Sample Chapter

INSTANT DOWNLOAD

 

Foundations of Mental Health Care 4th Edition by Michelle Morrison – Valfre – Test Bank 

 

Morrison-Valfre: Foundations of Mental Health Care, 4th Edition

 

Test Bank

 

Chapter 4: Sociocultural Issues

 

MULTIPLE CHOICE

 

  1. An older Asian female with a diagnosis of depression is cared for by her granddaughter. Her granddaughter is very attentive to the client’s needs, attends every therapy session, and is active in the planning and implementing of the treatment plan.  The granddaughter’s valuing of her grandmother is most likely due to her:
a. Ethnicity
b. Cultural beliefs
c. Religion
d. Stereotype

 

 

ANS:  B

Cultural beliefs develop over many generations and are a learned set of values, beliefs, and behaviors. Asian cultures commonly value their elderly family members. Ethnicity and religion do not explain the granddaughter’s behavior in that ethnicity describes customs and socialization patterns, and religion refers to an organized form of worship.  Stereotyping is a pre-conceived belief about another cultural group, so it does not apply to this situation.

 

DIF:    Cognitive Level: Application          REF:   Page 29          OBJ:   1

TOP:   Characteristics of Culture               KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A traditional Arab female client is brought to the emergency room by her husband.  She complains of feeling very anxious and short of breath and has chest pain. What would likely be a hindrance to the care of this client?
a. The emergency room physician is female.
b. Her husband asks if he can stay with his wife.
c. One of the emergency room nurses is of Arab descent.
d. The only caregivers available in the emergency room are male.

 

 

ANS:  D

In some traditional Arab cultures, a woman will not make eye contact with any man except her husband and may not be touched by another man. Having only male staff in the emergency room on this shift would block necessary care. Arrangements would have to be made to have a female staff member come to the emergency room to assist in client care. The other options should not cause a problem.

 

DIF:    Cognitive Level: Application          REF:   Page 30          OBJ:   3

TOP:   Characteristics of Culture               KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. On what is Western medicine primarily based?
a. Empirical knowledge
b. Religious customs
c. Scientific research
d. Folk treatments

 

 

ANS:  C

Western medicine typically disregards what cannot be explained by scientific research.  Empirical knowledge serves as the basis for folk medicine and refers to knowledge that comes from observation. It encompasses cause and effect without knowledge of why something happens. Religious customs do not form the basis of Western medicine.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 29          OBJ:   4

TOP:   Health and Illness Beliefs               KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is performing an admission assessment on a Greek couple seeking care from a family counseling center. Although the couple is talking, the wife states that she wants to work as a teaching assistant at their daughter’s school, but her husband adamantly objects to the idea. If the wife were to work outside the home, she most likely would be seen in their culture as:
a. Eccentric
b. Strong-willed
c. Self-sufficient
d. Dependent

 

 

ANS:  A

Traditional Greek cultural beliefs see the husband as the head of the household, and it is a dishonor if the wife works outside the home. The behavior is deemed eccentric or deviant. Strong-willed, self-sufficient, and dependent would not be adjectives that would describe feelings about the wife in this cultural situation.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 30          OBJ:   3

TOP:   Characteristics of Culture               KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Disease is defined as:
a. Social dysfunction
b. Emotional dysfunction
c. Physical dysfunction
d. Intellectual dysfunction

 

 

ANS:  C

Disease differs from illness in that disease is an abnormal physical function, whereas illness refers to social, emotional, and intellectual dysfunction. Illness is affected by culture, but disease is not.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 30          OBJ:   4

TOP:   Health and Illness Beliefs               KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is caring for a 20-year-old woman from Puerto Rico. The client speaks English, but she is accompanied by her mother, who does not. The client has a history of mental illness, and through the interpreter, the nurse learns that the mother, who has traditional Puerto Rican cultural beliefs, believes that the client’s mental illness is caused by:
a. Witchcraft
b. Stress
c. Chemical imbalances
d. A trance

 

 

ANS:  A

It is a common traditional Puerto Rican cultural belief that mental illness is caused by witchcraft, magic, or evil spells, as opposed to more traditional Western medicine, which believes that stress and chemical imbalances play a role in mental illness. A trance is considered a state of consciousness in some cultures.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 31          OBJ:   4

TOP:   Health and Illness Beliefs               KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A mental health care provider who is aware of her cultural views and attitudes toward other cultures and who strives to understand, communicate, and effectively work with clients of other cultures is considered to be:
a. Prejudiced
b. Culturally competent
c. Stereotypical
d. Proficient

 

 

ANS:  B

Culturally competent providers of mental health care are more likely to be effective in the treatment of individuals with disorders. Stereotyping and prejudice will block therapeutic interventions. Proficient simply means knowledgeable.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 32          OBJ:   5

TOP:   Cultural Assessment                       KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. When a cultural assessment of communication is performed, which of the following is considered nonverbal communication?
a. Silence
b. Volume of speech
c. Pronunciation
d. Music

 

 

ANS:  A

Silence is considered nonverbal communication that is important in determination of cultural practices and meaning, as are forms of verbal communication such as volume of speech, pronunciation, and music.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 32          OBJ:   5

TOP:   Communication in Cultural Assessment

KEY:  Nursing Process Step: Assessment  MSC:  Client Needs: Psychosocial Integrity

 

  1. A client is continually late for his appointment at the mental health clinic. What is a likely reason for his lack of punctuality?
a. Need for environmental control
b. Time orientation
c. Space comfort zone
d. Territorial needs

 

 

ANS:  B

Mental dysfunction can lead to incorrect perception of time, causing the client to be continually late. In addition, some cultures do not see schedules and specific appointment times as important, causing the client to be continually late in the eyes of the caregiver.  Environmental control refers to an individual’s need to control his or her perception of the environment. Comfort zones are highly culture based, meaning that individual interpretation of personal space varies among cultures. Territorial needs provide a sense of identity and security for some clients.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 34          OBJ:   5

TOP:   Space, Territory, and Time in Cultural Assessment

KEY:  Nursing Process Step: Evaluation   MSC:  Client Needs: Psychosocial Integrity

 

  1. Which client communication problem can the nurse most easily correct?
a. Age differences
b. Altered cognition
c. Cultural differences
d. Gender differences

 

 

ANS:  C

The nurse can easily correct communication problems caused by cultural differences in a number of ways, including learning what cultural beliefs and practices are important to the client and being accepting of those beliefs. Communication problems due to age and gender differences and altered cognition cannot be corrected by the nurse.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 32          OBJ:   5

TOP:   Communication in Cultural Assessment

KEY:  Nursing Process Step: Intervention MSC:  Client Needs: Psychosocial Integrity

 

  1. What is the social orientation among most middle-class American families?
a. Extended
b. Friends
c. Significant others
d. Nuclear

 

 

ANS:  D

The nuclear family is the social orientation of family that is seen most frequently in this group. The extended family is seen as the social orientation for cultures such as some Alaskan, traditional Chinese, and Mexican cultures. Friends and significant others are not identified as a social orientation of family.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 34          OBJ:   5

TOP:   Social Organization in Cultural Assessment

KEY:  Nursing Process Step: Assessment  MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is performing an admission assessment on a female client. She is a white middle-class American who has recently married a male of Greek descent with strong traditional Greek cultural beliefs. She is displaying signs and symptoms of an eating disorder, most likely attributable to:
a. Genetics
b. Gender role conflict
c. Learned behavior
d. Modeling of behavior

 

 

ANS:  B

White middle-class American women usually have cultural beliefs that women can be outspoken and assertive, which totally conflicts with the beliefs of traditional Greek culture. Eating disorders, as well as phobias and depression, are commonly seen in clients who experience gender role conflict. Genetics, learned behavior, and modeling behavior are not indicated as causative factors in this scenario.

 

DIF:    Cognitive Level: Application          REF:   Page 31          OBJ:   4

TOP:   Health and Illness Beliefs               KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

  1. It is important for the nurse to be familiar with the religious practices of clients cared for most often in a particular region because attitudes toward health and illness, death and burial, food, and procreation have a strong impact on a client’s beliefs and practices. The nurse knows that the religion practiced most often around the world is:
a. Buddhism
b. Jehovah’s Witness
c. Christianity
d. Ahmadiyya

 

 

ANS:  C

More than 2 billion individuals throughout the world are practicing Christians. Although these religions are seen in large numbers worldwide, it is important for the nurse to be familiar with the religions most frequently seen in the client populations with whom he works within his own area.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 35          OBJ:   6

TOP:   Social Organization in Cultural Assessment

KEY:  Nursing Process Step: Evaluation   MSC:  Client Needs: Psychosocial Integrity

 

  1. The metabolism of psychotropic medications is most likely to be affected by:
a. Ethnicity
b. Religion
c. Culture
d. Values

 

 

ANS:  A

A person’s genetics plays a role in how medications are metabolized through metabolic activity and enzyme functions; therefore, it is important for the clinician to monitor clients for effectiveness, side effects, and adverse reactions. Ethnicity is a determining factor in a person’s genetic makeup. Religious and cultural practices could play a role in the metabolism of medications as a result of food or alternative treatment interactions with medications, but the metabolism is more closely related to the genetic makeup.  Values have little to do with the metabolism of medications.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 35          OBJ:   5

TOP:   Biological Factors in Cultural Assessment

KEY:  Nursing Process Step: Evaluation   MSC:  Client Needs: Psychosocial Integrity

 

  1. A male Hmong client from Laos is a client at an outpatient mental health clinic who is being seen for his diagnosis of bipolar disorder. The importance of lithium testing was stressed in his discharge plans; however, it is discovered that he has had his lithium level checked only once, rather than the three scheduled times. What is the nurse’s best action?
a. Remind the client about the importance of lithium level testing.
b. Make scheduled appointments for the client to get his lithium level tested.
c. Give the client written information regarding the importance of lithium level testing and written instructions on how to make appointments for testing.
d. Talk with the client to see if there is a reason that he is not getting his lithium levels checked as outlined in his discharge plans.

 

 

ANS:  D

In the Hmong culture, it is believed that loss of blood leads to decreased body strength, which can cause the soul to leave the body, resulting in death. If the nurse did not discuss why the client was not getting his blood levels tested and gave him additional instructions as listed in the other options, the nurse would not understand and would not be able to incorporate the client’s cultural beliefs into the plan of care. The nurse and the client can now make revisions that will be acceptable while meeting the needs of the client.

 

DIF:    Cognitive Level: Application          REF:   Page 35          OBJ:   5

TOP:   Biological Factors in Cultural Assessment

KEY:  Nursing Process Step: Intervention MSC:  Client Needs: Psychosocial Integrity

 

  1. Culture includes common beliefs and practices in areas such as religion, economics, diet, health, and:
a. Genetics
b. Occupations
c. Patterns of communication
d. Stereotypes

 

 

ANS:  C

In addition to shared beliefs and practices in religion, economics, diet, and health, a person’s cultural integration consists of patterns of communication, politics, art, and kinship. The other three options are not part of a person’s culture.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 30          OBJ:   3

TOP:   Characteristics of Culture               KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. What is the usual approach to care for individuals who practice folk medicine?
a. Fragmented
b. Impersonal
c. Disjointed
d. Personalized

 

 

ANS:  D

Folk medicine is highly personalized; the descriptors fragmented, impersonal, and disjointed more often are associated with the Western medicine approach to health care.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 31          OBJ:   4

TOP:   Health and Illness Beliefs               KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A Navajo Native American is traveling across the country and becomes ill. He visits a hospital emergency room and appears very uncomfortable in the surroundings. The nurse knows that traditional Navajo Native Americans typically receive health care in:
a. Homes
b. Small hospitals
c. Physicians’ offices
d. Outpatient clinics

 

 

ANS:  A

Many traditional Native Americans receive health care in their homes, community settings, or social places. The emergency room setting would be very uncomfortable for this client.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 31          OBJ:   4

TOP:   Health and Illness Beliefs               KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. A male client is visiting his family in the United States and experiences what his family describes as a “breakdown.” His family takes him to a stress treatment center at a local mental health clinic. The client is a follower of traditional folk medicine practices and is agitated when he learns that he must see a licensed psychiatrist. Which care providers is this client most likely accustomed to? Select all that apply.
a. Healers
b. Shamans
c. Nurse practitioners
d. Spiritualists
e. Lay unlicensed therapists

 

 

ANS:  A, B, D, E

Individuals who practice folk medicine for care typically do not see licensed health care providers, such as nurse practitioners and physicians. Folk medicine beliefs regarding the causes of disorders and treatments are different from Western medicine beliefs.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 31          OBJ:   4

TOP:   Health and Illness Beliefs               KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which areas comprise the DSM-IV-TR cultural assessment tool for clients? Select all that apply.
a. Cultural identity of the client
b. Overall cultural assessment
c. Cultural explanation of the illness
d. Cultural factors relating to previous mental illness
e. Cultural factors relating to psychosocial environment
f. Cultural elements of relationship between client and care provider
g. Cultural factors related to level of functioning

 

 

ANS:  A, B, C, E, F, G

The six categories of cultural identity of the client, cultural explanation of the illness, cultural factors relating to psychosocial environment, cultural factors relating to level of functioning, cultural elements of the relationship between client and care provider, and overall cultural assessment constitute the cultural assessment tool, which allows mental health care providers to learn how clients perceive their world and how they cope, according to their culture. Previous mental illness would be found in the history section of a client’s assessment.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 33          OBJ:   5

TOP:   Cultural Assessment                       KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Refugees frequently experience depression, anxiety, and stress-related disorders caused by their particular circumstances. Therefore, in addition to a cultural assessment, what is important for the nurse to assess? Select all that apply.
a. Immigration history
b. History of arrival in the new country
c. How long the refugee has been in the new country
d. Whether anyone or anything was lost in coming to the new country
e. What type of medical insurance the refugee will be seeking to obtain

 

 

ANS:  A, B, C, D

A refugee is a person who flees from his or her home or country, usually because of war or persecution in the homeland. The refugee has experienced trauma not only in his life experiences, but also in the process of fleeing from home. Therefore, a more accurate assessment can be performed if these questions are answered. The type of medical insurance obtained is of little concern to this person at this time.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 35          OBJ:   7

TOP:   Culture and Mental Health Care     KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

COMPLETION

 

  1. A __________ is a simplified or standardized belief or conception regarding people who belong to another culture.

 

ANS:

Stereotype

Stereotyping can be negative or positive but can cause a mental health client to resist care if he feels he is being stereotyped by his caregiver. Extreme stereotyping is referred to as prejudice.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 29          OBJ:   2

TOP:   Characteristics of Culture               KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. __________ is a term that divides people into groups based on biological characteristics, including skin color, features, hair texture, and self-identification.

 

ANS:

Race

Race differs from ethnicity in that ethnicity refers to similar characteristics but is better defined socially.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 28          OBJ:   1

TOP:   Nature of Culture                           KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

  1. When a person believes that there is a power greater or higher than any human being, he is referring to his __________.

 

ANS:

Spirituality

This is an important concept for many individuals in terms of the progression of their illness and the plan of care.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 28          OBJ:   1

TOP:   Nature of Culture                           KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

Morrison-Valfre: Foundations of Mental Health Care, 4th Edition

 

Test Bank

 

Chapter 17: Cognitive Impairment, Alzheimer’s Disease, and Dementia

 

MULTIPLE CHOICE

 

  1. A 75-year-old male client is brought to the clinic by his son. The son states, “Ever since Mom died, Dad hasn’t been the same. At first he just seemed sad, but now he seems to get mixed up about everything.” The nurse is aware that based on the client’s history, the source of confusion is most likely:
a. Dementia
b. Depression from the loss of his wife
c. Hypoxia of the brain
d. Delirium from medications

 

 

ANS:  B

Depression in the elderly population is often a cause of confusion. The son’s description of the behaviors of his father since his wife’s death indicate that he became depressed, which has been followed by confusion. Dementia is a gradual onset of confusion, hypoxia is the result of brain injury, and delirium is sudden. Even though it appears that the confusion is caused by the depression, a thorough examination is warranted to confirm the cause.

 

DIF:    Cognitive Level: Application          REF:   Page 179        OBJ:   2

TOP:   The Five “Ds” of Confusion          KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. An elderly female client on the mental unit suddenly becomes upset because she can’t remember where she is and she says, “I can’t think straight.” The staff has never witnessed this behavior in the client, and this type of complaint is not documented in the nursing history. What is the client most likely experiencing?
a. Hallucinations
b. Dementia
c. Delusions
d. Delirium

 

 

ANS:  D

Delirium is characterized by a sudden onset of signs and/or symptoms such as disorientation, disorganized thinking, and decreased attention span. Delirium has various causes, such as medical conditions, drug reactions or interactions, and electrolyte imbalances. If the cause is determined early in the process, delirium is reversible. Hallucinations refer to perceptual alterations of the senses, dementia is a chronic condition of confusion related to disease, and delusions are irrational thoughts or beliefs that cannot be changed by rational explanations.

 

DIF:    Cognitive Level: Application          REF:   Page 180        OBJ:   2

TOP:   Clients with Delirium                                KEY:              Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. Vascular dementia is more common in individuals living in:
a. The United States
b. Japan
c. France
d. Australia

 

 

ANS:  B

The incidence of vascular dementia is more common in Japan for unknown reasons. Japanese citizens who move to the United States have been found to have a decreased rate of vascular dementia.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 182        OBJ:   5

TOP:   Causes of Dementia                       KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A 91-year-old female client with dementia is being seen by the home health nurse. Both she and her husband, who is 92 years old, were very active until her dementia became debilitating. Since that time, the client does not recognize her husband or children, forgets how to eat and dress, and wanders about the house day and night. Her husband wants to keep her at home to care for her, but the nurse notices that he is increasingly tired with each visit. What is the nurse’s priority intervention for the nursing diagnosis of caregiver role strain?
a. Discuss strategies to coordinate care and other responsibilities
b. Encourage involvement in support groups
c. Identify resources to include financial, legal, and respite care
d. Stress the importance of self-nurturing

 

 

ANS:  A

Although all the interventions relate to caregiver role strain, the highest-priority intervention for this situation, given the ages and circumstances, is to coordinate care and other responsibilities to family members or other health caregivers such as home health aides.

 

DIF:    Cognitive Level: Application          REF:   Page 189        OBJ:   9

TOP:   Caregiver Support                           KEY:  Nursing Process Step: Intervention

MSC:  Client Needs: Psychosocial Integrity

 

  1. A newly admitted elderly client seems to become confused and agitated every evening after dinner. This client most likely is suffering from:
a. Alzheimer’s disease
b. Acute dementia
c. Sundown syndrome
d. Delirium

 

 

ANS:  C

Sundown syndrome typically occurs during the late afternoon, evening, or night when an elderly person is in unfamiliar surroundings. The other three options occur at any time of day, evening, or night. The symptoms often disappear when the client is back in familiar surroundings.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 182        OBJ:   5

TOP:   Symptoms of Dementia                  KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The elderly spouse of a 74-year-old male client states that she has noticed that her husband “doesn’t remember as well as he used to.” She explains that he has been putting on his coat before his shirt, and that he can never get their checkbook to balance as it did in the past. The client is exhibiting signs and symptoms typical of:
a. Vascular dementia
b. Alzheimer’s disease
c. Acute delirium
d. Aging

 

 

ANS:  B

The person with Alzheimer’s disease commonly shows deficits in familiar tasks. Vascular dementia and acute delirium relate more to confused states, and dementia symptoms should not be assumed to be part of normal aging.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 183 | Page 184

OBJ:   6                    TOP:   Alzheimer’s Disease

KEY:  Nursing Process Step: Assessment  MSC:  Client Needs: Psychosocial Integrity

 

  1. The affective losses of Alzheimer’s disease refer to losses noticed in the individual’s:
a. Personality
b. Thought processes
c. Ability to make and carry out plans
d. Self-care

 

 

ANS:  A

Affective losses result in personality changes in the individual with Alzheimer’s disease. Thought processes and self-care do not relate to the individual’s personality, and the ability to make and carry out plans is referred to as conative loss.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 183        OBJ:   6

TOP:   Symptoms and Course of Alzheimer’s Disease

KEY:  Nursing Process Step: Planning       MSC:  Client Needs: Psychosocial Integrity

 

  1. The early stage of Alzheimer’s disease is characterized by:
a. Loss of recent memory
b. Loss of remote memory
c. Withdrawal from family
d. Apraxia

 

 

ANS:  A

Loss of recent memory is the most characteristic sign in the early stage of the disease.  Loss of remote memory occurs during the intermediate stage along with loss of recent memory; withdrawal from family and apraxia occur in the intermediate stage.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 184        OBJ:   6

TOP:   Stages of Alzheimer’s Disease        KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The average time that a person with Alzheimer’s disease lives after diagnosis is:
a. 2 years
b. 8 years
c. 10 years
d. 20 years

 

 

ANS:  B

Eight years is the average, with the life span ranging from 2 to 20 years after diagnosis of the disease.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 184        OBJ:   6

TOP:   After the Diagnosis                         KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Health Promotion and Maintenance

 

  1. For those family members who desire to care at home for loved ones who have been given a diagnosis of Alzheimer’s disease, it is important for the nurse to ensure that the family is aware of which caregiver skills and responsibilities will be necessary. What is one of the responsibilities of the caregiver during the middle stage of the disease?
a. Helping the loved one with memory and communication problems
b. Providing a stable, routine environment
c. Providing complete assistance with physical care
d. Adapting to the changing personality and behavior of the loved one

 

 

ANS:  D

The middle stage is when personality changes begin to occur. It is difficult for the family to see the loss of their loved one’s personality. Helping with memory and communication problems and providing a stable, routine environment occur in the early stage, and complete assistance with physical care is typically a responsibility of the caregiver during the severe stage.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 184        OBJ:   6

TOP:   Stages of Alzheimer’s Disease        KEY:  Nursing Process Step: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse is answering questions from a client and his family regarding a recent diagnosis of Alzheimer’s disease. The client asks how effective medication is in treating the disease. What is the nurse’s best response?
a. “There is no cure or treatment for Alzheimer’s disease.”
b. “Medications have shown little improvement in symptoms.”
c. “Medications for the disease have been found to improve thinking abilities, behavior, and daily functioning in some clients.”
d. “Alternative therapies, such as co-enzyme Q-10 and Ginkgo biloba, are more effective than any of the prescription medications used to treat the symptoms.”

 

 

ANS:  C

The most accurate statement is to say that medications have been found to improve thinking abilities, behavior, and daily functioning in some clients. Although no cure for the disease is known, it is inaccurate to say that there is no treatment. To say that medications have produced little improvement in symptoms is misleading because it sounds as though medications are not effective. Stating that alternative therapies are more effective is inaccurate because these therapies are still under investigation for determination of their effectiveness in treating symptoms of the disease.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 187        OBJ:   6

TOP:   Interventions with Alzheimer’s Disease

KEY:  Nursing Process Step: Planning       MSC:  Client Needs: Physiological Integrity

 

  1. The nurse is aware, when developing a care plan, that the three major goals of care for the client in whom Alzheimer’s disease has been diagnosed include providing for the client’s safety and well-being, therapeutically managing the client’s behaviors, and:
a. Supporting the client during curative care
b. Providing support for family, relatives, and caregivers
c. Arranging for nursing home placement
d. Tracking the progress of medical, legal, and financial records

 

 

ANS:  B

This disease is devastating not only to the client, but to significant others as well. A major component of the care plan is for the care of the client’s loved ones. Supporting the client during curative care is incorrect because there is no cure for Alzheimer’s disease; nursing home placement is not going to be the plan of action for all clients with the disease; and tracking medical, legal, and financial records is a responsibility of the family.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 185        OBJ:   7

TOP:   Therapeutic Interventions               KEY:  Nursing Process Step: Planning

MSC:  Client Needs: Psychosocial Integrity

 

  1. Which of the following is an effective communication technique that should be included in the teaching plan for the family members of a woman in whom Alzheimer’s disease has been diagnosed recently?
a. Use simple, familiar words, along with short and simple sentences.
b. If the client tends to pace a lot, be sure to encourage her to sit during interactions.
c. If she doesn’t understand the communication, change key words.
d. Use hand gestures when speaking to try to explain what is being said.

 

 

ANS:  A

Alzheimer’s affects cognitive ability, so it is best to use words and phrases that do not require a great deal of thought to be understood. Having the client sit when she likes to pace may increase her anxiety and block communication. Repeat key words to assist in understanding; changing the key words may further confuse the client. Hand gestures may further confuse the troubled thought processes.

 

DIF:    Cognitive Level: Application          REF:   Page 187        OBJ:   7

TOP:   Interventions with Alzheimer’s Disease

KEY:  Nursing Process Step: Planning       MSC:  Client Needs: Psychosocial Integrity

 

  1. The elderly spouse of a female Alzheimer’s client states that his wife seems to wander aimlessly from room to room looking for things in incorrect places, such as kitchen utensils in the bedroom and laundry detergent in the kitchen. He asks the nurse for suggestions of what he can do to help her. What is the nurse’s best response?
a. “Keep rooms well lit.”
b. “Keep the home environment simple and user-friendly for her.”
c. “Have clocks and calendars with large letters in several rooms of the house.”
d. “Place large signs on doors or entryways that identify the room.”

 

 

ANS:  D

All of these options will assist her in keeping her orientation to the environment, but because she is wandering to the wrong rooms to look for items, signs on the doors and entryways would be most helpful to her as she finds the appropriate room.

 

DIF:    Cognitive Level: Application          REF:   Page 188        OBJ:   7

TOP:   Interventions with Alzheimer’s Disease

KEY:  Nursing Process Step: Intervention MSC:  Client Needs: Psychosocial Integrity

 

  1. The nurse performs a functional assessment of a client upon admission to a home health service. The purpose of this assessment is to determine the client’s:
a. Level of consciousness
b. Ability to perform activities of daily living
c. Degree of reasoning, judgment, and thought processes
d. Level of functioning memory

 

 

ANS:  B

This is an important point of assessment if the nurse is trying to determine the level of care necessary for this client. The other options also may be assessed at some point in the admission, but they do not make up the functional assessment.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 186        OBJ:   N/A

TOP:   Assessment    KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. A 72-year-old client with dementia, who resides in a long-term care facility, frequently goes to her room and cries because she misses her children. This client could benefit most from which intervention?
a. Life review
b. Doll therapy
c. Comfort touch
d. Audio presence therapy

 

 

ANS:  D

Because missing her children brings sadness to this client, she may benefit from hearing their voices on tape and recalling pleasant family memories. The other interventions are effective therapies for clients with dementia, but they do not address this client’s immediate need.

 

DIF:    Cognitive Level: Application          REF:   Page 188        OBJ:   7

TOP:   Interventions with Alzheimer’s Disease

KEY:  Nursing Process Step: Intervention MSC:  Client Needs: Psychosocial Integrity

 

  1. Most individuals with Alzheimer’s disease are cared for in:
a. Nursing homes
b. Their homes
c. Mental health facilities
d. Long-term care facilities specifically set up for clients with Alzheimer’s

 

 

ANS:  B

Most clients are cared for in their homes by family and friends with the support of home care agencies.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 189        OBJ:   6

TOP:   Caregiver Support                           KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The medication donepezil (Aricept) frequently is used to treat the early-stage symptoms of Alzheimer’s disease. When administering this particular medication, the nurse should be especially alert to assess the client for:
a. Weight changes
b. Tremors
c. Increased sweating
d. Alterations in blood pressure

 

 

ANS:  D

This medication may cause high or low blood pressure. The other options typically are not seen with donepezil (Aricept) but sometimes are seen with other Alzheimer’s medications.

 

DIF:    Cognitive Level: Application          REF:   Page 187        OBJ:   7

TOP:   Interventions with Alzheimer’s Disease

KEY:  Nursing Process Step: Assessment  MSC:  Client Needs: Physiological Integrity

 

  1. Which symptom of Alzheimer’s disease is associated with disorientation to time and place?
a. Forgetting in what order to put clothes on
b. Forgetting simple words
c. Forgetting where he or she lives
d. Becoming suspicious of others

 

 

ANS:  C

Additional examples of disorientation to time and place include getting lost on the street that one lives on and forgetting how he or she got to places. Forgetting in what order to put on clothing relates to difficulty with performing familiar tasks; forgetting simple words relates to problems with language; becoming suspicious of others relates to changes in personality.

 

DIF:    Cognitive Level: Comprehension   REF:   Page 184        OBJ:   6

TOP:   Stages of Alzheimer’s Disease        KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. An elderly woman is brought to the clinic by her daughter. The client states that she has had a cold for several days. Her daughter states that her mother has been confused about when her routine medications are to be taken and that her mother has never experienced confusion about her medications before. Based on this information, it is important that the nurse ask the client whether:
a. There is a history of mental illness in the family
b. She has been given a diagnosis of a mental health disorder in the past
c. She can recall her last visit to a physician
d. She has taken any over-the-counter medications for her cold

 

 

ANS:  D

Over-the-counter cold medications can cause confusion in the elderly population. Because this client has had a cold recently, it would be important to determine whether she has been taking any of these types of medications. There is no indication that the other options have any significance in relation to the acute confusion.

 

DIF:    Cognitive Level: Application          REF:   Page 180        OBJ:   3

TOP:   Medications and the Elderly Population

KEY:  Nursing Process Step: Assessment  MSC:  Client Needs: Physiological Integrity

 

MULTIPLE RESPONSE

 

  1. The nurse anticipates that the normal aging process of losing neurons and shrinkage of brain size will result in which assessment findings in older adults? Select all that apply.
a. Confusion
b. Slower response times
c. Depression
d. Deficiencies in short-term memory

 

 

ANS:  B, D

These are normal occurrences in aging. Confusion and depression are not considered normal responses to aging and should be investigated further.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 179        OBJ:   1

TOP:   Normal Changes in Cognition         KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Physiological Integrity

 

  1. Which characteristics are commonly seen in clients with dementia? Select all that apply.
a. Gradual onset
b. Poor short-term memory
c. Problems with judgment
d. Fast onset
e. Poor remote memory
f. Difficulty with abstract thinking
g. Personality changes

 

 

ANS:  A, B, C, E, F, G

These are all signs and symptoms of dementia, regardless of whether it is classified as Alzheimer’s or non–Alzheimer-type dementia.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 182        OBJ:   5

TOP:   Symptoms of Dementia                  KEY:  Nursing Process Step: Evaluation

MSC:  Client Needs: Psychosocial Integrity

 

COMPLETION

 

  1. __________ refers to thinking and thought processes.

 

ANS:

Cognition

Cognition relates to intelligence, judgment, reasoning, knowledge, understanding, and memory.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 179        OBJ:   1

TOP:   Confusion Has Many Faces            KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. __________ is a progressive, degenerative disease that affects the brain and causes impaired memory, cognition, and behavior.

 

ANS:

Alzheimer’s disease

The disease was discovered in 1907. Pathological findings include abnormal tangles of nerve fibers in the brain, degenerated nerve endings, and shrunken brain tissue.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 183        OBJ:   6

TOP:   Alzheimer’s Disease                       KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity

 

  1. The causes of confusion are grouped into five categories known as the five D’s. These categories consist of damage, delirium, dementia, depression, and __________.

 

ANS:

Deprivation

Deprivation refers to sensory deprivation related to poor vision or hearing.

 

DIF:    Cognitive Level: Knowledge          REF:   Page 179        OBJ:   2

TOP:   The Five “Ds” of Confusion          KEY:  Nursing Process Step: Assessment

MSC:  Client Needs: Psychosocial Integrity