Mental Health Exam 4 Practice Q's
A community mental health nurse plans an educational program for the staff of a home health agency specializing in care of the elderly. A topic of high priority should be A.identifying clinical depression in older adults. B.identifying nutritional deficiencies in the elderly. C.providing cost-effective foot care for the elderly. D.psychosocial stimulation for those who live alone.
A
Veronica tries to refer to the electric bill, but ends up saying, "you know, the invitation. The invitation". What is this a sign of? A.Aphasia A.Apraxia B.Agnosia Perseveration
A
Which child would be most difficult to diagnose for a neurodevelopmental disorder? A.3 years old B.5 years old C.8 years old 12 years old
A Younger children are more difficult to diagnose than older children because of their limited language skills and cognitive and emotional development.
A patient is scheduled for DBS. Which of these disorders is most likely to improve from such treatment, if all else has failed? A.Tic disorder B.ASD C.Social communication disorder D.Developmental coordination disorder
ANS: A A sort of pacemaker for the brain, deep brain stimulation (DBS) is used when more conservative treatments for tic disorders fail. A fine wire is threaded into affected areas of the brain and connected to a small device implanted under the collarbone that delivers electrical impulses. Users of DBS can turn the device on to control tics or shut it off when they go to sleep.
Acute onset of disordered thinking is most associated with: A.delirium. B.Alzheimer's disease. C.frontotemporal dementia. D.dementia with Lewy bodies.
ANS: A Acute onset and fluctuating levels of awareness are key findings in delirium.
A family member of a patient with advanced dementia says to the nurse, "I will sign the consent for my mother's surgery." What is the nurse's best response? A."This should be a family decision. When will your siblings arrive?" B."Can you please show me the Court order designating you as guardian?" C."Thank you. Please use a black ballpoint pen to sign." D."The patient is able to sign her own consent."
ANS: B A guardianship is a court-ordered relationship in which one party, the guardian, acts on behalf of an individual, the ward. Many people with mental illness, mental retardation, traumatic brain injuries, and organic brain disorders, such as dementia, have guardians. It is important that health care workers identify patients who have guardians and communicate with the guardians when health care decisions are being made.
A 4-year-old frequently lashes out in anger at adults and other children. This child's style of behavior is an aspect of A.neurobiology. B.temperament. C.resilience. D. culture.
ANS: B Temperament is the style of behavior a child habitually uses to cope with the demands and expectations of the environment.
Mr. Nixon needs help with his prescription ordering. Which component of Medicare assists seniors to pay for prescription drugs? A.Part A B.Part B C.Part C D. Part D
ANS: D Medicare Part D pays 75% of total drug costs, after a $275 deductible, up to the initial limit of $2,510.
Mimi's mother is not abusive or neglectful, but she does put her child at some risk for being overly controlling and keeping her a bit too close, largely out of worry or fear. Which of the following is most prevalent cause of child abuse? A. Physical abuse B. Sexual abuse C. Verbal abuse D. Neglect
ANS: D Neglect is the most prevalent form of child abuse in the United States. According to the U.S. Department of Health and Human Services (2016) 75% of all abuse victims were neglected, 17% physically abused, and about 8% were sexually abused. Although neglect has a much higher incidence rate than physical or sexual abuse, research into its effect on children's mental health has been studied less.
Mr. Nixon, who has difficulty walking because of shortness of breath secondary to COPD says, "Every day is a struggle when you get old. No one cares about old people." Select the best response. A."Rest periods are important. Don't try to overexert yourself." B."It sounds like you're having a difficult time. Tell me about it." C."Let's not focus on the negative. Tell me something good." D."You are still able to get around, and your mind is alert."
B
Which statement demonstrates that Victor's dad understands the diagnosis of ADHD? A."Victor will never be able to graduate or go to college but may be able to learn a vocational skill." B."Victor's performance will improve in a structured setting that provides rewards for appropriate behavior." C. "Nothing is wrong with Victor. The school hasn't provided qualified teachers and classroom settings." D."Victor is just going through a stage. This problem will go away with time."
B
Let's return to Addie, who fainted during gym class. She is grossly underweight, wears baggy clothes, and her skin is dry. To further assess for anorexia nervosa, the school nurse should ask: A."Do you often wear heavy clothing in warm weather?" B."When was your last menstrual period?" C."Do you use any drugs or alcohol?" D. "Do you ever lose lapses of time?"
B Amenorrhea often accompanies anorexia nervosa.
Veronica's AD has progressed. One morning, she attempts to brush her teeth with a spoon. Which problem is evident? A.Aphasia B.Apraxia C.Agnosia D. Perseveration
B Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment.
Which is an indication that Veronica does not have delirium? A.She seems confused. B.She gets anxious and agitated. C.She seems disorganized in her thoughts. D.Her problems with memory have been developing gradually.
D Delirium has an abrupt onset, while Veronica's problems with memory have been developing gradually. Both delirium and dementia patients can exhibit signs of confusion, anxiety, agitation, and disorganized thoughts.
Earlier we learned that Addie's skin was slightly yellow and her skin showed signs of dehydration. What is yellow skin in anorexia nervosa linked to? A.Lanugo B.Amenorrhea C.Use of street drugs D. Hypercarotenemia
D As anorexia nervosa progresses, the patient develops, among other things, hypercarotenemia, which manifests as yellow skin. Lanugo (fine body hair) and amenorrhea (loss of menstrual periods) are other signs of anorexia due to other causes, including starvation and low weight.
Hypoalbuminemia in a patient with an eating disorder would produce which assessment finding? A.Lanugo B.Jaundice C.Amenorrhea D.Peripheral edema
D Peripheral edema often results from deficits of the protein albumin.
Mr. Anderson is found to be eating laundry powdered detergent on more than one occasion. This is most likely a sign of which feeding problem? A.Binge eating B.Rumination C.Bulimia D.Pica
D Pica is a feeding problem (as opposed to an eating disorder) and involves the eating of nonfood items after maturing past toddlerhood. It is not part of any other mental illness. Rumination is regurgitation of food. Binge eating and bulimia are two types of eating disorders, as opposed to feeding problems.
Addie condition worsens and she collapses at home. She is admitted to your unit with anorexia. You have completed your physical and biopsychosocial assessment of her. Which common personality trait is likely to present a particular challenge? A.Lack of hygiene and cleanliness B.Lack of interest in self and others C.Irresistible desire to purge D. Perfectionism
D The common personality traits of these patients—perfectionism, obsessive thoughts and actions relating to food, intense feelings of shame, people pleasing, and the need to have complete control over their therapy—pose additional challenges.
1.Which statement demonstrates a well-structured attempt at limit setting? a. "Hitting me when you are angry is unacceptable." b. "I expect you to behave yourself during dinner." c. "Come here, right now!" d. "Good boys don't bite."
a
2.When considering an eating disorder, what is a physical criterion for hospital admission? a. A daytime heart rate of less than 50 beats per minute b. An oral temperature of 100°F or more c. 90% of ideal body weight d. Systolic blood pressure greater than 130 mm Hg
a
5.Which patient statement supports the diagnosis of anorexia nervosa? a. "I'm terrified of gaining weight." b. "I wish I had a good friend to talk to." c. "I've been told I drink way too much alcohol." d. "I don't get much pleasure out of life anymore."
a
7.Taylor, a psychiatric registered nurse, orients Regina, a patient with anorexia nervosa, to the room where she will be assigned during her stay. After getting Regina settled, the nurse informs Regina: a. "I need to go through the belongings you have brought with you." b. "You can use the scale in the back room when you need to." c. "You will be eating five times a day here." d. "The daily structure is based around your desire to eat."
a
Malika has been overweight all of her life. Now an adult, she has health problems related to her excessive weight. Seeking weight loss assistance at a primary care facility Malika is surprised when the nurse practitioner suggests: a. A trial of SSRI antidepressant therapy b. Mild exercise to start, increasing in intensity over time c. Removing snack foods from the home d. Medication treatment for hypertension
a
The older patient is discussing chronic pain and asks the primary care provider for a prescription. Which medication should the nurse anticipate being ordered rather than an opioid? a. Gabapentin b. Acetaminophen c. Morphine d. Fentanyl
a
What is the rationale for providing a patient diagnosed with dementia easily accessible finger foods thorough the day? a. Increases input throughout the day b. The person may be anorexic c. Assists with monitoring food intake d. Helps prevent constipation
a
Which statement made by a family member tends to support a diagnosis of delirium rather than dementia? a. "She was fine last night but this morning she was confused." b. "Dad doesn't seem to recognize us anymore." c. "She's convinced that snakes come into her room at night." d. "He can't remember when to take his pills or whether he's bathed."
a
5. Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply. a. Limited language skills b. Level of cognitive development c. Level of emotional development d. Parental denial that a problem exists e. Severity of the typical mental illnesses observed in young children
a b c
4.What assessment question should the nurse ask when attempting to determine a teenager's mental health resilience? Select all that apply. a. "How did you cope when your father deployed with the Army for a year in Iraq?" b. "Who did you go to for advice while your father was away for a year in Iraq?" c. "How do you feel about talking to a mental health counselor?" d. "Where do you see yourself in 10 years?" e. "Do you like the school you go to?"
a b d
7. In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply. a. Children of color and poor economic conditions being underserved b. Increased stress in the family unit c. Markedly increased funding d. Premature termination of services
a b d
Safety measures are of concern in eating-disorder treatments. Patients with anorexia nervosa are supervised closely to monitor: Select all that apply. a. Foods that are eaten b. Attempts at self-induced vomiting c. Relationships with other patients d. Weight
a b d
Nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels. Specialized skills training and continuing education are helpful to diffuse nursing stress, as well as: Select all that apply. a. Expressing emotions by journaling b. Describing stressful events on Facebook c. Engage in exercise and relaxation activities d. Having realistic patient expectations e. Happy hour after work to blow off steam
a c d
What side effects should the nurse monitor for when caring for a patient prescribed donepezil (Aricept)? Select all that apply. a. Insomnia b. Constipation c. Bradycardia d. Signs of dizziness e. Reports of headache
a c d e
3. When considering the need for monitoring, which intervention should the nurse implement for a patient with anorexia nervosa? Select all that apply. a. Provide scheduled portion-controlled meals and snacks. b. Congratulate patients for weight gain and behaviors that promote weight gain. c. Limit time spent in bathroom during periods when not under direct supervision. d. Promote exercise as a method to increase appetite. e. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.
a c e
6. Pam, the nurse educator, is teaching a new nurse about seclusion and restraint. Order the following interventions from least (1) to most (5) restrictive: a. With the patient identify the behaviors that are unacceptable and consequences associated with harmful behaviors b. Placing the patient in physical restraints c. Allowing the patient to take a time-out and sit in his or her room d. Offering a PRN medication by mouthe. Placing the patient in a locked seclusion room
a-1 b-5 c-3 d-2 e-4
1. Which patient statement acknowledges the characteristic behavior associated with a diagnosis of pica? a. "Nothing could make me drink milk." b. "I'm ashamed of it, but I eat my hair." c. "I haven't eaten a green vegetable since I was 3 years old." d. "I regurgitate and re-chew my food after almost every meal."
b
6.Obesity can be the end result of a binge-eating disorder. The nurse understands that the best treatment option in persons with a binge-eating disorder promotes: a. Bariatric surgery b. Coping strategies c. Avoidance of public eating d. Appetite suppression medications
b
Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to: a. Limited executive function b. Cerebellum maturation c. Cerebral stasis and hormonal changes d. A slight reduction in brain volume
b
Anxiety problems in older adults can manifest as a fear of falling, greatly influencing an older adult's personal freedom. A home health nurse checking on a patient with mild dementia and anxiety related to falling should question which new order? a. Yoga and tai-chi b. Xanax c. Relaxation techniques d. Electric wheelchair
b
April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April's mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that: a. Time-out is an important part of April's baseline discipline. b. Time-out is no longer an effective therapeutic measure. c. April enjoys time-out, and acts out to get some alone time. d. Time-out will need to be replaced with seclusion and restraint.
b
During an interview with a patient, which question asked of an older adult is associated with the Patient Self-Determination Act? a. "Who besides yourself may have access to your medical information?" b. "Have you discussed your end-of-life choices with your family or designated surrogate?" c. "Do you have the information you need to make an informed decision about your treatment?" d. "How can I help you feel comfortable about this interview and any decisions you need to make?"
b
When considering the pathophysiology responsible for both delirium and dementia, which intervention is appropriate for delirium specifically? a. Assist with needs related to nutrition, elimination, hydration, and personal hygiene. b. Monitor neurological status on an ongoing basis. c. Place identification bracelet on patient. d. Give one simple direction at a time in a respectful tone of voice.
b
Which statement by an older patient with a mild neurocognitive disorder demonstrates a safe response to beginning a new medication? a. "I read the information the pharmacist gave me when I got the prescription filled." b. "My daughter comes with me to appointments so that we get all the information we need." c. "I know I can call my doctor if I think of any questions later." d. "I always follow the instructions on the medication bottle."
b
You are caring for Ellie, age 91, whose provider has written a "DNR-CCO" order. Which nursing action would be appropriate if Ellie were to go into cardiac arrest? a. Immediately call for the code team b. Notify the attending physician and family of the change in status c. Administer prescribed medication morphine for pain control d. Initiate cardiopulmonary resuscitation
b
3. Cognitive-behavioral therapy is going well when a 12-year- old patient in therapy reports to the nurse practitioner: a. "I was so mad I wanted to hit my mother." b. "I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd." c. "I forgot that you told me to breathe when I become angry." d. "I scream as loud as I can when the train goes by the house."
b e
Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his "nice" mom, that he loves school, and gets above average grades. The strongest explanation of this response is: a. Temperament b. Genetic factors c. Resilience d. Paradoxical effects of neglect
c
Considering psychosocial role theory, which patient demonstrates healthy adjustment to aging? a. The 70-year-old who is training for a 5-mile running race b. The older adult who controls diabetes with diet and exercise c. The retiree who volunteers 3 days a week at the local library d. The 80-year-old who is upbeat and hopeful during chemotherapy for lung cancer
c
Malika agrees to try losing weight according to the nurse practitioner's outlined plan. Additional teaching is warranted when Malika states: a. "I am willing to admit I am depressed." b. "Psychotherapy will be a part of my treatment." c. "I prefer to have a gastric bypass rather than use this plan." d. "My comorbid conditions may improve with weight loss."
c
Nancy is a nurse. After talking with her mother, she became concerned enough to drive over and check on her. Her mother's appearance is disheveled, words are nonsensical, smells strongly of urine, and there is a stain on her dressing gown. Nancy recognizes that her mother's condition is likely temporary due to: a. Early onset dementia b. A mild cognitive disorder c. A urinary tract infection d. Skipping breakfast
c
Which statement made by a nurse requires immediate correction by the supervisor? a. "Many older patients are depressed." b. "Retirement is a difficult time for older patients." c. "Cognitive decline is normal in patients who are 65 and older." d. "Sleep-related problems are often reported by older adults."
c
Which statement made by the primary caregiver of a patient diagnosed with dementia demonstrates accurate understanding of providing the patient with a safe environment? a. "The local police know that he has wandered off before." b. "I keep the noise level low in the house." c. "We've installed locks on all the outside doors." d. "Our telephone number is always attached to the inside of his shirt pocket."
c
2.Which activity is most appropriate for a child with ADHD? a. Reading an adventure novel b. Monopoly c. Checkers d. Tennis
d
4.Which intervention will promote independence in a patient being treated for bulimia nervosa? a. Have the patient monitor daily caloric intake and intake and output of fluids. b. Encourage the patient to use behavior modification techniques to promote weight gain behaviors. c. Ask the patient to use a daily log to record feelings and circumstances related to urges to purge. d. Allow the patient to make limited choices about eating and exercise as weight gain progresses.
d
Darnell is an 84-year-old widower who has lived alone since his wife died 6 years ago. A neighbor called Darnell's son to tell him that Darnell was trying to start his car from the passenger's side. He became angry and aggressive when the car would not start. After a medical assessment, Darnell was diagnosed with a major neurocognitive disorder. The nurse realized additional family teaching is necessary when Darnell's son states: a. "My father's diagnosis is interfering with his daily functioning." b. "This neurocognitive disorder will probably progress." c. "Advancing age is a risk factor in my father's diagnosis." d. "With person-centered care, my father will be able to remain in his home."
d
Fred is an older adult with spinal stenosis and who is being treated with a short-term prescription of opioids for an acute episode of back pain. His nurse recognizes additional teaching is necessary when Fred states: a. "Sitting up straight seems to reduce the pain." b. "Sometimes I use a heating pad on my back." c. "Once I get moving for the day my pain gets better." d. "My wife and I share my Norco for our aches and pains."
d
In the 2 months after his wife's death, Aaron, aged 90 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate? a. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him. b. Meet with family and support them to accept, anticipate, and prepare for the progression of his stage 2 dementia. c. Avoid touch and proximity; these are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented. d. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression.
d
Ling works as a registered nurse in an Alzheimer's care home. Ling has a specialized rapport- building technique she uses called reminiscence. She uses this technique by: a. Telling the residents stories about her grandparents' lives. b. Playing music from the residents' formative years. c. Reviewing movies that the residents enjoy. d. Encouraging the residents to talk about pleasurable past events.
d
Marco, age 83, has dementia and difficulty feeding himself despite the fact that there is nothing wrong with his motor functions. Which term should the nurse use to document this finding? a. Aphasia b. Apraxia c. Agnosia d. Disinhibition anergia
d
Ophelia, a 69-year-old retired nurse, attends a reunion of her former coworkers. Ophelia is concerned because she usually knows everyone, and she cannot recognize faces today. A registered nurse colleague recognizes Ophelia's distress and "introduces" Ophelia to those attending. The nurse practitioner recognizes that Ophelia seems to have a deficit in: a. Lower-level cognitive domain b. Delirium threshold c. Executive function d. Social cognition
d