Foundations of Mental Health Care 5th Ed By Michelle Morrison – Valfre –
Chapter 1: The History of Mental Health Care
- The belief of the ancient Greek philosopher Plato that the rational soul controlled the irrational soul could be compared with the belief of the more recent psychological theorist:
- During the mid-1500s, behaviors associated with mental illness were more accurately recorded by professionals. This practice led to ______________ for different abnormal behaviors.
- During the latter part of the eighteenth century, psychiatry became a separate branch of medicine, and inhumane treatment was greatly diminished by the French hospital director:
- In 1841, _______________ surveyed asylums, jails, and almshouses throughout the United States, Canada, and Scotland and is credited with bringing about public awareness and reform for the care of the mentally ill.
- As a direct result of Clifford Beers’ work and book, A Mind That Found Itself, the Committee for Mental Hygiene was formed in 1909 with a focus on prevention of mental illness and:
|a.||Early detection of symptoms of mental illness|
|b.||Education of caregivers|
|c.||Current treatment options|
|d.||Removing the stigma attached to mental illness|
- During the 1930s, what common treatment for schizophrenia caused clients to fall into a coma that could last as long as 50 hours?
- In the 1930s, what mental health disorder was electroconvulsive therapy (ECT) most often used to treat?
- In the early twentieth century, a frontal lobotomy was a common treatment for violent behaviors. Which description of this procedure is accurate?
|a.||A procedure that delivers an electrical stimulus to the frontal lobes of the brain|
|b.||A surgical procedure that drills holes in the front of the skull to drain fluid|
|c.||A surgical procedure that severs the frontal lobes of the brain from the thalamus|
|d.||A surgical procedure that inserts implants into the frontal lobes of the brain|
- Which class of drugs was introduced in the 1930s for the treatment of depression?
- In 1937, Congress passed the Hill-Burton Act, which was significant for the treatment of mental health because it funded:
|a.||Research on drugs for the treatment of mental health disorders|
|b.||Training of mental health professionals|
|c.||Construction of psychiatric units in facilities throughout North America|
|d.||Development of community mental health clinics|
- The National Mental Health Act of 1946 provided a means for funding of programs that promote research on mental health and:
|a.||Development of mental health clinics in the community|
|b.||Training of mental health professionals|
|c.||Treatment for veterans suffering from mental health disorders|
|d.||Educating the public about mental illness|
- Which of the following best describes the disorder that was first recognized in veterans following the Korean and Vietnam Wars?
|c.||Posttraumatic stress disorder|
|d.||Paranoid schizophrenic disorder|
- The introduction of ___________ in the 1950s led to the deinstitutionalization of many mentally ill individuals.
|b.||Community mental health clinics|
|c.||Residential treatment centers|
|d.||State mental health facilities|
- In 1949, an Australian physician discovered which therapy to be an effective treatment for bipolar (manic-depressive) illness?
|c.||Lithium carbonate therapy|
- In the early 1960s, a committee appointed by President John F. Kennedy recommended the development of a new approach to the way mental health care was administered, with an emphasis on the introduction of:
|b.||State mental health care systems|
|c.||Community mental health centers|
|d.||Deinstitutionalization of patients|
- The Mental Health Systems Act of 1980 was one of the most progressive mental health bills in the history of the United States, but its enactment was interrupted by the:
|a.||Election of a new president|
|b.||Appointment of a new Surgeon General|
|c.||Rapid expansion of community centers|
|d.||National Alliance for Mental Illness (NAMI) surveys|
MSC: Client Needs: Psychosocial Integrity
- The Omnibus Budget Reform Act (OBRA) of 1987 prevented the housing of people with chronic mental illness in:
|b.||State mental health facilities|
|c.||Residential treatment centers|
- In the late 1980s, government funding for mental health care dwindled, and most insurance companies __________ coverage for psychiatric care.
- In 2006, the National Alliance on Mental Illness (NAMI) conducted a comprehensive survey and grading of state mental health care for adults and learned that the overall grade for care was:
- Which of the following persons has the greatest risk for developing ineffective coping behaviors?
|a.||The middle-aged man whose diet is high in saturated fat and has a 20-year history of tobacco use|
|b.||The single 30-year-old female facing the death of her father|
|c.||The 19-year-old college student with a family history of schizophrenia|
|d.||The 9-year-old child whose parents are nurturing but provide chores and responsibilities|
- In the early 1900s the first theory of mental illness that showed behavior could be changed is attributed to:
- During the middle ages, mentally ill patients often were burned at the stake and were greatly mistreated. In an attempt to treat mentally ill people more humanely, Bethlehem Hospital, more commonly called ___________, was created.
- The humoral theory of disease embraced by Hippocrates required a balance of which elements? (Select all that apply.)
- Which aspects of adult mental health care systems did the National Alliance on Mental Illness survey focus on? (Select all that apply.)
|a.||Availability of care|
|b.||Access to care|
|c.||Regulation of medications|
- Mental health is said to be influenced by which of the following factors? (Select all that apply.)
|a.||Diet and nutritional intake|
|c.||Activities of daily living|
Chapter 2: Current Mental Health Care Systems
- Because mental health care is not covered in Australia under the basic health plan, which citizens are more likely to receive mental health care?
- Mental health care is available under the universal health care system in Britain, which is funded primarily by:
- The __________ model views clients holistically with the goal of creating a support system designed to encourage independence in the client with a mental health disorder.
|a.||Community support systems|
|c.||Multidisciplinary health care team|
- The home mental health nurse visits a female client to assess her ability to care for herself at home after discharge from an inpatient setting. Which component of the case management system does this demonstrate?
- A client with a severe, treatment-resistant mental illness has been assigned to an assertive community treatment (ACT) team. An ACT treatment strategy that helps to prevent recurrent hospitalizations for mental health reasons is to meet with the client in the community setting _____ per week.
|b.||Two to four times|
|c.||Five to six times|
|d.||Seven to eight times|
- Which member of the multidisciplinary mental health care team is primarily responsible for evaluating the family of the client, as well as the environmental and social surroundings of the client, and plays a major role in the admission of new clients?
|d.||Psychiatric social worker|
- It is estimated that approximately __________ of adults experience some form of mental or emotional disorder.
- A male client with a diagnosis of bipolar disorder is admitted to an inpatient unit during a severe manic episode. As a result of guidelines implemented by the Health Care Financing Administration in 1983, the client’s Medicare will pay for his stay in this unit for:
|a.||The length of time necessary for his condition to be stabilized|
|b.||Up to 6 months with appropriate documentation|
|c.||A predetermined length of time based on the diagnosis|
|d.||2 to 4 weeks|
- A female client was given the diagnosis of schizophrenia and recently has lost her job. She tells the nurse that she has enough money for only two more house payments, and if she does not find a job, she fears she will become homeless. The nurse knows that this client falls in the group of nearly __________ of U.S. citizens who live below poverty level.
- Addiction to recreational drugs, such as crack, cocaine, and heroin, combined with use of psychotherapeutic drugs is associated with:
|a.||Permanent psychotic states|
|c.||Generalized anxiety disorder|
- A female client who is undergoing therapy for depression is divorced and has two children, ages 2 and 4. She has just enrolled in a local community college and is worried about providing food and clothes for her family while holding down a minimum wage job and also devoting the time needed to be successful in school. The nurse determines that the best community resource for assisting this client to meet these needs is:
|a.||A shelter for victims of domestic violence|
|b.||Women, Infants, and Children (WIC)|
|d.||Family recreation center|
- The home care nurse is providing care to an older adult client with a diagnosis of depression who is caring for his wife who has Alzheimer’s disease. He states that he hardly has enough energy to cook and clean the house. The couple has no children, and no relatives live within a close distance. Which community agency would be of greatest benefit to this client?
|a.||A recreational club|
|b.||An adult education program|
|c.||A daycare center for elderly|
|d.||Meals on Wheels|
- A 9-year-old girl is given the diagnosis of depression. She has low self-esteem, does not enjoy group therapy, and does not show her emotions. The nurse has had difficulty establishing rapport with this client and decides to ask for assistance from another treatment team member. Which team member would be the best choice to assist in this situation?
- Nearly __________ of all countries in the world have no clear governmental policy that addresses mental health issues.
- A woman is admitted to an inpatient psychiatric unit after a suicide attempt by overdose. The primary rationale for her admission is to:
|a.||Have limited supervision by health care personnel.|
|b.||Maintain responsibility for her own behavior.|
|c.||Receive treatment in the least restrictive manner.|
|d.||Provide her with a safe and secure environment.|
- A client suffering from chronic mental illness often forgets to take her medication and needs to be reminded to take care of daily hygiene. She does not have family or other support persons living in the area. The care delivery provider facility that would be most beneficial for this client is:
|c.||Community mental health center|
|d.||Psychiatric home care|
- A 35-year-old client with a long history of schizophrenia who often forgets to take his medication is admitted to an inpatient unit after police found him threatening passengers on a bus. This is his fourth admission in 3 months. This frequent re-hospitalization is an example of:
- Arranging community resource linkages for a client and her children who are victims of domestic violence, which resource would be the most immediately appropriate community resource link for a client and her children who are victims of domestic violence?
|a.||Adult education program|
|b.||Family recreation center|
- Which principles characterize mental health care in Canada? (Select all that apply.)
|e.||Private insurance models|
- In the United States, which factors determine whether a client requires inpatient rather than outpatient care? (Select all that apply.)
|a.||Severity of the illness|
|b.||Level of dysfunction|
|c.||Suitability of the setting for treating the problem|
|e.||Level of client cooperation|
|f.||Ability to pay|
- Which client populations are at greater risk for the development of mental health disorders? (Select all that apply.)
|b.||Clients infected with HIV or AIDS|
|c.||Those in crisis|
|e.||Clients living in rural areas|
- The case management for a client requiring community mental health services would include which of the following? (Select all that apply.)
|c.||Provision of referrals to a shelter|
|d.||Administration of psychotropic medications|
|e.||Developing a client’s plan of care|
- The __________ therapist of the mental health team uses methods such as pet therapy and music therapy when working with clients and is responsible for providing leisure-time activities and for teaching inpatient clients useful ways to pass time.
Chapter 3: Ethical and Legal Issues
- A male teenage client tells the nurse that his friends like to drink alcohol occasionally to get drunk. The client’s friends see nothing wrong with their drinking habits. The client states that he was taught by his parents and agrees that underage drinking is not acceptable. Also, he has never seen his parents drunk; therefore, he refuses to drink with his friends. Which mode of transmission best describes how this client’s particular value was formed?
- A female client becomes combative when the nurse attempts to administer routine medications. The nurse would like to ignore the client but chooses to talk with the client to calm her. The nurse is successful in calming the client, and the client takes her medications. What process best describes how the nurse decided on the course of action taken?
- Twenty-three states have enacted mental health parity laws. The most accurate description of these laws is that they require insurance companies to include coverage for:
|b.||Substance abuse treatment|
|c.||Mental illness that is equal to coverage for physical illness|
|d.||Outpatient therapy for individuals with substance abuse|
- The client is feeling very anxious and has requested that a p.r.n. antianxiety medication be ordered. The nurse informs the client that the medication can be administered only every 4 hours and was given 3 hours ago. The nurse promises to give the client the medication as soon as it is due, but the nurse goes to lunch 1 hour later without giving the client the medication. Which ethical principle did the nurse violate?
- A male client is seeking help in a mental health clinic for anger management problems. He voices that he is fearful that his wife may divorce him because of his anger problem, and he is willing to do “whatever it takes” to control his anger. Later in the week, the client’s wife also seeks assistance because she is going to divorce her husband. The nurse who is caring for both of these clients tries to decide the correct action to take. The nurse is experiencing:
|a.||A moral dilemma|
|c.||An ethical conflict (or dilemma)|
|d.||A breach of confidentiality|
- The psychiatrist asks the nurse to perform a procedure that she is not familiar with, and the nurse is unsure whether this is something within the scope of practice. Where can the nurse find the answer to her question?
|a.||National nurse practice act|
|b.||State nurse practice act|
|c.||Regional nurse practice act|
|d.||Community nurse practice act|
- An order written by a physician is reviewed by the nursing staff, and no one is familiar with the treatment instructions. A nurse who was recently hired knows that this treatment is covered by the state’s nurse practice act. What is the nurse’s best course of action?
|a.||Call the physician to ask for clarification.|
|b.||Check the state’s nurse practice act again.|
|c.||Contact the nursing supervisor for approval to carry out the treatment.|
|d.||Refer to the facility’s policy and procedure to determine the course of action.|
MSC: Client Needs: Safe and Effective Care Environment
- Standards of nursing practice for mental health can best be described as helping to ensure:
|a.||That certain clients receive care|
|b.||Quality and effectiveness of care|
|d.||Proper medication administration|
- If a client is involuntarily committed to a mental health care facility indefinitely, the law requires that the case must be reviewed every _____ months.
- A male client is being argumentative during a group therapy session. The male psychiatric technician warns the client that if he does not cooperate with the nurse, he will physically restrain him and take the client to his room for the remainder of the day. For which action could the technician be held liable?
- Which of the following circumstances, when it occurs on an inpatient mental health unit, would be considered false imprisonment?
|a.||An alert and oriented client is confined to his room after being loud and argumentative with another client in the recreation area.|
|b.||Restraints are placed on a client who has been admitted in a lethargic state because of misuse of medications and who has fallen three times since admission.|
|c.||A client is housed in a private room with visual monitors after attempting suicide at home on the previous day.|
|d.||An alert and oriented client who was admitted for a 72-hour involuntary commitment is prevented from leaving the facility 2 days after admission.|
- The nurse often assists in the process of obtaining informed consent from the client for treatment and/or procedures. Who has the responsibility of providing information to the client so he can give informed consent?
|d.||Facility’s legal representative|
- An important responsibility of the nurse in a mental health facility is to ensure that clients do not __________ from the facility without a discharge order, by carefully supervising and accurately documenting client behaviors and therapeutic actions.
- If a female client tells the nurse of extensive plans she has to harm the girlfriend of her ex-husband, what is the nurse’s best action?
|a.||Try to talk with the client to convince her not to harm the girlfriend.|
|b.||Have the client sign a contract with you stating that she will not harm the girlfriend.|
|c.||Inform the ex-husband of the intentions of the client.|
|d.||Inform the girlfriend of the intentions of the client.|
- A female client asks the nurse if the medication risperidone (Risperdal), an antipsychotic medication for schizophrenia, has any side effects. Which response by the nurse would violate the ethical concept of veracity?
|a.||“I am not sure, but I will find out.”|
|b.||“Risperdal has no documented side effects.”|
|c.||“Risperdal does have some side effects.”|
|d.||“Let’s talk to your physician about potential side effects.”|
- The charge nurse on a busy inpatient psychiatric unit is concerned because a nurse and a nursing assistant have called out for the shift. Upon calling the nursing office, the charge nurse is informed that there is no one to replace them. In addition, the emergency call button at the nurse’s station is malfunctioning. This charge nurse sees this as a violation of:
|b.||The patient bill of rights|
|c.||Care provider rights|
- The nurse encounters a client crying in her room. Upon talking to the client, it is discovered that she is upset because a new nursing assistant made her go out for a walk with the group even though the client informed her that she waits for her daughter to go for her walk. This is a potential violation of which ethical principle?
- A client preparing for discharge from an inpatient unit asks a nurse which psychiatrist she would recommend to use for follow-up as an outpatient. The nurse responds, “There are several good physicians on your list. Make sure you do not use Dr. Smith. I have heard some terrible things about his methods of treatment.” This is an example of which type of potential liability?
|b.||Invasion of privacy|
- A client frequently wanders around the unit, and the staff frequently needs to reorient the client to the environment and remind her not to walk into the rooms of other clients on the unit. Due to short staffing, the decision is made to use a restraint device to prevent this from occurring. This action may constitute:
- If a person is perceived to be a threat to himself or others, who can implement an involuntary commitment to a mental health facility? (Select all that apply.)
|e.||Representatives of a county administrator|
- For a nurse or health care provider to be found negligent, what requirements must the provider’s misconduct meet? (Select all that apply.)
|a.||The provider owed a duty to the client.|
|b.||The provider breached a duty to the client.|
|c.||The provider had intent to harm the client.|
|d.||The provider caused injury to the client by action or inaction.|
|e.||The provider caused loss or damage through his or her actions.|
- The use of protective devices may be considered false imprisonment. In order to assure the rights of the client are not violated, which practices must be implemented when using a device? (Select all that apply.)
|a.||A written medical order must be on the medical record.|
|b.||Client must be confined to bed.|
|c.||Restraints must be removed and limb exercised every 2 hours.|
|d.||Implement use of restraints in the event of short staffing as a preventive measure.|
|e.||Client must be assessed and monitored every 15 minutes.|
- The nurse documents on the medication administration record that a medication has been given as ordered on a daily basis, but the medication actually has been out of stock for a week. This nurse is guilty of __________.
- __________ is either omitting or committing a duty that a reasonable and prudent person would or would not do that brings harm to an individual in a health care environment.
- __________ describes an individual’s attitudes, beliefs, and values and helps a person distinguish between what is considered right and wrong behavior.
Chapter 4: Sociocultural Issues
- 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 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.|
- Disease is defined as _____ dysfunction.
- 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 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|
|c.||Space comfort zone|
- Which client communication problem can the nurse most easily correct?
- What is the social orientation among most middle-class American families?
- 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:
- The metabolism of psychotropic medications is most likely to be affected by:
- 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.|
- Culture includes common beliefs and practices in areas such as religion, economics, diet, health, and:
|c.||Patterns of communication|
- What is the usual approach to care for individuals who practice folk medicine?
- 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 client seen in the mental health clinic feels her depression is the result of being “punished” due to becoming pregnant as an adolescent and giving the infant up for adoption against her family’s wishes. This view of her depression is considered:
- The nurse in the Emergency Department finds a woman collapsed on the floor and crying loudly. The woman’s husband was in a car accident and is being attended to by the medical staff. Which statement by the nurse best demonstrates acting in a culturally competent manner?
|a.||“You need to control yourself. Your husband was not injured that badly.”|
|b.||“Let me take you to a room with more privacy so we can talk.”|
|c.||“I am concerned about how you are acting right now. No one else here is acting like this.”|
|d.||“We will call the psychiatrist to see if medication can be ordered for you.”|
- A 45-year-old married man comes to the community mental health center after he is suspended from his job for fighting. Upon talking to him, the nurse discovers he and his wife recently moved to the United States and his wife needs to work to pay bills. He is angry and embarrassed that he cannot be the sole provider for his family. His behavior may be the result of:
|b.||Gender role conflict|
- A nurse preparing to interview a client in the client’s room begins to move newspapers off a chair to sit down. The client requests that the nurse sit in another chair and leave the newspapers where they were. The client is demonstrating:
- 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.)
|e.||Lay unlicensed therapists|
- 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|
- 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.)
|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|
- Cultural assessments allow the health care provider to understand the unique beliefs clients may have regarding mental illness and how they cope. Key areas to assess include: (Select all that apply.)
|b.||Space and territory|
- A __________ is a simplified or standardized belief or conception regarding people who belong to another culture.
- __________ is a term that divides people into groups based on biological characteristics, including skin color, features, hair texture, and self-identification.
- When a person believes that there is a power greater or higher than any human being, he is referring to his __________.
Chapter 5: Theories and Therapies
- A male client who has a diagnosis of generalized anxiety disorder (GAD) is seen in the emergency room with complaints of chest pain, shortness of breath, and inability to concentrate, along with feelings of overwhelming anxiety. The nurse uses Maslow’s theory to triage the client’s complaints, knowing that which complaint must be addressed first?
|a.||Inability to concentrate|
|b.||Shortness of breath|
- According to Freud’s theory, a baby who is crying in response to wanting to be held by his mother is an example of which part of the personality’s control over behavior?
- According to the theorist Erik Erikson, an individual strives to actualize his identity, is most productive, and demonstrates guidance of and concern for others with a core task of caring during which stage of psychosocial development?
|a.||Young adulthood (18 to 25 years)|
|b.||Maturity (65 years to death)|
|c.||Middle adulthood (25 to 65 years)|
|d.||Puberty (12 to 18 years)|
- During a therapy session, a client is asked to respond to a word with the first word or phrase that comes to mind. What term is commonly used to refer to this technique?
- Carl Jung was the founder of analytical psychotherapy; he differed from Freud in that he believed that the mind was divided into three levels: the conscious ego, the personal unconscious, and the:
- Jean Piaget’s theory of cognitive development identifies an interrelationship between the __________ and the __________ functions in the development of one’s personality.
- How many stages of the human life cycle did Erik Erikson identify?
- A 4-year-old client in a pediatric unit is imitating the actions of the nurse. The nurse knows, according to Erik Erikson’s theory, that this child is displaying a characteristic seen during which developmental stage?
- Humanistic theories are important to health care because these theories serve as the foundation for the concept of:
- During a conversation with a male client, he voices that he really appreciates his family, likes his job, and enjoys groups in which he volunteers. According to Maslow’s theory, what is this client experiencing?
- The nurse knows that the major concept of the systems theory is that individuals are viewed as functioning:
|a.||Within a set of interacting and related units|
|b.||According to activities of attention, language, and imagery|
|c.||According to unmet needs|
|d.||Within accepted social aspects of behavior|
- Group therapy, which assists in relieving emotional distress and encourages psychological and behavioral changes, was developed following World War II as a result of a:
|a.||Study of the benefits of group therapy|
|b.||Decreasing number of mental health facilities|
|c.||Shortage of psychiatrists|
|d.||Grant from the federal government|
- Betty Neuman developed the nursing theory that promotes nursing interventions to assist individuals in reaching and maintaining the highest level of wellness possible. What is this theory known as?
|d.||Self-care deficit model|
- Following an argument with his daughter, a father takes away her phone privileges. He later feels guilty about the argument and asks her if she would like to go shopping for new clothes. What is this defense mechanism known as?
- A female client with low self-esteem tries to dress and act like the nurse who cares for her in an outpatient clinic setting. This behavior is an example of which defense mechanism?
- During group therapy, certain group change mechanisms may be observed. When an individual engages in helping others, resulting in improvement in his or her own self-esteem, which group change mechanism has the individual experienced?
- A client is granted permission to watch a favorite television show in the evening because she participated in an occupational therapy activity. Her therapist bases this on ______ theory.
- A client does not participate in group sessions due to feeling inferior to others in the group. Based on cognitive theory, he would be directed to:
|a.||Review his previous relationship with his parents.|
|b.||Participate in group to receive extra privileges.|
|c.||Suppress negative thoughts about the group.|
|d.||Recognize and change his negative thoughts.|
- Which of the following assessment parameters is a priority in a biobehavioral model of practice?
- The nurse who feels the most beneficial part of the client’s inpatient stay is the establishment of an interpersonal relationship with the nurse is an example of which nursing theorist?
- Freud’s psychoanalytical theory states that an adult is more likely to be mentally healthy if there is a balance between which parts of the mind? (Select all that apply.)
- Psychobiology theory considers the causes of mental illness to be which of the following? (Select all that apply.)
|c.||Immune system dysfunction|
- Freud believed that an individual’s personality developed through stages of sexual instinct from birth to adulthood. This is known as the __________ theory of personality development.
- Dr. Sigmund Freud believed that a person’s unconscious thoughts and emotions affect his or her behavior. The now well-known therapy that he developed to explore an individual’s unconscious thoughts is referred to as ____________.
- Good problem-solving is necessary for the mentally healthy individual. Place the following steps of the problem-solving process in chronological order. (Separate letters by a comma and space as follows: A, B, C, D, E, F, G.)
- Examine all possible options.
- Examine outcomes of the option’s application.
- State the problem.
- Evaluate and revise actions based on outcomes.
- Collect information about the problem.
- Choose the best option, and apply it to the problem.
- Identify the causes or patterns of the problem.
Chapter 6: Complementary and Alternative Therapies
- For a client with a sleep disorder, which CAM therapy could be used safely without interference with any allopathic methods of treatment?
- A female client would like to use biofield therapy for her addiction to nicotine. Which form of therapy would she most likely choose?
- A male client experiences a phobia of enclosed spaces (claustrophobia) and is seeking an energy-based therapy that he can practice and initiate on his own when he experiences symptoms. Which therapy will the nurse recommend?
|a.||Music and sound therapy|
|b.||Relaxation and visualization|
- Which theory best describes energy medicine?
|a.||There is a harmony within the body, nature, and the world.|
|b.||The body has a natural ability to heal itself.|
|c.||There is a vital, life-force energy that flows through an individual’s body.|
|d.||The mind and spirit affect body functions and influence illness.|
- A female client is receiving therapy for severe depression that consists of repetitive transcranial magnetic stimulation. This form of therapy is considered to be:
|b.||Illegal according to FDA regulations|
|c.||A form of expressive therapy|
|d.||A biofield therapy|
- A 70-year-old male client tells the nurse that he is using chelation therapy to prevent Alzheimer’s disease. Which adverse effect is the client most likely to experience?
|b.||Low potassium levels|
|c.||Elevated blood glucose levels|
|d.||Interactions with other medications|
- A male client of Indian origin practices meditation and yoga, uses herbs and follows specific diet practices, and practices controlled breathing and exposure to sunlight. Which type of CAM therapy is this individual practicing?
|a.||Traditional Chinese medicine|
MSC: Client Needs: Psychosocial Integrity
- What is the main function of the National Center for Complementary and Alternative Medicine (NCCAM)?
|a.||To seek scientific validation of CAM and also be a resource for the public for CAM therapies|
|b.||To investigate and develop new CAM therapies|
|c.||To produce a monthly newsletter on new CAM therapies|
|d.||To monitor the production of dietary and herbal supplements used in CAM therapies|
- The Food and Drug Administration (FDA) does not impose the same guidelines on __________ as it does on prescription drugs.
- A 45-year-old male client uses a treatment method that focuses on the relationship between an individual’s body structure and its function. This mode of treatment is:
- Massage therapy manipulates muscles and connective tissue and has been found to be very successful as a CAM method in the treatment of which disorder(s)?
|c.||PTSD and OCD|
|d.||Depression and anxiety|
- Which type of therapy has yielded positive results for psychological functioning and is considered one of the safest treatment modalities?
- A therapy that once was denounced by the scientific community but now is being used to treat successfully victims of the events of 9/11, Hurricane Katrina, and the South Asian tsunami of 2004 and that helps the rational left side of the brain bond with a traumatic memory from the emotional right side of the brain is known as:
|b.||Eye Movement Desensitization and Reprocessing (EMDR)|
- __________ is a form of therapy that has been used for over 2000 years to successfully treat clients with drug addiction; it is believed to restore the energy balance in the body and to stimulate the release of certain neurotransmitters and hormones.
- Color therapy has been found to be especially effective in the treatment of:
|a.||Seasonal affective disorder|
|d.||Generalized anxiety disorder|
- A client experiencing symptoms of anxiety would benefit from which therapy?
- A child who is the victim of domestic violence refuses to talk about the experience. He is doing poorly in school and having trouble sleeping. Which therapy would he benefit from?
- Which CAM therapy would a nurse be most concerned about if used by a client being treated with antipsychotic medications?
|a.||Biologically based practices|
|c.||Mind body practices|
- An allopathic mental health practitioner would most likely recommend which treatment for a client suffering from anxiety?
- Which treatments are used in biologically based practice? (Select all that apply.)
- Which of the following principles best describes the beliefs of naturopathic practitioners? (Select all that apply.)
|a.||Treatment of the whole person should occur.|
|b.||Prevention of diseases/disorders is a key concept.|
|c.||The doctor is the teacher.|
|d.||Use of wavelengths is beneficial for client treatment.|
- Self-help groups provide support to individuals who are dealing with or who have had similar experiences. Which of the following are characteristics of self-help groups? (Select all that apply.)
|a.||Groups are informal, nonprofit, and free of charge.|
|b.||Membership requires referral from a physician or counselor.|
|c.||Meetings are facilitated by trained counselors.|
|d.||Groups provide support, education, and encouragement to members.|
|e.||Groups benefit individuals who are dealing with life-altering events such as addiction.|
- Which of the following CAM mental health therapies are indicated for a client with PTSD? (Select all that apply.)
|c.||Eye movement desensitization|
- CAM therapy is an acronym for __________.
KEY: Nursing Process Step: Assessment MSC: Client Needs: Psychosocial Integrity
- New approaches to mental health care that include telemedicine, telephone counseling, and radio psychiatry are known as _______________ approaches.
Chapter 7: Psychotherapeutic Drug Therapy
- During client teaching, the nurse must inform the client prescribed a tricyclic antidepressant (TCA) to not expect to see a difference in mood or anxiety level for up to:
|b.||2 to 3 weeks|
|c.||4 to 5 weeks|
- A male client with the diagnosis of depression is taking a monoamine oxidase inhibitor (MAOI). Which is the most important teaching point the nurse must include in his care plan?
|a.||Avoid foods high in sodium content.|
|b.||Avoid alcoholic beverages.|
|c.||Ensure that protein intake is 60 grams per day.|
|d.||Take a potassium supplement.|
- A female client is 3 days postoperative and has been receiving meperidine (Demerol) for pain control. The family mentions to the nurse that the client has been taking phenelzine (Nardil) for years for her depression. The client did not list this medication on admission. What signs and symptoms should the nurse look for in case of reaction between these two medications?
|a.||Increased pulse and respirations|
|b.||Hyperactivity and difficulty concentrating|
|c.||Increased tearing and increased urinary output|
|d.||Sedation, disorientation, and hallucinations|
- The nurse is aware that he or she may be administering the new antianxiety medication pregabalin (Lyrica) to clients without an anxiety disorder for the purpose of treating:
- Selective serotonin reuptake inhibitors (SSRIs) are most health care providers’ drug of choice for the treatment of depression because:
|a.||Side effects are more manageable than with most antidepressants.|
|b.||They are the only class safe for long-term therapy.|
|c.||This is the oldest class of antidepressants.|
|d.||They are fast-acting medications.|
- In preparing discharge planning for a client who has been prescribed lithium for the treatment of bipolar disorder, the nurse must be sure that the client demonstrates an understanding of the need to monitor his or her diet for intake of:
- A female client calls the clinic for advice after forgetting to take her morning dose of twice-daily lithium 5 hours ago. Which instructions should the nurse give the client?
|a.||Take the dose immediately, and then take the second dose 3 hours late.|
|b.||Take half of a dose now, and then take the second dose at the normal time.|
|c.||Eliminate the dose missed, and take the second dose at the normal time.|
|d.||Immediately take the missed dose, and take the second dose at the normal time.|
- A female client who has had bipolar disorder for several years decides to stop all of her medications because she is tired of the side effects. She also cancels all appointments with her therapist, stating that it is just too difficult to plan the visits in her hectic schedule. This client is considered:
|c.||Suffering from an anxiety disorder|
|d.||Possessing obsessive-compulsive tendencies|
- A male client with schizophrenia lives in an assisted-living complex for individuals with mental health disorders. He is tired of the Parkinson-like symptoms he experiences with his antipsychotic medication and therefore stops taking his medication after much discussion with his treatment team. He is progressively withdrawing from reality but is not a safety risk at this point to himself or others. What is the best response of the nurse and treatment team?
|a.||Try to coerce him into taking his medication.|
|b.||Ensure that the client and those around him are safe, and monitor for additional symptoms of his schizophrenia while maintaining trust with the client.|
|c.||Crush his antipsychotic medications and put them in his food to stop the process of his withdrawal from reality.|
|d.||Speak to his family about seeking an involuntary emergency hold in a mental health facility to get him back on his medications.|
- An adult female client has been diagnosed recently with mild depression but opts not to take the medication prescribed by her physician after talking with the physician about the benefits, risks, possible outcomes, and side effects. She decides to investigate alternative treatments. This client is making this decision based on the premise of:
|d.||Right to privacy|
- The nurse is administering medications to a client with a diagnosis of paranoid schizophrenia. The nurse would expect to see which medication ordered for this client?
- Psychotropic medications can cause a parasympathetic and/or sympathetic response from the autonomic nervous system. Which of the following is considered a sympathetic response?
|b.||Increased saliva production|
|c.||Decreased heart rate|
- While completing the history portion of an admission assessment of a client with schizophrenia, the nurse notices that the client is continually moving in the chair and frequently stands, then sits back down. The nurse knows that this client most likely is experiencing the side effect of:
- __________ is a side effect that can occur while a client is taking an antipsychotic medication, causing muscle rigidity, high fever, unstable vital signs, confusion, and agitation.
|b.||Neuroleptic malignant syndrome (NMS)|
- The __________ constitute a class of drugs that are commonly prescribed for cardiac arrhythmias but also have been found to be effective treatment for social phobias.
- Valium is administered to a client anxious about impending surgery. Which of the following side effects is the client at risk for?
- When educating the client being treated with lithium, which item in their diet should be monitored or avoided?
|c.||Hot dogs and ham|
- The CMA is administering an antianxiety medication to a client. Monitoring side effects is the responsibility of which member of the health care team?
- Careful assessment for changes in attitude and suicidal gestures should be monitored in a client taking which medication?
- Which of the following are basic responsibilities of nurses who administer psychotherapeutic drugs? (Select all that apply.)
|a.||Monitoring and evaluating the client’s response to the medication|
|b.||Continually assessing the client’s condition|
|c.||Adjusting medication dosages according to therapeutic levels|
|d.||Assisting in the coordination of the client’s care|
|e.||Teaching clients about their medications|
|f.||Administering prescribed medications|
- The nurse is developing a teaching plan for a client who has been diagnosed recently with a mental health disorder and has been prescribed a psychotropic medication. Which interventions regarding the medication should the nurse include in the teaching plan? (Select all that apply.)
|a.||Teach signs and symptoms of side effects and what to do if these occur.|
|b.||Provide written information regarding the purpose, dosage, route, and dosing schedule.|
|c.||Ask the client and significant other to verbally explain when it is necessary to contact the physician should side effects occur.|
|d.||Provide written information regarding how the client should decrease dosages in response to side effects or improvement in symptoms.|
- Clients diagnosed with Type I–positive schizophrenic symptoms respond better to antipsychotic medications. Manifestations of Type I schizophrenia include which of the following? (Select all that apply.)
- __________ side effects can occur when antipsychotic medications are taken that manifest as abnormal movements such as akathisia and pseudo-Parkinson symptoms.
- The four classes of psychotherapeutic medications include antianxiety agents, antidepressants, antimanics, and __________.
- Lithium levels are considered toxic when they become higher than __________ mEq/L.
Chapter 8: Skills and Principles of Mental Health Care
- An adult female client becomes combative with the nurse during routine medication administration. What is the nurse’s primary responsibility in this situation?
|a.||To ensure that the client takes her medications|
|b.||To ensure that the client is placed in physical restraints to protect the safety of the staff and other clients|
|c.||To ensure that chemical restraints are used in the future until the client displays more appropriate and compliant behavior|
|d.||To ensure that the client is kept safe while trying to protect staff safety and to reason with the client to try to de-escalate the combative behavior|
- A nurse is trying to develop trust with a client on an inpatient mental health unit. Which action by the nurse is going to best promote development of a mutually trusting relationship?
|a.||At the beginning of the shift, the nurse promises to play a game of cards with the client at some point during that day and does so before the end of the shift.|
|b.||The nurse promises to play a game of cards with the client on the following day.|
|c.||The nurse leads a group discussion with clients about ways to develop trust in a relationship.|
|d.||The nurse gives the client written information about the medications he is taking.|
- An adult female client is exhibiting behavior that the nurse interprets as anger toward another client. What is the nurse’s best action?
|a.||Continue to monitor the client’s behavior and document it as anger directed toward another client.|
|b.||Talk with the client about the observations made, and ask whether she was displaying anger toward the other client.|
|c.||Ask the other client if she felt that the client was angry with her.|
|d.||Ask the client to write in a journal the emotions she was feeling at that time.|
- A nurse and an adolescent female client develop a plan of care together that addresses the client’s difficult relationship with her parents. The client says that her parents just don’t understand her, and she is always getting privileges taken away for not doing things that she is supposed to do. What is the nurse’s best action?
|a.||Talk with the client about how important it is that she carry through with actions that her parents feel are important.|
|b.||Identify two priority responsibilities that are agreed upon between the client and her parents, and monitor her ability to comply with the plan for 1 week.|
|c.||Discuss with the parents what responsibilities they feel are important, to determine what actions should be planned with the client.|
|d.||Identify what the client feels are reasonable responsibilities.|
- __________ coping mechanisms are means of successfully solving a problem or reducing one’s stress level.
- A married woman, who is the mother of two children, has been in an abusive relationship for 4 years. She decides to leave her husband after suffering an episode of severe physical abuse. She and her children, ages 7 and 9, arrive at a crisis intervention center. What is the nurse’s priority intervention?
|a.||Offer immediate emotional support.|
|b.||Refer her to a woman’s domestic abuse center.|
|c.||Begin to develop a treatment plan for the client and her children.|
|d.||Thoroughly assess the situation from most recent to 2 weeks prior to this incident.|
- A male client with the diagnosis of depression has not attended his last two group meetings. The nurse provides a printed schedule of meeting dates and times to the client the next time she sees him. The nurse’s actions can be described as:
- An adolescent female client continually displays a negative attitude toward everyone she comes into contact with and toward life in general. Which action should the nurse implement first that will be helpful in assisting this client to develop a more positive attitude?
|a.||Helping the client recognize negative thoughts, emotions, and attitudes|
|b.||Pointing out every negative behavior that the client displays|
|c.||Assisting the client to replace negative thoughts by frequently repeating positive statements|
|d.||Praising positive behavior exhibited by the client|
- A caregiver is said to be practicing __________ care not only when she takes into consideration the client’s actual or potential problems but also when she considers the client’s family, work responsibilities, and social aspects of life.
KEY: Nursing Process Step: Evaluation MSC: Client Needs: Psychosocial Integrity
- A client is believed to have adapted to a situation when he or she exhibits which characteristic?
|a.||The client has become accustomed to his or her surroundings.|
|b.||The client has shown improvement in behavior as evidenced by the ability to carry out activities normal to his or her life.|
|c.||The client has accepted his or her current behavior patterns.|
|d.||The client has established a trusting relationship with the caregivers who are providing care.|
- One of the goals of therapy established with a client on a mental health unit who has been given a diagnosis of obsessive-compulsive disorder (OCD) is to improve his feelings of stability in his environment. Much of his OCD behavior manifests as cleanliness and control of germs. Which nursing intervention most likely would help this client to feel more stable in his environment?
|a.||Encouraging visits from family members and friends|
|b.||Rewarding him for acceptable behavior by increasing the number of times he is allowed to clean his bathroom daily|
|c.||Encouraging him to participate in group activities|
|d.||Allowing him to wash his hands only for an agreed upon number of times daily|
- Which is the best way that a nursing unit manager can assist his or her staff in maintaining a professional commitment to their job and profession?
|a.||Frequently offering and requiring a specific number of hours of in-service training on new care modalities within the facility|
|b.||Requiring out-of-facility continuing education hours twice a year|
|c.||Encouraging staff to subscribe to nursing journals to keep up-to-date on new information|
|d.||Keeping nursing journals on the unit for easy access to staff|
- The nurse is working with a male client to instill a feeling of self-commitment to improve his self-esteem. From which of the following interventions would the client most benefit?
|a.||Having the client promise himself that he will do the best he can in a particular situation, knowing that failure is a possibility|
|b.||Encouraging the client to do the best he can in any given situation, while reminding him that failure is a possibility|
|c.||Ensuring that the client limits activities to those in which he is sure to be successful|
|d.||Allowing the client to set goals that are nearly impossible to achieve but giving him the opportunity to try his best to meet these goals|
- The nurse is working with a health care team with that believes in the philosophy of reality therapy. The nurse is aware that the team’s belief is centered around:
|a.||Reorientation of the client to his or her environment|
|b.||Describing clients as irresponsible rather than mentally ill|
|c.||Looking at the client’s past in determining how it has affected present behavior|
|d.||Accepting the client’s perceptions of right and wrong behavior in the development of his treatment plan|
- A busy community mental health center treats a client who is in crisis. The client is provided with instruction on relaxation exercises, but throws them away. Two weeks later the staff is dismayed when the client returns with her condition worsened. This lack of success after the previous visit is due to which of the following factors?
|d.||Lack of commitment|
- A client is monopolizing a group session, not allowing other members to participate. What is the most appropriate way to address the client?
|a.||“You are not allowed to speak for the remainder of the session.”|
|b.||“You are selfish and must leave now. ”|
|c.||“You are very rude when you act this way.”|
|d.||“You need to stop this behavior. Let’s see what others have to say.”|
- The night before her final exam, the nursing student cannot sleep, and is convinced she will fail. Which of the following actions will help to promote a more positive outlook?
|a.||Continue to study rather than continue attempting to sleep.|
|b.||Accept the possibility of failure and plan to repeat the course.|
|c.||Use the negative thoughts as motivation.|
|d.||Visualize staying relaxed during the exam and successfully passing.|
- A client with frequent re-admissions to the inpatient unit refuses to eat or participate in activities. The nurse functions as the client advocate by which of the following actions?
|a.||Respecting the client’s wishes by taking food away and leaving the room door closed|
|b.||Scolding the client as a way to motivate a change in behavior|
|c.||Providing consistent encouragement to attend activities and having food available|
|d.||Ignoring the client and encouraging other health care team members to do the same|
- Identify the stages experienced by a person in a crisis. (Select all that apply.)
- Which of the following are signs that indicate that the mental health nurse is becoming overly involved with a client’s care? (Select all that apply.)
|a.||Knowing when to help and when not to help a client|
|b.||Showing greater levels of concern for one client over all other clients|
|c.||Feeling that the nurse is the only caregiver who understands the client|
|d.||Being committed to providing competent health care at all times|
- An important component of providing good care is for health caregivers to take care of, or nurture, themselves. Which of the following are ways that effectively assist health caregivers to nurture themselves? (Select all that apply.)
|a.||Be supportive of colleagues.|
|b.||Recognize and accept one’s own limitations, and strive to improve.|
|c.||Take pride in oneself.|
|d.||Accept all challenges presented.|
|e.||Be responsible and accountable for one’s own actions.|
- A recently widowed 74-year-old male is seen in the mental health clinic for sleep disorders and depression. Which of the following nursing actions demonstrate caring? (Select all that apply.)
|a.||Providing a private place to interview the client|
|b.||Delegating other tasks to a colleague while speaking to the client|
|c.||Addressing the client as “honey” to provide comfort|
|d.||Asking about his daily activities and hobbies during the interview|
|e.||Listening intently to his responses and not being distracted by his nonverbal communication|
- __________ mechanisms are thoughts or actions that are used to help individuals handle or reduce stress.
- Place in proper chronological order the steps in the process of growing as a result of failure. (Separate letters by a comma and space as follows: A, B, C, D, E, F, G.)
- Consider one’s failure as a learning experience.
- Give oneself permission to fail.
- Understand that failure is a necessary part of change.
- Discover opportunities that are created by failure.
Chapter 9: Mental Health Assessment Skills
- The nurse asks the client a series of questions upon entry into a mental health care system. This action is an example of which phase of the nursing process?
- A nurse administers antidepressant medication to a client in an assisted-living facility. This is an example of which phase of the nursing process?
- Following completion of a male client’s series of group therapy sessions, the nurse periodically talks with the client to determine whether he has any signs of relapse of his previous problems. This action by the nurse is an example of:
- During a session with a female client with a diagnosis of social phobia, she talks about how proud she is of herself because she was finally able to shop at the grocery store. The nurse documents the events and knows that this would be considered which phase of the nursing process?
- The treatment team meets with a client for the first time and determines, with the client’s input, a nursing diagnosis, goal, and steps to reach this goal. In addition to a nursing diagnosis, the treatment team has completed which phase of the nursing process?
- Without assessment of six specific aspects of an individual’s being, the mental health nurse’s scope of care is narrow and limited in effectiveness. These aspects include social, physical, cultural, intellectual, emotional, and spiritual areas of a person’s life, known as a(n) __________ assessment.
- The nurse is reviewing information regarding a female client that was obtained with the psychiatric assessment tool. The client’s ability to provide food and shelter for herself is included in which area of the assessment?
|a.||Appraisal of health and illness|
|b.||Coping responses, discharge planning needs|
|d.||Previous psychiatric treatment|
- During an interview with a 15-year-old female client admitted for depression, the nurse expresses her disappointment when she to learns that the client recently became pregnant and then had an abortion. The nurse is contradicting the effective interview guideline of:
|a.||Paying close attention to the client’s nonverbal communication|
|b.||Avoiding making assumptions|
|c.||Avoiding one’s personal values that may cloud professional judgment|
|d.||Setting clear client goals|
- A male client with a history of schizophrenia was admitted to the mental health facility after he was found on the street in a confused state and was uncooperative when approached by the police. One of the first assessments that should be performed on this client upon admission is a _____ assessment.
MSC: Client Needs: Physiological Integrity
- During the mental status examination, the nurse observes that the client rapidly changes from one idea to another related thought. Which disordered thinking process is the client displaying?
|d.||Flight of ideas|
- When reviewing the nursing notes from the previous shift, the nurse notices notations indicating that the client was experiencing a somnolent level of consciousness. The client’s behavior would be described as:
|a.||“Falling asleep easily and only awakening with strong verbal stimuli”|
|b.||“Frequently sleeping and awakening only to strong physical stimuli”|
|c.||“Unresponsive to any verbal or painful stimuli”|
|d.||“Having alternating periods of excitability and drowsiness”|
- During the mental status assessment, the nurse hands the client a piece of paper that reads “Please raise your left hand.” If the client follows the command, the nurse has just assessed which ability of the client?
- According to the DSM-IV-TR Axis guidelines, clinical disorders are described as:
|a.||Dependent, antisocial personality disorders, and levels of retardation|
|b.||Educational, housing, legal, and economic problems|
|c.||Heart and digestive disorders|
|d.||Mood disorder, substance abuse, and schizophrenic disorders|
- A score of 1 to 10 on the global assessment functioning (GAF) scale would indicate that a client was at risk for:
|a.||Mild difficulty in focusing|
|b.||Mild difficulty in handling social situations|
|c.||Hurting himself or others|
|d.||Serious impairment in social and occupational functioning|
- A client with a history of delusions demonstrates which of the following behaviors?
|a.||Shifts from laughing to crying with no apparent cause|
|b.||Insists the government is out to harm them|
|c.||Has trouble remembering what he had for breakfast|
|d.||Expresses a constant fear of dying|
- A client complains to the nurse that he has been fired from his fourth job in 10 months because his bosses and co-workers “didn’t understand him.” While he once had a few close friends, he no longer associates with them for the same reason. His level of functioning on the global assessment of functioning (GAF) scale would be:
|a.||71-80; transient symptoms|
|b.||61-70; some mild symptoms|
|c.||41-50; serious symptoms|
|d.||1-10; persistent danger of hurting self or others|
- The nurse suspects the client is experiencing a manic episode based on which of the following observations?
|a.||Clothing is very colorful and mismatched, and client cannot sit in chair during interview.|
|b.||Hair is not combed, clothing is dirty, and client has no interest in surroundings.|
|c.||Client repeatedly washes her hands and picks at a button on her shirt.|
|d.||Client expresses fear that someone is waiting outside the room to harm her.|
- A client seen in the emergency department is noted to be stuporous. Which of the following assessment findings would be of most concern?
|a.||Elevated blood pressure|
|b.||Elevated cholesterol levels|
|c.||New exercise routine|
|d.||Painting furniture in a windowless room|
- Upon entrance into a mental health care system, clients are thoroughly assessed, and this is followed by the development of a mental health treatment plan. Which of the following are purposes of the treatment plan? (Select all that apply.)
|a.||Proof of care for insurance reimbursement purposes|
|b.||A means of monitoring the client’s progress|
|c.||An instrument for communication and coordination of care|
|d.||A guide for planning and implementation of care|
|e.||Evaluating the effectiveness of interventions|
- The assessment phase of the nursing process refers to the phase when data collection occurs. Which methods does the nurse use to collect data? (Select all that apply.)
|a.||Interpreting client behaviors|
|b.||Interviewing the client and significant others|
|c.||Observing client behavior|
|d.||Performing physical assessment|
|e.||Reviewing diagnostic testing results|
- During the sociocultural assessment of a client who is entering a mental health program, the nurse focuses on which information related to the client? (Select all that apply.)
- Short-term memory loss is seen in which of the following disorders? (Select all that apply.)
- __________ is how the client displays his or her emotions through facial, vocal, or gestural behavior.
- List the five steps of the nursing process in proper chronological order.
Chapter 10: Therapeutic Communication
- A male client with a diagnosis of schizophrenia begins to have hallucinations during a conversation with the nurse; this prevents him from receiving the message that the nurse is trying to communicate to him. According to Ruesch’s theory of communication, this unsuccessful interaction is called _____ communication.
- The theorist Eric Berne theorized that an individual’s three ego states of parent, child, and adult make up one’s:
|d.||Ability to communicate|
- The nursing student is assigned a client to interview and is asked to practice the therapeutic communication technique of sharing perceptions. Which statement made by the student nurse best describes this technique?
|a.||“I noticed that you pace the halls, and you have a tense look on your face. I sense that you are anxious about something.”|
|b.||“Can you tell me more about how you feel when you are arguing with your daughter?”|
|c.||“I would like to talk with you about your plan of care.”|
|d.||“Tell me if I understand you correctly.”|
- The nurse is talking with a male client regarding his recent relapse of alcohol addiction. The client alludes to the fact that he started to drink again after a fight with his wife. The nurse uses clarification to ensure an accurate understanding of the client. Which statement is the best example of clarification?
|a.||“You said that the fight you had with your wife caused you to start drinking again?”|
|b.||“Let’s discuss what made you feel the need to drink.”|
|c.||“Could you tell me again when and what happened that you feel caused you to start drinking again?”|
|d.||“Tell me what your childhood was like.”|
- A female client discusses her feelings of jealousy regarding the relationship between her mother and her daughter. The nurse responds in a nontherapeutic way by making a statement that is defensive and challenging. Which statement is the best example of a defensive and challenging nontherapeutic response?
|a.||“Tell me more about the feelings you have regarding their relationship.”|
|b.||“I think that you should tell them how you feel.”|
|c.||“Let’s not talk about that right now.”|
|d.||“Don’t you think that you should be thankful that your daughter has a good relationship with her grandmother?”|
- A female client has been attending group therapy for support regarding an abusive relationship with her husband. The client voices concern about her 10-year-old daughter growing up in this environment but states that she just can’t find the strength to leave her husband. The nurse responds by using the nontherapeutic technique of reassuring. Which statement is the best example of this nontherapeutic technique?
|a.||“I can’t believe that you would want your daughter to grow up in this environment.”|
|b.||“I understand your concern. Let me give you some information on our local council for domestic abuse.”|
|c.||“I’m sure it won’t be that bad to be out on your own. I know you can do it.”|
|d.||“I think you should not think about leaving and should just do it.”|
- Therapeutic communication techniques support effective communication between the client and the nurse. Which group of therapeutic techniques is most likely to be effective when one is conversing with a client?
|a.||Broad openings, restating, and advising|
|b.||Clarification, focusing, and confrontation|
|c.||Listening, silence, and reflection|
|d.||Humor, informing, and reassuring|
- While the nurse is talking with a female client, the client becomes silent for several seconds. Which is the nurse’s best response?
|a.||To interpret this action as an indication that the client is finished with the conversation|
|b.||To ask the client a question so the interaction can continue|
|c.||To remain silent and be attentive to the client’s nonverbal communication|
|d.||To tell the client that help can be more effective if she shares her feelings|
- A client who usually is very active in her therapy group tells the nurse that she really does “not feel well today” and would “rather not attend the group therapy session.” Which is the nurse’s most appropriate response?
|a.||“You don’t feel like attending the group therapy today?”|
|b.||“I will just stay with you for a while.”|
|c.||“It’s okay to skip a session every once in a while.”|
|d.||“Why don’t you want to attend group therapy?”|
- The nurse is talking with a male client with a diagnosis of schizophrenia who often experiences auditory hallucinations. For this communication to be most effective, the nurse should:
|a.||Sit with the client and encourage him to not verbalize.|
|b.||Do most of the talking.|
|c.||Discuss several different topics to keep the client’s attention.|
|d.||Use simple, concrete language.|
- The nurse’s ability to interpret communication effectively in the mental health setting depends mostly on:
|a.||How well the client communicates|
|b.||The nurse’s relationship with the client|
|c.||The nurse’s understanding of mental health disorders|
|d.||The nurse’s ability to listen to and observe the client’s verbal and nonverbal messages|
- Which nurse response is the best example of the therapeutic principle of respect?
|a.||“I’m interested in what you have to say.”|
|b.||“Describe how you are feeling for me.”|
|c.||“I hear how worried you are about your future and can imagine how you feel.”|
|d.||“You signed a contract stating that you would let me know when you have those thoughts.”|
- A female client is being discharged from an inpatient mental health unit after receiving treatment for bipolar disorder. She has responded well to treatment but voices concern about going home and maintaining balance in her life. The client would benefit most by a response from the nurse that conveyed the therapeutic communication principle of:
- A nurse has just graduated from nursing school and has been hired on a mental health unit. The nurse wants to practice good communication skills with clients but knows that a mistake made by many new nurses in trying to communicate effectively involves:
- A client has difficulty in communicating as a result of his illness. He displays a rapid, confusing delivery of speech patterns. Which term best describes this difficulty in communicating?
MSC: Client Needs: Psychosocial Integrity
- When practicing therapeutic communication with a client, the nurse demonstrates which of the following listening skills?
|a.||Finishing the client’s sentences to indicate listening|
|b.||Not clarifying messages to avoid interrupting|
|c.||Avoiding taking notes to detract from listening|
|d.||Changing the environment to decrease distractions|
- The nurse asks a client how she is feeling, and the client provides a detailed description of everything she is experiencing. This is an example of:
- The client tells the nurse that she believes there is no improvement in her manic episodes. Her clothing matches, and her makeup is more subdued. She sits quietly in the chair during the session. What does this indicate?
|a.||Verbal communication takes priority.|
|b.||Verbal communication is not congruent with nonverbal communication.|
|c.||Nonverbal communication indicates the client is lying.|
|d.||Nonverbal communication should take priority.|
- When the adolescent client is asked about the magazine she is reading, she responds, “It’s an article about my favorite movie star. Did you see all the stars out last night? I used to be afraid of the dark at night.” Which speech pattern is this an example of?
|b.||Flight of ideas|
- Which elements must be present for communication to occur? (Select all that apply.)
- Which interventions assist the nurse to effectively communicate with clients from other cultures? (Select all that apply.)
|a.||The nurse adapts his or her behavior to accommodate the difference in communication styles.|
|b.||The nurse identifies and clarifies confusion during the interaction.|
|c.||The nurse recognizes the difference between communication styles and assists the client to change to the nurse’s communication style.|
|d.||The nurse uses a limited number of slang terms when communicating with the client.|
- Which nurse responses could block effective communication with a client? (Select all that apply.)
|a.||“This is what I think you should say…”|
|b.||“Don’t stress over it. Everything will turn out fine.”|
|c.||“Why did you do that?”|
|d.||“Most people in your circumstance…”|
- In order to be therapeutic when communicating with a client living in a homeless shelter, it is important to apply which techniques? (Select all that apply.)
|a.||Show acceptance and respect.|
|b.||Avoid clarifying terms.|
|c.||Use medical terminology to avoid talking down.|
|d.||Consider the client’s environment.|
|e.||Assess client’s pattern of verbal and nonverbal communication.|
- __________ is the transferring between people of information, including ideas, beliefs, feelings, and attitudes.
- During the process of communication, a chain of events occurs as soon as the message is sent. Steps in this chain include transmission, perception, and evaluation. Place these steps in proper chronological order. (Separate letters by a comma and space as follows: A, B, C.)
Chapter 11: The Therapeutic Relationship
- The nurse is attempting to develop trust with a newly admitted female client for the purpose of establishing a therapeutic relationship. The nurse is currently administering medications to all clients on the unit. The newly admitted client asks the nurse to sit and talk with her for a while. What is the nurse’s best response?
|a.||“I am busy right now, but I will come back later.”|
|b.||“Give me just a few more minutes to finish passing medication to the other clients.”|
|c.||“I will return in 20 minutes so we can talk.”|
|d.||“I have to finish giving all the clients their medications, but I will then come back so we can talk.”|
- A nurse is working with a male client in a mental health outpatient clinic. The client voices a desire to become more autonomous. Which goal will assist the client in becoming more autonomous?
|a.||The client will check his calendar each night to plan for commitments scheduled on the following day.|
|b.||The nurse will remind the client weekly of his appointment at the clinic for the following week.|
|c.||The client will ask the nurse to call him to remind him of his appointment.|
|d.||The nurse will complete the client’s calendar of daily commitments scheduled for the week.|
- An important aspect of developing a therapeutic relationship with a mental health client is for the nurse to show that she cares about the client. The nurse who is working on an inpatient unit can show signs of caring by:
|a.||Telling a client several times a day that he or she cares about him or her|
|b.||Asking a client what his or her favorite movie is, then showing that movie during a movie night on the unit|
|c.||Giving a client a card that has a sentiment that says the nurse cares about him or her|
|d.||Telling a client that he or she is the favorite client|
- The nurse is caring for a female client with a diagnosis of severe bipolar disorder. Out of many treatment methods, the one treatment that the client and the team have found to be most effective is the medication lithium. The client voices concern about her future with this diagnosis. Which nurse response best represents the concept of hope?
|a.||“You need to take your lithium unless you want to relapse.”|
|b.||“You are doing so well that there is nothing you can’t do if you put your mind to it.”|
|c.||“You are doing very well since we found that lithium helps. You should do well as long as you continue your therapy and medication.”|
|d.||“A lot of people are much worse off than you are, so you should be thankful that you are doing as well as you are.”|
- A male client with schizophrenia has lost his job and home and has been living in a homeless shelter. He voluntarily admits himself into a mental health treatment facility. The client’s current living situation and lack of a job at this time likely will contribute to his having difficulty with which dimension of hope?
- A female client with obsessive-compulsive disorder is undergoing treatment in an outpatient setting and is attending group therapy sessions. She is working on controlling the compulsion of touching her head three times every time she talks. To maintain the therapeutic relationship established with the client, by which action can the nurse show acceptance?
|a.||Ignoring the compulsion during the group therapy session and talking with the client privately about the behavior|
|b.||Asking the group to remind the client every time she touches her head to help her consciously stop the compulsion|
|c.||Pointing out the compulsion to the group each time the client exhibits the behavior|
|d.||Asking the client to stop talking during the group session until she has learned to control her compulsion|
- The characteristic of genuineness helps in establishing a therapeutic relationship with a client. Which nurse response is the best example of a display of genuineness to a client who is going through a difficult divorce?
|a.||“I know exactly how you feel. My husband and I divorced 2 years ago because of his infidelity.”|
|b.||“Divorcing my husband was the best thing I ever did.”|
|c.||“I have friends who have gone through a divorce. It must be difficult for you.”|
|d.||“I am sorry that you have to go through this difficult time.”|
- During the preparation phase of a therapeutic relationship with a client, what is the main task to be completed by the nurse?
|a.||To establish with the client the purpose of the relationship|
|b.||To gather and review all possible information regarding the client|
|c.||To build trust with the client|
|d.||To obtain agreement from the client to work in conjunction with the nurse|
- When should the nurse begin preparations for the termination phase of a therapeutic relationship?
|a.||During the orientation phase|
|b.||Prior to the last meeting|
|c.||During the last meeting|
|d.||After all goals have been met|
- The nurse is preparing an adult male client, who has been successfully treated for a social phobia, for the termination phase of the therapeutic relationship. During their last meeting, the client told the nurse that he noticed he has developed a nervous habit that started a few days ago of checking his door at home several times a day to be sure it is locked. This client is exhibiting the client response to termination known as:
- When a caregiver becomes a role model for a client during a therapeutic relationship, the caregiver is functioning in the role of:
- A male client is being discharged from a mental health facility and is worried about what to tell his friends and co-workers regarding his time away. The nurse helps the client plan what to say to others about his disease. The nurse is functioning in the role of:
- A female client is admitted with suicidal tendencies. The client is placed in suicide precautions for the first 24 hours of her stay. Ensuring client safety is included in the therapeutic role of:
- The nurse who is caring for a client begins to have very protective feelings toward the client that are interfering with the therapeutic relationship between the nurse, the client, and the client’s family. This is an example of a problem that is encountered in some therapeutic relationships and is known as:
|a.||An environmental problem|
- A 19-year-old male client is being treated for a drug addiction. He continually voices his dread of being discharged because he knows he will have to live with his parents and follow their rules until he can earn enough money to live on his own. He is showing increasing resistance to treatment measures, such as attending group sessions, but is refusing to acknowledge that he has an addiction or that he needs treatment. Which behavior is the client demonstrating?
- A client response to the termination phase of the therapeutic relationship is withdrawal. This response most often is manifested by client behaviors such as:
|a.||Bringing up new problems|
|b.||Being absent from appointments|
|c.||Returning to maladaptive behavior|
|d.||Having increased anxiety|
- A 22-year-old woman with depression misses her scheduled meeting with the nurse. Although they have established a contract to meet on an agreed upon schedule, the nurse understands that the client is still testing the relationship and working on trusting her care provider. This behavior usually manifests itself during which phase of the therapeutic relationship?
- The new nurse confides to his supervisor, “I am feeling frustrated. Mr. J has been doing so well in dealing with his issues over the last month, and today he refused to discuss anything productive in our session.” What is the most appropriate response?
|a.||“You are still in the preparation phase and need to check the medical record for information.”|
|b.||“The orientation phase is a time where in which the client is building trust and testing you.”|
|c.||“During the working phase the client may have growth and resistance.”|
|d.||“The termination phase is a difficult one for both nurse and client.”|
- Which of the following actions indicates that the nurse has gone beyond the boundaries of the client–caregiver relationship?
|a.||The nurse consciously focuses on the client during meetings.|
|b.||The nurse works to establish a trusting relationship with the client.|
|c.||The nurse instills a sense of hope in the client.|
|d.||The nurse defends the client to her family and the staff.|
- As the nurse begins to discuss discharge plans for a 45-year-old female client hospitalized for anxiety, the client states, “You never really cared whether I get better! Why not stop this charade?” The nurse recognizes this to be:
- For which roles is the caregiver responsible in a therapeutic relationship? (Select all that apply.)
- Which of the following are characteristics of a therapeutic relationship? (Select all that apply.)
|e.||Therapeutic use of self|
- __________ refers to the ability of the nurse to establish a meaningful connection with a client.
- The acronym TEACH represents the components of a therapeutic relationship, including __________, __________, __________, __________, and __________.
- A therapeutic relationship has four phases. Place these phases in proper order. (Separate letters by a comma and space as follows: A, B, C, D.)
Chapter 12: The Therapeutic Environment
- Crisis stabilization provides care to clients in treatment settings with the purpose of reestablishing homeostasis; it usually lasts for _____ days.
|a.||1 to 2|
|b.||2 to 4|
|c.||4 to 6|
|d.||6 to 8|
- Which is an accepted criterion for inpatient admission to a mental health facility?
|a.||The client likes the security and comfort of the mental health facility.|
|b.||The client feels that he is no longer able to cope with life stressors or maintain control of his behavior.|
|c.||A client’s behavior becomes unusual.|
|d.||The client suffers from depression.|
- A male client with a diagnosis of schizophrenia refuses to take his medication because of his paranoia that the medication may be poisoned. Frequent inpatient readmissions to the facility occur as a result. Which term is given to repeated inpatient admissions?
- An adult female inpatient client with a diagnosis of paranoid schizophrenia will not take her medications from the nurse. She states, “I know you are poisoning that medicine.” Which nursing action is most appropriate?
|a.||Promise the client that the staff would not do anything to harm her.|
|b.||Let the client watch the medication preparation process.|
|c.||Administer medications to her in unit dose packages so that she can open the packages herself.|
|d.||Allow the client to retrieve the medications out of the medication cart with supervision.|
- A male inpatient client who is experiencing depression has no interest in eating. He skips meals frequently and has been losing weight. What is the best nursing action in this situation?
|a.||Ask the client to “Please eat one meal for me.”|
|b.||Leave food with him at mealtime and offer snacks frequently.|
|c.||Give the client information on the benefits of good nutrition.|
|d.||Remove client privileges every time he doesn’t eat.|
- Encouragement for clients to practice good hygiene habits not only meets basic physiological needs, it also meets the hierarchal need of:
|a.||Love and belonging|
|b.||Safety and security|
- With regard to the environment, it is important for the nurse to be aware of lighting for some clients. Clients with a diagnosis of schizophrenia may be bothered by lights that are flickering because this may trigger:
- A female client on the mental health unit experiences periods of psychosis at intervals. She often asks what day she came to the facility and what day it is now, and she seems never to be aware of the time. Which nursing intervention would help this client the most?
|a.||Remind her of the time of day every time she asks.|
|b.||Assist her to keep a written schedule, including her day of admission, on a calendar posted in her room and a clock beside the calendar.|
|c.||Tell her it doesn’t really matter what day she came to the facility; what matters is what day and time it is now.|
|d.||Instruct the staff to not answer her repetitive questions because she has been told numerous times her day of admission, and there is a clock on the wall.|
- A 15-year-old female client is noted to often sit alone in the activity room of the facility while watching television. She often begins to join in activities on the unit but then retreats back to her room. Which intervention is most appropriate in this situation?
|a.||Encourage her to join in on a group activity and actively participate in the activity with her until she feels more comfortable on her own.|
|b.||Keep encouraging her to participate in the group activity.|
|c.||Offer her rewards, such as extended television privileges, for joining in a group activity.|
|d.||Offer her support as she tries to become more involved in activities.|
- The nurse can assist a client best in meeting his or her needs for self-esteem and/or self-actualization by:
|a.||Setting rules and regulations|
|b.||Allowing the client to set rules and regulations for the inpatient unit|
|c.||Informing the client of what the treatment team has decided regarding the plan of care|
|d.||Allowing the client to make choices involving his or her care when appropriate|
- The nurse is aware that during the admission process to a mental health facility, the anxious client:
|a.||Is acutely aware of his or her surroundings|
|b.||Often forgets some of what is said in the unfamiliar surroundings|
|c.||Has a keen memory in his or her heightened state of awareness|
|d.||Frequently has no recollection of what is said by the staff during admission|
- Bright colors in the environment of the client are often:
- The nurse should monitor the temperature of the environment of a client who becomes easily agitated, with awareness that increased temperatures sometimes may cause the client to become:
- A male client is in the process of being admitted to a mental health facility. He is sure that the nurse is the administrator of the hospital, despite the nurse’s insistence that he is a staff nurse on the unit. This client is experiencing:
- When establishing a client’s level of consciousness, the nurse is aware that this is determined by assessing the client’s:
|a.||Level of awareness|
|b.||Ability to tell the nurse where he or she is at any given time|
|c.||Accuracy in expressing the current month, date, or year|
|d.||Capability to explain why he or she is in the facility|
- A 16-year-old client is in the lounge with other clients on the inpatient unit when he suddenly becomes agitated. Which action by the nurse would be most appropriate in this situation?
|a.||Turn up the volume on the television to distract the client.|
|b.||Bring him to sit at the nurses’ station while the staff is doing shift report.|
|c.||Keep him in the lounge and attempt to converse with him.|
|d.||Accompany him to a room where soft music is playing.|
- The goal in treating a client with a chronic mental illness is to prevent recidivism. Which factor is crucial in this effort?
|a.||Increased use of psychotherapeutic medications|
|b.||Increased lengths of stay on the inpatient unit|
|c.||Increased commitment to the plan of care by the client|
|d.||Group residential homes with vocational training|
- The use of therapeutic touch as a relaxation technique in the mental health setting is beneficial for clients displaying which symptoms?
- A 22-year-old woman is brought to the inpatient unit for attempting suicide. Her clothes are clean, and her general appearance is neat and well groomed. She appears to be well nourished. In considering Maslow’s hierarchy of needs, which is a priority for this client?
|b.||Love and belonging|
|d.||Safety and security|
- Inpatient services provide care mainly for mental health clients who are experiencing which conditions? (Select all that apply.)
|a.||Acute mental or emotional problems|
|b.||Chronic mental or emotional problems|
- Which are common causes for client noncompliance in the plan of care? (Select all that apply.)
|b.||Lack of support by family|
|c.||Staff dislike of a client|
|d.||Inability to understand the treatment plan|
|e.||Lack of access to treatment services|
- Admission to an inpatient mental health unit is often a stressful event. Which actions on the part of the health care provider will help to decrease the anxiety of the client? (Select all that apply.)
|a.||Conduct the admission interview with a team of health care providers.|
|b.||Answer any questions the client may have.|
|c.||Support the client in being oriented to the unit.|
|d.||Provide simple, clear instructions and repeat if needed.|
|e.||Communicate concern for the client.|
- __________ describes the setting or environment in which mental health care is provided.
- __________ refers to the process of achieving one’s full potential in life.
- Discharge planning for an inpatient mental health facility client begins on __________.
Chapter 13: Problems of Childhood
- Social and emotional development occurs at a more simple level in the child who is _____ years old.
- A 10-year-old male client is 20 pounds overweight. Which intervention by the nurse is the most effective in this situation?
|a.||Place the client on a strictly controlled calorie-restricted diet.|
|b.||Talk to the client about why he is so overweight.|
|c.||Teach the client and his parents about healthy eating habits and choices.|
|d.||Make a list of foods that are to be restricted in the client’s diet.|
- A couple comes to the sleep disorder clinic because their 3-year-old daughter has problems falling asleep every night. The parents say that it takes their daughter 1 to 2 hours each night to fall asleep, and one of the parents ends up having to lie down with her. Which intervention should the nurse first suggest?
|a.||The parents should trade each night who tries to put her to bed.|
|b.||The daughter could start falling asleep in the parents’ bed, then could move to her own bed.|
|c.||Place the child in bed at the same time each night, and don’t allow her to get out of bed.|
|d.||Follow a bedtime ritual each night, such as reading one book.|
KEY: Nursing Process Step: Planning MSC: Client Needs: Psychosocial Integrity
- The parents of a 2-year-old boy seek assistance at a family therapy clinic because their son throws a temper tantrum every time he is not allowed to throw his food on the floor during meals. Which therapeutic intervention does the nurse suggest?
|a.||Leave him during the tantrum, so that he feels isolated from others as a result of his behavior.|
|b.||Try to distract him when he becomes frustrated, and reward him for positive behavior.|
|c.||Hold the child down until the tantrum stops.|
|d.||Put him in the corner for punishment while he is having the tantrum.|
- Poverty influences the growth and development of children and is often a precursor to mental health disorders in children. Nearly _____ of children in the United States come from families that live at the poverty level.
- During the interview process with a homeless client, which is an appropriate nursing action?
|a.||Wait until later in the interview to ask questions such as address or nearest relative.|
|b.||Ask the client early in the interview what is his or her highest education level.|
|c.||Ask the client where he or she planned to sleep that night.|
|d.||Encourage the client to bathe as soon as possible.|
- Adult disorders such as chronic anxiety and depression often are associated with childhood:
- For children older than 4 years, separation anxiety should last for no longer than:
|a.||A few days|
|b.||A few weeks|
|c.||A few months|
- The parents of a 9-year-old girl with mental retardation voice concerns to the nurse regarding their child’s eating insects and leaves. The parents report that this behavior has been occurring for almost 4 months. From what is this child most likely suffering?
- As the caregiver for a male client whose mental retardation level is classified at a moderate level, the nurse’s most appropriate action is to:
|a.||Encourage him to work in a supervised setting at a fast food restaurant.|
|b.||Persuade him to look for an apartment in which he can live on his own.|
|c.||Find a group home that he would adjust well to.|
|d.||Seek placement for him in a long-term setting for clients with cognitive disabilities.|
- A 12-year-old female client with a normal IQ has difficulty with math at school. She performs well in all subjects except math, for which she is unable to earn above a grade of “D,” no matter how much she studies. What is this client most likely suffering from?
|b.||A learning disorder|
|c.||Pervasive developmental disorder|
|d.||An anxiety disorder|
- The parents of a 3-year-old boy are concerned because their son seems to speak very slowly and has an odd rhythm to his speech pattern. What is this child most likely experiencing?
|d.||Expressive language disorder|
- A 7-year-old male client displays behaviors such as an inability to make eye contact with others, inappropriate facial expressions, difficulty in making friends, and showing little emotion with family members. He talks with adults but is awkward in his conversation. Given these behaviors, what is this client most likely experiencing?
|a.||Childhood disintegrative disorder|
- The Denver II is a tool that is used for assessment of early childhood development. What is this tool used to assess?
|c.||Gross and fine motor skills|
- The emotional developmental task of industry vs. inferiority that occurs in childhood is characteristic of which age group?
|a.||Infancy: birth to 1 year old|
|b.||Early childhood: 1 to 3 years old|
|c.||Preschool age: 3 to 6 years old|
|d.||School age: 6 to 12 years old|
- Breath-holding spells typically occur when a child becomes extremely frustrated, cries, and either intentionally or unintentionally holds his or her breath. This rarely occurs in children younger than the age of ______ months.
- A mother of a 9-year-old is concerned because her child complains of frequent stomachaches in the morning before leaving for school. No medical reason has been found for this condition. The family has recently moved to the area after the woman and her husband divorced and the child is attending a new school. What is the most appropriate response the nurse can give to this mother?
|a.||Ignore the child’s complaints and send the child to school.|
|b.||Allow the child to stay home from school when this occurs.|
|c.||Provide support and reassurance to the child as he adjusts.|
|d.||Take away computer privileges to stop this behavior.|
- The school nurse meets with the parents of a 7-year-old child who frequently shows a lack of respect for his teacher and the rules of the classroom. His parents report he fights with his siblings and has tried to run away from home when they attempt to take away privileges. Based on this assessment, what does the nurse understand about his future?
|a.||He is experiencing a normal developmental task and will grow out of it.|
|b.||His prognosis for recovery will be good if not punished.|
|c.||Due to his age, future prognosis is poor.|
|d.||He should be allowed to set his own limits.|
- Due to the proximal to distal physical development of the child, which of the following motor skills is able to be accomplished by a toddler?
|b.||Buttoning a shirt|
|c.||Eating finger foods|
|d.||Cutting food with a fork and knife|
- The parents of a 5-year-old are concerned because he has recently starting wetting himself during the day while at school. They inform their pediatrician about this when they bring their newborn daughter in for her first immunizations. After ruling out any physical cause, the pediatrician informs the parents that this is due to?
|a.||Primary nocturnal enuresis|
- The parents of a 9-year-old boy have been told by the child’s teacher that he exhibits symptoms of attention-deficit/hyperactivity disorder (ADHD). Which specific behaviors may the child exhibit for this diagnosis to be made? (Select all that apply.)
|a.||Frequently interrupts or intrudes on others|
|b.||Is easily distracted by outside stimuli|
|c.||Has feelings of restlessness or frequently fidgets with hands and/or feet|
|d.||Exhibits an excellent short-term memory|
|e.||Often leaves tasks incomplete|
- Before the diagnosis of mental retardation can be made, which factors must be present? (Select all that apply.)
|a.||IQ of 70 to 100|
|b.||Inability to communicate effectively|
|c.||Poor adaptation to social situations|
|d.||IQ less than 70|
|e.||Inability to care for self appropriate to age|
|f.||Maladaptive coping skills|
- A fifth grade teacher is concerned that one of his students is at risk for violent behavior. Which signs will the school nurse advise him to be aware of? (Select all that apply.)
|a.||Enjoys contact sports|
|b.||Engages in risk-taking behaviors|
|c.||Frequent angry outbursts|
|e.||Isolates self from others|
|f.||Damages school property|
- __________ is a disorder that involves an individual’s ability to communicate, interact with others, use the imagination, and display appropriate behavior.
- The developmental period of middle childhood is considered to encompass the ages of _____ to _____ years.
Chapter 14: Problems of Adolescence
- The child in early adolescence experiences developmental issues with his or her identity as evidenced by:
|a.||Feeling stable with his or her self-esteem|
|b.||Conforming to group norms|
|c.||Being very self-centered|
- Internal developmental problems are seen as a causative factor for some behavioral and family problems during adolescence. Psychological developmental issues that can lead to problems during late adolescence (17 to 20 years old) include:
|a.||Wide mood swings|
|b.||Tendency to withdraw when upset|
|d.||Concealing of anger|
- A male adolescent client tells the nurse that he is almost positive that he is homosexual. This realization most likely has occurred during the developmental period of:
- Environmental problems often lead to mental health problems among adolescents. Approximately _____ million children and adolescents must cope with the issue of having a parent in jail or on parole.
- The nurse is working with a 15-year-old girl and her parents on a treatment plan for her diagnosis of attention-deficit/hyperactivity disorder (ADHD). The nurse should be sure to:
|a.||Encourage the parents to seek teachers for their daughter who are going to be lenient with assignment schedules because of her diagnosis.|
|b.||Remind the parents to determine ahead of time consequences/punishment that they will give their daughter when she is not listening to them and/or teachers.|
|c.||Teach the parents how to structure and enforce limits on their daughter’s behavior that are appropriate to her condition.|
|d.||Inform the client and her parents that medications typically used for ADHD are very safe and have few side effects.|
- The nurse is working with a teen in whom conduct disorder was diagnosed and his family on developing a plan of care for treatment. What is the nurse’s first intervention?
|a.||Assessing and/or stabilizing the home environment|
|b.||Teaching effective communication skills to the client and family members|
|c.||Advocating behavior modification for the client to gain self-control|
|d.||Teaching effective discipline techniques|
- Adolescents and young adult women account for ______% of Americans affected by eating disorders.
|a.||25 to 30|
|b.||55 to 60|
|c.||70 to 75|
|d.||85 to 90|
- In a research study of eating disorders, it was found that the most frequent weight loss method used by female high school students was:
|c.||Using diet pills|
- A 15-year-old girl is being admitted to an inpatient mental health clinic with the diagnosis of anorexia nervosa. The nurse knows that the most common personality characteristic of teens affected with this disorder is:
|c.||Normal body weight|
- When one is developing the care plan for a female adolescent with an eating disorder, the primary issue to consider as the underlying cause is:
- One of the major goals of therapy for adolescents with chemical dependency is:
|a.||Replacing the use of the chemical with effective coping skills|
|b.||Placing the chemically dependent adolescent in a residential treatment program|
|c.||Finding a group home setting to which the adolescent will be able to adjust|
|d.||Isolating the adolescent from family and friends during withdrawal from the chemical|
- Personality disorders in the adolescent are characterized by:
|a.||Onset usually in middle childhood|
- The parents of a 13-year-old girl are concerned that their daughter has a gender identity disorder. Which sign or symptom most indicates that their concern is correct?
|a.||Their daughter is playing sports typically considered boys’ sports.|
|b.||Their daughter has more male friends than female friends.|
|c.||Their daughter does not like to change her clothes in front of anyone.|
|d.||Their daughter frequently wears clothes designed for males.|
- Signs and symptoms of schizophrenia often are first seen in:
- The rate of attempted suicide in adolescents is _____ times higher with females than with males.
- A teenage girl’s boyfriend of 1 year ended their relationship and began to date someone else, resulting in the girl’s attempting suicide by taking an overdose of her mother’s sleeping medication. What is the most likely cause of this girl’s suicide attempt?
|b.||Serious mental illness|
|c.||The need to influence others|
|d.||An anxiety disorder|
- A 16-year-old teenage boy who is bullied at school has recently started staying in his room and not associating with his friends. His grades are dropping and he refuses to eat dinner with his family. What actions should his parents be advised to take?
|a.||Accept this as a normal part of adolescent behavior and do not interfere.|
|b.||Take the door off his room and scold him for his behavior.|
|c.||Realize that his peer group will handle this as he needs to break away from family.|
|d.||Set limits with him in a respectful manner and assist him to problem solve.|
- One of the developmental tasks of adolescence is to establish intimacy and relationships. By the age of 14, what percentage of teens have experienced sexual intercourse?
- By the ages of 14 to 17, teens are able to demonstrate problem solving skills using concepts, generalizations, and being flexible in planning actions and goals. What is this an example of?
- A 15-year-old female started going to parties earlier in the year where drinking and drug use occurred. Her friends now notice that she actively looks for a party every weekend and attends even when her friends are not invited. If they suggest an alternate activity, she refuses to go with them, and is avoiding them at school. What stage of chemical dependency is she exhibiting?
- Which of the following are common signs and symptoms of the eating disorder bulimia? (Select all that apply.)
|a.||Intake of less than 1000 calories per day|
|b.||Purging after meals|
|c.||Body weight greater than 20% under normal|
|d.||Consumption of 5000 to 20,000 calories per day|
|e.||Erosion of tooth enamel|
- Social development and forming an identity are important tasks for the adolescent. Which of the following is true regarding the function of a peer group? (Select all that apply.)
|a.||Provides stability during change|
|b.||Helps loosen ties to family|
|c.||Serves as standard for dress and behavior|
|d.||Helps to define future roles|
|e.||Learn to doubt self-made choices|
- Adolescence is defined as beginning at age _____ years and ending at age _____ years.
- Obesity is defined as body weight that is _____ above average, based on the individual’s height and build.
- Adolescents who become chemically dependent progress through four stages. Place these stages in order of occurrence. (Separate letters by a comma and space as follows: A, B, C, D.)
- Active seeking
Chapter 15: Problems of Adulthood
- The nurse is caring for an adult male client who lacks a strong sense of personal identity. With which area of development will this client most likely struggle the most?
- __________ is a major challenge for adults because energies are not concentrated on the self, and the demands can create feelings of anxiety, isolation, inadequacy, and helplessness.
- An adult male client is admitted to a mental health facility with the diagnosis of depression following the breakup of a long-term engagement. He states that he couldn’t “commit to marriage.” In conducting his admission assessment, the nurse learns that during his childhood he did not feel guided, nurtured, or accepted by his parents. One of the goals for this client is to help him develop a positive personal identity. Which intervention should the nurse implement to meet this goal?
|a.||Improve his strength in the ability to adapt to new situations.|
|b.||Develop the ability to establish and maintain an intimate relationship.|
|c.||Discern his feelings about relationship choices and level of commitment.|
|d.||Outline his life’s dream.|
- The term “sandwich generation” best describes adults:
|a.||Caught between adulthood and late adulthood|
|b.||Caring for their children and aging parents|
|c.||Caring for their children and grandchildren|
|d.||Caught between young adulthood and adulthood|
- An increasing number of are the head of the household of families in the United States.
- The nurse is caring for a client who is a single mother of two young children, has no financial or parental support from her ex-husband, is troubled by her financial circumstances and future, and works at a local fast-food restaurant. She is seeking help for depression. What is the nurse’s best action?
|a.||Assist the client in seeking educational and/or vocational programs for single parents.|
|b.||Encourage the client to explore her feelings related to the reasons for her divorce.|
|c.||Persuade the client to contact her ex-husband for financial and parental support.|
|d.||Share information with the client regarding support groups for single mothers.|
- An adult female calls a crisis hotline stating that she moved a few months ago to seek a new job “in a big city.” She is crying and says that she doesn’t think she can stand being so lonely anymore but doesn’t want to move back to her small home town and face her family and friends as a “failure.” What is the nurse’s first response?
|a.||“Would you like me to call your family to assist you in deciding what is best for you to do?”|
|b.||“I am sure you will make friends once you find a steady job that you like.”|
|c.||“Can you tell me what you mean by your statement that you don’t think you can stand being lonely anymore?”|
|d.||“Let me give you a list of some social groups that might be of interest to you.”|
- AFRAIDS is a condition that most likely would be seen in:
|a.||The homosexual population|
|b.||Sexually promiscuous heterosexuals|
|c.||Individuals in a heterosexual monogamous relationship|
|d.||Persons who have a chemical dependency on illegal intravenous drugs|
- How many people in the United States have a severe mental illness?
- When the nursing care plan for a client with a mental health disorder is developed, what is the most likely reason that interventions are ineffective and goals are not met?
|a.||The client sees his goals as less important.|
|b.||The client’s family is not supportive.|
|c.||The client’s disorder is difficult to treat.|
|d.||The client’s medications are being adjusted.|
- A 42-year-old male client continues to enter into business deals that cause him to lose large amounts of money. He subsequently seeks mental health care for stress-related disorders. Which characteristic of a successful adult is this client lacking?
|a.||Acceptance of self|
|b.||Finding a balance between giving and taking|
|c.||Making sound decisions|
|d.||Learning from past decisions|
- A 68-year-old woman tells the nurse that since she retired a few months ago, she has been “taking it easy” by sleeping later and staying around the house to rest. She has recently noticed that she is having a little trouble with remembering things. The nurse is aware that intellectual development is continuous and suggests to the client:
|a.||“You might think about volunteering somewhere to keep your mind sharp.”|
|b.||“You are probably just tired from all those years at work.”|
|c.||“After you have gotten used to being at home, I am sure your memory will improve.”|
|d.||“Sometimes we must accept the fact that as we get older, we sometimes become more forgetful.”|
- A 49-year-old woman who has been the owner of a successful large business for several years decides to sell her business and move to a remote island to open a small dress shop. She most likely has made this decision based on her need to:
|a.||Avoid becoming stagnant in her life.|
|b.||Earn more money.|
|c.||Prevent another company from taking over her business.|
|d.||Improve her social development.|
- A 37-year-old client who has been divorced for several years recently lost joint custody of a 10-year-old daughter because of drug and alcohol use, along with nonpayment of child support. The client is referred to the clinic as the result of a court order. When arriving at the clinic, the client has been on a drinking binge for 2 days. What is the most appropriate nursing diagnosis for this client?
|b.||Family processes, readiness for enhanced|
- A 45-year-old woman is admitted to an inpatient mental health facility with the diagnosis of severe depression. She lives by herself and has been very active in her community for many years. During the past 6 months, she has become increasingly withdrawn from her family and friends and was terminated from her job because of excessive absenteeism. When she arrives on the unit, she makes little eye contact with the nurse, has a flat affect, and answers with one or two words. What is the most appropriate nursing diagnosis for this patient?
|a.||Diversional activity, deficient|
- _____% of the adult population in the United States has a mental health disorder.
- A 35-year-old woman in a managerial position has had a number of employees under her supervision resign or transfer to other departments over the past year. In addition, she has rarely had a close personal relationship for more than a few months. She feels other people “just don’t measure up to my expectations.” Her situation is the result of a possible _____ disorder.
- A newly married couple residing in a large city is expecting the birth of their first child in 3 months. The wife wishes to maintain her career and remain in their apartment. The husband has expressed the desire to relocate to a more suburban setting to raise their child. Their ability to successfully face this challenge depends upon their ability to:
|a.||Negotiate a mutually satisfying solution.|
|b.||Employ appropriate coping mechanisms.|
|c.||Avoid conflict by dealing with the issue at a later time.|
|d.||Maintain a firm sense of individuality.|
- An obese woman is seen in the emergency department complaining of headaches. Her blood pressure is 150/92. Also present are her 4-year-old son and 2-year-old daughter. When the nurse offers to call a family member to pick up the children, the woman states that they are living alone in a women’s shelter. What is the most appropriate action for the nurse to take?
|a.||Instruct the client on proper nutrition and educate her regarding the dangers of hypertension.|
|b.||Make a referral for the client to a weight loss center.|
|c.||Assist the client to plan better coping strategies.|
|d.||Assess the family’s daily living needs and consult social work for community resources.|
- The parents of a 21-year-old college student who attended church services on a consistent basis are concerned when their child returns home from college and announces she is converting to another religion. This individual is most likely experiencing:
|a.||A personality disorder|
|b.||The need to challenge a value and belief system|
|c.||Instability due to dysfunctional parenting|
|d.||Regression to an unresolved developmental task|
- Which statements describe the adult who has achieved the successful emotional development of adulthood? (Select all that apply.)
|a.||The adult is able to function effectively in a stressful environment.|
|b.||The adult possesses effective intellectual and abstract problem-solving skills.|
|c.||The adult is able to adapt to growing older.|
|d.||The adult sets realistic personal and professional goals.|
- One of the ways in which the social development of adults can be assessed is by observing the individual’s ability to effectively communicate with whom? (Select all that apply.)
|a.||His or her significant other|
|b.||His or her physician|
|c.||His or her children|
|d.||His or her co-workers|
- Therapeutic interventions are effective in the prevention of mental and emotional disorders and assisting the client to cope. Which of the following interventions assist in providing for a positive personal identity? (Select all that apply.)
|a.||Continue to define identity in terms of role in nuclear family.|
|b.||Develop career path and goals.|
|c.||Recognize how emotions influence achievement of goals and relationships.|
|d.||Maintain personal distance in relationships.|
- Adulthood is defined as beginning at age ____ years and ending at age ____ years.
- The __________ environment defines stressful or anxious situations.
Chapter 16: Problems of Late Adulthood
- _____% of older adults are living at the poverty level.
- A 55-year-old man is extremely fearful of the effects of growing old. He is experiencing:
|c.||An age phobia|
- Physical signs of aging usually begin in the late 30s. Physical signs of aging begin to slow after one reaches the age of approximately:
- An elderly man has serious vision problems and is no longer allowed to obtain a driver’s license. He has been very independent until this time. Which nursing diagnosis is most appropriate for this situation?
|c.||Self-esteem, risk for situational low|
- The home health nurse is caring for a 79-year-old man with the diagnosis of hypertension who is on a fixed income. He was discharged from the hospital a few weeks ago with his newly prescribed medication to keep his BP under control. His BP measurements have been gradually increasing over the last few visits, with no other changes in status assessed. Which nurse statement would be most appropriate?
|a.||“Have you been taking your medication as often as you are supposed to?”|
|b.||“I don’t understand why your BP is up.”|
|c.||“Maybe I should check your BP at another time.”|
|d.||“I hope you are taking your medication. Otherwise, I am wasting my time.”|
- A 2006 survey indicates a ____% increase in elder abuse.
- Which intervention will be most effective when one is teaching a client about his or her medications and their administration?
|a.||Pointing out the colors of the medications for easier identification|
|b.||Referring to medications by name and providing written instructions|
|c.||Quizzing the client on each medication’s purpose, side effects, and drug interactions|
|d.||Encouraging the client to hold all questions until the end of the discussion so the nurse will not have to repeat information|
- The nurse is caring for a 79-year-old client with dementia. The client worked as an obstetrics nurse before retiring. Despite her dementia, she still remembers terms and procedures and basic nursing care interventions from her past career. This is an example of:
- An elderly client states that she paid $10,000 to a “nice repairman” for fixing her broken window and fence. This is an example of elder abuse known as:
|a.||Violation of rights|
- The nurse must be aware of physical signs and symptoms of depression because these are often the first, sometimes overlooked, signs of the disorder. Physical signs and symptoms of depression include:
|a.||Decreased or slowed memory|
|c.||Changes in appetite|
- The nurse is implementing validation therapy with an elderly male client to assist him in resolving old conflicts and making peace with himself. Which is one of the techniques used?
|c.||Helping the client write a paragraph about his life|
|d.||Contacting old acquaintances for their interpretation of the client’s life|
- It is important for the nurse to be aware that ____% of individuals over 45 years old take prescription, over-the-counter, or a combination of these medications.
- One of the ways that nursing care of the elderly is ensured is by the enactment and monitoring of:
|b.||State boards of health|
|c.||Standards of geriatric nursing practice|
|d.||State nurse practice acts|
- What percentage of the population has reached 65 years of age?
- The visiting nurse is at the home of an 88-year-old woman whose physician is concerned that she is losing weight. While performing an assessment, the nurse discovers that the client’s dentures are ill-fitting and this makes eating painful. The client claimed she informed her daughter of this, but the daughter is too busy to take her to the dentist. The nurse is concerned that this is a possible sign of:
- The nurse is completing an admission interview with an older adult on a busy medical unit. What action is most appropriate for the nurse to take?
|a.||Complete the admission interview with the client’s son.|
|b.||Shout at the client so he or she can hear.|
|c.||Provide pen and paper and let the client write his answers.|
|d.||Allow the client time to respond to the questions regarding health history.|
- A 70-year-old woman who was recently widowed expresses a desire to go back to school and finish the degree she started before her children were born. What response is most appropriate?
|a.||“Why would you want to stress yourself at your age?”|
|b.||“That may not be possible. As you age, your ability to learn decreases.”|
|c.||“Going back to school will keep you engaged and active.”|
|d.||“Let’s do a cognitive function test to see if you are eligible.”|
- A 78-year-old woman is admitted to the hospital with a diagnosis of pneumonia. She appears to be confused and combative at times. Her daughter is concerned because her mother was alert and oriented prior to being diagnosed with pneumonia. Her altered mental status is related to:
|a.||The onset of Alzheimer’s disease|
|b.||Alteration in oxygenation|
|c.||Result of family neglect|
- Which conditions most commonly place older adults at risk for overdose from medications and severe reactions? (Select all that apply.)
|b.||Higher rate of metabolism|
|c.||Interaction with other medications|
|d.||Problems with sight and memory|
- Which emotional signs and symptoms of depression in the elderly must the nurse be aware of and monitor for? (Select all that apply.)
|a.||Increased anxiety or dependence|
|c.||Feels he or she has no purpose|
|d.||Withdraws from people|
- To respectfully and effectively provide health teaching to the older adult, which of the following actions should be employed? (Select all that apply.)
|a.||Speak very loudly and in high-pitched tones.|
|b.||Ask clients to repeat your message.|
|c.||Break complex tasks into small, pertinent steps.|
|d.||Refer to medications by color.|
- __________ refers to a state of wholeness or quality of one’s character.
- Although __________ is often a desire of older adults, it can bring loss of income and loss of opportunities for socialization.
Chapter 17: Cognitive Impairment, Alzheimer’s Disease, and Dementia
- 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:
|b.||Depression from the loss of his wife|
|c.||Hypoxia of the brain|
|d.||Delirium from medications|
- Vascular dementia is more common in individuals living in:
|a.||The United States|
- A newly admitted elderly client seems to become confused and agitated every evening after dinner. This client most likely is suffering from:
- 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:
- The affective losses of Alzheimer’s disease refer to losses noticed in the individual’s:
|c.||Ability to make and carry out plans|
- The average time that a person with Alzheimer’s disease lives after diagnosis is _____ years.
- 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|
- 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.”|
- 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.|
- 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.”|
- 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|
- 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?
|d.||Audio presence therapy|
- 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:
|d.||Alterations in blood pressure|
- 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|
- 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|
- The daughter of an elderly nursing home resident is crying outside her father’s room. When the nurse comforts her, she states, “It is so hard to come here to visit when my mother doesn’t even know who I am.” The nurse knows the client is in which stage of Alzheimer’s disease?
- A 75-year-old man finds that he continually misplaces items he uses every day. In addition, his wife becomes annoyed when he asks the same question several times because he does not remember the answer. What advice is the most appropriate for his health care provider to give him?
|a.||These symptoms are a normal part of aging and he should accept it.|
|b.||He has Alzheimer’s disease, and nothing can be done to help him.|
|c.||Further assessment is needed to determine the cause of these symptoms.|
|d.||Admission to a nursing home for more intensive care is needed.|
- The most common severe cognitive impairment in the United States is Alzheimer’s dementia. What percentage of the population over the age of 85 are at risk for getting the disease?
- Which client exhibits signs and symptoms of delirium and not dementia or depression?
|a.||The onset is sudden and acute.|
|b.||The cognitive changes are hidden by client.|
|c.||The client demonstrates apathetic demeanor or flat affect.|
|d.||The client’s ability to perform ADLs is intact.|
- 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.)
|b.||Slower response times|
|d.||Deficiencies in short-term memory|
- Which characteristics are commonly seen in clients with dementia? (Select all that apply.)
|b.||Poor short-term memory|
|c.||Problems with judgment|
|e.||Poor remote memory|
|f.||Difficulty with abstract thinking|
- Which interventions will help to lessen the effects of sundown syndrome? (Select all that apply.)
|a.||Provide activity that stimulates the client’s interest.|
|b.||Assist in toileting to prevent incontinence.|
|c.||Turn on lights before the room gets dark.|
|e.||Prepare client for sleep by turning off lights.|
|f.||Reduce environmental stimulation at dinner.|
|g.||Maintain client’s familiar routine.|
- __________ refers to thinking and thought processes.
- __________ is a progressive, degenerative disease that affects the brain and causes impaired memory, cognition, and behavior
- The causes of confusion are grouped into five categories known as the five Ds. These categories consist of damage, delirium, dementia, depression, and __________.
Chapter 18: Managing Anxiety
- When a client has a mild level of anxiety, his or her emotional response is:
|a.||Relaxed and calm|
|d.||Helplessness with loss of control|
- A female college student is seeking help from the counseling center for test anxiety. She reports that during an exam, she “freezes,” and says, “It feels like the time I have to take the exam is racing by, and I can’t answer any of the questions when I know the answers.” Which level of anxiety is the client experiencing?
- A learned response to an anticipated event, such as when the person who does not like to fly experiences nausea and sweaty palms before boarding the airplane, is best described as:
|a.||A normal anxiety response|
|c.||An anxiety state|
|d.||An anxiety trait|
- A client tells the nurse that exercising in the gym helps him keep his stress level reduced. Which type of coping mechanism best describes this situation?
MSC: Client Needs: Psychosocial Integrity
- A nurse who talks to teens about the dangers of tanning beds in causing skin cancer but loves to tan herself and does so before she goes on vacation is using which defense mechanism?
- The nurse is aware that several theories have been proposed to explain anxiety. Which theory explains anxiety as a result of interactions with others?
- Adolescents who ineffectively cope with anxiety often express their anxiety through:
- What is the term for physical expression of anxiety by an individual in ways such as nausea or headaches?
- Which term best describes an individual’s feelings of anxiety that are broad, long-lasting, and excessive?
|a.||Generalized anxiety disorder|
- A client has constant thoughts about locking his front door every time he leaves his house. This client is experiencing a(n):
- Which is a typical symptom of posttraumatic stress disorder?
|a.||Constant use of defense mechanisms|
|c.||Distressing persistent thoughts|
- The treatment team and a male client in whom obsessive-compulsive disorder associated with hand washing has been diagnosed decide on a treatment plan for the disorder. The nurse begins to implement the plan by having the client gradually extend the time between hand washes. This intervention is an example of which type of therapy?
- A female client is taking a benzodiazepine for her anxiety disorder. She complains of anorexia and nausea since she started taking the medication a few days ago. What is the nurse’s best response?
|a.||“Be sure to take the medicine on an empty stomach to avoid these symptoms.”|
|b.||“It takes a while to get used to the medicine. Give it a couple of weeks.”|
|c.||“Try taking the medication with food or milk, and see if the symptoms improve.”|
|d.||“Stop taking the medication immediately, and I will notify your doctor.”|
- A male client has had agoraphobia for several years. In the past 2 years, he has not left his home and only speaks to people on the phone occasionally. Which nursing diagnosis has the highest priority in this situation?
|b.||Thought processes, disturbed|
|c.||Coping, ineffective individual|
- Of individuals who suffer from panic attacks, ____% are women.
- Symptoms of obsessive-compulsive disorder can occur in children as young as _____ years old.
- An adolescent caught stealing a classmate’s laptop says that he needed it to write his paper and the classmate “has enough money to buy another one anyway” is demonstrating which of the following defense mechanisms?
- On the morning of a final exam, the student is feeling tense and excited, with her heart rate and breathing slightly increased. She is feeling energized and alert with her attention focused on the exam. Based on these findings, what advice can the student be given?
|a.||Practice deep breathing and do some exercise to stabilize vital signs.|
|b.||Request to take the exam at a later date when anxiety decreases.|
|c.||Take the exam more seriously and treat it with more concern.|
|d.||The level of anxiety described should allow for a positive outcome.|
- A 6-year-old is preparing to have a dental procedure. His anxious mother is in the room with him. When the child asks if everything will be okay, she assures him it will, but continues to pace and wring her hands. What is the most appropriate action for the dentist to take?
|a.||Give the mother a seat near the child and continue to assure the mother.|
|b.||Request that the mother wait in the waiting room.|
|c.||Allow the mother to verbalize what her concerns are.|
|d.||Tell the child to ignore his mother.|
- The nurse is meeting with a client suffering from agoraphobia who recently moved to the United States from a country where acts of violence and civil unrest are common. The theoretical model that links anxiety to the uncontrollable events the client experienced in his previous country is the ________ model.
- Which statements best describe an anxiety disorder? (Select all that apply.)
|a.||Anxiety is expressed in ineffective ways.|
|b.||Coping mechanisms are used to deal with anxiety.|
|c.||Coping mechanisms do not relieve anxiety.|
|d.||Defense mechanisms are used occasionally.|
- Which symptoms may be seen in a person who is having a panic attack? (Select all that apply.)
|a.||Shortness of breath|
|b.||Fear of dying|
|c.||Recurrent persistent thoughts|
|f.||Feelings of depersonalization|
- Which of the following activities are examples of addictive behaviors? (Select all that apply.)
|d.||Excessive sexual activity|
- __________ refers to a vague, uneasy feeling of uncertainty and helplessness.
- When an individual uses psychological strategies to cope with stressors in an attempt to decrease anxiety, this person is using a __________.
- __________ is a defense mechanism that is characterized by redirecting one’s energy to another person or object.
Chapter 19: Illness and Hospitalization
- The abnormal process in which aspects of the social, physical, emotional, or intellectual function of a person are diminished or impaired is called:
- The client feels unwell. She knows that she would be better off if she rested today, but important matters at work are waiting. She stops at the drugstore on her way to work and purchases several over-the-counter cold remedies. Her behaviors are related to the stage of illness experience called:
|b.||Medical care contact|
|c.||Assuming the sick role|
|d.||Dependent patient role|
- If illness or hospitalization results in a change in physical appearance, it is likely to have a strong impact on the person’s:
|d.||Acceptance of the problem|
- For most people, being hospitalized is seen as a(n):
|c.||Chance to rest|
- The client has been admitted to the medical unit for unexplained weight loss and fatigue. He does not speak except to answer questions, and he refuses to interact with other people except when necessary. Which coping mechanism is he using to deal with his hospitalization?
- The most important reason for performing a crisis assessment on hospitalized clients is that it allows the care provider to:
|a.||Implement appropriate care measures.|
|b.||Encourage clients to share their concerns.|
|c.||Identify the requirements for additional supplies and personnel.|
|d.||Identify problems before a crisis develops and plan preventive interventions.|
- The caregiver is encouraging a mother to participate in bathing her daughter, who is in traction for a fractured femur. The caregiver is recognizing the family’s:
|a.||Physical need to work|
|b.||Social need to stay with the client|
|c.||Intellectual need to control the situation|
|d.||Emotional need to be involved in caring for the client|
- The process that helps clients cope with illness or surgery after leaving the institution is called:
|d.||Role change planning|
- Which is the best way for the nurse to assist clients in managing their pain?
|a.||By setting mutual goals|
|b.||By focusing on nursing care|
|c.||By administering narcotic analgesics|
|d.||By telling the client to think of something else|
- The stage of hospitalization during which the client reestablishes personal identity and becomes self-centered is the time when the client is:
|a.||Going to be discharged|
|c.||Becoming emotionally stabilized|
|d.||Adapting to the environment|
- The nurse begins discharge planning measures with a hospitalized client:
|a.||Near the time of discharge|
|b.||At the time of admission|
|c.||3 days into the hospital stay|
|d.||On the day before discharge|
- During a crisis assessment due to the diagnosis of a terminal illness, the nurse is trying to determine what the client’s history is with regard to losses. Which question will best assess this area?
|a.||“How easily do you adapt to new situations?”|
|b.||“What is your understanding of the current situation?”|
|c.||“Who or what has helped you through crisis situations in the past?”|
|d.||“How is this situation affecting your family?”|
- A male client has been diagnosed recently with a chronic illness. His family tells the nurse that they have noticed that he has not been attending his weekly card game night with his friends and does not return their calls. What reaction is this client most likely experiencing?
- The nurse is admitting a male client so he can undergo testing for diagnostic purposes. The nurse explains how the equipment in the room works and how to order meals. After the nurse leaves the room, the client yells for the nurse because he can’t remember how to use the call light. What emotional response is the client experiencing?
- A female client admitted to a mental health facility for depression is frequently asking for help in deciding on what foods to choose for her meals, as well as which activities she should participate in. Which stage of illness is she experiencing?
|c.||Recovery and rehabilitation|
- The nurse is talking with a male client recently admitted to a mental health facility. He is very anxious to begin his treatment for alcohol and drug addiction because he states that he “really wants to get well this time.” Which stage of illness is the client experiencing?
|c.||Recovery and rehabilitation|
- An individual notices that he is experiencing periods of feeling very depressed followed by periods of elation and increased energy. He knows that something is wrong and talks with his family about what he should do. This is an example of the stage of illness called:
|c.||Recovery and rehabilitation|
- A business owner is hospitalized after suffering a heart attack. The staff finds him very demanding and angry toward all personnel and noncompliant in his therapy and treatment plan. What is the best strategy for the nurse to employ with this patient?
|a.||Give him an ultimatum to cooperate or face a longer recovery period.|
|b.||Allow him to continue this behavior due to his role outside the hospital.|
|c.||Provide him with necessary information to actively participate in goal setting.|
|d.||Request that a health care provider with a stronger personality take care of him.|
- A 72-year-old woman from the Dominican Republic is hospitalized after fainting while visiting her daughter. The staff has voiced complaints regarding the family ignoring hospital rules regarding visiting hours and number of visitors allowed in the room. In addition, the daughter brings food to the mother from home that is not a part of the client’s prescribed diet. How can the staff deal with these issues in a professional manner?
|a.||Meet with the patient and family to determine how to provide support for cultural practices.|
|b.||Have security remove the family and focus on the client’s care and needs.|
|c.||Accept the food from the family and throw it out without informing them.|
|d.||Allow family presence to take priority over treatments and therapies.|
- A woman arrives at the hospital to deliver her first child. She has no previous history of hospitalization or serious illness. During her stay, the client is highly anxious and demands to be informed of all information documented on her medical record. The client’s husband informs the nurse that the client’s mother died in the hospital 10 months ago after a brief battle with lung cancer. he most probable reason for the client’s current reaction is:
|a.||An obsessive fear of dying|
|b.||Reluctance in becoming a mother|
|c.||Symbolic meaning of the hospital|
|d.||Ambivalence regarding the sick role|
- The client being transferred to a rehabilitation center following hospitalization for surgical repair of a fractured hip is portrayed by the nurse in the hospital setting as being very involved and making good progress in his physical therapy sessions. However, the nurse in the rehabilitation facility observes that the client is withdrawn, and often asks to defer his physical therapy sessions. Which statement best describes the change in patient behavior?
|a.||The patient is suffering from delirium due to the unfamiliar surroundings.|
|b.||The patient has adapted to the recovery role and does not need rehabilitation.|
|c.||The patient enjoyed the dependency role in the hospital setting.|
|d.||The patient is adjusting to a new environment and is in a vulnerable position.|
- How does the experience of entering a psychiatric treatment facility differ from hospitalization for physical reasons? (Select all that apply.)
|a.||The client may fear other clients’ behaviors.|
|b.||The client receives a negative diagnostic label.|
|c.||The client can enjoy the attention of caregivers.|
|d.||The client must cope with the stigma of mental illness.|
|e.||The client must cope with the stigma of physical illness.|
|f.||Insurance companies may deny payment for treatment.|
|g.||Insurance companies never deny payment for treatment.|
- Which natural remedies may the nurse use to assist clients in alleviating pain? (Select all that apply.)
- Which functions of a person are diminished or impaired during illness? (Select all that apply.)
- __________ is a continually changing state of well-being that encompasses an individual’s physical, social, and mental well-being.
- A psychological defense mechanism that allows a person to block painful feelings associated with a problem is known as __________.
Chapter 20: Loss and Grief
- The client is 21 years old and has just been given the diagnosis of terminal cancer. She is coping with a(n) ____ loss.
- The group best able to accept their losses and grow from their experiences is:
- The set of emotional reactions that accompany a loss is called:
- The behavioral state of thoughts, feelings, and activities that follow a loss is called:
- Persons may refuse to acknowledge that a loss has occurred during the first stage of:
|b.||The grieving process|
|c.||The rage reaction|
|d.||The denial process|
- The client lost her husband of 50 years 10 months ago. She now sees every day as a gray fog with no light. She has begun to experience changes in eating, sleeping, and activity levels; angry, hostile moods; and an inability to concentrate or complete work tasks. What is the client experiencing?
|b.||A normal grief reaction|
- The last stage of growth and development is called:
- The concerns of children in whom terminal conditions have been diagnosed focus on how the illness affects the child’s:
|a.||Loss of a future|
|b.||Family and friends|
|d.||Activities of daily living|
- To make the remainder of a terminally ill person’s life as meaningful and comfortable as possible is the goal of:
|b.||The stages of dying|
|c.||The grieving process|
- When care is provided for a dying client in pain, addiction to analgesics is:
|a.||Not an issue|
|b.||To be evaluated daily|
|c.||To be carefully avoided|
|d.||To be prevented with pain management techniques|
- Decisions about a terminally ill client’s remaining time belong to the:
|c.||Medical care team|
- To assist them with their grief experiences, many health care facilities offer caregivers who work with dying clients:
|c.||Time off from work|
|d.||Peer evaluation groups|
- The father of three young children dies. The wife expresses how worried she is about how to raise the children on her own without the support of her husband. She finds herself crying and living through each day without accomplishing anything. In which grieving stage is this behavior typically experienced?
|b.||Depression and identification|
|c.||Acceptance and recovery|
- Three years after the loss of her husband of 35 years, the wife has a full-time job but finds that she cannot sleep well at night, has frequent mood changes, and attends the couple’s night out with friends that she and her husband attended. Upon seeking counseling, she discovers that she is exhibiting symptoms of:
- The 39-year-old daughter of a client with a terminal illness tells the nurse that she thinks something is wrong with her because she frequently cries, is often sad, and can’t imagine losing her mother. The nurse assures the daughter that these are normal feelings associated with:
- A family experiences the loss of their wife and mother to a car accident. Which family member reacts by asking “When is mommy coming back?”
|a.||The 17-year-old son|
|b.||The 11-year-old daughter|
|c.||The 4-year-old son|
|d.||The 7-year-old daughter|
- A 10-year-old patient on a children’s oncology unit has had an unsuccessful bone marrow transplant. The family is distraught but remains positive in front of the child. One night the child asks the nurse about death and dying. What counseling should the nurse give to the parents?
|a.||Avoid talking about death in front of the child.|
|b.||Change the subject if the child asks about dying.|
|c.||Allow the child to have an honest discussion about dying.|
|d.||Allow the physician to discuss this with the child.|
- Which age group through the life cycle has the most difficult time relating to their own death?
- A person with terminal cancer makes a call to a family member she has not spoken to in 30 years in order to make amends. According to Kübler-Ross, what stage of dying is this person in?
- Which of the following are therapeutic interventions for unresolved grief? (Select all that apply.)
|b.||Providing emotional support|
|c.||Keeping the griever medicated|
|d.||Referring to appropriate resources|
|e.||Forcing the client to eat properly|
|f.||Telling the client that he or she must learn to cope|
|g.||Encouraging return to work as soon as possible|
- Loss of which of the following can result in the individual’s experiencing external losses? (Select all that apply.)
|e.||Favorite piece of jewelry|
- According to Glaser and Strauss, the closed awareness model can be applied to family, friends, care providers, and the dying individual. Which of the following statements are true of the closed awareness model? (Select all that apply.)
|a.||Medical personnel and family keep the condition secret from the client.|
|b.||Caregivers and client know about impending death but do not talk about it.|
|c.||Caregivers and client accept death and have open conversations.|
|d.||Dying client feels isolated from the ability to share with family.|
|e.||Dying client becomes suspicious of the truth, and information is tightly controlled by family.|
- Place the steps of grieving in proper chronological order. (Separate letters by a comma and space as follows: A, B, C, D.)
- Acceptance and recovery
- Depression and identification
- __________ occurs when an individual who has experienced a loss is working through or resolving his or her grief.
- Following the funeral of her husband, the wife is seen crying and holding his picture. She is demonstrating __________.
Chapter 21: Depression and Other Mood Disorders
- A prolonged emotional state that influences one’s whole personality and life functioning is called:
- The moods of adolescents:
|d.||Are not related to growth and development|
- Depression in the elderly is:
- Theories that view depression as a group of learned responses are called ____ theories.
- Severe, prolonged depression affects a person’s risk for physical illness by ____ the risk.
|d.||Having little effect on|
- A disorder defined as daily moderate depression that lasts longer than 2 years is called a(n) ____ disorder.
- The client lives his life by rapidly bouncing from feelings of deep sadness to great joy. The client’s diagnosis is most likely:
|c.||An anxiety disorder|
- Recent studies have demonstrated that daily exposure to full-spectrum light (phototherapy) is most effective in improving symptoms in people who are experiencing:
|d.||Seasonal affective disorder|
- The goal of treatment during the first phase of depression is to:
|a.||Develop a plan for treatment.|
|b.||Reduce uncooperative behaviors.|
|c.||Help the client to adjust to antidepressants.|
|d.||Reduce symptoms and inappropriate behaviors.|
- The nurse must be alert to signs of suicidal thoughts with clients in whom major depressive disorders have been diagnosed because approximately _____ die from suicide.
- During the continuation phase of therapy, a client with a diagnosis of depression asks, “What is the goal of therapy during this 4- to 9-month period?” What is the nurse’s best response?
|a.||“We are going to work together to try to reduce your symptoms.”|
|b.||“Our goal is to determine the cause of your depression and cure it.”|
|c.||“We want to prevent you from ever having any depressive episodes in the future.”|
|d.||“Our goal is to prevent you from relapsing and experiencing distressing emotional states.”|
- A client with major depressive disorder is scheduled for electroconvulsive therapy (ECT). Which point will the nurse teach the client?
|a.||“ECT treatments take about 1 hour.”|
|b.||“You will most likely receive between 6 and 12 treatments over several weeks.”|
|c.||“ECT often is used as one of the first treatments for major depression.”|
|d.||“ECT treatments help your depression by decreasing levels of the neurotransmitter norepinephrine.”|
- A client asks the nurse which types of antidepressants have the fewest side effects. What is the nurse’s most accurate response?
|c.||“Monoamine oxidase inhibitors (MAOIs)”|
|d.||“Selective serotonin reuptake inhibitors (SSRIs)”|
- A male client with bipolar disorder who takes lithium tells the nurse that he has been “nauseous a lot lately,” feels tired, and has had “some blurry vision.” The client most likely is suffering from what level of lithium toxicity?
- Which one of the following are biological causes of mood disorders?
|a.||Anger turned inward|
|c.||Reactions to external stressors|
|d.||Imbalance of neurotransmitters|
- A client seen in the community mental health clinic appears for one appointment in multiple layers of brightly colored clothing. Her speech is very pressured, and she is telling everyone in the waiting room about a date she had the previous evening. The next visit she is dressed in old, drab clothes and has no makeup on. She has a flat affect and is not making eye contact. The most probable cause of her behaviors is which of the following conditions?
|a.||Bipolar I disorder|
|c.||Bipolar II disorder|
|d.||Major depressive episode|
- Which client would be a candidate for ECT?
|a.||A client with mild depression|
|b.||A severely depressed client with congestive heart failure|
|c.||A client with severe, long-lasting depression|
|d.||A severely depressed client with history of a brain tumor|
- Which client is suffering from a major depressive episode?
|a.||An adolescent who expresses feeling lost after the death of his mother last week|
|b.||A 50-year-old male who has been depressed for a month and is contemplating suicide|
|c.||A 30-year-old female who is being treated for episodes of depression she has suffered since the age of 21|
|d.||An elderly adult who feels like she is in a fog after the diagnosis of terminal cancer given to her 8 days ago|
- Which statements regarding depression are correct? (Select all that apply.)
|a.||It occurs in all age groups.|
|b.||It rarely occurs in the elderly.|
|c.||It occurs in men more often than in women.|
|d.||It occurs in women more often than in men.|
|e.||It is rarely seen but is severe when it occurs.|
|f.||It is common in those who must cope with illness.|
|g.||It is one of the most common and treatable mental disorders.|
- In which groups does postpartum depression occur more frequently? (Select all that apply.)
|c.||Women who do not have a husband|
|d.||Women who have had a difficult delivery|
|e.||Women who experienced complicated pregnancies|
|f.||Those who are also coping with illness|
|g.||Women who are not emotionally prepared for motherhood|
- A client is experiencing an episode at the level of mania. Which behaviors are characteristic of this level? (Select all that apply.)
|a.||Outgoing, happy, and worry free|
|b.||Decreased ability to concentrate|
- Which of the following statements are true regarding depression in the elderly? (Select all that apply.)
|a.||Highest rates are among individuals who receive long-term care.|
|b.||It is a normal consequence of aging.|
|c.||Most depressed older adults volunteer to share their feelings.|
|d.||Depression is higher in elderly women than elderly men.|
|e.||Older adults express feelings of depression in more subtle ways than younger persons.|
- Which group of medications for depression will the nurse tell the client to take at bedtime? (Select all that apply.)
|c.||Monoamine oxidase inhibitors (MAOIs)|
|d.||Selective serotonin reuptake inhibitors (SSRIs)|
- __________ is the electrolyte that the nurse must teach the client to monitor in his or her diet when taking lithium.
Chapter 22: Physical Problems, Psychological Sources
- The human physiological stress response mechanism is also called the ____ response.
- People who are able to recognize and defuse their stressors early ____ suffer from the physical effects of stress.
- Most psychosomatic problems and somatoform disorders begin in:
- The physiological stress response has an effect on _____ system(s).
|b.||Only the nervous|
|d.||The cardiovascular and respiratory|
- Several studies have demonstrated that significant ____ changes occur in people who displayed hostile or negative behaviors.
- Somatization disorder is a polysymptomatic disorder, which means that the disorder is associated with ____ symptoms.
|a.||Few signs and|
|c.||Many signs and|
|d.||Specific signs and|
- The client had recently witnessed a horrific auto accident. Now she is complaining of double vision, loss of balance, and a constant “lump in her throat.” She is exhibiting the signs and symptoms of:
|d.||Posttraumatic stress reaction|
- La belle indifference is a characteristic that most often is associated with:
|d.||Posttraumatic stress reaction|
- The client can acknowledge the possibility that she exaggerates her symptoms, but she continues to hold on to the belief that something is physically wrong, in the face of evidence to the contrary. What is the client’s diagnosis most likely to be?
|c.||A conversion reaction|
|d.||Body dysmorphic disorder|
- The client thinks her nose is so ugly that most people cannot bear to look at her. She often describes herself as ugly. Which condition is the client experiencing?
|c.||A conversion reaction|
|d.||Body dysmorphic disorder|
- The main feature of a factitious disorder is that symptoms are purposefully produced to allow the individual to:
|a.||Get out of work.|
|b.||Assume the sick role.|
|c.||Assume control of treatment.|
|d.||Get the attention of health care providers.|
- The client complains of severe back pain and is excused from work. Later, he is seen water skiing and jogging. These behaviors describe:
|d.||A factitious disorder|
- A male client is so preoccupied with his thinning hair that he is missing work and avoiding social gatherings. This client is exhibiting signs of:
|c.||Body dysmorphic disorder|
- In the __________ culture, mental and emotional disorders are expressed as somatoform complaints on the basis of the belief that the body is the property of the ancestors.
- A female client frequently complains of chest pain, has had extensive physiological testing with negative results, and sees several different medical doctors. This client is exhibiting signs and symptoms characteristic of:
|c.||Body dysmorphic disorder|
- Your client is a wife and mother who, in addition to doing most of the household tasks, has a difficult time saying no to helping out with functions at school and church. Based on Fromm’s psychodynamic theory, what illness is she more prone to develop?
|b.||High blood pressure|
- Once the acute feelings of illness are resolved, what is an appropriate intervention when treating a client with a psychosocial problem?
|a.||Avoid expression of feelings as this will provide a relapse of acute symptoms.|
|b.||Minimize secondary gains.|
|c.||Convey an attitude that such behavior is not acceptable.|
|d.||Assist the client to limit social network to avoid additional stress.|
- A mother brings her 9-month-old son to the emergency department because he stopped breathing at home. She demands that he receive a full diagnostic work-up. When asked for the name of her pediatrician, she states she has not found one she is satisfied with. The nurse suspects:
|d.||Munchausen’s syndrome by proxy|
- A woman arrives at the hospital complaining of chest pains and shortness of breath. She has come in several times over the past two 2 weeks and the staff is doubtful that her symptoms are real. What is the first action for the health care team to implement?
|a.||Complete a history, physical, and diagnostics.|
|b.||Arrange for a psychiatric consult.|
|c.||Provide discharge instructions and arrange for a follow-up visit.|
|d.||Obtain a prescription for an antianxiety agent.|
- Which of the following are characteristics of somatoform disorders? (Select all that apply.)
|c.||Have no organic medical source|
|d.||Are related to a medical condition|
|e.||Significantly impair one’s level of functioning|
|f.||Often occur in those who must cope with illness|
|g.||Occur in clients who are unaware of or unable to express emotional distress|
- Which are the essential features of conversion disorder? (Select all that apply.)
|a.||Preoccupation with fears of disease|
|b.||Deficits in motor function|
|c.||Long history of vague complaints|
|d.||Deficits in sensory function|
- Which of the following are indicative of hypochondriasis? (Select all that apply.)
|a.||Symptoms most commonly appear in early childhood.|
|b.||First diagnosed following a severe stressor.|
|c.||More frequent in person exposed to a serious illness in childhood.|
|d.||Sufferers usually have strained interpersonal relationships.|
- __________ is the biochemical fight-or-flight response that is a survival tool against stressors.
- In the past, disorders that were emotionally related to physical problems were called __________ illnesses.
Chapter 23: Eating and Sleeping Disorders
- Trends that have contributed to the recent increase in eating disorders in the United States include a(n):
|a.||More competitive workplace|
|b.||Increase in the number of divorces|
|c.||Focus on being thin as a measure of attractiveness|
|d.||Increase in the number of nonnutritional foods consumed|
- What is the main issue for adolescents with anorexia?
- Which disorder is associated with persons with a body weight that is normal or even slightly above average?
- The persistent eating of nonfood items such as clay, laundry starch, insects, leaves, or pebbles that lasts for longer than 1 month is called:
- The main focus of medical management for anorexia is to:
|a.||Encourage rapid weight gain.|
|b.||Encourage the client to eat voluntarily.|
|c.||Teach more appropriate food choices.|
|d.||Keep the client from developing additional problems.|
- Although all age groups can be affected, sleep disorders occur most frequently in:
- The inability to fall asleep or stay asleep is called:
- A disorder that interrupts normal sleep patterns and is characterized by repeated, brief jerks of the arms and legs that occur every 20 to 60 seconds during the beginning of sleep is called:
- Sleep disorders that are characterized by abnormal behavioral or physical events during sleep are called:
- Sleep terrors usually occur only once a night, during stages 3 and 4 of NREM sleep. They are often accompanied by which physical sign?
|d.||Intense motor activity|
- The first step in the treatment of sleep disorders is to:
|b.||Give hypnotics for sleep.|
|c.||Evaluate sleeping patterns.|
|d.||Teach clients to retire early.|
- The collection of perceptions, thoughts, feelings, and behaviors that relate to one’s size and appearance is called:
- The average age for onset of anorexia nervosa is _____ years old.
- The nurse who is caring for a 23-year-old client with bulimia knows that the most common method of purging to monitor this client for is:
|c.||Excessive enema use|
|d.||Use of syrup of ipecac|
- The nurse who works in a sleep clinic knows that approximately _____% of adults suffer from insomnia.
|a.||10 to 20|
|b.||30 to 40|
|c.||50 to 60|
|d.||70 to 80|
- During an episode of binge eating, what type of food is usually taken in large amounts?
|c.||Fried or high fat content foods|
|d.||Cakes, donuts, or sweets|
- A client with a diagnosis of anorexia is admitted to an inpatient setting. Which therapeutic intervention is used with caution prior to stabilization and weight gain?
|a.||Establish rapport and trust|
|b.||IV or tube feeding|
- Which of the following persons is most likely a candidate for primary hypersomnia?
|a.||A 50-year-old who has wakeful periods during the night and naps during the day following the death of her husband|
|b.||A 6-year-old who wakes up in the middle of the night after having a nightmare and is tired the next day|
|c.||An obese 40-year-old who has snoring and periods of apnea at night and is tired the next day|
|d.||An 18-year-old college student whose mother complains he sleeps all night and still naps during the day|
- A police officer complains of feeling tired and not able to sleep for an extended period of time after being assigned to work the night shift. He is most likely suffering from:
|a.||Circadian rhythm sleep disorder|
|d.||Obstructive sleep apnea syndrome|
- Which of the following conditions are eating disorders? (Select all that apply.)
- Which are key features of anorexia nervosa? (Select all that apply.)
|a.||Excessive laxative use|
|c.||Severe weight loss|
|e.||Hunger is denied|
- What are the criteria for the diagnosis of bulimia? (Select all that apply.)
|a.||Occasional episodes of binge eating|
|b.||Refusal to maintain body weight that is more than 15% below normal|
|c.||Excessive emphasis placed on body shape and weight|
|d.||Eating binges at least twice per week for at least 3 months|
- The death rate from anorexia is higher than any other mental illness. Death usually results from: (Select all that apply.)
|b.||Loss of critical muscle mass|
TOP: Anorexia Nervosa KEY: Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- The medical term for a sleep test is a __________.
Chapter 24: Dissociative Disorders
- The father of a 6-month-old and a 3-year-old discovers that his wife, who is the mother of the children, has abandoned the family and moved to another state. During this developmental stage, this abandonment will have the strongest negative effect on the children’s:
- Following the death of his wife of 50 years, the hospice nurse notices that the surviving husband’s affect is flat, he states that he has stopped attending the weekly card club he belongs to, and he voices difficulty in making decisions on a daily basis. The caregiver knows that this client is displaying the characteristics of the dissociative disorder of:
|c.||Dissociative identity disorder|
- The nurse witnesses different personalities emerging in the client with dissociative identity disorder (DID). The primary personality is referred to as the:
- When developing the nursing care plan for a client with dissociative identity disorder (DID), the nurse knows that one of the major goals of therapy is to assist the client in:
|a.||Naming all personalities for clarification|
|b.||Integrating the personalities into one functional personality|
|c.||Realizing when different personalities are about to emerge|
|d.||Learning how to move from one personality to another|
- During a home visit, the client tells the nurse that she feels that her medication is no longer helping her dissociative diagnosis of depersonalization disorder because she has noticed that she is not thinking clearly, is having difficulty with her memory and judgment, and is often disoriented to the time. The nurse knows that the doctor must be contacted and that this client most likely will be:
|a.||Admitted to a long-term care agency because she is a threat to herself|
|b.||Admitted to a state-psychiatric facility for an extended period for intense therapy|
|c.||Referred to a group home setting for better supervision|
|d.||Admitted to the hospital for evaluation and possible adjustment of her medications|
- The care provider is aware that in addition to assessment, one of the first goals of therapy for the client with a dissociative disorder is:
|a.||Revisiting of past traumas|
- Those who care for individuals with dissociative disorders must be aware that they often will try to __________ the staff members who are caring for them.
- Which of the following is considered a primary nursing diagnosis for a client with a dissociative disorder?
|b.||Personal identity, disturbed|
|c.||Role performance, ineffective|
- During assessment of a client with a dissociative disorder, the nurse notices that the client has been cutting herself on both arms. After talking with the client, the nurse, along with other members of the treatment team, decides that the best intervention at this time to prevent further self-destructive behavior would be:
|a.||Establishing a signed contract with the client to tell a team member when she is having self-destructive thoughts|
|b.||Isolating the client from all other clients and activities until she is no longer having self-destructive thoughts|
|c.||Administering medications that will reduce the client’s anxiety levels|
|d.||Involving the client in activities as a diversion from self-destructive thoughts|
- A client with the diagnosis of depersonalization disorder notices that he experiences periods of depersonalization when confronted with certain stressors. When developing the care plan, the nurse is aware that one of the most helpful activities in self-control for this client is for the client to:
|a.||Contact a treatment team member to discuss his thoughts and feelings every time he is confronted with a stressor.|
|b.||Keep a daily journal of his thoughts and feelings, paying special attention to thoughts and feelings during stressful times.|
|c.||Recall periods of stressful times in his life during his clinic visit.|
|d.||Join an exercise program that will help to decrease his stress level.|
- The 15-year-old son of a single, full-time working mother frequently is left at home alone to care for himself. According to Erikson’s theory, the nurse is aware that this adolescent most likely would have difficulty in developing a comfortable:
- A female client with a diagnosis of a dissociative disorder who attends group meetings at a community mental health clinic often voices that her boss at work frequently complains that she is working at a level below her capabilities. The client also states that she feels that she “never gets anything done.” Which nursing diagnosis best addresses these issues?
- What is the first nursing priority in a client with the nursing diagnosis of Personal identity, disturbed?
|b.||Assist the client to manage any threatening feelings.|
|c.||Assess causative and/or contributing factors.|
|d.||Determine which medications will work most effectively.|
- A “spell” is a culturally defined mental health disorder or a dissociative “state” seen in African Americans, Europeans, and Americans from southern U.S. cultures. This “state” is characterized by:
|a.||Sudden collapsing with eyes open and inability to see, while still hearing and understanding without being able to move|
|b.||Seizure activity and coma for up to 12 hours preceded by extreme excitement or irrational behavior|
|c.||A state in which spirit possession interferes with daily activities|
|d.||Communication with deceased relatives or spirits that occurs during a trancelike state|
- The wife of a 70-year-old man is concerned that her husband refuses to participate in any activities with her since his retirement 2 years ago. He is often short tempered and sees any type of hobby as a “waste of time.” Which intervention or activity would help him enhance his feelings of self worth?
|a.||Begin taking antidepressant medication.|
|b.||Move with his wife to an assisted living community.|
|c.||Get involved in a retired businessmen’s group providing assistance to new companies.|
|d.||Taking up a less strenuous activity to decrease stress and information overload.|
- A family adopts a 7-year-old boy from an international adoption agency with little information on the child’s history. They bring the child to a therapist because the child is withdrawn, destroys things in the house, and hits his adoptive siblings without provocation. As the therapist develops a trusting relationship with the child, what type of intervention would be initially used to gain input from the child?
|c.||Joint stabilization plan|
|d.||Development of coping strategies|
- A woman has had several episodes where she finds new clothes in her closet that are much more colorful than the style she usually buys. Today, a co-worker approached her to thank her for hosting a dinner party that she had no recollection of hosting. What is the most appropriate nursing diagnosis for this client?
|b.||Personal identity, disturbed|
|c.||Body image, disturbed|
- Which dissociative disorder is a result of a disturbance of identity?
|b.||Dissociative identity disorder|
- A client with a dissociative disorder has the nursing diagnosis of disturbed body image. Which nursing interventions would address the nursing priority of determining the coping abilities and skills of this client? (Select all that apply.)
|a.||Assess the client’s current level of adaptation.|
|b.||Help the client differentiate between isolation and loneliness.|
|c.||Note the use of addictive substances.|
|d.||Identify previously used coping strategies and their effectiveness.|
- A male client with a dissociative disorder copes with his low self-esteem by displaying behaviors associated with an exaggerated sense of self-importance. Which behaviors would this client most likely exhibit? (Select all that apply.)
|a.||Bragging about special abilities|
|b.||Setting unrealistic goals|
|c.||Having unrealistic dreams|
|d.||Having a view of life that everything is either right or wrong|
- A person’s self-concept, or how a person sees himself or herself, comprises which of the following? (Select all that apply.)
- Dissociative fugue is identified by which characteristics? (Select all that apply.)
|a.||Presence of two or more distinct personalities|
|b.||Sudden travel with inability to recall the past|
|c.||Behave normally during travel but confused by own identity|
|d.||May assume a new life|
- Of the four types of dissociative disorders identified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the disorder that formerly was called multiple personality disorder is now called __________.
- When a person is unable to bring his various childhood identifications into one effective adult personality, the individual is said to have identity _______________.
Chapter 25: Anger and Aggression
- The use of inappropriate, harmful, or destructive behaviors to express current or past emotions is defined as:
- Toddlers often express their anger through:
- In the assault cycle, people are unable to listen to reason, follow directions, or engage in mental exercises during the stage of:
- Crisis interventions are very successful if begun early in the assault cycle, in the ____ stage.
- Persons who naturally relate aggressively to others, seldom have empathy, and lack appropriate guilt feelings are given the diagnosis of ____ disorder.
- Emotional or behavioral problems that develop in response to an identifiable source and last no longer than 6 months are called ____ disorders.
- Level one interventions for potentially assaultive clients should be practiced as:
- Interventions for assaultive clients that focus on protecting the client and others from potential harm are level ____ interventions.
- Restrained clients must be monitored and their condition documented at least every ____ minutes.
- As long as the client is limiting her behaviors to verbal assaults and harmless physical movements:
|a.||She is placed in seclusion.|
|b.||The acting out may continue.|
|c.||The caregiver is prepared to apply restraints.|
|d.||She is reminded of the inappropriateness of her behavior.|
- Interventions that help caregivers the most in coping with their own anger focus on:
|a.||Learning to effectively interact with clients|
|b.||Assessing which stressors and coping skills are being used|
|c.||Learning to effectively control feelings of anger|
|d.||Establishing a trusting therapeutic relationship via clear communications|
- Which situation would most negatively affect a female client with a diagnosis of adjustment disorder?
|a.||Marrying her partner she has lived with for 5 years|
|b.||Beginning college after graduating from high school 12 years ago|
|c.||Being promoted in the company at which she has worked for the past 10 years|
|d.||Meeting with a friend with whom she keeps in contact but has not seen for 8 years|
- A married couple is seeking counseling for domestic abuse issues. The husband states that he can’t control his anger when his wife constantly nags at him. In the assault cycle, the wife’s behavior in this situation is the stage known as:
- A male client is being seen for anger management issues following an incident in which he was late for work, became angry at the driver in front of him for not driving faster, and intentionally ran into the car at a stop sign. This client is displaying actions most typical of:
|a.||Intermittent explosive disorder|
|b.||Passive aggressive behavior|
|c.||Oppositional defiant disorder|
|d.||Adjustment disorder with anxiety|
- An intramuscular injection of an antianxiety agent is administered to a client who has become violent toward the staff in the emergency room. This is an example of what level of therapeutic intervention?
- Which of the following persons is exhibiting passive aggression?
|a.||The woman who willingly volunteers to help out at her child’s school play|
|b.||The woman who says no when asked to go to a charity event|
|c.||The woman who asks a coworker to cover her shift|
|d.||The woman who agrees to cover a coworker’s shift and complains to customers that she is supposed to be home|
- Children in preadolescence have started to channel aggression through which positive activity?
|a.||Fights in schoolyards|
- A 15-year-old female is seen in the clinic for episodes of cutting herself since her parents divorced six 6 months ago. Which nursing diagnosis is a priority for this client?
|a.||Behavior, risk-prone health|
|c.||Social interaction, impaired|
|d.||Family processes, interrupted|
- A man who hit his wife yesterday causing her to fall and break her arm has called out of work today to take care of her and buy her flowers. He repeatedly tells her how horrible he feels and promises this will never happen again. What stage of the assault is he demonstrating?
- Which mental health problems are categorized as anger control disorders? (Select all that apply.)
|g.||Oppositional defiant disorder|
- During the psychosocial portion of the assessment of a client with anger, aggression, or violent behavior issues, the nurse will assess which of the following? (Select all that apply.)
|c.||Value and belief systems|
|d.||Cultural, spiritual, and occupational interests|
|e.||Potential for engaging in inappropriate behavior|
- Which of the following psychosocial nursing diagnoses are related to anger and aggression? (Select all that apply.)
|b.||Violence, risk for other-directed|
|d.||Violence, risk for self-directed|
|e.||Coping ineffective, individual|
- __________ is a forceful attitude or action that does not take into consideration others’ feelings or needs and may be expressed verbally, physically, or symbolically.
- __________ typically express anger and/or aggression with temper tantrums.
- The __________ theory explains aggression and violence as being caused by physical or chemical differences among people.
Chapter 26: Outward-Focused Emotions: Violence
- Mr. Right employs 22 children in his clothing factory. Each child is no older than 10 years of age and works 11 hours a day, 6 days a week. Mr. Right is practicing:
- The theory that cites poverty, unemployment, and crime as sources of violence is known as the ____ theory.
- What concept do feminist theories use to explain violence against women?
- The term that describes repeated physical abuse, usually of a woman, child, or elder, is:
- A male who, as a child, observed the women in his family being dominated is, in his own life, more likely to:
- Whenever there is a history of unexplained lethargy, fussiness, or irritability in an infant, caregivers should suspect ____ syndrome.
- Eating disorders, substance abuse, delinquent behaviors, posttraumatic stress disorder, and suicide most commonly are seen as the result of abuse in which population?
- A physically or mentally impaired older woman who is living with a relative and has a history of unexplained bruises or injuries, burns in unusual places, or poor personal hygiene is likely a victim of:
- A rule of thumb for recovering from a rape or other violent experience states that the greater the force or brutality, the greater the psychological harm and:
- Many victims of violence believe that their abusers may attempt to hurt them again, even as they are seeking help. Recognizing this, the care provider:
|a.||Does not leave the client alone|
|b.||Posts security guards at the door|
|c.||Leaves the client alone no longer than 15 minutes|
|d.||Immediately gets the name and phone number of the perpetrator|
- By law, what are health care providers required to do when they encounter incidents of suspected or actual abuse or neglect?
|c.||Report to the authorities|
|d.||Report to the client’s family|
- During the recoil stage of recovery from violence, the major characteristic is:
|d.||Struggle to adapt|
- A female who is physically abused by her husband arrives in the emergency room following a serious battering incident. During this phase of the domestic abuse cycle, the nurse expects the client to:
|a.||Have experienced the battering episode a few days prior to the incident|
|b.||Be very nurturing and compliant and seeking to please her husband|
|c.||Believe in the permanency of their relationship and believe that it will not happen again|
|d.||Ask the emergency room nurse to call the police immediately to arrest her husband|
- Child prostitution in Thailand is widespread, and it is estimated that _____% of these children have AIDS.
- Which signs and/or symptoms should alert the caregiver to a child who is suffering from neglect?
|a.||Bruises and welts at various stages of healing|
|b.||Consistently dirty, hungry, and inappropriately dressed|
|c.||Child has torn, stained, or bloody underclothing|
|d.||Any fracture in a child younger than 2 years of age or fractures at various stages of healing in a child of any age|
- When a functional family is faced with a crisis or unexpected situation, which of the following behaviors do they exhibit to overcome it?
|a.||Avoid the conflict and focus on positive aspects of their lives.|
|b.||Isolate the family and attempt to reach resolution without outside interference.|
|c.||Maintain clear and supportive communication to address the crisis.|
|d.||Look to the head of the family to resolve based on role.|
- While an abused woman cannot be categorized to fit a specific profile, which of the following traits is most commonly identified?
|c.||Accomplished in non-traditional female career|
- Abuse during pregnancy endangers the health and well-being of the pregnant woman and her fetus. Which complicating factor is seen twice as much in women experiencing abuse during pregnancy?
|c.||Maternal substance abuse|
|d.||Delivery by caesarean section|
- Which nursing diagnosis would be most appropriate for an adolescent client suffering from test anxiety who was continually told by her mother that she was inferior to her siblings and could never amount to anything?
|c.||Self-esteem disturbance, situational low/chronic low|
|d.||Violence, risk for other-directed|
- Which are characteristics of a dysfunctional family? (Select all that apply.)
|d.||No clearly defined roles|
|e.||Members are self-centered|
|f.||Family boundaries are rigid|
|g.||Clear and supportive communications|
- During the first phase of the domestic abuse cycle, the female victim of domestic violence inflicted by a male usually displays which characteristics or behaviors? (Select all that apply.)
|a.||Denial of the seriousness of the problem|
|b.||Feeling that she cannot control his behavior|
|c.||Blaming alcohol and work for his behavior|
|d.||Feeling that she deserves minor abuse|
- A 25-year-old woman expresses concern regarding some of her new boyfriend’s behaviors. Which of the following statements might indicate that he has an abusive personality? (Select all that apply.)
|a.||Even though they have been dating for less than 2 months, he wants to get married as soon as possible.|
|b.||He does not allow her to go out with friends unless he accompanies them.|
|c.||He finds fault with her family and seeks to convince her that they are trying to sabotage her relationship with him.|
|d.||He has a poor relationship with his own parents, blaming them for not supporting him after he was fired from various jobs.|
|e.||He would like to further his education, but realizes that he must first work for a while to pay off student loans.|
- __________ refers to a sudden occurrence of physical force that causes harm or injury to another person.
- The __________ theory implies that aggressive and violent behaviors are learned through role modeling of other people.
- __________ refers to abuse or battering of a family member by another family member.
Chapter 27: Inward-Focused Emotions: Suicide
- Self-protective responses are seen in behaviors that meet basic:
- Bob drives fast everywhere he goes, especially when he is drinking. Last night, he was arrested for gambling and loud behavior. Bob is engaging in ____ behavior.
- Suicide in the United States is:
|a.||Not a problem|
|b.||The tenth leading cause of death|
|c.||Most prevalent among the middle-aged|
|d.||Controlled by the use of antidepressants|
- The theory that suicide rates are affected by group support, social changes, regulations, religion, legal sanctions or limitations, and philosophical beliefs is known as the ____ theory.
- Children are at greater risk for committing suicide if they have ____ problems.
- Suicide is attempted three times more frequently by ____ but is more often successfully completed by ____.
|a.||Adult men, women|
|b.||Adult women, men|
|c.||Adult fathers, mothers|
|d.||Adolescent mothers, fathers|
- The caregiver works with suicidal clients to establish therapeutic rapport. The focused communications and concerned actions encourage suicidal persons to:
|a.||Feel in control|
|c.||Talk about themselves|
|d.||Feel foolish for thinking about suicide|
- Suicide attempts by ____ are more successful because one out of every two attempts results in death.
- When the environment lacks security or presents dangers, the perception that life will be short or will end in violence is most compelling for:
- All people who commit suicide are depressed or psychotic. This statement is a(n):
- The nurse is caring for a male client with a major depressive disorder who has not responded well to various treatments in the past. The latest treatment method has resulted in slight improvement in the client’s symptoms. On this particular day, the client has a very positive affect and says he feels “amazingly better.” The nurse should:
|a.||Congratulate him on his recovery.|
|b.||Document the client’s improvement.|
|c.||Ask him what he feels has helped him feel better so suddenly.|
|d.||Assess the client for signs and symptoms of suicidal thoughts.|
- An adult female whose fiancé recently called off the wedding attempts suicide by taking an overdose of sleeping medication. Immediately after taking the medication, she calls friends and family to tell them what she has done. Her friends and family activate the emergency response system, and she is taken to the emergency room and is admitted to a mental health facility for monitoring. She is exhibiting signs and symptoms most evident of which suicidal motivational category?
|a.||Crying for help|
|c.||Preoccupation with suicide|
|d.||Refusal to accept a diminished style of life|
- A terminally ill female client chooses the time and place of her own death. This is an example of:
- An elderly male client’s wife of 50 years recently died from cancer. He suffers from a chronic debilitating illness and has been refusing to eat, drink, or take his medications. This client is displaying behavior characteristic of:
- In the ______ dimension, an individual who is considering suicide experiences distorted thinking and self-defeating thoughts.
- Methods of suicide differ by gender. What is a preferred method of female suicide victims?
- Biological studies of suicide victims show an imbalance of which neurotransmitter system?
- In assessing a client for suicide, which finding presents the greatest risk for the client?
|a.||“If I had AIDS or cancer and died, then my family would be sorry.”|
|b.||“I just don’t see any other way out of this situation.”|
|c.||“I tried to kill myself 6 months ago, but my friend stopped me. The next time, no one will know.”|
|d.||“I have thought about planning it, but I haven’t done it.”|
- After establishing a no-harm contract with the client, the nurse should:
|a.||Begin to assess client risk factors.|
|b.||Continue to maintain close observation.|
|c.||Decrease observation activity to allow client autonomy.|
|d.||Begin treatment with antidepressants.|
- Which of the following are included in the continuum of self-protective responses? (Select all that apply.)
|f.||Growth promoting risk taking|
- Which are facts about suicide? (Select all that apply.)
|a.||Suicide occurs most often in lower socioeconomic classes.|
|b.||Depression is a high risk factor for attempting suicide.|
|c.||Giving away important possessions is a sign of suicidal thoughts.|
|d.||It is harmful to discuss the subject of suicide with clients.|
|e.||Suicidal threats are serious only if the client conveys the planned method.|
- Which social factors impact the incidence of suicide? (Select all that apply.)
|b.||Legal status of gun ownership|
|c.||Poverty and homelessness|
|d.||Veterans of combat|
|e.||Availability of Internet resources|
- Standard interventions implemented in a mental health facility to prevent a client from attempting suicide are called __________.
- __________ is a term that is used to describe a form of active suicidal behavior, such as gestures, threats, or attempts to end one’s own life.
- __________ is when a client thinks or fantasizes about death with no definite intent to commit suicide.
Chapter 28: Substance-Related Disorders
- Abused substances are those chemicals that alter the person’s perception by affecting the _____ system.
- Children who are smaller at birth, have small heads (microcephaly), and fail to develop normally have characteristics of:
|a.||Parents who smoke|
|b.||Fetal alcohol syndrome|
|c.||Fetal alcohol intoxication|
|d.||Fetal accumulation syndrome|
- With children younger than 12 years of age, drug abuse:
|a.||Does not exist|
|b.||Is never a problem|
|d.||Occurs more often than is suspected|
- The drug most often abused by adolescents is:
- The client has frequent drug reactions to, and side effects from, his medications. He is 72 years old and lives alone. What should he be assessed for?
|a.||Clarity of mind|
|c.||Concurrent substance use|
|d.||Using someone else’s medications|
- The main active ingredient in coffee, black teas, most cola drinks, and many other bottled beverages that stimulates the nervous system, relieves fatigue, increases alertness, and increases the body’s metabolic rate is:
- One begins to prefer being high to other activities during which stage of addiction?
|a.||The early stage|
|b.||The middle stage|
|c.||The late stage|
|d.||The chronic stage|
- Significant complications such as sudden death due to cardiac dysrhythmia or respiratory depression are associated with the use of:
- For a substance-related disorder to be diagnosed, the pattern of substance use must lead to:
|a.||Significant costs involved with the habit|
|b.||Significant disturbances in social functioning|
|c.||Significantly impaired functioning and distress|
|d.||Significant physical changes related to the abused substance|
- Before treatment of an addiction can actually begin, many persons first must go through the process of removing the substance from their bodies under medical supervision. This is known as:
- A drug that is taken daily to help reduce the desire for alcohol is:
- Typical central nervous system responses when an individual has drunk five or more alcoholic beverages or has a blood alcohol content of 0.20% within a 4-hour period include:
|a.||Thought, restraint, reaction time, and judgment are slowed, and the individual usually is more at ease socially|
|b.||The entire motor area of the brain is depressed; individual is staggering, easily angered, and emotional and feels fatigued|
|c.||Comatose, medullary area of the brain is severely depressed, and respiratory failure can result in death|
|d.||Confused, unresponsive to most external stimuli; loss of ability to control involuntary responses and decreased vital signs|
- __________ is a processed stimulant that reaches the brain immediately and produces an intense but short-lived high.
- A male client takes ibuprofen twice a day, every day, for his arthritis. He becomes very anxious when he does not take his normal doses. This client is experiencing:
- The nurse assessing the newborn shortly after delivery notes that the infant is very jittery, irritable, and has a high- pitched cry. The nurse suspects that the mother took which substance during pregnancy?
- The school nurse reports that a student who was brought to her appears to be tense, angry, and her speech is rapid. She denies use of illegal substances. What does the nurse suspect the student has ingested?
- Which of the following persons is said to have a dual diagnosis?
|a.||The anorexic adolescent suffering from depression|
|b.||The school-aged child suffering from a learning disorder and asthma|
|c.||The older adult suffering from hypertension and diabetes|
|d.||The young adult suffering from psychosis and smokes marijuana regularly|
- The family of a 35-year-old alcoholic who refuses to seek treatment reaches out to the community health center for assistance. Which organization should the nurse refer them to for counseling?
- The breathing in of volatile substances has become popular with adolescents and young adults because such inhalants are: (Select all that apply.)
|g.||Undetectable in the body|
- Which are signs and symptoms most commonly associated with heroin use? (Select all that apply.)
- It is important for the nurse to ensure that the client understands the physical reactions associated with drinking alcohol while taking disulfiram (Antabuse). Which of the following are reactions that may result from ingesting alcohol while taking Antabuse? (Select all that apply.)
|a.||High blood pressure|
- Which of the following are interventions included in the plan of care for an individual with substance abuse? (Select all that apply.)
|a.||Ignore physical symptoms of dependence and withdrawal to ensure the individual will rehabilitate|
|b.||Focus on client’s weaknesses to encourage him or her to change|
|c.||Teach client about the negative effects of the disease|
|d.||Monitor the effects of therapies prescribed to control substance use|
|e.||Meet physical needs during detoxification|
|f.||Encourage client to focus on present and future, not only the past|
- __________ is the drug of choice in the treatment of heroin addiction to ease the effects of withdrawal from the drug.
- When the body physically needs or is dependent on a substance, the individual is said to be __________ to the substance.
Chapter 29: Sexual Disorders
- The end of the continuum that is marked by sexual actions harmful to self or others in some manner is known as:
- A strong influence on discussion of sexual issues with clients is the nurse’s or caregiver’s:
- The caregiver has been assigned to care for Mr. X, a pedophile who is being treated for AIDS. The thought of caring for him disgusts her. The caregiver’s therapeutic interactions and interventions are most likely to be:
|d.||Effective if she can conceal her true feelings|
- Children learn to label themselves according to their sex around the age of ____ year(s).
- By the time they enter school, it is thought that most children identify with:
|c.||The same-sex parent|
|d.||The opposite-sex parent|
- An image of the older adult as an asexual, unintelligent person who is not interested in sex represents:
- The client was injured in a work accident. He now has a fused spine and moves with difficulty. He wonders if he will ever be able to be intimate with his wife. What is the nurse’s most accurate response?
|a.||“You will not be able to engage in sexual activity.”|
|b.||“You can enjoy a satisfying sex life with some adaptation.”|
|c.||“You eventually will return to the preinjury level of functioning.”|
|d.||“You will become more sexually active after you recover from the injuries.”|
- People who express their sexuality with members of the opposite sex are:
- Experiencing sexual excitement from wearing the clothing of the opposite sex is defined as:
- The client confides in the nurse that intercourse has been painful since she became menopausal. What is the nurse’s most therapeutic response?
|a.||“Don’t worry; it will pass.”|
|b.||“Are you still sexually active?”|
|c.||“Perhaps we can discuss this with your doctor.”|
|d.||“I understand how difficult it is to discuss sex.”|
- Between the ages of __________ years, the greatest amount of sexual activity with multiple partners and serial relationships occurs.
|a.||13 and 17|
|b.||18 and 24|
|c.||25 and 34|
|d.||35 and 44|
- An individual is bisexual. The belief that this individual’s sexual variation is related to genetic influences is the belief held by _____ theorists.
- A female client is suffering from vaginismus. The nurse is aware that this is a type of:
|d.||Gender identity disorder|
- A male client is transsexual and decides to become a female through major surgery and hormonal therapy. The nurse informs the client that this process may be delayed for as long as _____ years.
- A homosexual couple lives together, but both partners continue to have sexual experiences with others. This is an example of a(n) _____ relationship.
- The rate of pregnancy and transmission of HIV is higher in the adolescent population than the general population of sexually active adults due to the fact that because adolescents:
|a.||Have more sexual partners|
|b.||Utilize ineffective contraception|
|c.||Have not been educated regarding sexuality|
|d.||Seek behaviors that reflect their need to be independent|
- An individual’s orientation, whether heterosexual, homosexual, or bisexual, is established by the time of:
- While performing a search of an adult male’s home based on suspicion of criminal activity, the police find pictures of him with young children between the ages of 5 and 10. The pictures are sexual in nature. The man is suspected of:
- A 68-year-old man is being treated for an enlarged prostate. While discussing health history with the nurse, he states that he seems to be having erectile difficulties and is not sure if it is from his medical condition or the medication he is taking. Which nursing diagnosis is most appropriate?
|b.||Injury, risk for|
|d.||Family processes, dysfunction|
- Which are signs of sexual addiction? (Select all that apply.)
|a.||Inability to stop|
|b.||Bragging to others about exploits|
|c.||Refusing to stop enjoying the act|
|d.||Out-of-control sexual behaviors|
|f.||Persisting in behaviors despite severe consequences|
|g.||Spending excessive time pursuing sexual experiences|
- The criteria for healthy or adaptive sexual response include: (Select all that apply.)
|a.||Sexual acts between two consenting adults|
|b.||Sexual acts that fulfill the desire of only oneself|
|c.||Sexual acts that are not forced or coerced|
|d.||Sexual acts that are conducted in privacy|
|e.||Sexual acts that fulfill the desire between two people|
- What are the types of relationships that put individuals at greatest risk for sexually transmitted diseases, including HIV/AIDS? (Select all that apply.)
- Which of the following are indicative of sexual dysfunction? (Select all that apply.)
|a.||Sexual aversion disorder|
- The primary nursing diagnoses for a client who is experiencing problems with sexuality are sexual dysfunction and __________.
- According to the DSM-IV-TR, sexual arousal that is attained by an individual while he is observing an unaware person who is naked, disrobing, or engaging in sexual activity is known as __________.
Chapter 30: Personality Disorders
- Infants who experience nurturing environments develop the ability to:
|d.||Model others’ behaviors.|
- Behavioral theorists see personality disorders as the result of:
|d.||An imbalance among the three forces of the personality|
- Paranoid personality disorders are diagnosed more often in:
- Studies of families, twins, and relatives with personality disorders have demonstrated that the developing personality is influenced by:
|b.||Order of birth|
|d.||Number of siblings|
- The group of personality disorders characterized by odd or strange behaviors is known as the ____ cluster.
- The central feature of one of our most pressing mental health problems today is a pervasive pattern of disregard for, and violation of, the rights of others. This personality disorder is called:
- The client relies on deceit and manipulation to get his own way. He seems to have a complete lack of conscience. His goal is always self-gratification at the other person’s expense. He is referred to as:
- The childhood trait that increases the risk for developing an antisocial personality disorder is:
|a.||Poor impulse control|
|b.||Frequent reading in solitude|
|c.||Poor preschool learning practices|
|d.||Difficulty controlling others in the environment|
- The client is a 38-year-old woman with a diagnosis of narcissistic personality disorder. Behaviors associated with this diagnosis are:
|b.||Odd or eccentric|
|d.||Reflective of lack of trust in others|
- The client is unable to make a decision by herself. She clings to her husband and quickly moves to fill his requests. Although she sometimes appears angry, her emotions are not expressed. The client’s diagnosis is:
|b.||Paranoid personality disorder|
|c.||Dependent personality disorder|
|d.||Narcissistic personality disorder|
- The nurse is planning goals for a male client with the diagnosis of personality disorder. What is the main goal of the client’s therapy?
|a.||To adjust to his medications|
|b.||To learn to get along with others|
|c.||To learn to control his environment|
|d.||To become aware of how his behavior affects his life|
- In treating clients with personality disorders, compliance with prescribed medications must be monitored frequently and safeguards must be put in place to prevent or reduce the risk for:
- A male client has schizotypal personality disorder. A female client compliments him on his style of dressing, and he interprets this as her caring deeply for him and desiring to date him. What is the client experiencing?
|b.||Ideas of reference|
|d.||Delusions of grandeur|
- A wife is discussing her co-worker with her husband. The wife states, “I am so tired of her. She is always dressing in flamboyant clothing and pretends to have an accent. She doesn’t relate well to any of our co-workers because she is so superficial.” Which personality disorder is being described?
- Medications are used with extreme caution in clients with personality disorders because of their questionable effectiveness. If a client is receiving an antipsychotic medication, it is especially important for the nurse to monitor the client for side effects of:
|a.||Increased thirst and urination, nausea, and anorexia|
|b.||Dry mouth, altered taste, sexual dysfunction, and dizziness|
|c.||Bone marrow depression, gastrointestinal symptoms, and confusion|
|d.||Extrapyramidal movements, dry mouth, blurred vision, and photophobia|
- The daughter of an elderly man notices that her father has stopped seeing his friends for their daily walk and acts in an aggressive manner when anyone comes to his house. She states that he normally looks forward to interacting with his friends on a daily basis, and his general demeanor is friendly and caring. What does the nurse advise?
|a.||This is a normal part of aging and there should be no reason for concern.|
|b.||The change in personality and behavior should be ignored as it is manipulative.|
|c.||The change in personality and behavior should be evaluated.|
|d.||The change in personality and behavior indicates it is time for nursing home placement.|
- The 40-year-old woman who works at the same entry level job for many years without seeking advancement and politely declines when friends ask her to try new vacation spots or hobbies may be suffering from which personality disorder?
- Two nurses are discussing a new patient during report. They discover that she has the staff divided on their opinion of her. One group has had very positive interactions with her and find her to be very cooperative. The other group has had a difficult time in gaining her compliance in treatment interventions. What action would be most appropriate in dealing with this situation?
|a.||Provide consistent limit setting with the client.|
|b.||Assign the staff with the positive interactions to the client’s care.|
|c.||Work with the group experiencing the negative interactions to maintain an accepting attitude.|
|d.||Take away privileges from the client until she changes her behavior.|
- Clients suffering from a personality disorder usually do not seek treatment because they:
|a.||Do not have identifiable impairments|
|b.||Cannot be treated|
|c.||Are unable to recognize their problems|
|d.||Often do not have health insurance|
- Which are characteristics of a personality disorder? (Select all that apply.)
|d.||Inappropriate sexual behaviors|
|e.||Inflexible and maladaptive behaviors|
|f.||Difficulties with interpersonal relations|
|g.||Behaviors that cause significant functional impairment|
- Personality disorders that are considered to be in the erratic cluster include: (Select all that apply.)
- Characteristics of borderline personality disorder include which of the following? (Select all that apply.)
|a.||Fear of being abandoned|
|d.||Engaging in unsafe sex|
|e.||Isolation of self from others|
- A characteristic trait of an individual with __________ disorder is that they may be extremely orderly and overly preoccupied with details that they may accomplish very little.
- An individual with an __________ personality disorder relies on deceit and manipulation to get his or her way.
Chapter 31: Schizophrenia and Other Psychoses
- The client lives so completely in a world of his own that they he is unable to recognize reality, relate to others, or cope with life’s demands. This client is considered:
- Schizophrenia in children as young as 5 years:
|a.||Is a myth|
- When people successfully adapt to their environment by using logical thought and socially appropriate ways, they are said to be functioning at the adaptive end of the ____ continuum.
- Schizophrenia affects approximately ____% of the world’s population.
- Theories based on study of the brain and its activities are called:
- The client has become unable to recognize formerly familiar objects and people in his environment. The client is experiencing:
- The client is describing her trip to town. She tells the nurse, “I cold town yellow water girl outside below ground.” This speech disturbance is called:
|c.||Flight of ideas|
- The signs and symptoms of schizophrenia must be present for at least ____ months before a diagnostic label is assigned.
- The client in whom schizophrenia has been diagnosed usually is medicated with what class of drugs?
- The client interprets the proverb “A rolling stone gathers no moss” as “As long as the rock keeps moving, it won’t turn green.” This is an example of:
|b.||Flight of ideas|
- The nurse notes that a male client, who is taking an antipsychotic medication, is constantly moving from chair to chair during a group activity, and he complains that he feels “nervous and jittery inside.” The nurse is aware that this client most likely is experiencing:
- To cope with the devastating effects of schizophrenia and other serious mental illnesses, family members or significant others and clients will benefit most from:
|b.||Intensive short-term therapy|
|c.||Ongoing treatment and support|
|d.||Continued medication adjustments|
- The onset of schizophrenia most commonly occurs during the decade of age in the:
- A female client with a psychotic disorder is experiencing olfactory hallucinations. Most likely, she would be complaining of a _____ that is disturbing to her.
|d.||Sense of touch|
- The police bring a man to the emergency department because he is wandering the streets yelling to people. He attempted to attack the police officer because he accused him of “being a part of that plot to kill the president and me.” Which category of schizophrenia is he exhibiting?
Nursing Process Step: Assessment
MSC: Client Needs: Psychosocial Integrity
- The family of a client diagnosed with schizophrenia describes her behavior over the last few days as being very docile and non-confrontational. When asked to go and change her shoes to go shopping, she goes to change them, but a when a family member checks on her several minutes later, she appears to be lost in thought. This phase of schizophrenia is the ________ phase.
- The mother of a 20-year-old man diagnosed with paranoid schizophrenia is upset by the fact that her child tried to attack her during her daily visit. What is the most appropriate support the nurse can give her after this incident?
|a.||“Your child is working through relationship issues with you and does not know how to express them.”|
|b.||“You should stop coming for a while, as your visits upset your child.”|
|c.||“Your child’s illness is due to a loss of contact with reality, and not directed to you as his mother.”|
|d.||“You must make him realize that his behavior toward you is inappropriate.”|
- A woman who delivered a healthy infant three 3 weeks ago is experiencing auditory hallucinations and has not changed her clothes or taken a shower in a week and expresses no interest in her infant. After a short inpatient stay, her symptoms improve and she is back to caring for her herself and her infant. What disorder is this indicative of?
|d.||Brief psychotic disorder|
- The client who is taking a low-potency antipsychotic medication should be informed by the nurse that the most common side effects are: (Select all that apply.)
- Positive symptoms of schizophrenia include: (Select all that apply.)
|f.||Withdrawal from others|
- Neuroleptic malignant syndrome (NMS) is a potentially fatal side effect of antipsychotic medications. Which of the following symptoms are indicative of NMS? (Select all that apply.)
|g.||Slow, shallow respirations|
- __________ are central nervous system alterations that are characterized by abnormal, involuntary movement disorders caused by antipsychotic medications and leading to an imbalance between two major neurotransmitters (dopamine and acetylcholine) in portions of the brain.
- Schizophrenia is a complex syndrome of maladaptive thoughts and behaviors that affects human functioning in the emotional, spiritual, intellectual, and __________ areas of an individual’s life.
Chapter 32: Chronic Mental Health Disorders
- Persons with chronic mental health problems have much higher rates of:
- The process of emptying state mental hospitals and placing mentally ill persons in the community is known as:
- The experience and suffering of living with mental illness:
|a.||Decreases as one grows older|
|b.||Is unique to each person|
|c.||Follows a predictable course|
|d.||Is common to all mentally ill persons|
- The client finds fault in every success she has. She is afraid to try anything new because she “just knows” that she will fail because she is mentally ill. Her behaviors demonstrate:
|c.||Low abstraction abilities|
|d.||Altered thought processes|
- The child has not developed the ability to respond to others. He cannot communicate his needs. He may remain dependent upon others throughout his life. He is most accurately described as having:
- Approximately _____% of individuals with chronic mental illness use or abuse drugs.
- The client has been diagnosed with depression for a long time. He recently started using cocaine to help relieve his depression. The most accurate description of these behaviors is a(n):
|c.||Fear of failure|
- The criterion that necessitates the need to hospitalize an individual with chronic mental health problems occurs when his or her:
|a.||Behaviors pose a threat.|
|b.||Caregivers need a respite.|
|c.||Subsistence benefits expire.|
|d.||Medications need readjustment.|
- The client has schizophrenia. He has moved frequently between the community and mental health facilities for the past 7 years. The client’s behavior is an example of:
- A male client is experiencing hallucinations. The intervention that would be most helpful in controlling the hallucinations is:
|a.||Actively listening to his concerns|
|b.||Establishing a trusting relationship|
|c.||Encouraging appropriate behaviors|
|d.||Teaching him to use distraction techniques when experiencing hallucinations|
- Neuroleptic drugs are prescribed to treat _____ disorders.
- Individuals with mental illness live an average of _____ years less than the general population.
|a.||2 to 4|
|b.||5 to 8|
|c.||10 to 15|
|d.||18 to 25|
- Individuals with schizophrenia tend to use the chemical __________ most often.
- A female client with a chronic mental health disorder tells the nurse that she has great difficulty every morning getting ready for work because she cannot decide what to wear to work or what to eat for breakfast. This client is experiencing:
|b.||Altered thought processes|
|c.||Delusions of grandeur|
|d.||Chronic low self-esteem|
- A client in an inpatient mental health setting is scheduled to be discharged, with follow-up at a community mental health center. His family is concerned that his inpatient stay was not long enough, and he will be re-admitted in the near future. The nurse knows that the average length of inpatient stay is:
- A 50-year-old man suffering from schizophrenia and depression for the last 30 years is treated on an outpatient basis. What is the primary goal for his treatment plan?
|a.||Client will return to pre-illness employment and activities of daily living.|
|b.||Client will be managed permanently on an inpatient basis due to the effects of his antipsychotic medications.|
|c.||Client will enter into a vocational training program and not experience an exacerbation of symptoms.|
|d.||Client will be able to live independently and purchase his own home.|
- A woman with a history of chronic mental illness was dating someone for about a month before they ended the relationship. What is the probable action the woman will take?
|a.||Endure a brief period of grieving and seek to begin dating again.|
|b.||Speak to friends and other support persons and consider the positive aspects of the relationship.|
|c.||Withdraw and refuse to seek out or enter into another relationship.|
|d.||Take up an activity with friends to avoid staying home and thinking about the failed relationship.|
- Which of the following clients in the community with chronic mental illness is most likely to be compliant in taking his or her prescribed medications on a consistent basis?
|a.||The client who has an understanding of his or her disease and medication’s effect in controlling symptoms|
|b.||The client who has insurance that covers the cost of all prescribed medications|
|c.||The client who has very little insight of his or her illness and is living with a family member|
|d.||The client who is trying to live independently in a homeless shelter|
- In the United States today, the effects of deinstitutionalization include: (Select all that apply.)
|a.||A comprehensive mental health care system|
|b.||A decrease in the need for medical treatment|
|c.||An increase in the jail and prison populations|
|d.||An increase in the homeless population|
|e.||People who cannot obtain adequate food or shelter|
|f.||Well-adjusted people with CMI|
|g.||Unlimited access to mental health care|
- Psychiatric rehabilitation focuses on: (Select all that apply.)
|a.||Helping clients control their behaviors|
|b.||Assisting clients to cope effectively with their life situations|
|c.||Helping clients identify their feelings|
|d.||Preventing the client from harming himself or herself|
|e.||Assisting the client with problem-solving techniques|
|f.||Assisting with occupational and vocational training|
- Persons with which of the following diagnoses respond well to therapeutic interventions and may have no further problems? (Select all that apply.)
|f.||Erratic behavioral disorder|
- The nurse on a mental health unit administers a medication to a female client for the purpose of reducing her psychotic symptoms and quieting her behavior. This medication is considered a __________.
- Adolescents in whom diabetes is diagnosed have high rates of depression and __________.
Chapter 33: Challenges for the Future
- The need for mental health applies to:
|b.||People with illnesses|
|c.||All married persons|
|d.||People with mental problems|
- An aging population, an overburdened welfare system, and a cost conscious U.S. Congress exerting its influence on the health care system are all examples of ____ changes.
- Families without a home now make up _____% of the homeless population in the United States.
- To implement the concept of the least restrictive treatment environment, care team members:
|a.||Monitor the medications schedule.|
|b.||Assess the client’s ability to live alone.|
|c.||Assess available financial resources.|
|d.||Assess available community resources.|
- A treatment team member works with a client who is living in a residential treatment facility who has a diagnosis of severe paranoid schizophrenia. The team member who collaborates with the physician to coordinate the client’s therapy and medications and necessary referrals is the:
|a.||Nurse case manager|
|c.||Certified nursing assistant|
|d.||Home health care provider|
- Routine health screenings, regular educational discussions, and support groups are nursing responsibilities that are:
- A way of helping people with mental health problems to readjust and adapt to life in the community that is based on a nonmedical model of treatment is:
|c.||Compliance with medications|
- As many as 75% of people with chronic mental health disorders:
|b.||Refuse to take their medications|
|c.||Use or abuse drugs|
|d.||Use or abuse their prescribed medications|
- The deliberate effort to make things different within a system is called:
- Each complaint of people with HIV/AIDS must be investigated carefully because CNS problems can be mistaken for:
- In the United States, 1 in _____ individuals has a diagnosable mental health disorder.
- Historically, the homeless population has primarily consisted of:
|b.||African-American men over 40 years of age|
|c.||White male adults with an average age of 50 years|
|d.||Individuals in their 30s with mental and physical disabilities|
- Adults with chronic mental illness account for approximately _____ of the homeless population.
- A male client was discharged to home from an inpatient setting with the diagnosis of obsessive-compulsive disorder. Upon discharge, he was able to reason, understand, and make informed choices regarding his care. Now, he is unable to leave his house, is engaging in compulsive behaviors, and is not taking his medication. The best description of this situation is that the client is lacking in:
- A nurse is overheard by a family member of a client discussing the condition of the client. This nurse is in violation of the:
|a.||Client’s informed consent|
|b.||Right to competent care|
|c.||Americans With Disabilities Act|
|d.||Health Insurance Portability and Accountability Act|
- A woman whose culture believes her depression is the result of being possessed by the spirit of a deceased relative is considered to have a(n):
|a.||Impaired coping mechanism|
|c.||Medically diagnosed disorder|
- The nurse who advocates for a health-oriented approach to clients is likely to encourage the development of which outcome?
|a.||The client will maintain compliance in medication administration.|
|b.||The client will adjust to the limitations of chronic illness.|
|c.||The client will keep in mind his limitations as a barrier to achievement of goals.|
|d.||The client will focus on continued progress and improvements in planning goals.|
- A nurse at the mental health clinic is leaving his job and relocating to another part of the country in 6 months. What is the best way for him to deal with his clients?
|a.||Begin to prepare clients for his departure by assisting to transition them to another nurse.|
|b.||Increase dosage of medications for each client in anticipation of the effect his leaving will have on their progress.|
|c.||Do not inform clients until after the nurse leaves to avoid additional anxiety.|
|d.||Wait until the nurse’s last day to inform clients to allow them to say good-bye, but avoid additional anxiety.|
- A person suffering from paranoid schizophrenia is discharged from an inpatient facility before community mental health services can be established for him. Which statement most appropriately describes this action?
|a.||The client has a right to be discharged to the least restrictive environment.|
|b.||The client is not competent to be discharged without community mental health resources for his transition to a less restrictive environment.|
|c.||The client has a responsibility to ask to remain in the inpatient setting.|
|d.||The client will demonstrate improved compliance with treatment once in a less restrictive environment.|
- In the United States today, the seriously mentally ill constitute: (Select all that apply.)
|a.||The neglected, the abused, and the confined|
|b.||A large segment of jail and prison populations|
|c.||More than half of all homeless persons|
|d.||More than one third of the homeless population|
|e.||The main pool of workers covered under the ADA|
|f.||Most persons receiving medical treatment|
|g.||Unmarried, intermittently employed, white adult males|
- What should the client do to cope with information overload? (Select all that apply.)
|a.||Learn to think critically.|
|b.||Ignore any information.|
|c.||Be open to new information.|
|d.||Promise yourself that you will look at it later.|
|e.||Learn to find relationships in new information.|
|f.||Learn at least one new piece of information a day.|
|g.||Ignore new information unless it relates directly to the job.|
- In order to be actively involved in a plan of care, the client must demonstrate which of the following responsibilities? (Select all that apply.)
- A person is considered __________ according to the Americans With Disabilities Act (ADA) if he has a mental or physical impairment that significantly limits one or more major life activities.
- Because of the active role of the consumer in today’s society, the term __________ is used frequently to describe the consumer of health care.
- The __________ is the member of the mental health treatment team who has advanced certified nursing assistant training and provides care in both inpatient and community settings.