alcohol is not good, because the drinking may get out of control or the alcohol may interact with prescribed medications. Having the medical team make all decisions reinforces the lack of control the patient feels and encourages negative coping mechanisms of denial and avoidance.
a charge nurse is reviewing Kubler-ross: five stages of grief with a group of newly licensed nurses. which of the following stages should the charge nurse include in the teaching (SATA) a. disequilibrium b. denial c. bargaining d. anger e. depression
b, c, d, e rationale on incorrect: disequilibrium is the second stage of Bowlby's four stages of grief (a)
A parent tells the nurse about the death of a child 2 years ago. Which comment by this parent warrants the nurse's priority attention? a. "I still have some of my child's toys and clothes." b. "A parent should never live longer than their child." c. "I never returned to church again after the death of my child." d. "My child has been dead a long time, but it seems like only yesterday."
b. "A parent should never live longer than their child." The correct response represents a covert message and suggests possible suicidal thinking by the parent. The nurse should further assess the meaning of the comment.
The nurse is assessing the coping abilities of a patient recently diagnosed with a degenerative neuromuscular disease with no known cure. Which statement by the patient alerts the nurse that more intervention is needed? a. "I have decided to take some art lessons at the community center." b. "I am sleeping much better when I have two drinks and smoke before bed." c. "I am scheduling a family reunion for the upcoming holiday." d. "I have decided to sell my house and move into an apartment with my son."
b. "I am sleeping much better when I have two drinks and smoke before bed." Using alcohol, smoking, or drugs to enhance sleep is not a positive coping mechanism, and it is also a safety hazard; other interventions should be enlisted to help the patient cope with the devastating diagnosis. Taking art lessons and planning a family reunion are positive ways to not focus on the illness and keep the patient from becoming more isolated. Moving in with a family member is a problem-solving strategy that allows the patient to maintain more control over the illness outcome.
The school nurse assesses four adolescents who appear to have a healthy weight. Which comment would lead the nurse to explore further for an eating disorder? a. "I usually try to exercise 30 minutes a day." b. "I know everything in my life will be better once I lose 15 more pounds." c. "I forgot my lunch today, so I will only be eating an apple." d. "I know I shouldn't eat potato chips, but I just love them."
b. "I know everything in my life will be better once I lose 15 more pounds." People with eating disorders may perceive themselves as overweight and place unrealistic value on being thin. Losing 15 pounds is not likely to alter all aspects of someone's life.
A client is currently expressing suicidal ideations. Which statement made by the client demonstrates knowledge of appropriate crisis management techniques that are focused on safety? a. "I know the thoughts will likely go away." b. "I need you to stay with me." c. "I have survived the urge to kill myself before." d. "I trust the staff here to help."
b. "I need you to stay with me." During a suicidal crisis, it is important that the client understand that the crisis is temporary; unbearable pain can be survived; that help is available; and he or she is not alone. The knowledge most relevant to the client's safety is that he or she is not alone. Being attended to by another demonstrates that he or she is important and cared about. These are the feelings necessary to resist following through on his or her suicidal ideations.
Which client statement reflects resiliency associated with a situational crisis he or she is experiencing? a. "I wasn't planning on another pregnancy but I would never consider an abortion." b. "Losing my son is so hard but when my father died, grief counseling really helped." c. "Retirement is something I had always dreaded but so far it's been pretty enjoyable." d. "When my son died in the flood, I depended on my family and friends for support."
b. "Losing my son is so hard but when my father died, grief counseling really helped." Situational crises are somewhat common, and at least some of them, like experiencing a loss through death, will be experienced by all individuals during their lifetime. Response to the situation depends in part upon the degree of support available. The existence of caring friends, family members, and groups as well as previous success in navigating life events (resiliency), and the overall physical and emotional health of the individual all contribute to an individual's resiliency. The correct option represents both a situational crisis and resiliency based in a past experience. Retirement is a maturational crisis, and the option demonstrates acceptance but not resiliency. While the pregnancy is a situational crisis, the option demonstrates a value but not resilience. The death of a loved one in a flood is an example of an adventitious crisis and the option doesn't demonstrate a past experience upon which to rely.
The nurse in a high school meets with small groups of students the day after a school bus accident resulted in the death of five students. Which comment should the nurse use to begin the session? a. "Sometimes life is not fair. Yesterday's tragedy is an example of just how unfair it can be." b. "We're grateful that you are safe. Our discussion is to talk about feelings associated with yesterday's tragedy." c. "We've had a terrible loss. I also feel your pain. You need to talk about your feelings associated with the event." d. "Thank you for coming today. As school leaders, we know it is very important to respond to yesterday's tragedy."
b. "We're grateful that you are safe. Our discussion is to talk about feelings associated with yesterday's tragedy." In phase 1 of a crisis, a person faces a conflict or problem that threatens the self-concept and responds with increased feelings of anxiety. The nurse should first assure students that they are safe and then specify the reason for the session.
Which nursing assessment question is focused on determining the client's motivation for binge eating? a. "Does binging help you get the attention you need?" b. "Would you say that you are less depressed after binging?" c. "Are you less likely to hear voices while you are binging?" d. "Do you sleep better at least temporarily after binging?
b. "Would you say that you are less depressed after binging?" Overeating is frequently noted as a symptom of a depression. Binge eaters report that binge eating is soothing and helps to regulate their moods. The dysfunctional eating pattern is not associated with a need for attention, auditory hallucinations, or a sleep disorder.
Which nursing intervention will best address the intense need to control demonstrated by a client receiving treatment of bulimia nervosa? a. Monitoring the client for the presence of suicidal thoughts and behaviors b. Clearly stating expectations and admitting that they differ from those of the client c Helping the client reframe irrational thinking that leads to dysfunctional eating d. Having the client keep a journal that identifies triggers that cause dysfunctional eating
b. Clearly stating expectations and admitting that they differ from those of the client A straightforward statement that the nurse's perceptions are different will help avoid a power struggle. Arguments and power struggles intensify the patient's need to control. Suicide assessment relates to client safety. While reframing and journaling are appropriate, those interventions are not associated with the need for the client to control his or her life.
A patient diagnosed with major depressive disorder was hospitalized for 2 weeks on an acute psychiatric unit. One day after discharge, the patient completed suicide. Recognizing likely reactions among staff, which action should the nursing supervisor implement first? a. Assess each staff member individually for suicidal intent and/or plans. b. Provide a private setting for staff members to talk about feelings associated with the event. c. Remind staff members that suicide is a risk for the patient population and that they are not at fault. d. Invite a guest speaker to conduct an educational session for staff members about suicide risk factors.
b. Provide a private setting for staff members to talk about feelings associated with the event. All health care members who provided care for a suicide victim, including medical staff, nursing staff, and ancillary staff, are at risk of being traumatized by suicide. Staff also may experience symptoms of posttraumatic stress disorder with guilt, shock, anger, shame, and decreased self-esteem. To reduce the trauma associated with the sudden loss, posttrauma loss debriefing can help to initiate an adaptive grief process and prevent self-defeating behaviors.
A client has made a successful suicide attempt while hospitalized on a unit that specializes on the treatment of depression. When considering both milieu control and crisis management, which intervention will the nursing staff implement? a. All group therapy sessions will be held on the unit for at least a 72-hour period. b. Suicide precautions for a full 24 hours will be implemented for all clients. c. Every client will be questioned concerning the impact the suicide had on him or her personally. d. A client-focused psychological postmortem assessment will be conducted immediately.
b. Suicide precautions for a full 24 hours will be implemented for all clients. A successful suicide attempt is a crisis situation for the unit. The safety of the milieu and of the individual clients are of primary importance. Since the unit focuses on clients diagnosed with depression, all the patients on the unit need to be closely monitored for suicidal ideations. The first 24 hours after inpatient suicide is crucial for both safety and crisis management reasons. A postmortem assessment is conducted by staff and administrators to review policies and procedures that would be relevant to preventing such an occurrence. The remaining options are not therapeutic in this situation.
A nurse who has worked for a community hospice organization for 8 years says, "My patients and their families experience overwhelming suffering. No matter how much I do, it's never enough." Which problem should the nursing supervisor suspect? a. The nurse is experiencing spiritual distress. b. The nurse is at risk for burnout and compassion fatigue. c. The nurse is not receiving adequate recognition from others. d. The nurse is at risk for overhelping, which creates dependency.
b. The nurse is at risk for burnout and compassion fatigue. The nurse's comment suggests a negative self-judgment. Burnout, decreased work performance, and compassion fatigue (the emotional pain or cost of working with traumatized persons) may result in stress responses for nurses.
Recognizing that grief and mourning are different processes, which statement reflects a client's progress toward completing the mourning process? a. "I've discovered who I can rely upon since he died." b. "It's only been 2 years since he died but it seems so much longer." c. "He had his faults but I know he loved me." d. "My love of gardening has given me pleasure since losing him."
c. "He had his faults but I know he loved me." The work of mourning is complete when the bereaved person or persons can remember realistically both the pleasures and the disappointments of the lost relationship. Grief work is successful when the relationship to the deceased person has been restructured and energy is available for new relationships and life pursuits. Brief periods of intense emotions may still occur at significant times, such as holidays and anniversaries, but the person or family members have energy to reinvest in new relationships that bring shared joys, security, satisfaction, and comfort. If, after a normal period (12 to 18 months), a person has not been able to find pleasure, satisfaction, and comfort in his or her life, then reassessment and re-evaluation are indicated.
Which assessment question will provide the nurse with information concerning the client's perception of the situational crisis of losing their job? a. "Do you have a plan for meeting your financial obligations while unemployed?" b. "Have you ever been out of a job before?" c. "How much will being unemployed for several months affect your life?" d. "Who can you rely upon for help while you are looking for a job?"
c. "How much will being unemployed for several months affect your life?" Whether an event is perceived as a crisis is, in part, dependent on the outlook and strengths of the patient. Therefore it is important to view the event through the eyes of the patient. The nurse's initial task is to assess the individual's and possibly the family's perception of the problem. The correct option directly assesses the client's perception of the crisis. While the other options are not inappropriate, they don't focus on perception.
A nurse assesses four adolescents diagnosed with various eating disorders. Which comment would the nurse expect from the adolescent diagnosed with anorexia nervosa? a. "I look good because whenever I overeat, I purge myself." b. "I love sweets. I make myself throw up so I can eat more." c. "I've lost 60 pounds, but I'm still a size 2. I want to be a size 0." d. "I've hidden my eating disorder from everyone, even my parents."
c. "I've lost 60 pounds, but I'm still a size 2. I want to be a size 0." Thought processes that accompany anorexia nervosa include a terror of gaining weight, viewing oneself as fat even when emaciated, and judging one's self-worth by one's weight or size.
An adult has had long-term serious medical problems and has just started a new medication resulting in decreased libido and sexual performance. The adult's spouse privately says to the nurse, "I don't feel loved anymore. I feel sexual urges, but my partner is not interested." Select the nurse's therapeutic response. a. "Tell me about how your partner shows love for you." b. "You're describing a scenario that many couples face." c. "Let's consider some other ways you can satisfy your needs." d. "I'm glad you are able to talk about and accept your situation."
c. "Let's consider some other ways you can satisfy your needs." The scenario presents a maturational crisis. Helping the spouse to consider other options is the nurse's most therapeutic action.
Shortly after hospitalization, an adolescent diagnosed with anorexia nervosa says to the nurse, "Being fat is the worst thing in the world. I hope it never happens to me." Which response by the nurse is appropriate? a. "You need to gain weight to become healthier." b. "Your world would not change if you gained a few pounds." c. "Tell me how your world would be different if you were fat." d. "Your attractiveness is not defined by a number on the scale."
c. "Tell me how your world would be different if you were fat." Cognitive distortions with underlying emotions of anxiety, dysphoria, low self-esteem, and feelings of lack of control are often present in persons with eating disorders. In this instance, the adolescent is catastrophizing. The nurse should first help the patient to identify the fears. Cognitive distortions are consistently confronted by all members of the interdisciplinary team in preparation for carefully planned challenges to the patient later in treatment.
A client diagnosed with major depression is reluctant to agree to the medication therapy stating, "I don't see how medication that affects my brain is going to make me less depressed." Which statement by the nurse best addresses the client's concern? a. "The staff has your best interests in mind and knows that this medication is very effective in treating depression." b. "While the brain is a very complex organ, it does respond very well to this medication." c. "Your brain controls your emotions; this medication will help the brain do that more effectively." d. "Are you afraid of taking the medication because of what your friends and family may think?"
c. "Your brain controls your emotions; this medication will help the brain do that more effectively." When circuitry in the prefrontal cortex (PFC) is impaired by a mental disorder (e.g., schizophrenia, major depression, addiction), there is a decrease in executive function, attention, impulse control, socialization, regulation of drives (such as libido), and emotions. Drugs targeting specific molecules within PFC circuits are being developed to normalize disrupted PFC activity. While the other options are appropriate statements, they do not address the client's concern about the connection between the brain, the medication, and depression.
A nurse managing the care of a client diagnosed with an eating disorder has begun to experience frustration when the client consistently pushes back against the planned interventions. What action on the part of the nurse is indicated to help strengthen the nurse-client relationship? a. Regularly sharing with peers the feelings and asking for their suggestions on minimizing the frustration b. Demonstrating a very matter-of-fact attitude when addressing issues related to interventions c. Acknowledging to the client that working toward these treatment goals must be very frightening d. Asking that a more experienced nurse be allowed to act as monitor in order to identify any existing countertransference
c. Acknowledging to the client that working toward these treatment goals must be very frightening In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assumption of a parental role in the relationship. Frequent acknowledgment of the situation for the client and of the constant struggle that so characterizes the treatment will help during times of extreme resistance. Being supervised by a competent, supportive, more experienced clinician and sharing with peers help minimize feelings of frustration and can contribute to therapeutic growth in the nurse.
How will the nurse best assess a client for the current presence of suicidal ideations? a. Carefully observe the client's nonverbal behaviors. b. Determine whether the client has ever acknowledged suicidal ideations. c. Ask the client directly, "Are you thinking of killing yourself?" d. Place the client on one-on-one suicide observation.
c. Ask the client directly, "Are you thinking of killing yourself?" If suicidal ideations are suspected, always ask directly, "Are you thinking of killing yourself?" None of the other options effectively assess the client for currently suicidal thoughts/ideations.
While weighing patients on an eating disorders unit, the nurse overhears a psychiatric technician say, "I wish I had an eating disorder; maybe I'd lose a little weight." What is the nurse's best action? a. Report the clinical observation to the nursing supervisor. b. Ask the psychiatric technician, "What did you mean by that comment?" c. Privately discuss the importance of sensitivity with the psychiatric technician. d. Immediately interrupt the interaction between the patient and the psychiatric technician.
c. Privately discuss the importance of sensitivity with the psychiatric technician. The comment by the psychiatric technician trivializes the patients' problems. Low self-esteem and self-doubts about personal worth are characteristic features of persons who have eating disorders. The comment contributes to these aspects of self-perception.
A client has recently lost all his or her possessions in a fire a month ago. Which assessment data suggests that hospitalization should be considered? a. Has gained 10 pounds since the fire. b. Drinks a six pack of beer daily. c. States, "The fire made my life so hopeless." d. Reports, "I really do need someone to talk to."
c. States, "The fire made my life so hopeless." In crisis situations, it is important to evaluate the person's level of anxiety. Common coping mechanisms may be overeating, drinking, smoking, withdrawing, seeking out someone to talk to, crying, yelling, sleeping too much, praying, or engaging in other physical activity. The potential for suicide or homicide must be assessed. If the patient is thinking of harming themself or someone else, or is unable to take care of personal needs, hospitalization should be considered. The correct option demonstrates a potential risk for suicide.
The nurse is assessing a patient's coping abilities related to expected placement in a long-term care facility. Which risk factor is of most concern to the nurse? a. The patient's family members all live several hours away. b. The patient is a retired police officer. c. The patient was recently diagnosed with Alzheimer's disease. d. The patient will need assistance in moving from his home.
c. The patient was recently diagnosed with Alzheimer's disease. Poor cognition is a key risk factor for poor coping because the patient has difficulty assessing a situation and making decisions that allow a sense of control. Limited support is a risk factor, but decreased cognition adds to the patient's inability to understand changes. A retired police officer would typically have experienced stress and have some strengths in managing stress. Needing assistance to move is a short-term need; the inability to understand the need for the move or a new situation because of poor cognitive function is the greater concern.
When considering an individual's risk for suicide, which client will the nurse consider the priority? a. The older transgender female who has been repeatedly assaulted b. The resent Middle Eastern immigrant from a war torn country c. The teenager recovering from a self-inflicted gunshot wound d. The gay male who has been diagnosed with HIV
c. The teenager recovering from a self-inflicted gunshot wound By far the strongest risk factor for suicide is a previous suicide attempt but there is growing concern over the high suicide rates globally among vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; and lesbian, gay, bisexual, transgender, and intersex (LGBTI) persons. Higher suicide rates are also seen among those who are incarcerated and those who live through war.
Which anticonvulsant mood stabilizer often prescribed for bipolar disorder carries a Black Box warning that includes pancreatitis? a. Carbamazepine b. Lamotrigine c. Valproic acid d. Ramelteon
c. Valproic acid Valproic acid is helpful in bipolar patients unresponsive to lithium. Black Box warnings include hepatotoxicity, teratogenicity, and pancreatitis. There are no such warnings for lamotrigine or carbamazepine. Ramelteon is a melatonin receptor agonist that works as a hypnotic.
Which statement by the terminally ill client demonstrates an understanding of the concept of palliative care? a. "Palliative care will focus on the management of my cancer pain." b. "When I'm ready to die, I'll certainly consider palliative care." c. "The focus of hospice and palliative care are the same." d. "I'm dying and palliative care will help preserve my quality of life."
d. "I'm dying and palliative care will help preserve my quality of life." Palliative care provides holistic interdisciplinary care for people with serious life-limiting illness. This form of care emphasizes collaborative and coordinated care by an interdisciplinary team. It also provides services that are available concurrently or independent of curative or life-prolonging care as well as support of the patient and family, hope for peace, and dignity until death. Hospice is a model of care designed to help patients and family members during the last 6 months of life.
Which statement best demonstrates a client's understanding of how years of addiction have affected their ability to mature normally? a. "My years of addiction allowed me to avoid being a mature person." b. "Taking on grown up responsibilities is certainly a challenge." c. "I don't think I've ever had to think like an adult before." d. "I've got to learn how to address my problems like an adult would."
d. "I've got to learn how to address my problems like an adult would." Alcohol and drug addiction will interrupt an individual's progression through the maturational stages. As the patient escapes from stressors through the use of substances, he or she is not practicing communication and coping skills that contribute to maturity. When the individual gets clean and sober, he or she will discover that his or her maturation has been halted at about the age he or she began using drugs or alcohol. The good news is that the developmental process can resume and progress through supportive treatment. The correct option demonstrates an understanding of personal deficits and a need to address them, while the other options are statements of facts.
A nurse leads a bereavement group. Which participant's comment best demonstrates that the work of grief has been successfully completed? a. "Our time together was too short. I only wish we had done more things together." b. "I know our life together was a blessing that I did not deserve. I wish I had said, 'I love you' more often." c. "Other people knew my loved one as a good and helpful person. I hope people see me in the same way." d. "Our best vacations always involved water. When I see pictures of the ocean, those memories come flooding in."
d. "Our best vacations always involved water. When I see pictures of the ocean, those memories come flooding in." The work of grief is over when the bereaved can realistically remember the pleasures and the disappointments of the relationship with the lost loved one. Brief periods of intense emotions may still occur at significant times, but the person or family members have energy to reinvest in new relationships that bring shared joys, security, satisfaction, and comfort.
A patient has come to the health clinic for an annual checkup. He reports an increase of stress at work and having to work a lot of mandatory overtime hours. He has not been able to do his usual daily exercise for several weeks. What is the best response by the nurse? a. "There are other ways you can reduce your stress, such as cutting back on your work hours." b. "Have you considered a medication to help you sleep at night?" c. "Including exercise in your schedule will just increase the stress from work." d. "Regular exercise would be good because it helps the body deal with stress."
d. "Regular exercise would be good because it helps the body deal with stress." Exercise is a form of emotion-based coping that increases a feeling of well-being. Cutting back on hours may not be an option in his current work climate, although it might help reduce stress. There are other nonpharmacological methods that may help with stress, such as music or meditation, which would not involve possible side effects from medications. Exercise will decrease feelings of stress when balanced with the time requirements of the stressor.
A client has demonstrated behaviors suggestive of schizophrenia. As a part of the diagnostic process, the nurse is preparing the client for a magnetic resonance imaging study (MRI). Which statement by the nurse best addresses the client's concern about why the test is being done? a. "It's a series of cross-sectional pictures of the structure of your brain." b. "It's a painless way to see inside the brain and view its structures." c. "This method reduces the brain's exposure to x-rays and radioactive isotopes." d. "The study will show how well the blood is flowing to the ventricles of your brain."
d. "The study will show how well the blood is flowing to the ventricles of your brain." An MRI is capable of providing a high-resolution, 3D-like cross section of the brain. Such a view would allow an evaluation of the blood flow to the ventricles that are usually impaired in clients diagnosed with schizophrenia. The remaining options are correct statements but fail to provide an explanation regarding the value of an MRI to the diagnosis of schizophrenia.
A client prescribed a second-generation antipsychotic (SGA) asks why the medication is referred to with that term. What is the nurse's best response? a. "It's used to identify the newer form of antipsychotic medications." b. "SGAs produce fewer side effects than the first-generation formulation does." c. "SGAs are capable of treating a larger variety of mental illnesses." d. "They contain a higher ratio of serotonin to dopamine than first-generation forms do."
d. "They contain a higher ratio of serotonin to dopamine than first-generation forms do." A SGA has a higher ratio of serotonin (5-HT2) to dopamine D2-receptor blockade than do first-generation forms. The remaining options are true statements but fail to provide an explanation as to the reason for the difference in terms but rather identify differences in use and action.
A patient is hospitalized with a diagnosis of anorexia nervosa. The nurse reviews the patient's laboratory results, as follows: Sodium 143 mEq/L Potassium 3.1 mEq/L Chloride 102 mEq/L Magnesium 2.2 mEq/L Calcium 8.4 mg/dL Phosphate 3.0 mg/dL The nurse should take which action next? a. Measure the patient's body temperature. b. Inspect the patient's skin and sclera for jaundice. c. Assess the patient's mucous membranes for erosion. d. Auscultate the patient's heart rate, rhythm, and sounds.
d. Auscultate the patient's heart rate, rhythm, and sounds. The laboratory results show hypokalemia and hypocalcemia, which are likely to affect cardiac function, producing bradycardia, arrhythmias, and/or murmurs.
Which assessment data confirms that the client diagnosed with anorexia nervosa has achieved a fundamental treatment outcome? a. Acknowledges that symptoms of depression exist. b. Client has eaten 60% of three meals per day for 3 consecutive weeks. c. Demonstrates an understanding of what constitutes healthy eating habits. d. Client has maintained weight at 87% of ideal body weight for 2 months.
d. Client has maintained weight at 87% of ideal body weight for 2 months. Some common outcome criteria for patients with anorexia nervosa include normalize eating patterns, as evidenced by eating 75% of three meals per day plus two snacks and achieving 85% to 90% of ideal body weight; demonstrating two new, healthy eating habits and improved self-acceptance; and participating in treatment of associated psychiatric symptoms (defects in mood, self-esteem), not just acknowledging the presence of symptoms.
A widow is demonstrating signs of complicated grief after the death of her spouse 18 months ago. Which information included in her mental health assessment should the nurse identify as requiring further investigation? a. They had been happily married for over 50 years. b. The couple lost a child when she was 4 years old. c. Her husband was an insulin-dependent diabetic. d. His death was a result of a failed robbery attempt.
d. His death was a result of a failed robbery attempt. Indicators of the potential for complicated or unresolved grief include social isolation, extensive dependency on the deceased person, unresolved interpersonal conflicts, loss of a child, a catastrophic loss, or a violent and senseless death like that of her husband. While the loss of a child is considered a possible trigger, this client's current loss was not associated with a child. The remaining options are not recognized triggers for complicated grief.
A patient on an acute psychiatric unit removed the cap from the ceiling sprinkler, resulting in rapid flooding of the unit. After moving patients to a safe area, which action should the nurse take next? a. Conduct individual sessions with patients regarding the experience. b. Increase the volume of overhead music to distract patients from the event. c. Implement a psychomotor activity to reduce anxiety associated with the event. d. Lead a group session with patients to discuss feelings associated with the event.
d. Lead a group session with patients to discuss feelings associated with the event. After addressing safety concerns, the nurse should take steps to help patients feel safe and lower anxiety, such as providing a quiet environment, building rapport, and acknowledging their crisis experience. A group session will allow patients who are unable to articulate their feelings to hear from patients who are able to discuss it.
What classic characteristic is noted in clients diagnosed with bulimia nervosa? a. Involved in sports b. Obesity c. Male d. Onset in late adolescence
d. Onset in late adolescence The most common age of onset for eating disorders is during adolescence, although eating disorders can occur in patients of any age, gender, race, or ethnicity. The risk is highest for young men and women between 13 and 17 years of age. The onset of binge-eating disorders is most common in the mid-20s. The DSM-5 states that approximately one-third of binge eaters are obese. Being athletic is not considered a characteristic. Eating disorders of all kinds are more prevalent in females than males.
A single adult says to the nurse, "Both of my parents died several years ago, and my only sibling committed suicide 2 weeks ago. I feel so alone." After determining that the adult has no suicidal ideation, the nurse should: a. Explore the adult's feelings of survivor's guilt. b. Assess the adult's cultural beliefs and spirituality. c. Refer the adult for cognitive-behavioral therapy (CBT). d. Refer the adult to a self-help group for suicide survivors.
d. Refer the adult to a self-help group for suicide survivors. Referrals need to be made available to family members and friends to assist them in dealing with and addressing the many emotional reactions and problems that easily may develop after the suicide of a family member or friend. Self-help groups are extremely beneficial for survivors.
A nurse has begun working in a new unit with high-acuity patients who are scheduled for numerous diagnostic tests before being transferred to the appropriate medical or surgical unit. She also has care responsibilities for her children and her aging parents. The nurse is experiencing signs of being overwhelmed. What counsel might the nurse manager share with the nurse to help her cope with work stress? a. Take some time off to decide if she really wants to be a nurse. b. Encourage her to catch up on her documentation responsibilities while taking her lunch break. c. Enlist the help of other family members in the care of her children so she can focus on work. d. Request that another nurse help her focus on essential aspects of care rather than optional aspects of care.
d. Request that another nurse help her focus on essential aspects of care rather than optional aspects of care. Learning to prioritize care to what is essential to perform versus what would be nice to perform but could be eliminated on stressful days will help the nurse manage her physical and emotional resources at work. Taking time off does not address the underlying issue of how to handle work stress. Periodic breaks in a work day, such as a meal break, allow the staff to refocus and maintain energy to complete their work. Support from family may help address stressors at home but does not help manage stress at work.
A recently widowed adult says, "I've been calling my neighbors often, but they act like they don't want to talk to me. I just need to talk about it, you know?" What is the nurse's best action? a. Say to the person, "You may call me anytime you need to talk." b. Ask the person, "What do you mean by 'I just need to talk about it'?" c. Educate the person about the importance of finding alternative activities. d. Tell the person the location and time of a local bereavement support group.
d. Tell the person the location and time of a local bereavement support group. This person is mourning. A grief or bereavement support group is indicated and can provide comfort.
a nurse is caring for a client following the loss of a partner due to a terminal illness. identify the sequence of Engel's five stage of grief that the nurse should expect the client to experience a. developing awareness b. restitution c. shock and disbelief d. recovery e. resolution of the loss
sequence: shock & disbelief developing awareness restitution resolution recovery
