Intermediate Accounting 11th Canadian Edition Volume 2 by Donald E. Kieso –
CHAPTER 1—HISTORY OF PSYCHIATRIC NURSING
- The major driving force behind current mental health treatment models is which of the following forces?
|a.||potential to cause harm|
|b.||managed care principles|
|c.||availability of improved neuroleptic medications|
|d.||concern for humane treatment of the mentally ill|
- Persons experiencing an acute crisis related to a mental illness are most likely to receive which of the following types of care?
|a.||long-term commitment to a state hospital|
|b.||brief care in the least restrictive environment|
|c.||intensive psychotherapy with a private practitioner|
|d.||14 days of treatment in a private psychiatric hospital|
- Pinel is best known for which of the following major changes in mental health treatment?
|a.||removing the chains from the mentally ill and providing humane treatment|
|b.||discovering the benefit of chlorpromazine (Thorazine) for treating the mentally ill|
|c.||promoting the use of better trained personnel in hospitals for the mentally ill|
|d.||moving the treatment of the mentally ill from the large state institutions to the community|
- A student nurse is suffering from test anxiety and is referred to a mental health professional, who provides a variety of treatment modalities. Which of the following treatments would the student be able to attribute to the early work of Mesmer?
- Dix is noted for which of the following contributions to improvement of the care of the mentally ill in the United States?
|a.||worked with the poor and mentally ill in the tenements of New York City|
|b.||encouraged states to establish full service community mental health centers|
|c.||spoke to state legislatures and was instrumental in getting state hospitals built|
|d.||established the first school of nursing which included psychiatric nursing care|
- Beers wrote a classic work entitled A Mind That Found Itself, published in 1908. This work was based on which of the following experiences of Beers?
|a.||work with mentally ill inmates in jails and prisons|
|b.||shared stories of mentally ill private clients of Clifford Beers|
|c.||tormenting personal experiences as a patient in mental institutions|
|d.||work with clients who were under hypnosis and their recall of the past|
- Richards is noted for which of the following accomplishments?
|a.||publishing the first textbook on psychiatric nursing|
|b.||being the first graduate psychiatric nurse in the United States|
|c.||serving as the first director of nursing of a state mental hospital|
|d.||developing the first educational course for psychiatric technicians|
- When working with a client who has a diagnosis of schizophrenia, you will likely assess for the presence of the four A’s of schizophrenia, as identified by Bleuler. You would assess your client for associative looseness, autism, ambivalence, and which of the following symptoms beginning with the letter “A”?
- The Diagnostic and Statistical Manual of Mental Disorders was first published in what year?
- A master’s prepared nurse, who is certified as a clinical specialist by the American Nurses Association, is working with a client using a treatment modality based on the interpersonal theory developed by a theorist who postulated that anxiety can be reduced through a meaningful relationship that stresses effective communication. This nurse is most probably using the theories and methods of which of the following theorists?
|a.||Sigmund Freud||c.||Karen Horney|
|b.||Karl Gustav Jung||d.||Harry Stack Sullivan|
- When working in any setting, a nurse following the theories of Peplau would focus most on doing which of the following things when entering a client’s room or meeting with a client?
|a.||checking for any threats to safety|
|b.||identifying the roles of significant others|
|c.||assessing the client’s strengths and limitations|
|d.||building a relationship of mutual understanding|
- The first psychotropic medication to be used widely in the treatment of mental illness was which one of the following medications?
|a.||Elavil (amitriptyline)||c.||Eskalith (lithium carbonate)|
|b.||Haldol (Haloperidol)||d.||Thorazine (chlorpromazine)|
- The Community Mental Health Movement was generated mainly by:
|a.||psychiatrists and psychiatric nurses educating politicians and the public|
|b.||optimism over new psychodynamic approaches and the major tranquilizers|
|c.||patients in large psychiatric hospitals demanding a less restrictive treatment|
|d.||family and friends of persons with mental illness who wanted them at home|
- Nurses working with the mentally ill prior to community based care of the mentally ill focused their interventions mainly on:
|b.||primary prevention||d.||managed care|
- The focus of psychotherapies in the 1960s is best described as centered on:
|a.||transference||c.||the here and now|
|b.||long-term analysis||d.||early childhood experiences|
- Psychiatric nurses working with clients needing community mental health services most often find community mental health services to be fragmented with lack of coordination in aftercare and rehabilitation services for the mentally ill. Which of the following factors most accounts for this fragmentation and lack of coordination of mental health services?
|a.||decrease in the interest of the community in the mentally ill|
|b.||lack of adequate numbers of masters prepared psychiatric nurses|
|c.||federal government no longer funding Community Mental Health Centers|
|d.||lack of demand for services due to newer psychotropic medications|
- Telemedicine presents many challenges to the health care profession. What is the most important challenge to the nurse who is telecommunicating from a distant location and is assisting in the care of a client who is at home?
|a.||developing and maintaining a trusting relationship with the client|
|b.||coordinating the care of the client with the rest of the health care team|
|c.||getting the client to comply fully with changes in the treatment regimen|
|d.||finding out about relationships with significant others in the household|
- When working with a client who is being cared for at home, the client shares that she is taking an herbal medicine purchased from the health food store. The best action on the part of the nurse would be to:
|a.||accept the client’s right to take any medicine she chooses to take at home|
|b.||assist the client in researching the benefits and risks of this herbal medicine|
|c.||make a note of the herbal medicine as well as the dosage amount and frequency|
|d.||insist the client stop all herbal medicine immediately and stay away from them|
- When working as a psychiatric nurse in today’s changing society, you would most need to do which of the following things to meet the needs of individual clients and the community?
|a.||become culturally competent|
|b.||keep up with diagnostic changes|
|c.||be aware of new drug study results|
|d.||communicate with clients by e-mail|
- The mentally ill who were patients in mental institutions in the United States in the last two decades of the 1800s and received care from nurses who had been educated in the first formal training program for nursing of the mentally ill in this country could expect the nurses to provide care centered on:
|a.||love and belonging needs||c.||safety and physical needs|
|b.||developing psychosocial skills||d.||rehabilitation back into society|
- Which of the following had the most impact on changing the nursing role of psychiatric nurses caring for the mentally ill from that of a custodial role to a role focused on therapeutic and preventative perspectives?
|a.||American Nurses Association|
|b.||National Mental Health Act of 1946|
|c.||National Alliance for the Mentally Ill|
|d.||World War I work with mentally ill soldiers|
- The significance of psychiatric-mental health nursing practice to the nursing profession was most increased shortly after 1952 by which of the following actions by the National League of Nursing (NLN)?
|a.||offering nursing scholarships for study of psychiatric nursing at the master’s level|
|b.||offering certification for qualified psychiatric mental health nursing clinical specialists|
|c.||requiring accredited nursing schools to have a psychiatric-mental health nursing course|
|d.||requiring schools of nursing seeking accreditation to limit clinical experiences at night|
- If you were to work as a psychiatric nurse and fulfill the major functions of a psychiatric nurse as described by Tudor, you would find yourself focusing on which of the following activities?
|a.||facilitating communication, social interaction, and self-care|
|b.||forming an alliance with the client and increasing compliance|
|c.||orienting the client, reducing any psychosis, and keeping the client safe|
|d.||teaching the client about mental illness and medication benefits and risks|
- Psychiatric Mental Health nurses most often guide their practice with standards for their specialty published by which of the following entities?
|a.||American Nurses Association|
|b.||The National Institutes of Health|
|c.||Department of Health and Human Services|
|d.||National League for Accreditation of Nursing, Inc.|
- The Mental Health Act of 1980 and the National Plan for the Chronically Ill in 1981 had which of the following impacts on psychiatric nursing staff in inpatient treatment facilities?
|a.||Psychiatric nursing staff were now reimbursed for college tuition.|
|b.||Medications could no longer be given without a client consent form.|
|c.||Nurses were replaced by other health care professionals and attendants.|
|d.||Nurses were now required to have psychiatric-mental health nursing courses.|
- Psychiatric-mental health nurses interested in promoting the survival of the psychiatric-mental health specialty will recognize which of the following things as most critical to the survival of this specialty?
|a.||education of the public in regard to the treatment of mental illness|
|b.||private practice groups of several psychiatric nursing clinical specialists|
|c.||integration of holistic and evidence-based health care concepts into practice|
|d.||contributions to groups lobbying for the advancement of psychiatric nursing|
- Which of the following categorical systems was developed by Caplan and provide a helpful framework for the work of psychiatric-mental health nurses and other professionals in community-based mental health care, long term inpatient care, and other types of treatment for the mentally ill?
|a.||primary, secondary, and tertiary care|
|b.||the well, the sick, and the worried well|
|c.||inpatient, outpatient, and partial hospitalization|
|d.||custodial care, psychosocial programming, and community reentry|
- If psychiatric nurses were to follow McBride’s advice of the 1990s, nursing research and reading of research would focus on which of the following areas?
|a.||the cost of community based care compared with inpatient care|
|b.||the effects of interactions with significant others on recidivism rates|
|c.||the benefits of complementary therapies in treatment of mental illness|
|d.||increasing nursing knowledge about the neurobiology of mental illness|
- Psychiatric mental health nurses who followed the theories of Horney, a prominent psychoanalyst (1885-1952), would have looked to which of the following as most important in the development of personality and maladaptive responses?
|a.||biological drives||c.||id, ego, and superego|
|b.||genetic inheritance||d.||interpersonal relationships|
- In 1989, Congress proclaimed the 1990s as the decade of:
- What ratio of clients seeking conventional health care was also using complementary therapies according to the study conducted by Eisenberg and colleagues?
|a.||1 in 3||c.||1 in 7|
|b.||1 in 5||d.||1 in 10|
- Which nursing theorist promoted the therapeutic use of self?
|a.||Martha Rogers||c.||Hildegard Peplau|
|b.||Imogene King||d.||Dorothea Orem|
- In the late 18th century, the role of the psychiatric nurse was:
|b.||emphasized the nursing process and research|
|c.||involved use of various psychotherapeutic interventions|
|d.||focused on providing a safe, kind, and clean environment|
- Psychiatric nurses planning to serve as disaster relief personnel should base their decisions on the fact that the effects of terrorism as well as man-made and natural disasters:
|a.||are not an important issue in the United States|
|b.||do not require nurses to have any special training|
|c.||can result in a short- and long-term traumatic sequel|
|d.||usually do not require the services of a psychiatric nurse|
- Which organization established the first certification of psychiatric nurses?
|a.||National League for Nursing|
|b.||American Nurses Association|
|c.||National Institute of Mental Health|
|d.||National Center for Nursing Research|
- Which of the following stressed preventive care and the need for formal training in child psychiatry?
|a.||Sigmund Freud||c.||Adolph Meyer|
|b.||Clifford Beers||d.||Harry Stack Sullivan|
- The Alliance of Psychiatric Mental Health Nurses is composed of which organizations? Select all that apply.
|a.||National League for Nursing|
|b.||Coalition of Psychiatric Nurses|
|c.||Nurses in Action for Better Mental Health|
|d.||American Association of Colleges of Nursing|
|e.||American Psychiatric Nurses Association|
|f.||International Society of Psychiatric-Mental Health Nurses|
- Mental health nurses working in clinics which support the use of complementary therapies must familiarize themselves with the advantages and potential risks of which of the following? Select all that apply.
- Which statements regarding the deinstitutionalization of the mentally ill are correct? Select all that apply.
|a.||occurred during the 19th Century|
|b.||occurred during the 20th Century|
|c.||involved only secondary prevention|
|d.||was a result of better treatment in the state hospitals|
|e.||offered services to clients, families, and communities|
|f.||was a result of the Community Mental Health Centers Act|
- Which of the following were true about the treatment of mental illness during ancient times? Select all that apply.
|a.||Mental illness was seen as incurable.|
|b.||Custodial care was provided in asylums.|
|c.||Bloodletting was a common practice.|
|d.||Insanity was associated with sin and demonic possession.|
|e.||Herbs, precious stones, and ointments were used for treatment.|
|f.||The mentally ill were treated with patience and understanding.|
CHAPTER 2—CONCEPTS OF PSYCHIATRIC CARE: THERAPEUTIC MODELS
- A psychoanalytically oriented colleague tells you that the behavior of a client you are assigned to work with is driven by a strong thanatos. This client is most likely exhibiting which of the following behaviors?
- A client is informed by his family that they could not go on vacation because the cost of his mental health care prevented the family from having enough money for a vacation. Which of the following responses by the client would be the best example of the superego at work?
|a.||refusing further care||c.||getting angry at the family|
|b.||having feelings of guilt||d.||ignoring this statement|
- A client is thinking about suing the hospital and the doctor, even though he begins to admit to the nurse that his failure to comply with the treatment regimen may have caused his problems. He begins to share that he feels guilty about these thoughts of suing although he believes the hospital and doctor will settle out of court and he needs the money. The nurse understands that according to psychoanalytic theory, two parts of the client’s personality or two drives are warring. What drive or part of the client’s mind will mediate if the client is to come to a healthy decision?
- The mother of a teenager asks the nurse at what age a child’s personality is completely formed. A nurse applying psychoanalytic theory to this question would answer that the personality is almost completely formed by what age?
- The nurse is working with a young adult client who has been in an automobile accident and is fully conscious but seems to have little recall of the event. The client’s spouse asks the nurse why the client is not able to recall the event. The best answer by the nurse would be that the client is:
|a.||in a state of denial||c.||repressing details of the event|
|b.||suffering from a concussion||d.||suppressing details of the event|
- You determine that one of your assigned clients is using defense mechanisms, some of which are sublimation and projection. You realize that these defense mechanisms, sublimation and projection, are allowing the client to:
|a.||use other people in a way that is not healthy for them or for the client|
|b.||postpone dealing with problems in an unhealthy way for a long period of time|
|c.||keep unpleasant thoughts in the preconscious mind instead of the conscious mind|
|d.||discharge some of the energy needed to keep unwanted thoughts out of awareness|
- The nurse assesses an adult client who admits to being a nail-biter when the nurse observes extreme shortness and unevenness of the client’s nails. The nurse recalls that people who bite their nails are said to be fixated at which of the following stages in Freud’s stages of psychosexual growth and development?
- The nursing instructor advises students who are learning how to communicate with clients with mental health problems not to ask questions beginning with “Why did you…” for which of the following reasons?
|a.||It is an approach of authority.|
|b.||It hurts the trusting relationship.|
|c.||Often a person cannot identify unconscious motivation.|
|d.||The question makes the person feel like a child being parented.|
- When you are working with a client who is very anxious and is using a defense mechanism, which of the following approaches would be best?
|a.||Advise the client to stop using the defense mechanism.|
|b.||Discuss the defense mechanism and whether it is helpful or not.|
|c.||Help the client identify some ways to reduce anxiety before other interventions.|
|d.||Have the client weigh the advantages and disadvantages of the defense mechanism.|
- One of your colleagues is basing his work with clients on the theories of Erikson. When explaining personality development, your colleague would say that personality is:
|a.||almost totally inherited|
|b.||developed over the life span|
|c.||completely developed by age 5|
|d.||a result of experiences before age 18|
- Erikson saw the major task of life as:
- A young adult on the psychiatric ward asks a nurse for a date. Although the nurse realizes this is inappropriate and declines, the nurse will also:
|a.||make certain the client suffers some appropriate consequences for this action|
|b.||report this client’s behavior to the administrator and refuse to work with the client|
|c.||tell the client that this behavior is inappropriate with a professional nurse|
|d.||recognize age-appropriate behavior and advise the client of the professional nature of the relationship|
- A client is discussing some insights gained in therapy in the past and mentions archetypes of anima and animus. The nurse listening to this client realizes that this client received therapy based on the theories of:
|a.||Albert Ellis||c.||Carl Jung|
|b.||Eric Berne||d.||Sigmund Freud|
- Closely following the beliefs of Harry Stack Sullivan, a psychiatric nurse working with clients would look closely at what Sullivan referred to as the persona, which is best described as the:
|b.||“I” or “me”||d.||best friend|
- The main focus of Sullivan’s work was on:
|a.||insight through gestalt||c.||interpersonal relationships|
|b.||learned helplessness||d.||identifying a purpose in life|
- You are assigned to work with a client who describes a life of feeling isolated and helpless with many fears about dangers in the world. The client frequently demonstrates aggressive behavior or is verbally aggressive. Using Horney’s theories, you would view this aggressive behavior as:
|a.||a failure to develop a healthy personality|
|b.||incongruent with feeling helpless and isolated|
|c.||a means to protect what little security they have|
|d.||stemming from experiences with an aggressive mother|
- Applying interpersonal theories in the nurse-client relationship, the most important goal for the nurse and client to set for therapy sessions would be for the client to:
|a.||identify the causes of failed relationships in the past|
|b.||gain insight into how early relationships shape behavior|
|c.||deal with repressed anger against self and against significant others in his life|
|d.||verbalize a realistic and hopeful perspective of self in relationships with others|
- The nurse is caring for a young child in the hospital. As the child’s visiting parent prepares to leave, the child appears anxious and begins to cry and cling to the parent. Using Bowlby’s stages of separation anxiety to explain the child’s behavior, the child can be said to be in a stage called:
- A couple is concerned about the amount of time they must spend away from their infant. Looking at the findings of Bowlby in his work on attachment, you would most help the clients by setting and meeting which one of the following goals?
|a.||Improve the quality of time and interactions.|
|b.||Leave the child when the child is distracted.|
|c.||Decrease the period of time between separations.|
|d.||Increase the amount of overall time with the child.|
- When a child is in the final stages of separation anxiety as described by Bowlby and the primary caregiver returns to the child, the nurse should most likely expect the child to exhibit which of the following behaviors?
|a.||acting very excited||c.||clinging to caregiver|
|b.||engaging in a tantrum||d.||withdrawing from caregiver|
- When the primary caregivers of a hospitalized infant cannot stay in the hospital with the infant, which of the following diagnoses would the nurse most likely include in the care plan?
|a.||caregiver role strain|
|b.||interrupted family processes|
|c.||risk for impaired parent-infant attachment|
|d.||ineffective therapeutic regimen management|
- The systematic study of infant-caregiver attachment behaviors using the Strange Situation protocol was the work of which of the following persons?
|a.||Mary Ainsworth||c.||Karen Horney|
|b.||John Bowlby||d.||Bruno Bettelheim|
- In his theories, Skinner identified two types of behavior which he referred to as:
|a.||angelic and demonic||c.||good boy and bad boy|
|b.||respondent and operant||d.||past oriented and future oriented|
- A client comes to the psychiatric nurse for help with social situations. The client is not comfortable meeting with others. The nurse utilizes the theories of Bandura and Walters. Which of the following interventions by the nurse would most reflect application of Bandura and Walter’s theories and techniques?
|a.||Ask the client to do the opposite of the expected or desired behavior.|
|b.||Use a gradually increasing schedule of social contact to desensitize the client.|
|c.||Verbally reinforce the client for any attempt to increase socialization behavior.|
|d.||Have the client study a person who is successful at socializing and imitate them.|
- When working with clients diagnosed with schizophrenia who have been hospitalized several times in the last year after failing to fill their prescriptions, the nurse applies the self-efficacy model. What is the nurse’s primary goal in this case?
|a.||Making certain a staff member supervises the clients’ taking the medication.|
|b.||Reminding the clients daily through a phone call that the medication is due.|
|c.||Finding a source that will pay for, pick up, and deliver the medication to the clients.|
|d.||Convincing the clients they have the capacity to find a way to get the prescriptions filled.|
- When trying to reinforce a behavior using behavior modification techniques, the most effective schedule of reinforcement is:
- Beck is best known for his theories about which of the following:
|a.||behavior modification||c.||cognitive patterns|
|b.||interpersonal theories||d.||childhood development|
- You are working with a client who is upset because he believes one of his college classmates does not like him. If you were to apply the theories of Ellis, you would most likely respond:
|a.||“Describe the feelings that you have toward this classmate.”|
|b.||“Tell me what you have done to cause this classmate not to like you.”|
|c.||“Let’s examine this irrational thought that everyone should like you.”|
|d.||“This is really something that is wrong with her and not with you at all.”|
- When working with the mother of a young child who is in the later part of Piaget’s sensorimotor stage of development, you would teach the mother to do which of the following things to help the child move out of this stage?
|a.||play classical music frequently|
|b.||play peek-a-boo and hide and seek|
|c.||read the same book to the child every day|
|d.||reward the child for attempts to use the potty|
- When you administer the atypical antipsychotic agents ordered by the psychiatrist to a client who has schizophrenia, you realize that this medication is most likely to do which of the following things?
|a.||increase the activity of dopamine|
|b.||decrease the activity of dopamine|
|c.||increase the reuptake of serotonin|
|d.||have no effect on dopamine activity|
- When giving antipsychotic medication and atypical antipsychotics to clients with a diagnosis of schizophrenia, because of the effect of the medication on a specific neurotransmitter, you would most need to be frequently assessing these clients for:
|a.||weight loss||c.||ringing in the ears|
|b.||nausea and vomiting||d.||fine motor tremors|
- A client who is experiencing low levels of GABA or fewer GABA receptors is most vulnerable to which of the following disorders?
|a.||panic disorder||c.||conversion disorder|
|b.||bipolar disorder||d.||antisocial personality disorder|
- The latest and most popular theory of mental disorders is that the cause is most likely:
|a.||a combination of factors|
|b.||genetically and chemically based|
|c.||structural differences in the brain|
|d.||a result of disturbed interpersonal interactions|
- You are working with a client who has been playing tennis and has developed tendonitis. Which of the following remarks by the client would indicate function in an integrated way as identified by the theories of Dunn?
|a.||“What other sport would be less injurious?”|
|b.||“I will use heat on my elbow after playing tennis.”|
|c.||“I will avoid activity and rest my elbow until it is healed.”|
|d.||“An elbow brace will be a help in preventing further damage.”|
- Your client has shared a primary appraisal of a wedding he attended. Based on how he describes his experiences at the wedding, the appraisal could fall into any one of the three types of primary appraisal described by Lazarus. Which of the following statements by the client would place it into the benign positive type of appraisal?
|a.||“It was all right I guess.”|
|b.||“It was very tastefully done.”|
|c.||“I felt real happy even if I felt guilty not taking a present.”|
|d.||“It was a challenge to get there on time, but I did manage it.”|
- When working with clients using Orem’s nursing theories, you would be most interested in helping the clients to maximize their:
|a.||level of mental health||c.||spiritual dimension|
|b.||interactions with others||d.||ability to care for self|
- A basic assumption of Freud’s psychoanalytic theory is that all behavior:
|a.||is learned||c.||is unconscious|
|b.||has meaning||d.||is sexually oriented|
- A nurse who follows the therapeutic approach of Rogers, would most likely be using an approach focused on:
|a.||reality therapy||c.||client-centered therapy|
|b.||directive therapy||d.||psychoanalytic therapy|
- A common form of treatment on psychiatric inpatient units which focuses on the patient’s environment is known as:
|a.||milieu therapy||c.||encounter therapy|
|b.||reality therapy||d.||client-centered therapy|
- You are caring for a group of mental health patients, and you base your nursing practice on the belief that your clients should play a major role in their own self-care. These practices stem from the work of:
|a.||Martha Rogers||c.||Dorothea Orem|
|b.||Hildegard Peplau||d.||Ida Jean Orlando|
- Dialectical behavior therapy (DBT) was introduced by:
|a.||B. F. Skinner||c.||Albert Bandura|
|b.||Sigmund Freud||d.||Marsha Linehan|
- One of your clients constantly complains of feeling nervous even though his medicines have been administered as prescribed. The doctor orders one sugar tablet between doses of regularly scheduled medications. After taking the sugar tablet, the client states “That pill really worked. I feel much better now.” This is known as the:
|a.||halo effect||c.||placebo effect|
|b.||Skinner effect||d.||behavioral effect|
- Alterations in the seretonergic system or serotonin (5-hydroglyryptamine, 5HT) function along with NE have been implicated in the pathogenesis of:
|b.||eating disorders||d.||personality disorders|
- The nurse providing care to an alcoholic client administers Antabuse. The administration of Antabuse would be considered which form of behavioral therapy?
|a.||classic conditioning||c.||medical conditioning|
|b.||operant conditioning||d.||cognitive conditioning|
- A nurse researcher is conducting a study to determine his client’s capacity to recover or adjust to stressful or life-threatening situations. This ability is known as:
- Which of the following are essential features of DBT? Select all that apply.
|a.||daily individual psychotherapy|
|b.||weekly skills training|
|c.||encouraging and coaching via telephone|
|d.||consultation with client|
|e.||short-term inpatient hospitalization|
|f.||electroconvulsive therapy (ECT)|
- When interviewing a client, which of the following statements would indicate that the client has distorted cognition? Select all that apply.
|a.||“I’m having a difficult time concentrating on my course work.”|
|b.||“All of my teachers think I’m hopeless because I did poorly on the last exam.”|
|c.||“School is going well. I received an A on the last exam.”|
|d.||“I’d like to apply for graduate school when I complete the undergraduate program.”|
|e.||“My classmates don’t want to study with me.”|
|f.||“I’m going to try my best in school this semester.”|
- A nurse caring for a 9-year-old client would plan care based on the knowledge that according to Sullivan’s theory, clients between the ages of 8 and 11 are in the concrete operational stage. Because of this information, the nurse’s assessment would most likely reveal a client who can do which of the following? Select all that apply.
|c.||Demonstrate mature cognitive structures|
|d.||Solve complex verbal problems|
|e.||Solve conservation problems|
|f.||Demonstrate egocentric thought and language|
CHAPTER 3—INTERFACING BIOLOGICAL-BEHAVIORAL CONCEPTS INTO PSYCHIATRIC NURSING PRACTICE
- If you were to work with the family of a person who has had mental illness for many years and you asked the family how they felt about neurobiological and genetic research findings, the most likely answer would be:
|a.||relief that family interactions are no longer thought to be the major cause of mental illness|
|b.||happy that their family member will soon be able to be cured of mental illness|
|c.||upset that findings indicate that some illnesses are due to structural changes|
|d.||frightened that the person with mental illness will be taking newer, less tested drugs|
- Which of the following ideas held by Hippocrates in the 14th century are still valid in psychiatric-mental health work today?
|a.||The hypothalamic-pituitary-adrenal axis has a great deal to do with mental disorders.|
|b.||The brain gives rise to emotions and contributes to disturbances in affect or mood.|
|c.||There is a tenuous balance of four humors in the body that contribute to mood.|
|d.||All persons with mental disorders need to be treated kindly in a relaxing setting.|
- You are administering medications to a group of clients in treatment for various mental illnesses. Which of the following medications in your medication cart is a selective serotonergic reuptake blocking agent?
|a.||fluoxetine (Prozac)||c.||clozapine (Clozaril)|
|b.||quetiapine (Seroquel)||d.||haloperidol (Haldol)|
- You are preparing to administer medications to two of your assigned clients. One has an eating disorder and the other has an anxiety disorder. These two clients are on the same medications. You look up their medications to review appropriate usage as well as side effects. Which of the following medications would be most appropriate for treatment of both these clients and others with these two different diagnoses?
|d.||fluphenazine decanoate (Prolix Decanoate)|
- An elderly client is very concerned that she is aging and will become forgetful because she has heard that there are many changes in the brain as you age. Which of the following statements could you use in teaching this client about aging and the brain that would be true?
|a.||The brain gets bigger due to excess fluid as you age.|
|b.||There is very little loss of neurons after the fifth decade.|
|c.||There is no definitive evidence of mental decline with aging.|
|d.||If you are going to become forgetful, it usually happens by age 60.|
- Which of the following statements best describes the cause of mental illness?
|b.||a variety of contributing factors|
|c.||a failure of the immunological system|
|d.||underlying structural defects in the brain|
- When working with a client with a diagnosis of major depression, it is most important to assess these clients for any signs or symptoms of which one of following problems that has been shown by research to have adverse outcomes closely associated with depression?
- When working with a client who is being treated for hypertension with a regimen of medications, exercise, and lifestyle changes, which of the following conditions would you set as a top priority to periodically assess?
|a.||a change in sexual functioning|
|b.||uncontrollable coughing at times|
|c.||effect of exercise on the client’s mood|
|d.||any change in mood, especially depression|
- When assessing a client with depression, you would most want to assess for which of the following problems that is often associated with depression?
|a.||bulimia||c.||ringing in the ears|
|b.||nervous leg syndrome||d.||cognitive impairment|
- Researchers have suggested that the brain adapts to aging by preserving an abundance of nerve cells rich in which of the following substances that are linked to higher cortical functioning?
- Which of the following signs or symptoms would you most likely find when assessing a client with frontotemporal dementia (FTD) which is primarily affecting the left frontotemporal lobe?
|a.||Jacksonian seizures||c.||occasional inappropriate affect|
|b.||childlike silliness||d.||progressive speech difficulties|
- While reading the chart of a newly assigned client, you find that the physician has ordered donepezil (Aricept). In reviewing this drug, you will find that the expected action of this drug is to:
|a.||stimulate the production of cortisone|
|b.||stimulate the respiratory center of the brain|
|c.||regulate the production of thyroid hormones|
|d.||prolong the life of existing cholinergic neurons|
- Which of the following drugs is given in hopes it will delay the clinical decline of clients with a diagnosis of Alzheimer’s disease?
|b.||ceftuzixime sodium (Cefizox)|
|c.||clonidine hydrochloride (Duraclon)|
|d.||galantamine hydrobromide (Reminyl)|
- Which of the following neurotransmitters is classified as an inhibitory transmitter?
- One of your clients describes being able to move a heavy car off the body of a friend to save the friend’s life. The client most likely was able accomplish this due to:
|a.||weeks of workouts with weight lifting|
|b.||the release of large amounts of glucagon|
|c.||the hypothalamic-pituitary-adrenal response|
|d.||ability to control the mind with specific thoughts|
- Abnormalities in the hypothalamic-pituitary-adrenal axis have been found to contribute to and to be diagnostic of which of the following conditions?
|a.||myasthenia gravis||c.||functional psychosis|
|b.||conversion disorder||d.||systemic lupus erythematosus|
- The relatively new field of psychoneuroimmunology is a developing knowledge concerned with:
|a.||proving a connection between AIDS and the development of depression|
|b.||interconnections between the nervous system and the immune system|
|c.||providing clients at high risk for mental illness with preventative measures|
|d.||immunizing clients with psychiatric illness against neurological problems|
- A client with systemic lupus erythematosus (SLE) asks the nurse to talk about the cause of this disease. Which of the following responses by the nurse would be most accurate?
|a.||“There is a deficiency in dopamine and/or specific dopamine receptors.”|
|b.||“It is caused by a systemic virus that is most likely carried by a mosquito.”|
|c.||“This involves the destruction of the myelin sheath and problems in conduction.”|
|d.||“The immune system has attacked itself in a failure to recognize its own cells as self.”|
- The family of a young adult who has panic disorder asks you about recent research related to the cause of panic disorders. Which of the following statements would you share with the family as a true statement?
|a.||“New research points to a relationship to thyroid dysfunction.”|
|b.||“Panic disorders have been recently linked to immune dysfunction.”|
|c.||“Early childhood experiences coupled with genetic defects are implicated.”|
|d.||“This disorder is most likely a learned behavior according to recent research.”|
- Genetic theories regarding the cause of schizophrenia began during which of the following times?
|a.||early 1900s||c.||the Korean conflict|
|b.||World War II||d.||mid-1970s|
- Twin, adoption, and family studies of people with schizophrenia have supported which of the following premises?
|a.||Schizophrenia is most likely a group of related genetic disorders.|
|b.||Lack of family support is the major cause of relapse and recidivism.|
|c.||Environmental factors are just as relevant as genetic processes.|
|d.||It is unlikely that the cause of schizophrenia is genetic in nature.|
- When trying to identify clients at risk for alcoholism and other addictions, the nurse most needs to keep in mind which of the following factors that place certain individuals at greatest risk?
|a.||living with a friend or relative who is an alcoholic|
|b.||being in a location where there is access to alcohol|
|c.||having an alcoholic parent or grandparent and being in college|
|d.||suffering from bipolar disorder and having visual hallucinations|
- A popular explanation for substance abuse lies in the mesolimbic-mesocortical areas of the brain and mainly involves which of the following neurotransmitters and receptors?
- One area of newer technological advances is in the area of stem cell research. What is the hope of medicine in regard to stem cells?
|a.||They can be used to prolong the expected life span.|
|b.||They can be used to control negative emotions.|
|c.||Stem cells can be used as universal donor cells.|
|d.||Use of stem cells will cure quicker and cheaper than drugs.|
- The psychiatric nurse will find that the use of herbal medicines in the past decade has done which of the following things?
|a.||sharply decreased||c.||increased a small amount|
|b.||stayed about the same||d.||increased sharply|
- Recent studies of lithium and valproate acid have found that these substances regulate which of the following things?
|b.||adrenal hormonal production|
|c.||protein kinase C (PKC) activities|
|d.||dopamine receptor site receptivity|
- Which of the following examples of your clients’ experiences would best exemplify “kindling”?
|a.||building experiences with others through repeated interactions|
|b.||building a strong attachment bond between parent and child|
|c.||repeated seizures with the seizure threshold seeming to decline over time|
|d.||a sudden and prolonged burst of energy much like adding wood to a fire|
- Which of the following areas of the brain is most likely involved in modulating fear responses?
- In order for a nurse to gain an understanding of the severity of a sexual assault on a person, the nurse should most strongly consider:
|a.||the individual’s perception of the event|
|b.||the age of the victim of the assault|
|c.||whether any weapons were used|
|d.||how long the actual assault lasted|
- A nurse is working with a client who seems to be very calm during a crisis and also seems to have an exceptional buffering against emotional pain. Which of the following most likely plays a major role in producing calmness and protecting this client from emotional pain?
- A client expresses a desire to have a series of electroconvulsive treatments (ECT) as this helped her in the past. Your understanding about the current use of ECT is that:
|a.||it is gaining renewed acceptance as an effective treatment modality for some conditions|
|b.||the use of ECT has virtually disappeared from treatment centers that performed it in the past|
|c.||it is considered to be very risky and may lead to serious injury of the brain and limbs|
|d.||It is only given when the client has tried at least three of the newer neuroleptic drugs|
- The nurse whose practice is based on the belief that mentally ill clients have a biochemical imbalance and a natural predisposition for mental illness would most likely base client care on:
|a.||neurobiological theories||c.||behavioral theories|
|b.||interpersonal theories||d.||cognitive theories|
- A nurse who provides care based on Erikson’s Ego Theory would plan nursing interventions directed at:
|a.||compensating for knowledge deficit|
|b.||supporting the client’s developmental level|
|c.||forcing the client to participate in age-appropriate activities|
|d.||encouraging the client to regress to an age where she feels more comfortable|
- The most common approach to the treatment of adolescents with mental disorders would include:
|a.||token economy||c.||medication administration|
|b.||light therapy||d.||electroconvulsive therapy|
- Your client states that the voices are telling her she is bad and needs to be punished. An appropriate nursing diagnosis would be:
|a.||hallucinations of unknown origin|
|b.||anxiety related to hospitalization|
|c.||disturbed sensory perception (auditory)|
|d.||disturbed sensory perception (visual)|
- Your client has a nursing diagnosis of “impaired social interaction.” An appropriate outcome objective would be to:
|a.||verbalize coherently with others by discharge|
|b.||be able to bathe and dress self with minimal supervision|
|c.||complain less of auditory and visual hallucinations|
|d.||exhibit decreased agitation and aggression by discharge|
- A nursing intervention for a client experiencing visual and auditory hallucinations includes “Give direct and concrete explanations.” The rationale for this intervention is that it:
|a.||decreases anxiety and increases coherence|
|b.||enables the client to learn effective communication|
|c.||demonstrates the nurse’s ability to teach the mentally ill|
|d.||enables the nurse to assess the basis of the client’s behavior and responses|
- Which nursing intervention is the primary means of facilitating a trusting alliance and reducing anxiety and agitation in a client?
|b.||assisting with self-care|
|c.||giving direct and concrete explanations|
|d.||reinforcing and validating clear communications|
- Which of the following individuals would be more vulnerable to trauma?
|a.||a 1-year-old whose father is an alcoholic|
|b.||a 19-year-old attending nursing school|
|c.||a 35-year-old married business executive|
|d.||a 52-year-old engineer with a wife and three children|
- Which of the following structures in the brain are connected with the production of memories and emotions? Select all that apply.
- As the nurse on a mental health unit, you are assigned to administer medications this morning. Several of your clients are receiving selective serotonergic reuptake blocking agents (SSRIs). You know that SSRIs are used to treat which of the following disorders? Select all that apply.
|a.||eating disorders||d.||depressive disorders|
|b.||anxiety disorders||e.||impulsivity disorders|
|c.||psychotic disorders||f.||inflammatory disorders|
- You are the charge nurse on a unit where the majority of clients have been admitted with a diagnosis of post-traumatic stress disorder (PTSD). The clients’ ability to adapt to stress is related to which of the following? Select all that apply.
|a.||economic status||d.||developmental stage|
|b.||educational level||e.||genetic vulnerability|
|c.||severity of the stressor||f.||availability of a support system|
CHAPTER 4—FOUNDATIONS OF PSYCHIATRIC NURSING
- When psychiatric nurses closely assess older adults who are poor, whose relatives have a history of mental illness, who are unemployed, and clients from families that have disintegrated, the nurses have identified that these clients need this in-depth assessment because they:
|a.||are less likely to seek help|
|b.||have little self-care agency|
|c.||are in high-risk groups for mental illness|
|d.||need help in getting more public assistance|
- Which of the following actions by psychiatric nurses is an example of an initial move to incorporate a primary prevention measure into practice?
|a.||identifying persons at risk for mental illness|
|b.||teaching clients with mental illness about medications|
|c.||assessing for side effects of psychotropic medications|
|d.||comparing a client’s symptoms with the diagnostic manual|
- Which of the following activities by psychiatric nurses is the best example of secondary prevention?
|a.||giving immunizations at a clinic for 2 year olds|
|b.||teaching teenagers about the problems of alcohol abuse|
|c.||working with a terminally ill client in the hospice program|
|d.||implementing measures that reduce symptoms of mental illness|
- An elderly client describes being recently frightened by a snake and then suddenly having increased energy in preparation for running away. The nurse realizes that this client is describing which of the following stages identified in Selye’s general adaptation syndrome?
- You are working with a group of clients who ask you to explain what is meant by mental health. You would explain that there are many definitions, but the broadest agreement is that a key component is the ability to:
|a.||amass material property||c.||get one’s needs met without delay|
|b.||be optimistic in all situations||d.||respond to stress effectively|
- Caplan believed that which of the following was most essential in predicting mental heath?
|a.||ego function||c.||strong father figure|
|b.||strong superego||d.||church attendance|
- You rate yourself on the Holmes and Rahe Social Readjustment Rating Scale by measuring a number of stressful events occurring to you over a 12-month period. Your accumulated stressful events score of 300 indicates that your chance of becoming ill is:
|a.||minimally increased||c.||increased by 80%|
|b.||increased by 25%||d.||diminished slightly|
- You are working with a client who feels hate toward her husband and is very angry with him for not making more money and spending it on her. Yet, she is very pleasant and loving toward him and tells him that money is not important. You realize that this client is using the defense mechanism of:
- A client gets the results of laboratory tests from the physician and the news is not good. The nurse goes into the client’s room a short while later and the client acts angry at the nurse, telling the nurse to get out of the room. Which of the following actions by the nurse would be best?
|a.||Talk to the client about the tests and focus on any good news.|
|b.||Say to the client, “You sound like you are upset about something.”|
|c.||Tell the client, “I am sorry if I upset you,” and leave the client’s room.|
|d.||Ask the registered nurse to talk with the client about being upset with you.|
- Criticism of the Holmes and Rahe Social Readjustment Rating Scale has led to the development of other tools to determine how people handle daily stress. Which of the following tests is best for measuring how people handle daily stress?
|a.||Beck Depression Inventory||c.||Jalowiec Coping Scale|
|b.||Thermatic Apperception Test||d.||Mini-Mental State Examination|
- The psychiatric nurse clinical specialist is assessing a client on Axis V of the DSM-IV-TR. The nurse is trying to determine:
|a.||the presenting clinical problem|
|b.||physical disorders and conditions|
|c.||the client’s highest level of functioning in the past year|
|d.||the severity of psychosocial stressors the client is experiencing|
- When reviewing the chart of an assigned client with a psychiatric disorder and a personality disorder, where would you find the personality disorder on the DSM IV-TR axis?
- When the American Psychiatric Association revised the DSM-IV text revision, what major change occurred?
|a.||new disorders were added|
|b.||updating of changed ICD-9 Codes|
|c.||the appendix sections were changed|
|d.||major changes in mental disorder criteria|
- A client whose father recently died is seen in the clinic with first-time signs and symptoms of rheumatoid arthritis. Using Lazarus’ system which categorizes responses to stressors which he refers to as appraisals of life events, the nurse would categorize the client’s form of appraisal of the father’s death to which of the following categories?
- Using Lazarus’ system of categorizing appraisals in describing responses to stressors, comparing the demanding or challenge forms of appraisal with those that are hazardous, the nurse finds a major difference in that the challenge form:
|a.||takes less time and energy||c.||produces fewer physical reactions|
|b.||generates more positive thoughts||d.||involves less interpersonal conflict|
- The nurse who is using Roy’s model of nursing when working with a client who is dealing with a divorce will most likely base his work with this client on which of the following assumptions?
|a.||Response to divorce is universal.|
|b.||The client subconsciously wants the divorce.|
|c.||Responses to a stressor vary from person to person.|
|d.||The client has contributed to the marriage breakup.|
- You are working with a client who has a mental illness. The client suddenly yells at you, “You think you are so smart. Get out of my sight and don’t come back!” Using Roy’s model of nursing, your best response to this interaction is to:
|a.||assign the client to a communication class|
|b.||advise the client that this behavior is acceptable|
|c.||tell your supervisor that this client no longer wishes to have any interactions with you|
|d.||recall that all behavior has meaning and purpose while observing the client at a distance|
- When working with families, the nurse needs to teach families that health promotion and illness prevention must begin at which of the following periods?
|a.||the prenatal time|
|c.||vaccinations as an infant and toddler|
|d.||first signs and symptoms of an illness|
- When working with expectant mothers who are concerned about neuronal development in the growing fetus, the nurse would help the mother in developing the following goals. Which goal, based on recent research, would have the greatest positive impact on fetal development?
|a.||Reduce caffeine intake.|
|b.||Drink at least two glasses of milk each day.|
|c.||Practice stress reduction techniques at least three times daily.|
|d.||Exercise three times a week for at least 30 minutes to 1 hour.|
- When teaching parents about attachment and bonding, the nurse using Bowlby’s theories would tell parents that the final stage of attachment occurs at which of the following times?
|a.||In utero||c.||Within about a month|
|b.||At the end of 24 hours||d.||At about 3 years of age|
- The nurse is working with parents, infants, and small children and is using Bowlby’s theories of attachment. The nurse realizes that the stages of attachment are most consistently a source of which of the following responses for the infant and small child?
- A mother wants to know when an infant learns to discern primary caregivers from others. If the nurse uses Bowlby’s stages of attachment to frame an answer, the answer would be:
|a.||within 24 hours||c.||between 2 and 6 months|
|b.||at 1 month||d.||after 6 months|
- A parent is having difficulty with an infant’s crying. The nurse will best help the parent cope with the crying by doing which of the following things?
|a.||Get the parent to design and follow a stress reduction plan.|
|b.||Offer to care for the infant while the parent takes a break.|
|c.||Get the parent to talk about feelings of being a parent.|
|d.||Provide the parent with a book about child growth and development.|
- When assessing parents of small children and their parenting styles, the nurse discovers that one set of parents is experiencing unusually high stress levels due to a business failure, bankruptcy, and the father’s having to work long hours in several jobs to provide for the family. The most important thing for the nurse to be aware of and assess is:
|a.||alcohol and other drug abuse||c.||inconsistent or harsh discipline|
|b.||support from other sources||d.||appropriate developmental toys|
- As infants in our society become toddlers and begin to experience mobility and autonomy, the greatest stressor in their lives is usually which of the following?
|b.||limit setting||d.||being babysat|
- A nurse is working with a family that seems to be proud of never attending their child’s sports events or participating in any school conferences. They explain that they want their child to be independent. The nurse explains the importance of parents showing an interest in their child’s activities. What is the best reason that the nurse can give for parents’ needing to show interest in a child’s academic and sports activities?
|a.||Parental interest enhances the child’s self-worth and acceptance.|
|b.||Teachers will not help the child when parents are not participating.|
|c.||It is proven the best positions in sports go to children whose parents help.|
|d.||These activities look good when someone falsely accuses you of poor parenting.|
- What percentage of adolescents experience psychiatric disorders or mental illness?
- Nurses conducting a health assessment on an older adult need to assess for the predominant theme that characterizes stress in older adults. The major stressor of older people is:
- When you demonstrate empathy as one of your essential qualities as a nurse, you will:
|a.||lose your own identity as the nurse|
|b.||first try to put the client in your place|
|c.||experience the client’s feelings as your own|
|d.||feel sorry for the client when the client has difficulties|
- According to the U.S. Census Bureau (2000), it is projected that by the year 2050 ethnic minority population will reach:
- The purpose of defense mechanisms is to protect which of the following structures from intense feelings?
- Which defense mechanism is being used by a paranoid client who blames others for problems he is experiencing?
- A married woman who expresses hostility toward a male coworker to avoid dealing with her sexual attraction to him is using which defense mechanism?
- A woman who is unable to bear children and who begins working in a preschool is using which defense mechanism?
- The nurse assesses that a recently divorced, depressed client, who has incorporated negative feelings and hatred of his wife, is most likely using which defense mechanism?
- The nurse caring for a client with agoraphobia would most likely administer which of the following medications as part of the treatment plan?
- A nurse whose care is based on theories of adaptation and coping would utilize concepts from which of the following theorists?
|a.||Selye and Roy||c.||Rogers and Sullivan|
|b.||Freud and King||d.||Erickson and Orem|
- The nurse whose discharge planning includes referring a client to a group home is implementing which level of prevention?
- If a nurse geneticist conducted a screening exam on young couples to determine whether they possess a gene which causes schizophrenia, the nurse geneticist would be utilizing which level of prevention?
CHAPTER 5—THE NURSING PROCESS
- The concept of nursing process originated during which of the following periods of time?
- When using an active listening approach with a client, you must:
|a.||use a steady gaze and good eye contact|
|b.||periodically tell the client something related to what she is saying|
|c.||use an unhurried approach and pay close attention to what the client says|
|d.||ask as many questions as needed to obtain relevant data; use an unhurried approach|
- When the nurse assesses the client’s affect, the nurse will be observing the client’s:
|a.||financial resources||c.||way of interacting with others|
|b.||what the client values||d.||emotional responsiveness|
- You are assessing speech in your assigned client who is experiencing a manic episode. You will most likely find and chart that your client’s speech is:
- When observing and assessing a client for mood and affect, it is most important to assess:
|a.||if the client’s thoughts are rational|
|b.||the energy level of the client at any given time|
|c.||if the client can gauge her own mood accurately|
|d.||if the thought content is congruent with the mood and affect|
- You are observing a client who has to check the door to see if it is locked at least 50 times before leaving the house. The client you are observing is experiencing which of the following?
- A nurse is working with a client who talks in a steady stream of words, moving rapidly from topic to topic, and mentioning various famous people, places, and important jobs in the past. The nurse would chart this client’s thought processes as being:
|b.||flight of ideas||d.||loose associations|
- When working with a client with schizophrenia, you find that this client, who has had absolutely no sexual experience, no blood transfusions, and is very isolative, believes she has a venereal disease. All examinations and lab tests are negative, and even when the lab tests are shown to the client, she persists in believing she has a venereal disease. This client is experiencing:
|a.||a delusion||c.||an obsession|
|b.||an illusion||d.||a hallucination|
- When working with clients who have hallucinations, you can expect that these hallucinations:
|a.||are not going to be welcomed and encouraged by the client|
|b.||are not all visual or auditory and can involve any of the senses|
|c.||tend to occur when the client is in stressful interactions with others|
|d.||are going to be frightening to the client who will need extra support|
- The advanced practice psychiatric nurse instructs the client to draw clocks with designated times. This nurse is testing the client for:
|a.||memory||c.||orientation to time|
|b.||visuospatial ability||d.||ability to follow directions|
- The psychiatric nurse wants to test the client’s ability to abstract. To test the ability to abstract, the nurse will instruct the client to:
|a.||put a puzzle together||c.||sum a column of figures|
|b.||explain a given parable||d.||draw a modernistic figure|
- The nurse asks the client the following question: What if a check for five hundred dollars came in the mail with your bills–what would you do first? The nurse is testing the client’s:
- The nurse tells the client, “You shouldn’t cry over spilled milk” and asks the client to explain what this means. The client responds, “If you spill your glass of milk, you shouldn’t cry.” The nurse will chart the parable and the client’s response and note that the client demonstrated which of the following types of thinking?
- You are working with a client who has a diagnosis of borderline personality disorder. In this case and in other cases of personality disorders, as well as in clients with cognitive impairment or drug intoxication or withdrawal, you would mostly expect to find which of the following signs or symptoms?
- After you take a health history from a client with a background of mental illness, you suspect the client is fabricating much of the history presented. The client tells of working in important jobs in government, but the story seems to place him in two different parts of the world at the same time with two different wives. Which of the following chart entries would be most acceptable?
|a.||“The majority of the history appears to be fabricated.”|
|b.||“Seems confused about dates, times, and facts, relating tales of two wives.”|
|c.||“Reliability as a historian is questionable. Relates two wives at the same time.”|
|d.||“May be telling stories of important jobs in remote places to impress the interviewer.”|
- The nurse is taking a psychosocial assessment on a client who has a suspected mental illness. The nurse wants to assess the presence and history of suicidal/homicidal ideations. Which of the following approaches would be best?
|a.||Ask family and friends about any suicide attempts and avoid upsetting the client.|
|b.||Observe for subtle clues of suicidal ideation but do not give the client ideas by asking.|
|c.||Apologize for asking a question about suicide ideation and then ask if they are suicidal.|
|d.||Ask the client, “Do you have or have you ever had any thoughts of harming self or others?”|
- When working with a client with a psychiatric diagnosis, it is important to make certain her medical condition has been assessed for which of the following reasons?
|a.||to prevent lawsuits should the client suddenly die|
|b.||to obtain Medicare payment|
|c.||to ensure that the psychiatric symptoms do not arise from underlying medical problems|
|d.||because almost 90% of the clients with psychiatric problems also have medical problems|
- The psychiatric mental health nurse will initially write nursing diagnoses for a client based on which of the following things?
|a.||A nursing care plan book|
|b.||An analysis of assessment data|
|c.||Problems identified by significant others|
|d.||Current Diagnostic and Statistical Manual|
- Which of the following is the most important basis for your nursing interventions that are necessary to achieve outcomes for which you will be accountable?
|a.||care plan books||c.||lectures by teachers|
|b.||nursing diagnoses||d.||suggestions by family|
- You are working with a client who has a history of aggressive verbal assaults on others. The best example of a client outcome would be that the client will:
|a.||reduce the number of aggressive verbal assaults|
|b.||not escalate verbal assaults into physical assaults|
|c.||have no incidents of verbal assaults for 48 hours beginning now|
|d.||count to 10 whenever she feels like verbally assaulting someone|
- Which of the following is an example of objective data?
|a.||The client is pacing the floor.|
|b.||The client states she is anxious.|
|c.||The client complains of dizziness.|
|d.||The family states the client has not been herself.|
- Which ANA standard of care is addressed when the nurse reviews the client’s progress toward goal achievement?
|a.||Standard I Assessment|
|b.||Standard II Planning|
|c.||Standard III Outcome Identification|
|d.||Standard V Evaluation|
- You are visiting a client after she has been discharged from the mental health hospital. During your interview, the client constantly turns to the television to see what is happening on the soap opera. This would be an example of:
- A student nurse asks her instructor, “What is the difference between mood and affect?” The best response by the instructor would be:
|a.||“There is really no difference between the two.”|
|b.||“A person’s mood is observable but her affect is not.”|
|c.||“Nurses assess the mood of children and adolescents, but they assess the affect of adults and elderly clients.”|
|d.||“A mood is a person’s sustained emotional state that depicts her perception of the world, while affect is emotional responsiveness demonstrated in body language.”|
- You are interviewing the family members of the client who was recently admitted. Which question is appropriate for family members?
|a.||“Why did you wait so long to bring her to the hospital?”|
|b.||“Why did you bring your family member to the hospital?”|
|c.||“What is your understanding of the reason(s) for the client’s admission to the hospital?”|
|d.||“What problems are your family experiencing that might have caused the client to get ill?”|
- You are assigned to a client newly admitted to your mental health unit. When charting, you would include which of the following as part of your objective data? Select all that apply.
|a.||gait unsteady||d.||actively hallucinating|
|b.||in room crying||e.||blood pressure is 140/85|
|c.||MRI normal||f.||complaints of feeling nervous|
- Which of the following would be appropriate client outcomes? Select all that apply.
|a.||Encourage group participation.|
|b.||Participate in all ward activities.|
|c.||Set limits on inappropriate behavior.|
|d.||Will state side effects of current medications.|
|e.||Spend at least 20 minutes with client each day.|
|f.||Discuss feelings about a diagnosis of mental illness.|
- The nurse can assess a client’s memory by which of the following? Select all that apply.
|a.||asking the client to interpret a proverb|
|b.||asking the client what she had for breakfast|
|c.||asking the client to draw a geometric figure|
|d.||asking the client to draw a clock with a specific time|
|e.||asking the client what she would do if she saw someone being robbed|
|f.||asking the client to repeat a set of numbers that are read to her|
- The nurse assessing the thought content and processes of a mental health client would assess which of the following? Select all that apply.
|a.||memory||d.||flight of ideas|
- The nurse conducting a Psychosocial Assessment would gather data on which of the following?
|a.||recent stressors||d.||present medications|
|b.||spiritual needs||e.||substance abuse history|
|c.||vital signs||f.||previous psychiatric treatment|
CHAPTER 6—THERAPEUTIC COMMUNICATION
- The nurse who is planning to have therapeutic communication with a client must, as a first priority, do which of the following things that serves as the foundation of therapeutic communication?
|a.||establish rules||c.||get eye contact|
|b.||develop rapport||d.||sit within arm’s length|
- Studies have indicated that the use of carefully selected nonverbal communications by health care providers with older people did which of the following things?
|a.||confused the older people||c.||improved the quality of care|
|b.||caused older people to talk||d.||increased quality of sleep|
- What is the third stage of language development?
- The nurse teaching clients to use transactional analysis (TA) would share with clients that TA is based on:
|a.||the work of Freud||c.||games people play|
- The nurse who is teaching clients to use transactional analysis (TA) will discuss the three major ego states of TA which consist of:
|a.||id, ego, superego||c.||parent, adult, child|
|b.||me, you, others||d.||father, mother, sibling|
- In transactional analysis (TA), the client will learn that the child is divided into the “free child” and the:
|a.||“little professor”||c.||“costly child”|
|b.||“enslaved child”||d.||“junior psychiatrist”|
- Which of the following ideas about communication is most attributed to Reusch?
|a.||One cannot communicate.|
|b.||It requires a sender, a message, and a willing recipient.|
|c.||It is a universal function that occurs everywhere.|
|d.||Competency affects interactions.|
- Which of the following percentages of communication is believed to be based on nonverbal communication?
- A nurse sitting in on a group of clients where all the participants are seated on the floor observes that one of the clients always stands to talk. The nurse realizes that this behavior most likely can be interpreted as:
|a.||nervousness||c.||attempt to establish power|
|b.||restlessness||d.||readiness to leave if confronted|
- When working with clients with a diagnosis of bipolar disorder manic type, the nurse would expect these clients to need redirection for which of the following behaviors?
|a.||sleeping during group and other activities|
|b.||withdrawing and isolating in their rooms|
|c.||refusing to participate in the competitive games|
|d.||being intrusive and invading the space of others|
- You are working with a client and find yourself experiencing internal body changes during the dialogue. You suspect your blood pressure and perhaps your respiration may be changing as you are attempting to stay calm. You are experiencing a phenomenon that is referred to as:
|a.||verbal-nonverbal exchange||c.||internal coding|
|b.||embodied language||d.||physiological language|
- Which of the following things would most likely help you establish rapport with a new client who has a diagnosis of mental illness?
|a.||sharing about the mental illness in your family|
|b.||telling an especially humorous joke|
|c.||providing a quiet, comfortable environment|
|d.||playing a game of ping-pong before talking|
- When sitting with the client in a one-on-one discussion, the best position for the nurse in most cases is:
|a.||setting directly across from the client with a desk between the client and the nurse|
|b.||leaning a bit forward with eye contact while at arms’ length from the client|
|c.||standing in a relaxed manner while the client is sitting comfortably|
|d.||sitting with arms crossed in front of self, ready to raise them in self-protection|
- When planning for a meeting with a client with a psychiatric illness, the nurse takes into consideration that the client is likely to be more cooperative and participate in treatment if the nurse uses which one of the following approaches?
|a.||offering a hug|
|b.||calm, concerned approach|
|c.||firmly in charge and no nonsense|
|d.||enthusiastic with hand outstretched|
- One of your assigned clients on the psychiatric ward asks you to do something with them. However, you need to leave immediately for a meeting which is scheduled to last 30 minutes. Your best response would be to tell the client:
|a.||you have to go to a meeting and promise to be back in 30 minutes|
|b.||they need to find someone else to help them as you must now leave|
|c.||you have to leave for awhile and ask them to remind you when you get back|
|d.||there is an important meeting you can’t be late for and you are sorry to leave|
- During a nurse’s one-to-one conversation with a client, the client says, “You know my brother. You know how he is.” Having met the brother once or twice, the nurse suspects that the client means that his brother is somewhat competitive with him. The best response on the part of the nurse would be to say:
|a.||“No, I don’t really. Can you tell me what you mean by ‘how he is’?”|
|b.||“Do you mean to say that he is somewhat competitive with you?”|
|c.||“Yes, I have an idea of how your brother is since I met him a couple of times.”|
|d.||nothing, encouraging the client to continue to see if he will clarify his meaning|
- You are working with an Asian client who has postpartum depression after the birth of her new baby. The client refuses to bathe or to eat most of the food served. The nurse will do well to first look at the client’s behavior in the context of:
|a.||need for cleanliness||c.||relevant diagnosis|
|b.||the cultural system||d.||compliance with treatment|
- You are working in a health care setting in which there are people of many cultures as clients. You find you are having difficulties with intercultural communication when assigned to clients of other cultures. Which of the following actions would be best on your part?
|a.||Ask the supervisor not to assign you clients from other cultures.|
|b.||Tell whoever makes assignments that you want only English-speaking clients.|
|c.||Look into your own cultural heritage and resist judgmental reactions.|
|d.||Sign up for a foreign language class to learn to speak that language.|
- Which of the following would most affect a client’s willingness to ask for and accept help?
- When assigned to a morbidly obese client, a nurse has some thoughts about obese people being apt to whine and be demanding. The nurse trades assignments with a peer who thinks of obese people as being pleasant and quick to see humor in life. These nurses are acting on which of the following?
- The key to understanding inaccurate perceptions and observations of client responses is through:
|a.||the opinions of friends||c.||self-awareness|
|b.||checking with a supervisor||d.||taking time out|
- When working with a client, you decide you need to maintain a personal distance from this client. Using the distances identified by Hall, who introduced the concept, you would stand how far from the client?
|a.||6 to 12 inches||c.||4.5 to 5 feet|
|b.||18 inches to 4 feet||d.||5.5 feet|
- The nurse needs to keep in mind that the basis of all nurse-client interactions is:
|a.||clarification by the nurse||c.||questioning|
- Which of the following descriptions best describes what the nurse is doing when using the therapeutic technique of active listening?
|a.||keeping eye contact without saying anything|
|b.||asking questions about related ideas and information|
|c.||questioning clients so they will reach further back into memory|
|d.||using all the senses to assess verbal and nonverbal messages|
- When listening to a client using the active listening technique, you would most need to:
|a.||be careful to be objective and note only what the client says|
|b.||observe just the nonverbal behavior and the words of the client|
|c.||look for themes, feelings, and content as well as words and nonverbal behavior|
|d.||use eye contact and lean forward to indicate an interest in what the client has to say|
- The client tells you that he is upset because he has no one to talk with except you, and you are going on vacation. Which of the following approaches is best?
|a.||Give the client some advice on which people to try to talk with in your absence.|
|b.||Arrange to have someone talk with the client in your absence.|
|c.||Tell the client not to be upset, that you will work it out somehow.|
|d.||Ask the client if they have any ideas on how to deal with this problem.|
- Which of the following questions is an example of a closed-ended question?
|a.||Would you like help?|
|b.||How can I help you?|
|c.||Which game would you like to play?|
|d.||Tell me more about yourself.|
- A nurse is having a one-to-one interaction with a newly assigned client. The nurse’s goals include learning more about the client’s relationship with his family. Which of the following statements by the nurse would be best in this situation?
|a.||“Are your parents alive?”|
|b.||“Where does your family live?”|
|c.||“Tell me a little about your family.”|
|d.||“Do you get along with your family?”|
- While talking with a client about his family relationships, the client suddenly asks the nurse if she is married. The best response of the nurse is to:
|a.||answer the question and then ask the client another question|
|b.||refocus the client saying something like “Let’s focus on you for now.”|
|c.||tell the client this question is inappropriate and not answer it|
|d.||say “yes” whether married or not to discourage client fantasies|
- You enter the room of your depressed client and find him crying. What is your best response?
|a.||“I’m sorry, I will come back later when you are not so upset.”|
|b.||“Don’t worry, everything will be much better tomorrow.”|
|c.||“I’m sorry you are upset. I will stay with you awhile.”|
|d.||“You should not be crying. Things could be so much worse.”|
- A client recently admitted to the ICU after a car accident says to you, “Am I going to die?” Your best response would be:
|a.||“Why do you think you are dying?”|
|b.||“You must be very frightened right now.”|
|c.||“Many people survive car accidents like the one you had.”|
|d.||“Don’t worry, the doctors and nurses are all trying to help you.”|
- The primary focus of therapeutic communication with any client is:
|a.||the client’s needs||c.||the nursing diagnosis|
|b.||the nurse’s needs.||d.||the medical diagnosis|
- A nursing instructor wants to evaluate the students’ understanding of the difference between open-ended questions and closed-ended questions. The instructor will determine that the students know the difference if they identify which of the following as open-ended questions? Select all that apply.
|a.||“Tell me about your family.”|
|b.||“Did you rest well last night?”|
|c.||“Do you have any children?”|
|d.||“Are you feeling comfortable?”|
|e.||“What brought you to the hospital?”|
|f.||“Would you like to talk about your problem?”|
- A nurse working with mentally ill clients wants to include therapeutic touch as one form of communication with clients. Which factors must the nurse consider before implementing therapeutic touch with the clients? Select all that apply.
|c.||the client’s gender|
|d.||nurse’s personal safety|
|e.||whether the nurse likes the client|
|f.||developmental and cultural considerations|
- A nurse whose nonverbal behaviors convey warmth, caring, and calmness would demonstrate which of the following behaviors? Select all that apply.
|a.||Face the client directly.|
|b.||Stare at the client continuously.|
|c.||Avoid all eye contact with the client.|
|d.||Turn and lean your face and body toward the client.|
|e.||Present a frown to communicate disappointment.|
|f.||Nod to convey validation, acceptance, and understanding.|
- A new graduate nurse is planning his first interaction with a newly admitted client. The nurse realizes that barriers to active listening can impede development of a therapeutic relationship. Which of the following would the nurse avoid? Select all that apply.
|d.||interrupting or changing the subject|
|e.||nodding to convey validation and acceptance|
|f.||leaning face and body toward client|
- In caring for a mentally ill client, the nurse knows that body language includes:
|a.||posture and gait||d.||specific spoken words|
|b.||facial expressions||e.||hand movements and gestures|
|c.||physical appearance||f.||tone of voice and rate of speech|
- Which of the following would be considered therapeutic communication techniques? Select all that apply.
- The nurse assessing his own communication style would recognize that the ability to communicate therapeutically will be influenced by which of the following? Select all that apply.
|b.||culture||e.||anxiety and stress|
|c.||attitude||f.||personal space issues|
CHAPTER 7—CULTURAL AND ETHNIC CONSIDERATIONS
- A nurse is working with a client who grew up in a South American country before moving to the United States where she married a Japanese man. She became acculturated into the Japanese culture and then moved to France when her husband’s company transferred him. They have been in France for 25 years. The client is now very ill. The nurse can most expect that the client will operate under the worldview perspectives associated with the time and cultural experiences in which of the following:
- When working with clients of differing worldview perspectives, it is important to realize that you will:
|a.||value the worldview perspective that is most like your own worldview|
|b.||value the one least like your own worldview perspective|
|c.||need to realize no one worldview is to be valued or devalued more than another|
|d.||want to stop focusing on the client’s worldview perspective|
- As the nurse works with clients and considers his own worldview, the nurse needs to keep in mind which of the following ideas about worldview based on the ideas of Nichols?
|a.||These perspectives evolve mainly through news on current day television and other media.|
|b.||A person may use a variety of perspectives depending on the situation and environment.|
|c.||The culture of nursing is separate and kept separate from other worldview perspectives.|
|d.||Cultural values of a person’s racial group have little or nothing to do with their worldview.|
- If you are working with a client who has an analytical worldview perspective, using Nichols’ ideas on worldview perspectives, to which of the following racial cultural groups would this person most likely belong?
|a.||African American||c.||Hispanic American|
|b.||European American||d.||Native American|
- When working with a person from an Asian American cultural group, you would most expect to find which of the following expanded worldview perspectives?
- When working with a Native American client, you find the client to be quiet. Conversation is minimal with the client learning by “taking in.” Which of the following reasons is the most likely explanation for this client’s behavior?
|a.||The client is meditating and concentrating to get deeper into the meditation.|
|b.||These are the characteristics of the ecological expanded worldview perspective.|
|c.||You are not of the same worldview perspective and the client cannot relate to you.|
|d.||The client is not well and is conserving energy forces to use in making the body well.|
- When providing care to a client with an analytic worldview perspective, the nurse will need to:
|a.||be precisely on time in providing care|
|b.||pass some time in social talk before getting to the point|
|c.||realize not much importance is put on acquiring material objects|
|d.||be aware that the client prefers discussion to pamphlets and books|
- When doing health teaching with a client who has a community worldview perspective, the nurse will most need to:
|a.||get right to the point in telling or asking the client something and omitting nonessential talk|
|b.||realize that it is important to have family and friends present during health care visits|
|c.||work with the client in the context of being spiritual and purpose-directed in life|
|d.||get feedback from the client to make certain the client understands the teachings|
- While not stereotyping people of African American homes, the nurse working with the family will realize that in many African American homes:
|a.||there is little conversation and people are expected to be quiet|
|b.||children are expected to have good behavior and respect elders|
|c.||visitors are not welcome unless they have called ahead of time|
|d.||there is little discipline from either the father or the mother|
- When does the nurse need to do assessments that include the components of a cultural assessment? Choose the best answer.
|a.||in every assessment conducted|
|b.||when a client is new to this country|
|c.||if a client does not speak English|
|d.||when the parents are foreign born|
- While conducting the initial interview of a client who speaks English, the nurse would preferably ask which of the following questions?
|a.||“Do I hear an accent?”|
|b.||“Where is your mother from?”|
|c.||“Do you speak any other languages?”|
|d.||“Which state were you born in?”|
- It has been found that mental illness disorders are often not diagnosed in children or persons from Asian cultures mainly for which of the following reasons?
|a.||The family will hide the mentally ill person from others.|
|b.||They are much quieter than their American counterparts.|
|c.||They have greater problems with trusting others with information.|
|d.||The symptomatology is often expressed as a pain or an ache.|
- When assessing persons for depression, the nurse may find that the depressed person over 70 years of age often describes their symptoms as:
|a.||nausea and diarrhea|
|b.||normal troublesome problems of growing older|
|c.||beginning of Alzheimer’s disease|
|d.||aches, pains, digestive and sleep disturbances|
- The nurse may find that the family of a mentally ill person from Asian or Latin American cultures is talking about the “hot and cold balance.” The nurse realizes that the family most likely is:
|a.||afraid the client will be burned by hot water from a faucet or shower|
|b.||talking about restoring the hot and cold balance as a cure for mental illness caused by imbalance|
|c.||wanting the client to have only tepid drinks due to a belief that very hot and very cold is bad|
|d.||talking about the temperature of the hospital and the client’s room, wanting to get a balance|
- When assessing a community group for depression, the nurse will find which of the following groups having the highest rates of depression?
|a.||men ages 15 to 24||c.||men ages 45 to 55|
|b.||women ages 25 to 44||d.||women ages 45 to 55|
- When assessing for depression, the nurse will find persons from which of the following cultural groups having the greatest suicide rate in the age range of 5 to 24 years of age?
- A nurse is talking with the pharmacist about a client from another culture and the medication the client is using. The pharmacist talks about drug polymorphism. What does he mean by this term?
|a.||taking numerous over-the-counter drugs prescribed from a number of physicians|
|b.||Unusual and varied responses over time to a particular drug|
|c.||Interaction of chemical factors and a person’s genetic responses to pharmacological agents|
|d.||Changes in the person over time due to the drugs taken over time|
- When working with clients from Asian cultures, the nurse may find that it is not uncommon for this group to respond in which of the following ways to anxiolytics, antidepressants, and lithium?
|a.||Asians metabolize these drugs at a slower rate.|
|b.||Asians may have an extreme allergic response.|
|c.||Asians may require somewhat larger doses.|
|d.||Asians may develop visual and auditory side effects.|
- While working with a client who is a Native American, the nurse learns that when the client drinks even one alcoholic beverage, the client has a sudden increased heartbeat, palpitations, sweating, and intense heat and redness of the neck and face. The nurse suspects that the most likely cause of these symptoms is:
|a.||drinking immediately after being in the sweat lodge|
|b.||interaction of alcohol with another drug|
|c.||deficiency of a precursor needed to make a specific enzyme|
|d.||consuming alcohol after several days of fasting|
- An African American male is having a great deal of difficulty with the lithium prescribed for her mania. Her manic symptoms are exacerbated and she is often at a toxic level of lithium. What is the most likely explanation for this?
|a.||Individuals of this culture often tend to retain more salt.|
|b.||The client is suffering from water intoxication.|
|c.||The client has a toxic-type reaction to lithium.|
|d.||There has been some deviation in taking the medication as scheduled.|
- When beginning a health assessment, which of the following questions or statements would be best for you to begin with?
|a.||“What health problems do you have?”|
|b.||“How may I as a nurse help you today?”|
|c.||“What is your chief complaint?”|
|d.||“How are you feeling today?”|
- You are working for a physician in an outpatient clinic. One of your clients who is Asian American tells you that her mother is using some Chinese herbs to give her more energy. You would preferably tell this client which of the following things?
|a.||“I would not advise you to take any Chinese herbs as they can be dangerous.”|
|b.||“You need to check with the nurse or doctor before taking any herbal remedies.”|
|c.||“Meditation will be more helpful to your mother than taking Chinese herbs.”|
|d.||“The doctor can prescribe something better than Chinese herbs to give your mother energy.”|
- The three primary metabolic pathways or chemical sites involved in the conversion of pharmacological agents within a person’s biological system are acetylation, debrisoquine-ds, and:
- Current national mental health and wellness protocols and goals support the need for prevention and treatment protocols and strategies to be:
- The current literature indicates that it is hardest to get a true estimate of the incidence and prevalence of mental illness in which of the following groups?
- When speaking with a client from a Mediterranean culture, the client describes her illness using the term “sustos.” The nurse knows that “sustos” mirrors which of the following disorders?
|a.||eating disorders||c.||depressive disorders|
|b.||psychotic disorders||d.||personality disorders|
- The nurse provides information about medications and considers cultural factors associated with medications for which of the following reasons?
|a.||The nurse wants to avoid being charged with a malpractice suit.|
|b.||The nurse needs to demonstrate that the she is more knowledgeable than the client and family.|
|c.||Because the doctor’s order states that medication teaching must be conducted before the client is discharged.|
|d.||Awareness of ethnopharmacological factors assists in providing a safe dose of medication and reduces adverse side effects.|
- The nurse is caring for a client from a different culture and plans to encourage the client to use cultural stress management techniques. The rationale for this intervention is that:
|a.||it assures that the client will get well|
|b.||it places focus on positive attributes and increases self-esteem|
|c.||the nurse is a new graduate and has had very little experience with patient care|
|d.||most culturally specific stress management techniques are more cost effective when compared with traditional high-cost hospital treatments|
- You are working on a mental health unit and find that several of the clients are of Middle-Eastern descent. Recognizing that your clients have established prayer times that do not coincide with the scheduled rest period on your unit, you decide to serve as the clients’ advocate. In the role of advocate, you would:
|a.||tell the clients that prayer is not part of the treatment program|
|b.||support and defend your clients’ rights to their beliefs and values|
|c.||have the clients change their prayer time to meet hospital policy|
|d.||contact their embassy and inform them that the clients’ rights are being violated|
- Which of the following are cultural competence clinical guidelines that the psychiatric nurse should follow? Select all that apply.
|a.||Treat all clients from the same culture exactly the same.|
|b.||Avoid projecting the nurse’s worldview onto the client.|
|c.||Be aware of the cultural context of help-seeking behaviors.|
|d.||Be aware of the nurse’s worldview and level of cultural competence.|
|e.||Explore the meaning of the aberrant behavior from the client’s point of view.|
|f.||Recognize that mental health disorders are complex and are influenced by culture.|
- The cultural component of every nursing assessment should include which of the following? Select all that apply.
|b.||spiritual or religious beliefs|
|c.||nutritional patterns and practices|
|d.||view of health, wellness, and illness|
|e.||education and learning style preference|
|f.||biological and genetic factors affecting physical status|
- The nurse is interviewing the family of a 21-year-old Asian female. During the interview, the client’s mother states, “My daughter has been running ‘amok’.” The nurse asks the mother for clarification of the term “amok.” Which of the following behaviors would most likely be described? Select all that apply.
|c.||rumination||f.||encopresis and enuresis|
- Which of the following are critical tasks for the psychiatric mental health nurse caring for culturally diverse groups of clients? Select all that apply.
|a.||Be aware of cultural differences.|
|b.||Explain nursing care and procedures.|
|c.||Generalize about the behavior of particular cultural groups.|
|d.||Reduce the number of interpreters employed to be more cost effective.|
|e.||Recognize that life span and gender issues are the same for all cultures.|
|f.||Understand the ethnopharmacological factors related to prescribed medications.|
- The nursing in-service coordinator of a large mental health facility is planning a series of classes on cultural sensitivity for all nurses. The focus of the first class will include barriers to culturally competent care. Which of the following would be included in the class discussion? Select all that apply.
|a.||presence of social stigma associated with mental illness|
|b.||health care provider bias and lack of cultural knowledge|
|c.||lack of intelligence in most culturally diverse populations|
|d.||lack of ethnically and culturally diverse nurses within the health care system|
|e.||metabolic differences related to medication, alcohol, and substance use and abuse|
|f.||misinterpretation of symptomatology by health care providers who are not culturally competent|
- Your client recently immigrated to the United States after seeing her family tortured and murdered. She was brought to the hospital after threatening her neighbors and swearing that she would kill them and herself. During your initial interview, the client constantly states “You Americans don’t care about anyone but yourselves. Your life has been easy and I hate you for that. I have nothing to live for.” One of your nursing interventions is to “maintain a safe environment and assess level of dangerousness including change in mood.” The rationale for this intervention includes which of the following? Answer all that apply.
|a.||places restrictions on the client|
|b.||alerts nurse to the need for additional medication|
|c.||demonstrates the power of the health care providers|
|d.||promotes a safe environment for the health care providers|
|e.||change in mood or anxiety increase risk of dangerousness|
|f.||prevents suicide attempts as a result of active monitoring|
CHAPTER 8—LEGAL AND ETHICAL CONSIDERATIONS
- Elizabeth Packard succeeded in getting laws passed that accomplished which one of the following?
|a.||Mental health professionals have a duty to warn of possible danger from a client.|
|b.||Incarceration of the mentally ill should not be based solely on the opinions of others.|
|c.||Mentally ill persons are human beings and deserve to be treated accordingly.|
|d.||Information between a mental health professional and a client is privileged.|
- Who is best known for championing the development of therapeutic communities?
|a.||Clifford Beers||c.||Karl Menninger|
|b.||Bruno Bettelheim||d.||Viktor Frankl|
- You are working with a client who is voluntarily committed to a psychiatric hospital and has been hospitalized for some time. This client has decided that he wants to marry another client on a nearby ward and that they will live together after discharge. He wants to know what his rights are in regard to marriage. Your best answer is that he:
|a.||does have the right to marry|
|b.||can vote but cannot marry|
|c.||must get permission from a judge|
|d.||must have the permission of his physician|
- A client is undergoing tests to determine if he has an inherited disease. The nurse has seen the results of the tests and is aware of the outcome. However, when the client asks the nurse about the outcome, the nurse tells the client that he will need to talk with the physician about the results. The client then asks the nurse if she knows the results, and the nurse says “no,” thinking it is in the best interests of the client to receive the news from the physician with his wife present to support him. This nurse is using which of the following in her choice of responses?
|a.||deontological approach||c.||utilitarian approach|
|b.||nursing code of ethics||d.||state nurse practice act|
- The principle of beneficence in ethical decision making is best reflected in which of the following statements?
|a.||Be honest and open and tell the truth at all costs.|
|b.||Be faithful to promises and obligations.|
|c.||Treat people fairly and distribute resources equitably.|
|d.||Promote good, do no harm, and prevent harm.|
- A nurse is confronted with an ethical dilemma in which the client wants to die and is refusing to eat, but the family wants the nurses to figure out ways to get more nourishment into the client. Following a model for ethical decision making, the nurse will most likely do what as a first step?
|a.||gather the facts||c.||check with the physician|
|b.||weigh the client||d.||notify the hospital administrator|
- You find yourself in a situation whereby you have witnessed another nurse doing something that suggests the nurse is abusing drugs. Which of the following actions would be best?
|a.||Confront the nurse.|
|b.||Call the hospital supervisor.|
|c.||Discuss this with a trusted physician.|
|d.||Talk with your immediate supervisor.|
- A nurse involved in an ethical dilemma has followed the first few steps of the decision-making process and has arrived at the point when a decision must be made. Before making the decision for the best course of action, the nurse foremost needs to have:
|a.||gathered all the data|
|b.||identified all the options|
|c.||considered consequences and moral justification for each option|
|d.||involved the client in every aspect of the decision-making process|
- You are working in a psychiatric hospital. One of the clients on the unit is a famous artist. You mention you like his work and he offers you a drawing. What action is best on your part?
|a.||Offer to pay him $20 for the drawing.|
|b.||Wait until he is discharged and make a trade.|
|c.||Advise him you cannot accept this valuable gift.|
|d.||Give him some cigarettes and do not take the gift.|
- The client you are working with yells “I love you” to you as you are preparing to leave. The best course of action on your part is to:
|a.||say “I love you, too.”|
|b.||yell back: “I love everyone here.”|
|c.||discuss professional boundaries with the client|
|d.||ask your supervisor to assign you to another ward|
- Which of the following is the best example of distributive justice?
|a.||A committee deciding who on a long waiting list will receive donated organs.|
|b.||A unit being put on shutdown because someone took a knife from the kitchen.|
|c.||Making certain that every client gets the same treatment from the nursing staff.|
|d.||Applying the rules consistently from shift to shift on the inpatient psychiatric unit.|
- The phone rings on the psychiatric inpatient unit. A woman asks if a person by a certain name has been admitted to the hospital. You recognize the name as one of your assigned clients. The caller goes on to say that she is the client’s mother and that she is very worried something has happened to the client as he has been missing from his apartment for several days. She states that she has notified the police of his being missing. Select the best response.
|a.||Tell the woman that the client is in the hospital, but that it is confidential and not to reveal the source.|
|b.||Call the police and tell them that the client has been admitted, but that this information is confidential.|
|c.||Tell the caller that you cannot say whether he is admitted or not, get her number, and give it to the client.|
|d.||Put the caller on hold while you call the hospital administrator to see if an exception can be made.|
- While talking with a child in the hospital, the child reveals that his parents have punished him by withholding food for a day or two and locking him in a closet. Which of the following is the best course of action for you to take?
|a.||Report the abuse to the agency in your state that handles child abuse.|
|b.||Get the hospital social worker to arrange for some help for the parents.|
|c.||Talk with the parents to see if they will agree not to abuse the child anymore.|
|d.||Check to see what the policy in this hospital is in regard to child abuse reporting.|
- While caring for a child who has a broken bone, you and the attending physician see bruises and old injuries that highly suggest child abuse. You decide that the parents, who are well-respected community citizens, could not be guilty of child abuse and that these injuries are just the result of an overly active, risk-taking child. You do not report the abuse. What is the worst that will happen to you if the child suffers abuse later?
|a.||You will probably lose your job.|
|b.||Some colleagues will be upset with you.|
|c.||You will feel guilty about not reporting it.|
|d.||The law may hold you liable for this abuse.|
- The hospital has a policy that nurses must be given training and certified in order to use a glucose-testing machine. A newly hired nurse has not been trained or certified. This nurse goes ahead and checks the glucose level of a client. The level is low; however, the nurse mistakenly gets a higher reading and gives the client insulin from the ordered sliding scale. The client goes into insulin shock. The proper legal term for what this nurse is guilty of is:
- When a nurse is called as a witness in a case involving allegations against another nurse for actions possibly resulting in injury to a client, the lawyers will mention the words “standard of care.” By “standard of care,” the lawyers are referring to:
|a.||a specific standard related to omission and commission in the American Nurses Association’s Standards of Care|
|b.||a standard found in the nurse practice act of the state in which the incident occurred|
|c.||the hospital rule or policy related to the incident|
|d.||what a nurse with similar education, experience, and sound judgment would have done in a similar situation|
- In order for a nurse to be charged with malpractice, certain components must be present. For example, one component that has to be present is that the nurse had a duty to the patient. Another component that must be present is that there was:
|a.||actual harm or injury which occurred as a result of the nurse’s actions|
|b.||potential for harm or injury due to the nurse’s actions|
|c.||the death of the client was due to the nurse’s actions|
|d.||a permanent disability caused by the nurse’s actions|
- A nurse is caring for an adolescent in a psychiatric hospital. The parents admitted the adolescent against his wishes. The adolescent client is to receive a dexamethasone suppression test. The client does not want any treatment or tests. The best course of action by the nurse is to:
|a.||enlist staff members to help physically restrain the client just long enough to do the tests|
|b.||obtain an order from the psychiatrist for enough medication to calm the client so the tests can be performed|
|c.||inform the client that he will only harm himself if he fights having this test and treatments|
|d.||talk with the adolescent client on his level and attempt to get his consent|
- A client’s behavior is escalating and the nurse wants to put the client into seclusion. The first thing the nurse must do is:
|a.||make certain there is enough staff to take the client into seclusion|
|b.||obtain an order from the client’s psychiatrist|
|c.||use and document other less-intrusive interventions first|
|d.||read the Patients’ Bill of Rights to the client|
- A client hospitalized with a diagnosis of a mental disorder is overheard making threats on the telephone to family members with whom he normally lives. The family requests that the client’s phone privileges be denied. The nurse’s best course of action within the law is to:
|a.||tell the family this is not possible as the client has the right to communicate with others outside the hospital|
|b.||obtain an order from the treating psychiatrist for the client’s phone privileges to be suspended|
|c.||talk with the court appointed attorney ad littem and ask the attorney what to do|
|d.||follow the wishes of the client’s family as they are giving him a home outside the hospital|
- If a nurse suspends a client’s phone, mail, or other communication privileges based on a physician’s order, the nurse foremost needs to document:
|a.||nothing as there is a physician’s order for this action|
|b.||the time and type of the restriction and the rationale|
|c.||names of witnesses to behavior justifying this action|
|d.||only that these privileges were suspended|
- Which of the following actions on the part of a nursing student would be considered a violation of professional boundaries?
|a.||loaning the client a dollar to buy a soda drink|
|b.||helping the client make an appointment|
|c.||calling the client by his first name|
|d.||assisting the client in picking out new clothing|
- When the nurse charts on clients with psychiatric diagnoses, the nurse needs to be aware of which one of the following statements?
|a.||A client cannot legally get access to read his own chart if experiencing a thought disorder.|
|b.||Only mental health professionals or a judge have access to the chart.|
|c.||The chart can be subpoenaed and the client or other treatment providers, with the client’s permission, can get access to information.|
|d.||The chart can only be read by those professionals and the client when they are cleared to do so by an order of the treating psychiatrist.|
- You are assigned to admit a client with a diagnosis of major depression to the psychiatric hospital unit. The client brings a suitcase of clothes, hygiene equipment, and other possessions. Which of these belongings can the client keep in the room?
|a.||All of them since the client has a right to have personal belongings.|
|b.||Any that are not potentially harmful, stolen, damaged, expensive, or disruptive.|
|c.||All except the ones that are potentially harmful to the client or others.|
|d.||Any that the physician writes an order for the client to be able to keep in the room.|
- A nurse has been discussing ECT treatments with a competent client as a follow-up to a conversation the client has had with the psychiatrist. The client has not responded to any other treatment, including newer medications and psychotherapy. The psychiatrist has recommended ECT. Which of the following statements by the client indicates the best understanding of what the nurse has taught about ECT?
|a.||“I understand that you can have serious injuries during the seizure state.”|
|b.||“I know that the staff will hold me down so I won’t have serious injuries.”|
|c.||“I realize that you can give this to me regardless of whether I sign or not.”|
|d.||“I realize that I will get medication to prevent injury by induced seizure.”|
- A client who has been admitted to on an involuntarily commitment demands that the nurse complete his discharge papers immediately. What should the nurse do initially?
|a.||Complete the discharge papers and let the client go home.|
|b.||Administer the PRN antipsychotic medication immediately.|
|c.||Have the client restrained because his demanding behavior is inappropriate.|
|d.||Inform the client that since he was admitted involuntarily, discharge papers can not be completed at this time.|
- A depressed client refuses to eat or bathe. The nurse tells the client that if he does not follow orders, he will be put in restraints and force fed. By threatening the client, the nurse can be charged with:
|b.||Battery||d.||Breach of confidentiality|
- A young college student with a history of violence comes to the outpatient clinic for his regular appointment. During individual therapy, he tells the nurse that he recently purchased a gun and plans to kill an instructor who gave him a D grade on an exam. The client discusses in detail how he will carry out his plan. The nurse’s response must be guided by which law?
|a.||Duty to Warn||c.||Mental Health Centers Act|
|b.||Client Bill of Rights||d.||Patient Confidentiality Act|
- A nurse promises a client that she will talk with him after lunch. However the nurse becomes busy and forgets about the client. Which ethical principal has the nurse violated?
- A client is diagnosed with major depression and the psychiatrist recommends ECT treatments. The client refuses to undergo ECT treatments. The nurse assigned to the client knows that the client’s right to refuse treatment is protected by:
|a.||Informed consent||c.||Self-determination laws|
|b.||Taft Hartley Act||d.||Patient Bill of Rights|
- The charge nurse informs her staff that failing to check suicidal patients newly admitted to the psychiatric unit for contraband can result in which type of tort crime?
- The nurse is sitting in the nurse’s station charting. A client approaches and yells “Please place me in seclusion before I hurt someone.” What should the nurse do first?
|a.||Call the client’s physician.|
|b.||Place the client in seclusion immediately.|
|c.||Tell the client there is no written order for seclusion.|
|d.||Ignore the client since this is probably attention seeking behavior.|
- During the initial assessment of a mildly retarded adolescent, the mother begins shouting at the client using profanity and calling the client stupid and an idiot. At one points she says to the adolescent, “What kind of boy are you? You’re just a big dummy.” The nurse would interpret the mother’s behavior as:
|b.||sexual abuse||d.||emotional abuse|
- In which of the following situations could assault or battery charges be filed? Select all that apply.
|a.||Threatening to place a client in restraints.|
|b.||Placing a client in restraints without just cause.|
|c.||Placing a client in restraints after a suicidal attempt.|
|d.||A client hits another client on the mental health unit.|
|e.||Discussing a client’s case in an elevator filled with visitors.|
|f.||Forcing a client whose was admitted voluntarily to take medications.|
- Which of the following are included in the Code of Ethics for Nurses? Select all that Apply.
|a.||The nurse maintains competence in nursing|
|b.||The nurse participates in the profession’s efforts to implement and improve standards of nursing|
|c.||The nurse delegates accountability and responsibility for the care of clients to unlicensed assistive personnel|
|d.||The nurse safeguards the client’s right to privacy by judiciously protecting information of a confidential nature|
|e.||The nurse provides services with respect for human dignity and the uniqueness of the client unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems|
|f.||The nurse completes the minimum of a BSN and an MSN to demonstrates competency|
CHAPTER 9—THE CLIENT WITH A DEPRESSIVE DISORDER
- Epidemiological studies have consistently demonstrated that what percentage of primary care clients will experience significant depressive disorders?
- Nurses working with older adults who have major depressive disorders with a history of a chronic or recurring course are aware that the majority of these clients have which of the following kinds of prognoses?
- You are assessing a client with a diagnosis of major depressive disorder, and you are trying to discover any factors that your client has that are related to the prevalence of this disorder. Which of the following factors in your client would most match the factors that have the highest prevalence in major depressive disorders and is a clue to a possible cause of the disorder?
|a.||low socioeconomic status of the family of origin and the current family group|
|b.||single marital status of the client at present or at the time of the initial diagnosis|
|c.||low educational level attained by the client and by the early significant caregivers|
|d.||First-degree biological relatives also diagnosed as having a major depressive disorder|
- When teaching a group of women about major depressive disorders, the nurse will explain that the lifetime risk of women getting one of these disorders, compared to men, has been found to be:
|b.||about the same||d.||not known|
- When working in a medical-surgical hospital, the nurse is assigned to clients with a variety of diagnoses including clients with Alzheimer’s disease, multiple sclerosis, end-stage renal disease, and Cushing’s disease. Which of these diagnoses will the nurse recognize as having the highest incidence of mood disorders?
|a.||Cushing’s disease||c.||Alzheimer’s disease|
|b.||multiple sclerosis||d.||end-stage renal disease|
- The family of a client who has just been diagnosed with depression seems very upset and expresses concern that depression is very difficult to treat, fearing the client will be ill for a long time. Which of the following responses would be best on the part of the nurse?
|a.||“This disease is very hard on the person who has it, and she will need your support.”|
|b.||“You are correct that it is difficult to treat, can be chronic, and recurs periodically.”|
|c.||“About 80% of those who recognize symptoms and get help are treated successfully.”|
|d.||“The treatment team will do their best to support not only the client but the family, too.”|
- A client with a diagnosis of depression shares with you that her spouse is telling her she needs to have more willpower since recovery from depression is a matter of willpower. The nurse can be of most help to the client and spouse by explaining:
|a.||“Depression is inherited and willpower is not much help.”|
|b.||“A combination of medication and willpower is needed.”|
|c.||“Depression is a medical disorder that requires treatment.”|
|d.||“Willpower is very important in recovering from depression.”|
- The average age of onset of major depressive disorders is at which of the following times?
|a.||late 20s||c.||early 40s|
|b.||late 30s||d.||early 50s|
- The nurse has identified a client who is at risk for depression. Which of the following nursing interventions would most likely be the best effective primary preventive measure?
|a.||offer assistance in getting and keeping a job|
|b.||provide stress reduction and problem-solving instruction|
|c.||encourage anxious clients to get a prescription for anxiety|
|d.||offer instruction in more effective communication methods|
- A nurse is explaining to a group of students some of the current major theories concerning the role of neurotransmitters in depression. The student demonstrating understanding of the teachings about the role specific neurotransmitters play in depression would most likely say that, “In depression there is:
|a.||an increase in production of dopamine and in the receptor sites for dopamine.”|
|b.||imbalance in acetylcholine due to unsteady production of acetycholinesterase.”|
|c.||a reduction in release or production from presynaptic neurons of norepinephrine.”|
|d.||too much circulating serotonin and too little production of cortisol and aldosterone.”|
- After watching a program on television about depression, a client asks the nurse if serotonin plays a role in depression. The best answer by the nurse would be:
|a.||“Little or nothing is known about the role of serotonin in depression.”|
|b.||“No, serotonin is not one of the neurotransmitters involved in depression.”|
|c.||“Research is suggesting that too much serotonin is the cause of depression.”|
|d.||“Research points to decreased release, synthesis, and transport of serotonin.”|
- Researchers have found that there is a relationship between reduced levels of the metabolite of serotonin, 5-HIAA, and incidence of:
- A client who is taking Prozac (fluoxetine) wants to know why they need to take this medication for depression. The nurse’s best explanation is:
|a.||“If you comply with your treatment regimen, you will get well.”|
|b.||“Prozac increases serotonin in the brain and this improves your mood.”|
|c.||“Because the physician has prescribed it for you based on experience.”|
|d.||“This medication reduces circulating dopamine to elevate your mood.”|
- A person with a diagnosis of major depression, especially melancholic type, has which of the following situations in regard to the functioning of the hypothalamic-pituitary-adrenal (HPA) axis?
|a.||Insufficient cortisol is produced.|
|b.||The HPA axis functions normally.|
|c.||The hypothalamus is not stopping secretion of corticotrophin releasing factor (CRFCRH) in response to cortisol.|
|d.||The anterior pituitary does not release adrenal corticotrophin hormone to stimulate production of cortisol.|
- The nurse is explaining the role of the hypothalamus to a client who asks, “What does the hypothalamus do in addition to releasing a hormone?” The best answer by the nurse is that it governs:
|a.||the neurotransmitter system of the brain|
|b.||food intake, libido, and circadian rhythms|
|c.||aggressive impulses and intense emotions|
|d.||heart, respiratory, and blood pressure rates|
- Which of the following statements best describes the theories of Abraham in regard to depression?
|a.||The internal locus of control governs and is overactive in people with depression.|
|b.||Depression is due to overly protective parents not helping build a child’s constitution.|
|c.||Lack of parental nurturing or attention during childhood leads to dependency and then a state of “poor me” depression.|
|d.||Depression is linked to feelings of loss, guilt, and inadequacy related to unconscious hostility toward the lost person.|
- Which of the following statements best represents Freud’s theories on dysphoria?
|a.||Unresolved guilt over desiring the parent of the opposite sex leads to dysphoria.|
|b.||Early childhood trauma that has not been satisfactorily resolved can lead to dysphoria.|
|c.||Anger toward a lost person, turned inward, leads to dysphoria, guilt, and low self-esteem.|
|d.||Unconscious conflicts over moral issues relived in dreams is associated with dysphoria.|
- A major belief espoused by both Abraham and Freud is best reflected by which of the following statements?
|a.||It is unnecessary to take any notes during therapy as you will recall whatever is important.|
|b.||Early childhood traumatic experiences increase vulnerability to depression in future losses.|
|c.||Dream analysis is the best method of getting at unconscious conflicts experienced by a person.|
|d.||Unresolved early sexual conflicts are a major issue throughout the lifetime of the individual.|
- When working with clients of varied cultures, a nurse recognizes that symptoms of depression reported by clients comprised of Midwestern farmers, the Amish, and Central Europeans are:
|a.||likely not to be reported||c.||the same as for other cultures|
|b.||greatly exaggerated at times||d.||reported very early in the disease|
- A nurse working with several depressed African American women is aware that these women will probably respond better to which of the following interventions?
|a.||individual therapy over about 2 years|
|b.||long-term inpatient psychiatric treatment|
|c.||group treatment in familiar community settings|
|d.||individual crisis-oriented, short-term therapy sessions|
- The nurse working with a depressed client is using reinforcement theory based on the work of Lewinsohn. Applying this theory, the nurse would plan interventions which:
|a.||offer rewards for positive communication|
|b.||discourage the use of concern and sympathy|
|c.||use an intermittent schedule of reinforcement|
|d.||increase the use of the technique of extinguishing|
- In Seligman’s theories of depression resulting from exposing dogs to uncontrollable shocks, the inescapable shock was seen as analogous to:
|a.||corporal punishment given to prisoners|
|b.||the cattle prod used in herding various animals|
|c.||the negative reinforcers described by Skinner|
|d.||traumatic loss that may precipitate depression|
- Seligman and his colleagues coined which of the following phrases?
|a.||all behavior is learned||c.||shock therapy response|
|b.||learned helplessness||d.||electronic behavioral control|
- Using the learned helplessness model, the nurse looks for the cause of the traumatic loss, as perceived by the depressed person, that precipitated the depression as:
|a.||a natural course of life||c.||unfair, unjust, and personal|
|b.||internal, stable, and global||d.||punishment by a higher power|
- While working in the general medical-surgical hospital, the nurse is assigned to a suicidal client. In the initial assessment, the nurse finds that the client talks about being inadequate, worthless, and undesirable. The client describes the world as too difficult and too demanding, seeing only suffering and failure in the future. This information best fits the theory of:
|a.||cognitive triad||c.||learned helplessness|
|b.||transactional analysis||d.||reinforcement theory|
- When a nurse encounters a client who is using cognitive distortions, the nurse realizes that the client is using these in which of the following ways?
|a.||automatically and they are occurring rapidly|
|b.||after applying logic to ascertain the payoff|
|c.||with systematic analysis prior to utilizing them|
|d.||unconsciously without any retrievable memory|
- One of your clients is experiencing a first episode of major depressive disorder. What are the chances of this client’s experiencing recurrent symptoms within 10 years?
- When working on the children’s unit of a psychiatric inpatient hospital and in the outpatient clinic, the nurse will learn that depression in preschoolers is:
|a.||very common||c.||relatively uncommon|
- When assessing children at risk for depression, what symptom might the nurse see that would often vary from what adults display?
|a.||weight gain||c.||aggression or irritable mood|
|b.||loss of motivation||d.||constipation or paralytic ileus|
- The nurse is admitting an adolescent who has a tentative diagnosis of depression and is suspected of engaging in risky behaviors such as promiscuity and substance abuse. The nurse will interview this client in which of the following ways?
|a.||only with the parents present|
|b.||with a staff person in attendance, then with the entire treatment team present|
|c.||often alone, then with parents or guardians present, and finally, with the entire family present|
|d.||with a recorder or video camera|
- A teenager has been in an irritable mood, as observed by others, for over a year and has very low self-esteem, low energy, and has complained of fatigue. The adolescent was never symptom-free for longer than 2 months at a time during the year. The psychiatrist will probably find that this adolescent meets the criteria for:
|a.||major depression||c.||depressive episode|
- You learn that one of your assigned clients has a diagnosis of Seasonal Pattern. You would most likely expect your client to describe which of the following symptoms?
|a.||bipolar disorder or Recurrent Major Depression regularly between the beginning of October and the end of November|
|b.||seasonally related psychosocial stressors such as being unemployed each autumn from October to the end of November|
|c.||a second depressive period from mid-February to mid-April of each year|
|d.||one or more episodes of mood disturbance in 2 years whether consecutive or not|
- In caring for persons over age 75 in a long-term care facility, the nurse will assess for suicidal ideation and should be ever mindful that older men with depression, compared to women with depression, are:
|a.||more likely to seek mental health services|
|b.||are at higher risk of suicide|
|c.||seldom have unexplained somatic complaints|
|d.||less likely to be depressed over the loss of spouse|
- A woman writes instructions to be carried out after her death. She wants her dog to see her while she is in the casket. The most likely explanation for this is:
|a.||the woman is somewhat mentally unstable or ill|
|b.||she wants the dog to accept the reality of the loss|
|c.||the woman wants the family to see how important the dog is|
|d.||she has imagined that her spirit will be able to see the dog one last time|
- Children who experience the death of a parent often express one of three common concerns. Which of the following statements best represents one of the three common concerns of children who have lost a parent?
|a.||“Who will come to the funeral?”|
|b.||“What did I do to cause this to happen?”|
|c.||“Where do dead people go when they are dead?”|
|d.||“How much will the casket and the funeral cost?”|
- A school-aged child has told the school nurse that her father just died. The family asks the nurse whether the child should go to the funeral or not. The best answer by the nurse would be:
|a.||“You know your child best. Which do you think would be better?”|
|b.||“Children under 13 should never attend a traumatic event such as the funeral of a parent.”|
|c.||“It is usually best to include children in this decision and to support them if they decide to attend.”|
|d.||“Only allow the child to attend if you are going to be strong and model this as a normal event of life for the child.”|
- A mother tells the school nurse that her child will be kept out of school for a month after the funeral of a grandparent so that the child will not have to deal with school during a time of grief. The best response by the nurse would be:
|a.||It has been found that children do better if they return to their normal daily activities after a loss.”|
|b.||“Sometimes parents find that 3 weeks is sufficient time to work through the grieving process.”|
|c.||“Perhaps you should ask yourself if keeping the child home is more for you than for the child.”|
|d.||“It will be helpful for your child to go through the entire process of grieving before returning to school.”|
- You are caring for a client with a diagnosis of major depression and the client refuses to get out of bed much of the day. The client focuses on the loss of a spouse and refuses to talk about anything else. The most therapeutic and helpful thing you could say is:
|a.||“Cheer up. You will soon get over this loss.”|
|b.||“I can see that you are having a difficult time.”|
|c.||“I know how you feel. I’ve felt this way before.”|
|d.||“Regular exercise will make you feel much better.”|
- Which of the following statements by a client on Venlafaxine (Effexor) best indicates that the client understood the lessons taught by the nurse about this medication?
|a.||“If I miss a dose, I double up the next time a dose is scheduled.”|
|b.||“I won’t stop the medication suddenly but will reduce it gradually if it is discontinued.”|
|c.||“I limit my alcohol intake to one glass of wine or beer each day while on this drug.”|
|d.||“I take the medication at night so it does not affect my daytime driving.”|
- A nurse who focuses on a depressed client’s altered style of thinking is most likely using whose theory?
|a.||Aaron Beck||c.||Karl Abraham|
|b.||Erik Erikson||d.||Sigmund Freud|
- Discharge planning for a depressed client who was treated with Venlafaxine (Effexor) would include:
|a.||Stay out of the sun to prevent photosensitivity.|
|b.||Drink no more than three glasses of wine per day.|
|c.||Reduce the medication by one-half when feelings of depression begin to decrease.|
|d.||Contact the health care provider if severe headache or difficulty with urination is experienced.|
- The nurse assessing a depressed client recognizes that which of the following characteristics would be consistent with a diagnosis of depression?
|a.||insidious onset||c.||oriented in all spheres|
|b.||no clear precursor||d.||constant cognitive impairment|
- You are conducting an educational class for parents of adolescents who are grieving the loss of their classmates from a car accident. You would inform the parents that adolescent grief is generally demonstrated as:
- Your client begins showing symptoms of agitated depression. As her nurse, you should assess her lab work for which of the following?
|a.||high epinephrine levels||c.||high serotonin levels|
|b.||low epinephrine levels||d.||low serotonin levels|
- You are caring for a client who was brought to the hospital by her brother. The brother informs you that the client’s daughter died in a house fire 3 months earlier. He states that the client has been unable to eat or sleep and has lost nearly 50 pounds since her daughter’s death. She has stopped communicating with most family members and friends and takes little interest in her personal hygiene. The client states to the nurse, “I have nothing left. There is no purpose to go on.” Which nursing diagnosis would be appropriate for this client?
|b.||chronic low self-esteem|
|c.||risk of self-directed violence|
|d.||altered nutrition, less than body requirements|
|e.||anxiety related to her daughter’s death|
|f.||altered nutrition: more than body requirements|
- The nurse is caring for a client who experienced the loss of several loved ones during a major hurricane 2 years ago. To promote the client’s healthy adjustment, the nurse plans interventions which will address the issue of complicated bereavement and unresolved grief. The nurse should be prepared to address which of the following? Select all that apply.
|a.||acute grief reaction||d.||chronic grief reaction|
|b.||masked grief reaction||e.||premature grief reaction|
|c.||delayed grief reaction||f.||exaggerated grief reactions|
- When assessing an adolescent for depression, the nurse assesses for which of the following? Select all that apply.
|a.||dystonia||d.||flight of ideas and neologisms|
|b.||low self-esteem||e.||increased conflict with peers|
|c.||hopelessness and worthlessness||f.||acting out behavior|
- Which of the following are physiologic signs of depression? Select all that apply.
|b.||weight loss||e.||poor school performance|
|c.||suicidal ideations||f.||poor interpersonal relationships|
- The nurse planning care for clients with depression would structure interventions based on which core symptoms seen across all age groups? Select all that apply.
|b.||suicidal ideations||e.||rumination about problems|
|c.||sleep disturbance||f.||diminished concentration|
- The nurse is preparing an in-service program on the concept of grief. Which of the following would be included in the discussion as precipitators of a grief response? Select all that apply.
|a.||being fired from a job|
|b.||divorce after 3 years of marriage|
|c.||loss of a limb from a car accident|
|d.||death of a loved one or close friend|
|e.||being unable to attend due to financial constraints|
|f.||retirement from a job after 30 years of service|
CHAPTER 10—THE CLIENT WITH A BIPOLAR DISORDER
- Which of the following statements represents a key difference between bipolar and nonbipolar groups?
|a.||Lithium salts are more helpful for individuals in bipolar disorder groups.|
|b.||There are less frequent episodes or recurrences of mood swings in bipolar groups.|
|c.||There is a higher familial prevalence in nonbipolar groups compared to bipolar groups.|
|d.||Depressive episodes have a later age of onset in bipolar groups compared to nonbipolar groups.|
- According to the current Diagnostic and Statistical Manual, which of the following would you find when doing a history on a client with a diagnosis of Bipolar II Disorder who is currently in a depressive episode?
|a.||history of prior manic episodes|
|b.||far more depressive episodes than manic episodes|
|c.||no known history of hypomanic or manic episodes|
|d.||prior hypomanic episodes without prior manic episodes|
- When teaching clients about Bipolar I Disorder, the nurse would include which of the following statements in describing it?
|a.||Bipolar I is equally common in men and women.|
|b.||There are usually more manic episodes than depressive episodes.|
|c.||There are often no manic episodes preceding the first depressive episode.|
|d.||On average, there is about one manic episode in every six month period.|
- A nurse is assigned to work with an adult who has a diagnosis of Cyclothymic Disorder. From reviewing the disorder before meeting with the client, the nurse knows that the:
|a.||duration of the symptoms qualifying the client for this diagnosis is at least one year|
|b.||client has not been without symptoms during the required minimum time period for more than one month at a time|
|c.||symptoms can be due to the physiological effects of self-treatment with illicit street drugs, medications, or abuse of alcohol|
|d.||there have been numerous periods of hypomanic and depressive symptoms that do not meet the criteria for Major Depressive Episode|
- For a child to meet the DSM-IV-TR criteria for Cyclothymic Disorder, the duration of required symptoms has to be at least:
|a.||3 months||c.||1 year|
|b.||6 months||d.||2 years|
- When working with a client who has Bipolar Type II Disorder, you realize that the prognosis for this disorder, compared to recurrent (unipolar) major depression, is:
|a.||worse||c.||about the same|
|b.||only slightly worse||d.||better|
- You are assigned to a client whose mood is elevated. You will know that this is hypomania instead of mania if you have which of the following findings during your assessment of this client?
|a.||diminished creative ability||c.||lack of productive energy|
|b.||lack of psychotic symptoms||d.||great impairment in judgment|
- One of your assigned clients has been talking to the psychiatrist who mentioned that the client has rapid cycling. The client asks you to explain this term. Your best answer is which of the following?
|a.||Episodes of mania or depression that do not last longer than a week.|
|b.||The circadian rhythm cycle of 24 hours has been reduced somewhat.|
|c.||The sleep cycles are more rapid than normal and there is more REM sleep.|
|d.||There are four or more episodes of mania, depression, or mixed states each year.|
- In working with clients with bipolar disorder, the nurse observes that the risk of rapid cycling is:
|a.||lower during pregnancy|
|b.||higher with Bipolar Type I|
|c.||greater in months following pregnancy|
|d.||much greater in men compared to women|
- You are assigned to work with a client whose mood disorder is caused by a general medical condition. This client’s disorder could be classified as:
|a.||Bipolar III||c.||Medicus Mood State|
|b.||Bipolar IV||d.||Medical State Bipolar|
- Your assigned client is experiencing a depressive mood disorder which is suspected to be due to one of several medications the client is taking. The client is taking a multipurpose vitamin, low dose aspirin, an antihypertensive, and furosemide (Lasix). Which of these medications is one of the most frequent examples of medications that may cause depression?
|b.||low dose aspirin||d.||multipurpose vitamin|
- When working with a client who has a bipolar disorder, it is most important to assess for which of the following?
|b.||suicide ideation||d.||substance abuse|
- As part of lifelong learning, a nurse is reading research articles on findings from studies of specific abnormalities in the brain of young people with a diagnosis of bipolar disorder. The abnormalities that the nurse is reading about were those that were seen in MRIs. Which of the following abnormalities the nurse is reading about appear more often than would be expected in young people with bipolar disorder?
|a.||wide ventricular spaces|
|b.||diminished gray matter|
|c.||lesions in the white matter|
|d.||red heat areas in unexpected places|
- When assessing a client with bipolar disease, the nurse discovers that the client’s older brother, who is dead, had a diagnosis of bipolar disorder. The nurse most importantly needs to say which of the following things to the client?
|a.||“Tell me about his death.”|
|b.||“What was your brother like?”|
|c.||“Tell me about your brother’s symptoms.”|
|d.||“Who else in your family has bipolar disorder?”|
- When a nurse asks a client with a diagnosis of bipolar disorder about relatives with bipolar disorders, the nurse should be aware that:
|a.||less teaching will need to be necessary with a client who has relatives with the disorder|
|b.||the risk of developing bipolar disorder is greatest when first-degree family members have the disorder|
|c.||compliance can be greatly increased if the family has set a good example for the client with bipolar disorder|
|d.||the symptoms of a person with bipolar disorder may be behavior learned from family members with the disorder|
- When working with a college student who has a diagnosis of bipolar disorder, the nurse and the client have identified that the client is at risk for development of manic symptoms. The client has been medication compliant and the nurse will work with the client to develop some goals related to other areas. Which of the following goals would be most important in preventing an affective relapse?
|a.||Get a volunteer job or a small pet.|
|b.||Get 6 to 8 hours of sleep each night.|
|c.||Reduce contacts with significant others.|
|d.||Maintain weight within a 10-pound range.|
- What percentage of people with bipolar disorder will have recurrent episodes of depression and mania throughout their lives?
- Parents of children who have bipolar disorder often describe their bipolar children as being “different,” beginning in early infancy. Which of the following descriptions of their children’s behavior as infants would the nurse most likely hear from these parents?
|a.||hypervigilence such as stiffening and scanning the visual field frequently|
|b.||poor nursing or refusal to take the bottle and not wanting to be held at any time|
|c.||sleeping 18 to 20 hours a day, being lethargic and disinterested in interacting with others|
|d.||sleeping erratically, being irritable, anxious, and experiencing difficulty with separation from the mother|
- When assessing a client who has a diagnosis of bipolar disorder, the nurse will ask the client about alcohol and drug use since the comorbidity rate of substance abuse with bipolar disorder is best represented by which of the following?
- When preparing medication as ordered for a client with a diagnosis of bipolar disorder who is in the depressed phase, you find that the client is to be given lithium (Lithobid) and sertraline (Zoloft). What is probably the best reason the client is receiving Lithobid in addition to Zoloft?
|a.||Lithobid potentiates the effect of Zoloft.|
|b.||The combination keeps the client in the habit of taking the drugs.|
|c.||Mania can be a side effect of an antidepressant.|
|d.||Zoloft works best in combination with Lithobid.|
- In addition to antidepressants and mood stabilizers, what other major category of medications will the psychiatric nurse most often be administering to clients with a diagnosis of bipolar disorder?
- You are working with a young adult female client who has bipolar disorder. Her psychiatrist has ordered Lithobid, 300 mg, three times a day. Which one of the following things is most important for you to check before administering this medication?
|a.||allergies to chicken and eggs|
|b.||the weight and height of the client|
|c.||the temperature, pulse, and respiration of the client|
|d.||results of a pregnancy test and birth control methods|
- The first psychotropic agent found to be effective in preventing recurrent episodes of bipolar illness was:
|a.||valproic acid||c.||lithium carbonate|
- When working with a client who is taking lamotrigine (Lamictal), the nurse must look for the most common side effects which include which of the following problems?
|a.||difficulty sleeping||c.||extreme excitability|
|b.||a dangerous allergic rash||d.||ataxia and kidney stones|
- A client with bipolar disorder asks the nurse, “What is the major benefit of newer agents such as topiramate (Topamax) over traditional mood stabilizers?” The best answer by the nurse would be:
|a.||the depressive phases are not as deep with the newer medications|
|b.||there is less or no weight gain compared with traditional mood stabilizers|
|c.||topiramate was developed specifically to target certain symptoms of mania|
|d.||newer agents do not make the client feel drowsy like the old mood stabilizers|
- When working with a client who is on phenelzine (Nardil), the nurse teaches the client about the medication. Which of the following statements by the client best indicates that the client understands the lessons of the nurse?
|a.||“Palpitations are nothing to worry about.”|
|b.||“I can drink red wine but not white wine.”|
|c.||“I realize that I must stay on a special diet.”|
|d.||“This medication will help me immediately.”|
- When clients with bipolar disorder cannot tolerate lithium, are pregnant, or have sustained some degree of brain injury, which of the following medications is most likely to be used?
|c.||naltrexone hydrochloride (ReVia)|
|d.||ondansetron hydrochloride (Zofran)|
- A nurse is assigned to work with a client who has a bipolar disorder. The nurse notices that the client has a protruding tongue, exhibits chewing-like mouth movements, and has fine tremors of the hands. From these clues, the nurse would most suspect that the client has been on which of the following drugs, or a similar drug, for a couple of years or more?
|a.||haloperidol (Haldol)||c.||clozapine (Clozaril)|
|b.||resperidone (Resperdal)||d.||olanzapine (Zyprexia)|
- A nurse should advise the family of a client who is scheduled for a series of ECT treatments that the client will:
|a.||need to be in the hospital for several days for the series of treatments|
|b.||receive 6 to 10 treatments over a period of about five days to one week|
|c.||possibly experience temporary memory loss as a side effect of the ECTs|
|d.||need to have much of the body padded to prevent injury during the treatments|
- When working with clients with the diagnosis of bipolar disorder, your effective management of the milieu will require three essential elements. They are safety, stabilization, and which one of the following?
|b.||limit setting||d.||increased praise|
- You are helping a client in the manic phase to select an activity. Toward which of the following activities would you guide the client?
|a.||playing chess with another client|
|b.||working a 1500-piece puzzle with a group|
|c.||a volleyball game of clients against the staff|
|d.||shooting baskets one-on-one with a staff member|
- When working with a young adult and planning a teaching session about bipolar disorder and its treatment, the nurse will include the client in the planning. Which of the following questions is most important for the nurse to ask the client?
|a.||“When can your family come to a session?”|
|b.||“Who is your significant other at this time?”|
|c.||“Who do you want involved in the treatment?”|
|d.||“May I have permission to invite your parents?”|
- You are working with a married female client who has a diagnosis of bipolar disorder. Which of the following types of interventions, along with mood-stabilizing medication, would most probably keep the client out of the hospital without relapsing for longer periods of time and have greater reductions in mood disorder symptoms?
|a.||periodic home visits by a psychiatric nurse|
|b.||an outpatient educational support group with peers|
|c.||a series of electroconvulsive shock treatments (ECT)|
|d.||community-based, family-focused psychoeducational programs|
- Your client has been taking lithium and begins to experience fine bradycardia, arrhythmias, and seizures. Your nursing interventions will be directed at caring for a client who is:
|a.||experiencing early signs of lithium toxicity|
|b.||having an allergic reaction to the lithium|
|c.||demonstrating late signs of lithium overdose|
|d.||anxious over having an illness which requires lithium|
- Which is the priority of care with a client whose lithium level is 1.5?
|a.||Hold the next dose and contact the physician.|
|b.||Give the next dose and notify the physician.|
|c.||Give the next dose and take the client’s vital signs.|
|d.||Hold the next dose and offer the client orange juice.|
- The nurse is evaluating a client’s understanding of foods that should be avoided when taking an MAOI. Further teaching is needed if the client includes which of the following on a menu? Select all that apply.
- Priority goals or outcomes for a client with bipolar disorder would include which of the following? Select all that apply.
|c.||weight reduction diet|
|d.||reduced social interaction|
|f.||return to pre-illness level of functioning|
- Which of the following statements made by a client receiving lithium would indicate that the client understands the medication? Select all that apply.
|a.||“I should reduce the salt intake in my diet.”|
|b.||“I need to have my lithium level drawn regularly.”|
|c.||“I should eliminate foods high in tyramine from my diet.”|
|d.||“I can reduce my dosage when I begin to feel like myself.”|
|e.||“I should call my primary health care provider if I feel my mood changing.”|
|f.||“If I experience nausea, vomiting, and diarrhea, I should call my doctor immediately.”|
- Possible nursing diagnosis for a client with bipolar disorder who is in a manic phase includes which of the following? Select all that apply.
|a.||disturbed thought process|
|b.||impaired social interaction|
|c.||risk for injury related to agitation|
|d.||self-care deficit related to restlessness|
|e.||disturbed sleep pattern related to restlessness|
|f.||nutritional impairment: more than body requirement|
- The nurse assessing a client with Bipolar I Disorder, most recent episode manic, would most likely assess which of the following symptoms? Select all that apply.
|e.||inflated self-esteem or grandiosity|
|f.||sleep pattern reduced to three hours per night|
- Which of the following nursing interventions are appropriate for a client with bipolar disorder? Select all that apply.
|a.||Provide low salt diet.|
|b.||Provide a safe environment.|
|c.||Set limits on inappropriate behavior.|
|d.||Administer antipsychotic medications as prescribed.|
|e.||Provide activities for the safe expenditure of energy.|
|f.||Encourage client to participate in competitive games.|
- To treat the psychotic symptoms experienced by a client with bipolar disorder, the nurse would most likely administer which of the prescribed medications? Answer all that apply.
|a.||clozapine (Clozaril)||d.||Amitriptyline (Elavil)|
|b.||olanzapine (Zyprexa)||e.||nefazodone (Serzone)|
|c.||risperidone (Risperdal)||f.||quetiapine (Seroquel)|
- The nurse assessing a client who is receiving lithium would recognize that which of the following symptoms would be considered minor side effects? Select all that apply.
CHAPTER 11—THE CLIENT WITH AN ANXIETY DISORDER
- When teaching clients about anxiety, the nurse will explain that anxiety is:
|a.||the same as fear||c.||dangerous to health|
|b.||crucial in adaptation||d.||abnormal for humans|
- When assessing a client with acute stress disorder, the nurse will find which of the following signs or symptoms that must be present in order to meet the criteria for this diagnosis?
|a.||temporary loss of function of a body part|
|b.||initial symptoms evolved within six months|
|c.||symptoms have lasted for at least six months|
|d.||persistent reexperiencing of the traumatic event|
- A client who has an anxiety disorder will present with signs and symptoms that represent a:
|a.||narrow range of physiologically generated responses|
|b.||chemical dysregulation of the brain involving neurotransmitters|
|c.||wide array of biological, behavioral, motor, and cognitive responses|
|d.||learned response to imminently dangerous situations and perceived danger|
- When teaching community groups about anxiety disorders, the nurse would share that these disorders:
|a.||will affect about 2% of the general population at some point in life|
|b.||have great cultural variations in presentation and epidemiology|
|c.||have a much higher prevalence among young adult men|
|d.||are the least prevalent mental disorder in older adults|
- Sigmund Freud believed that lifelong adaptive responses to anxiety arise from experiences dealing with which of the following early life situations?
|a.||toilet training and giving up something from the body|
|b.||caregivers leaving and a great sense of loss over the separation|
|c.||having the bottle or breast withdrawn before hunger is satisfied|
|d.||separating from the womb and the trauma of the birthing process|
- You are working with an adult client who regresses as demonstrated by thumb sucking and baby talk during periods of anxiety. Applying psychoanalytic theories to your client’s use of these defense mechanisms, you would conclude that the client most probably has:
|a.||not had sufficient nurturing in the preschool and school age years|
|b.||tried more mature defense mechanisms that failed to protect the ego|
|c.||a desire to return to the earlier feeling of safety in the mother’s womb|
|d.||little or no knowledge about the problem-solving process and its uses|
- Which of the following is considered an immature defense mechanism according to the work of Anna Freud and psychoanalytic theory?
- John Paul Sartre coined a term that came to be applied to a particular type of psychotherapy. That term was:
- According to Beck and Emory, anxiety occurs when a threat or danger is:
- Behaviorists such as Eysenck and Wolpe view intense or disabling anxiety as:
|a.||a learned maladaptive response to stress|
|b.||caused by neurotransmitter dysfunction|
|c.||not amenable to change by behavioral therapy|
|d.||inherited but can be changed by conditioning|
- While assessing a family, the nurse notes that the family has one specific quality of overprotectiveness that immediately stands out in the assessment. This family quality will increase the likelihood of which of the following in the children?
|a.||treatment resistance||c.||well-rounded personality|
|b.||maladaptive responses||d.||isolation and shy behavior|
- While being cared for by a babysitter, a two-year-old child cries and calls for the parents and then expresses fear that the parents will not come back. When the parents return later, using Bowlby’s attachment theory and its three stages, you can predict which of the following behaviors on the part of the child?
|a.||ignoring the parents and not interacting|
|b.||continued crying and “fussy” behavior|
|c.||jumping on the parents and hugging them|
|d.||throwing fits and other expressions of anger|
- Parents ask the nurse for advice on when their child will be able to tolerate their short-term absence and feel secure with a relative or babysitter. The best reply by the nurse, using Bowlby’s attachment theory, is that children are able to tolerate short-term absences and feel secure by age:
- According to Ainsworth, a child develops a sense of control and predictability over the environment which is most fostered by:
|a.||introducing the baby to care by caregivers during the period of infancy|
|b.||keeping the baby on a strict schedule of feeding, changing, and bedtime|
|c.||Parents’ responding to the infant’s verbal and nonverbal cues or communication|
|d.||letting the baby cry at times so as to learn to deal with periodic times of frustration|
- A client who displays extreme neediness of others and frequently seeks medication for anxiety most likely:
|a.||was raised by highly emotional caregivers|
|b.||was weaned too soon from the bottle or breast|
|c.||had disturbed or inadequate attachment or bonding|
|d.||experienced some physical or psychological abuse|
- The nurse reviewing the literature on neuroendocrine studies will find these studies generally reporting which of the following hormones elevated in acute stress with related symptoms comparable to what happens in anxiety disorders?
- Research has shown that there is a high degree of probability that post-traumatic stress disorder (PTSD) involves:
|a.||increased levels of cholinesterase|
|b.||some systemic immunodeficiency|
|c.||excessive neuroendocrine secretion|
|d.||changes in the gray matter of the brain|
- Stimulation of the brain region that houses inhibitory alpha-2 adrenergic receptors will generate which of the following symptoms?
|a.||sensation of palpitations||c.||profuse diaphoresis in the evening|
|b.||feelings of doom and fear||d.||an increase in physical strength|
- When a nurse reads an article on anxiety disorders which discusses the hypothesis that these disorders stem from abnormal serotonin function and, in particular, dysregulation of 5-HT function, this makes sense to the nurse because SSRIs are effective in the management of anxiety disorders, such as panic disorder, because they act in which of the following ways?
|a.||increase postsynaptic 5-HT|
|b.||change 5-HT into 2- and 3-HT|
|c.||inhibit presynaptic 5-HT reuptake|
|d.||increase presynaptic 5-HT reuptake|
- A nurse wants to know why most anxiety symptoms respond positively to both short- and long-acting benzodiazepine medications. A literature search will reveal that these medications are believed to do which of the following things?
|a.||activate GABA receptors||c.||inhibit norepinephrine receptors|
|b.||activate dopamine receptors||d.||increase availability of serotonin|
- A nurse suddenly gets an insight into how GABA and neuroendocrine secretion could both play a role in producing the symptoms of panic disorder. Which of the following explanations best represents that insight?
|a.||Neuroendocrine secretion is increased due to negative feedback of low levels of GABA.|
|b.||GABA, in combination with serotonin, produces an excessive amount of neuroendocrines.|
|c.||Low levels of GABA produce one set of symptoms while excessive neuroendocrines produce others.|
|d.||Low levels of GABA or fewer receptors cannot override the effects of excessive neuroendocrine secretion.|
- In addition to neuroendocrine theories of contributors to causation of anxiety disorders, such as panic disorder and obsessive-compulsive disorder, recent neuroanatomical theories include which of the following?
|a.||asymmetries in the area of the brainstem|
|b.||abnormal dopamine receptor site activity|
|c.||increased electrical stimulation in the areas of the amygdala and the hippocampus|
|d.||glucose metabolism abnormalities in the frontal and prefrontal cortex and basal ganglia|
- When assessing a client who has a generalized anxiety disorder or phobias, the nurse asks the client about any relatives who might have anxiety disorders. The nurse asks this question for which of the following reasons?
|a.||Anxiety disorders have been proven to be due to genetic inheritance.|
|b.||If the client lived with these relatives, the anxiety behaviors may be learned.|
|c.||To assess the family experience with and understanding of symptoms and treatment.|
|d.||Genetic studies provide strong evidence of familial patterns of anxiety disorders.|
- The nurse assessing a client who has panic disorder also assesses the family for anxiety sensitivity. The nurse is trying to understand which of the following things?
|a.||how the client and the family perceive anxiety-related physiological symptoms|
|b.||where family members rate on tolerance of anxiety symptoms on a 1-10 scale|
|c.||the degree of vulnerability that various family members have for anxiety disorders|
|d.||the number of people in the family who have anxiety and anxiety-related symptoms|
- When working with a client who has a diagnosis of panic disorder, the nurse would most likely help the client to set a goal to:
|a.||identify warning signs of panic attacks and do preventative exercises|
|b.||control symptoms of panic attacks by relaxation and mental willpower|
|c.||verbalize reduction in or elimination of the fear of symptoms of panic disorder|
|d.||make it through at least one day per week without any symptoms of panic attack|
- A school nurse teaching parents and teachers about separation anxiety will share which of the following as fact?
|a.||Separation anxiety affects boys more than girls.|
|b.||Primary reinforcers include staying home and getting attention.|
|c.||When children do not like school, they will cling to the parents for protection.|
|d.||Symptoms must be present for a week for a child to be diagnosed with separation anxiety.|
- The most common prepubertal anxiety disorder is which of the following?
|a.||school phobia||c.||separation anxiety disorder|
|b.||social phobia||d.||Post-traumatic stress disorder|
- When working with a child who has separation anxiety disorder and refuses to leave the parents to go to school, the nurse will primarily need to do which of the following things?
|a.||arrange for tutors and give the caregivers information on home schooling|
|b.||develop rapport with the child followed by play therapy and talk therapy sessions|
|c.||have another child walk the client to school and sit with them during all the classes|
|d.||work with school and parents to develop a behavioral approach and develop the must-attend idea|
- A school nurse talks with an adolescent who describes feeling uncomfortable eating in front of others. The nurse’s best response would be which of the following?
|a.||“Don’t you feel lonely eating by yourself all of the time?”|
|b.||“Why do you feel so uncomfortable eating in front of peers?”|
|c.||“Let’s get your weight and height to see if you are getting enough calories.”|
|d.||“Describe how you feel if the teacher asks you to speak in front of the class.”|
- In order for a person under 18 to be diagnosed with social phobia, the symptoms must have been present for at least:
|a.||6 months||c.||1 year|
|b.||9 months||d.||2 years|
- Which of the following approaches would most likely be best for an adolescent who has distress when eating in front of other people?
|a.||a system of rewards for every bite eaten in front of others|
|b.||cognitive-behavioral interventions involving gradual exposure|
|c.||a system of punishment, such as a fine, for every meal eaten alone|
|d.||assign the adolescent to eat with a person who enjoys eating in front of others|
- When working with school-aged children, the school nurse will sometime encounter a child or children with overanxious disorder. The nurse will be suspicious that a child may have this disorder when observing which of the following behaviors?
|a.||isolation and withdrawal from others, flat, sad, or tearful affect, extreme emotional lability|
|b.||sitting on the edge of the chair, scanning the room, searching for the caregiver or other safe person|
|c.||nonstop talking, nail-biting, thumb sucking, hair pulling and twirling, and excess teasing of others|
|d.||extreme sensitivity, need for enormous consolation during times of stress, inability to settle down|
- When working with a child who has reported experiencing sexual abuse, the nurse can best help prevent maladaptation and severe PTSD symptoms in the child who is preparing to share this with her family, by doing which of the following things?
|a.||giving the child one of the standardized tests to assess trauma in children|
|b.||assuring the child that the person who did this to them will be punished soon|
|c.||working with the family to help them frame a positive reaction after disclosure|
|d.||keeping the child busy so there is less time to dwell on the trauma and reactions|
- A nurse working the night shift at the hospital checks on a postsurgical client who has seemed hypervigilant and appears to have some emotional numbing. The client is not sleeping well and she tells the nurse she just had a recurrent bad dream. From what the nurse has observed, the nurse suspects this client may have had a bad dream about:
|a.||dying from surgery||c.||not being in control|
|b.||a past traumatic event||d.||losing something of value|
- When assessing an adult who has a diagnosis of obsessive-compulsive disorder (OCD), the nurse will talk with the client to see if the client ever had any rituals or ever rewrote a letter until it was perfect and, if so, how old were they at the time. The rationale for obtaining this data is:
|a.||the earlier the rituals began, the harder it is to deal with the underlying cause|
|b.||One-third to one-half of adults diagnosed with OCD had symptoms when children|
|c.||in order to have an adult diagnosis, the symptoms must have been present by age 12|
|d.||finding out when rituals began will help the nurse gain insight into the cause of OCD|
- In assessing an individual who has a diagnosis of obsessive-compulsive disorder, the nurse asks the individual and her family if she ever had a Group A beta-hemolytic streptococcal (GABHS) infection. The reason for asking this question is:
|a.||to find out if the child had an antibiotic that might have precipitated OCD|
|b.||to ascertain how the person dealt with the idea of an infection in her body|
|c.||that some children may have OCD symptoms precipitated by GABHS infections|
|d.||that this information will help determine what medication to put the person on now|
- Which of the following approaches has been successful in decreasing symptoms of obsessive-compulsive disorder?
|a.||contracting with the client about the number of times to reduce rituals|
|b.||limit setting on the number of rituals and the amount of time for the rituals|
|c.||long-term insight-oriented therapy combined with hypnosis and self-hypnosis|
|d.||several sessions for desensitization combined with anxiety management training|
- The parent of a child with an anxiety disorder asks the nurse, “Will this anxiety problem disappear by the time my child goes to college?” The nurse will suggest that by working hard together and with new research, hopefully this will happen. What will the nurse also share with the parent about the usual course of childhood anxiety disorders?
|a.||Ninety percent of childhood anxiety disorders disappear by ages 18 to 21.|
|b.||Overall, childhood anxiety disorders tend to become adult anxiety disorders.|
|c.||Anxiety disorders are more stress-producing in childhood compared to adolescence.|
|d.||The anxiety disorder disappears in adolescence in 50% of cases regardless of treatment.|
- A middle-aged woman shares with the nurse that she has panic attacks. The nurse will quiz the client about signs and symptoms. Which of the following signs and symptoms would best match the symptoms of a panic attack?
|a.||warning aura of impending danger about one hour before the attack|
|b.||sudden onset of tachycardia, diaphoresis, paresthesias, and a sense of doom|
|c.||gradual onset of loss of strength and feeling, inability to run, and feeling lost|
|d.||sudden onset of headache, loss of vision, and feeling that her throat is closing off|
- A client describes having recurrent, intrusive, and persistent thoughts that her baby is going to die. The client sees images of the dead baby, feels a sense of doom, touches a cross 25 times, and checks the door locks 300 or more times a day. Which of the following behaviors of the client are examples of compulsions?
|a.||feeling a sense of doom|
|b.||images of the dead baby|
|c.||checking the door locks 300 times|
|d.||recurrent thoughts that the baby will die|
- Four clients are admitted to the emergency department at the same time. Which client should be assessed first?
|a.||the client with PTSD|
|b.||the client having a panic attack|
|c.||the client with a phobic disorder|
|d.||the client with obsessive-compulsive disorder|
- Which nursing intervention is the priority of care in the client with anxiety disorder?
|a.||Place the client in restraints|
|b.||Engage the client in 1:1 conversation|
|c.||Place the client in a quiet environment|
|d.||Limit the client’s interaction with other patients|
- One of the short-term effects of OCD in children includes:
|b.||mood disorders||d.||sleep disturbance|
- Which intervention would have the highest priority when caring for a client with severe anxiety?
|a.||providing for the client’s safety|
|b.||setting limits on the client’s behavior|
|c.||offering the client a warm cup of milk|
|d.||offering medications to reduce anxiety|
- When assessing an elderly client, the nurse should understand that which of the following is the most common psychiatric disorder in the elderly?
- As a client’s anxiety increases, the nurse should anticipate that the client’s perceptual field will:
|a.||increase||c.||remain the same|
- You are caring for a client diagnosed with bipolar disorder. The client is to begin taking lithium carbonate. As her nurse you are aware that before administering lithium carbonate to a client for the first time, you must assess the client for which of the following?
- A nursing intervention for a client experiencing panic attacks would include encouraging the client to:
|a.||avoid family and friends to reduce episodes of anxiety|
|b.||identify anxiety-provoking situations and thoughts that arise from them|
|c.||apply for a new job in order to refocus on less stressful situations in her life|
|d.||have her husband seek mental health services because he probably is the cause of her problems|
- The nurse interviewing a newly admitted client diagnosed with anxiety would observe for which of the following as an indication of cognitive or psychobiological responses? Select all that apply.
- Your client is being discharged with a prescription for Zoloft. Health teaching for this client would include notifying the physician if which of the following occurred? Select all that apply.
|a.||seizures||d.||excessive weight loss|
|b.||confusion||e.||nausea and vomiting|
|c.||heart palpitations||f.||fewer episodes of anxiety|
- You client’s anxiety begins to escalate and you review her PRN medications. The physician has written an order for the client to receive diazepam (Valium) 5 mg. PRN for increased anxiety. The Valium you have on hand is dispensed in 10 mg. tablets. You would administer __________ tablet/s.
CHAPTER 12—THE CLIENT WITH A SOMATIZATION DISORDER
- Somatization disorders have been recognized since which of the following periods of time?
|b.||end of the 18th century|
|c.||beginning of the 20th century|
|d.||the writing of the diagnoses for DSM-III|
- The syndrome later known as somatization disorder was first recognized by which of the following people?
- A nurse is working with a client who was admitted to the hospital with physical complaints. The client was diagnosed with a somatization disorder when the physical symptoms did not match any known medical condition. The client’s physical symptoms that cannot be explained by an underlying medical condition need to be understood by the nursing staff as:
|a.||medical problems for which no cause has yet been found|
|b.||a way to avoid dealing with adult relationships which are difficult|
|c.||a coping mechanism that enables the client to respond to stressors|
|d.||an attempt to get attention from the health care staff in an unacceptable manner|
- The primary gain from a conversion symptom is best represented by which of the following?
|a.||feelings of being important to family, caregivers, and others|
|b.||attention from the caregivers at home, friends, or health care staff|
|c.||getting out of negative, undesired, or stress-producing responsibilities|
|d.||reduction of anxiety by resolution of an unconscious psychological conflict|
- The psychoanalytic meaning of pain involves:
|a.||punishment for being unattractive and unlovable|
|b.||fulfilling an unconscious need for guilt or masochism|
|c.||the desire for death and the thanatos of a relative or friend|
|d.||reliving the traumatic experience of traversing the birth canal|
- When working with a client who has a somatization disorder, it is most important for the nurse to:
|a.||attend to the client’s needs immediately|
|b.||have the client keep a journal of the symptoms|
|c.||provide pain medication around the clock as ordered instead of as needed|
|d.||recognize manipulative behavioral patterns and avoid reinforcing dependency|
- According to the DSM-IV-TR, male relatives of women with somatoform disorders are predisposed to the risk of:
|a.||somatoform disorders, especially conversion disorder|
|b.||physical and emotional abuse by the female relatives and friends|
|c.||antisocial personality disorders and substance-related disorders|
|d.||caregiver burnout from attending to the needs of the females with somatoform disorder|
- The nurse working in a community clinic will need to keep in mind that a high-risk group for somatization is:
|a.||housewives||c.||persons in tropical climates|
|b.||school-aged children||d.||immigrants on a global scale|
- It is important for the nurse to recognize and understand cultural expression of somatization. Which of the following cultures has “dhat” syndrome which is associated with semen loss?
|b.||South Asian||d.||Eastern European|
- When taking a health history from a client with somatization disorder, you would most expect to find:
|a.||a stable interpersonal relationship with one partner|
|b.||a long-time relationship with one health care provider|
|c.||that the client is vague on many aspects of the information|
|d.||a calm, matter-of-fact presentation of many unremarkable ailments|
- While working with a client who has been diagnosed with somatization disorder, the nurse matches the client’s history and presenting complaints to see if the diagnosis seems warranted. In order to meet the criteria of somatization disorder, the client must have had a history of:
|a.||pain in some location for at least 6 months|
|b.||one gastrointestinal symptom other than pain|
|c.||many physical complaints starting before age 15|
|d.||one sexual or reproductive symptom other than pain|
- The client who meets the criteria for a diagnosis for somatization disorder must, in addition to meeting the criteria of pain and sexual and gastrointestinal symptoms, meet the criteria of one pseudoneurological symptom or deficit suggesting a neurological condition. Which of the following will the nurse consider to be a pseudoneurological symptom?
|a.||claiming erectile dysfunction when there is none|
|b.||faking hallucinations about seeing and hearing things|
|c.||unexplained paralysis of the arm from elbow to fingertips|
|d.||magnifying a relatively minor cough into whooping cough|
- A home health nurse suspects that a client has a factitious disorder. When the client complains of a high fever, the nurse puts a thermometer under the client’s tongue. Then the client asks the nurse to get a glass of water for him. When the nurse returns, the thermometer reads 103°F. What is the best course of action for the nurse?
|a.||give the client cool sponge baths|
|b.||ask the client what they usually take for fever|
|c.||call the physician to report the elevation in temperature and get orders to resolve it|
|d.||wait until near the end of the visit and retake the temperature while remaining with the client|
- A young athlete is scheduled to perform some difficult dives that he has not quite mastered. Sometimes he performs them perfectly, and at other times, he is embarrassed by his performance. Just before a competitive meet, the athlete is suddenly unable to use one leg, is hospitalized, and is assigned to your care. Preliminary tests and x-rays reveal no basis for the symptoms. While keeping an open mind, you suspect this client most likely has a:
|a.||conversion disorder||c.||true neurological disorder|
|b.||somatization disorder||d.||feigned neurological disorder|
- You are working with a client who writes for a living. The client has a conversion disorder with an inability to utilize the hand used for writing. Which of the following goals would the client likely benefit from the most?
|a.||verbalize a lack of stressors within 1 week|
|b.||demonstrate the ability to use the computer within 2 days|
|c.||describe five ways to effectively deal with stress within 2 days|
|d.||demonstrate the ability to write at least three pages within 1 week|
- When assessing a client with a diagnosis of fibromyalgia syndrome (FMS), you will expect to find, among other symptoms, which of the following?
|a.||fatigue lasting at least 6 months, flu-like symptoms, and tender lymph nodes|
|b.||11 to 18 tender points in specific areas, sleep disturbance, and widespread pain|
|c.||muscle aches and pains off and on for 2 years, low-grade fever, and tachycardia|
|d.||paresthesias and loss of sensation in several muscle groups throughout the body|
- When working with a client with hypochondriasis, the nurse needs to understand that the course of the disease is:
|a.||acute, lasting a short time|
|b.||varied and very individual|
|c.||completed in about 10 years|
|d.||chronic with waxing and waning periods|
- During assessment, the nurse will find that the client who has a diagnosis of body dysmorphic disorder will have which of the following symptoms?
|a.||dissatisfaction with body shape and size|
|b.||preoccupation with an imagined defect in appearance|
|c.||fantasizing oneself as changed into an ideal appearance|
|d.||a history of eight or more plastic surgeries on various body parts|
- The family of a client with chronic fatigue syndrome (CFS) asks the nurse, “What causes chronic fatigue syndrome?” The best answer by the nurse would be:
|a.||“It is a form of chronic Epstein-Barr virus infection.”|
|b.||“An acute infection activates dysregulation in the immune system.”|
|c.||“Dysregulation in the neuroendocrine process is the most likely cause.”|
|d.||“The cause is unknown but theories of causation are being researched.”|
- When teaching community groups about chronic fatigue syndrome, the nurse will tell the group that the major symptoms include chronic fatigue, which is unexplained and lasts for:
|a.||at least 2 weeks||c.||more than 6 months|
|b.||1 to 5 months||d.||at least 1 year|
- When working with clients with somatization disorders, the nurse needs to use which of the following approaches?
|a.||empathetic, quiet listener, and helper|
|b.||caring, nonjudgmental, and a firm manner|
|c.||promoter of self-care but otherwise unavailable|
|d.||gentle, kind, and attentive to all of the client’s needs|
- The nurse caring for a client with hypochondriasis would assess that which of the following defense mechanisms is characteristic of this disorder?
|a.||regression and repression|
|b.||projection and rationalization|
|c.||rationalization and sublimation|
|d.||reaction formation and rationalization|
- You are assigned to a client diagnosed with a somatization disorder. Your initial approach should be to:
|a.||explain to the client that there is no physiologic basis to the problems|
|b.||ask the client to describe the physical problems which caused this admission|
|c.||assure the client that you have cared for many other clients with similar problems|
|d.||discuss the client’s relationship with family and friends in order to assess the client’s support system|
- In planning nursing care for a client with body dismorphic disorder, the plan would reflect an understanding that body image is:
|a.||unchanging as the individual matures|
|b.||not a significant issue for adolescent boys and girls|
|c.||always an accurate perception of one’s self and one’s ability|
|d.||one’s physical perception, sense of identity, strengths, and limitations|
- The nurse assessing a group of individuals for somatic disorders would most likely determine that which cultural group has the highest rate for somatization?
|a.||Hispanics and Asians||c.||Asians and African Americans|
|b.||American Indians and Asians||d.||African Americans and Hispanics|
- The major nursing diagnosis for a child with BDD would be which of the following? Select all that apply.
|a.||self-esteem, low||d.||delusional behavior|
|b.||ineffective coping||e.||disturbed body image|
|c.||caregiver role strain||f.||alteration in elimination|
- The nurse is assigned to care for a client with a somatic disorder. The nursing plan of care would include which of the following? Select all that apply.
|a.||challenge and negate symptoms|
|b.||employ appropriate limit setting|
|c.||convey sympathetic understanding|
|d.||assess for depression and suicide risk|
|e.||avoid responding to somatic complaints|
|f.||strengthen coping and level of functioning|
- Nursing interventions for a client with body dysmorphic disorder would include which of the following? Select all that apply
|a.||teaching relaxation techniques|
|b.||promoting the client’s secondary gains|
|c.||encouraging the client to express his feelings|
|d.||denying that the client’s symptoms are real|
|e.||referring the client to group and family therapy as needed|
|f.||assisting the client with developing healthy coping strategies|
- Outcomes for a client with body dysmorphic disorder would include which of the following? Select all that apply.
|a.||improved functional ability|
|b.||demonstrate enhanced self-esteem|
|c.||dissatisfaction expressed with body|
|d.||effectively copes with fears and anxiety|
|e.||negative appraisal of personal appearance|
|f.||reduced preoccupation with perceived flaw|
- When planning care for a client with a conversion disorder, the nurse knows that which of the following are true? Select all that apply.
|a.||onset can occur at any age|
|b.||occurs more often in males than females|
|c.||may result in primary and secondary gains|
|d.||comorbidity is seen with somatization disorders|
|e.||may reflect school-, work-, and family-related stress|
|f.||most common somatoform disorder seen in children|
- Nursing interventions for clients with somatization disorders should be based on which of the following principals? Select all that apply.
|a.||Be firm and consistent and provide reassurance.|
|b.||When indicated, treat anxiety and depressive symptoms.|
|c.||Provide health education concerning major symptoms.|
|d.||Differentiate maladaptive behaviors from cultural factors.|
|e.||Establish a friendly and jovial relationship with the client and his family.|
|f.||Allow manipulative behaviors to reduce the client’s emotional stress.|
CHAPTER 13—THE CLIENT WITH A STRESS-RELATED DISORDER
- Alexander hypothesized that:
|a.||tuberculosis is caused by a stress response|
|b.||emotions can trigger physiological responses|
|c.||the stress reaction consists of three distinct stages|
|d.||there is a universal response to major life stressors|
- A nurse is working with a client who has a psychophysiological disorder. To be considered psychophysiological, a disorder must present with:
|a.||a medical condition on Axis III of the DSM-IV-TR|
|b.||a personality disorder on Axis II of the DSM-IV-TR|
|c.||more psychological symptoms than physical symptoms|
|d.||at least eight major symptoms of stress in four different body areas|
- Freud hypothesized that unreleased psychological tension was converted into symptoms such as paralysis or blindness. He termed this reaction:
|a.||paralysis neurosis||c.||conversion hysteria|
|b.||neurotic psychosis||d.||cathartic tension release|
- Which of the following theorists introduced the concept that a person’s inability to manage stress effectively increases their vulnerability to illness?
|a.||Hans Selye||c.||Anna Freud|
|b.||Erik Erikson||d.||Clifford Beers|
- Temperament has been found to play which of the following roles in health and illness?
|a.||Temperament determines, to a large extent, your willingness to take medications.|
|b.||Temperament makes some people vulnerable to allergic reactions and hay fever.|
|c.||It causes some people to get Huntington’s Chorea who would not otherwise get it.|
|d.||It causes most of the neuroendocrine dysfunctions associated with mental illness.|
- Which of the following behaviors would the nurse most expect to find in someone with a Type A personality?
|a.||easy going, laid back, reposed, a relaxed lifestyle, and goal directed|
|b.||aggressive, vindictive, focused on getting even with others who have more|
|c.||pleasant, personable, friendly to strangers, and a willingness to offer help to others|
|d.||rapid speech and walking, irritability, time consciousness, and difficulty with relaxing|
- While working with an assigned client, a nurse observes that the client appears somewhat anxious, has poor eye contact, and has her arms folded across her chest during interactions with others. Based on these observations, the nurse will most likely work with the client on which of the following goals?
|a.||initiate at least one interaction each day|
|b.||identify feelings at least once during the day|
|c.||make eye contact for at least 50% of interactions|
|d.||talk with the physician about medication for anxiety|
- A nurse reviewing some research journals reads about a study that used a test to measure the hardiness of student nurses. After reading the article, the nurse will understand that hardiness has most to do with:
|a.||the ability to withstand whatever comes one’s way without complaining about it|
|b.||the ability to resist being trapped into assimilating a learned helplessness manner|
|c.||a personality trait enabling one to maintain heath and cope well with stressful events|
|d.||presenting the appearance of a hard person while actually being sympathetic and gentle|
- Looking at research conducted in the last two decades, a nurse realizes that reducing the possible higher risk of coronary heart disease in a person with Type A personality most likely means helping the client deal with:
- A nurse working with a client who has Type A personality has been teaching about prevention of stress and heart attacks. Which of the following statements by the client would best indicate that she understood the teachings of the nurse?
|a.||“I have been journaling several times a week about my feelings.”|
|b.||“I am running several miles each day and getting more exercise now.”|
|c.||“I have organized my work so I can get it all done in an orderly way.”|
|d.||“I am attending a group therapy session where I listen to what others say.”|
- A nurse is working in a holistic health center. Clients from a variety of businesses present for blood pressure screenings as well as other health screenings. The nurse will find several people today who have elevated blood pressures. Which of the following approaches by the nurse will be best in dealing with clients who have elevated blood pressure, who are already under a physician’s care, and on medication?
|a.||talk with the client about her medication compliance and the importance of it|
|b.||provide the client with information on the causes and prevention of hypertension|
|c.||assess the client’s weight and height and put the client on a weight reduction diet if needed|
|d.||assess the client’s stressors and coping styles and develop an individualized teaching plan|
- The nurse, explaining how stress is linked with hypertension, will explain that stress causes:
|a.||liver impairment which results in lowered production of HDL and narrowed blood vessels|
|b.||an overproduction of cortisol which damages blood vessels and raises blood pressure and pulse|
|c.||release of biochemicals that raise blood pressure and pulse which eventually causes vessel constriction|
|d.||the body to conserve water and, with more fluids moving through vessels, blood pressure and pulse to elevate|
- Client and family education about antihypertensive medications is important because client compliance with medication regimens most often depends on:
|a.||the family reminding the client to take medications|
|b.||the nurse’s endorsement of the medication prescribed|
|c.||the client’s perceptions of the treatment’s effectiveness|
|d.||a thorough knowledge of the drug, effects, and side effects|
- The family of a child with asthma asks the nurse to explain the relationship of stress to asthma. Which of the following explanations would be best on the part of the nurse?
|a.||“Stress causes vagal stimulation which, in turn, causes bronchoconstriction.”|
|b.||“If a person is able to reduce the major stressors, they can eliminate asthma.”|
|c.||“Stress is the cause of 90% of all asthma cases with 10% caused by exercise.”|
|d.||“People breathe faster when under stress and, eventually, tire the air passages.”|
- A nurse assessing a client finds that the client has overproduction of gastric secretions and a disturbance in motility. The nurse’s best response is to:
|a.||recommend over-the-counter digestive aids|
|b.||treat these symptoms as major symptoms of GI disorders|
|c.||have the client lie down for an hour after eating each meal|
|d.||advise the client to drink six to eight glasses of water each day|
- A client has a diagnosis of irritable bowel syndrome. The nurse recognizes that, in addition to a need for education and assistance in ways to comply with strict medical regimens, the client and the client’s family will probably need the most assistance with:
|a.||helping the client to be able to work in a job|
|b.||keeping interpersonal relations going smoothly|
|c.||emotional needs and intense psychosocial stress|
|d.||obtaining the large number of costly medications|
- Clients with irritable bowel syndrome need to be approached by the nurse with which of the following manners?
|b.||calm and caring||d.||firm with limit setting|
- The nurse working with a demanding, needy, and stressed client with irritable bowel syndrome, and with the client’s family, needs to keep in mind that the long-term effects of irritable bowel syndrome are:
|a.||chronic but mild|
|b.||varied and individual|
|c.||potentially life threatening and debilitating and affect numerous body systems|
|d.||likely to have long remissions as well as exacerbations with personality changes|
- Nurses working with clients diagnosed with chronic skin conditions, such as alopecia, psoriasis, and urticaria, will want to assess for which of the following feelings that are most often associated with chronic skin conditions?
|a.||sadness and loss|
|b.||depression and aloneness|
|c.||feelings of helplessness and decreased self-esteem|
|d.||anger and the need for revenge against significant others|
- Minuchin and colleagues’ classic work on family dynamics suggested that childhood psychophysiological symptoms serve in which of the following ways?
|a.||as a homeostatic mechanism regulating family interactions|
|b.||to help children get the parents to give them what they want|
|c.||to get attention for the self that cannot be gotten in other ways|
|d.||as a way to release pent-up tension from stressors related to family|
- Minuchin and colleagues identified three factors as playing major roles in the formation of children’s symptoms. These factors are vulnerability and which of the following?
|a.||breast or bottle feeding and how close the child was held|
|b.||specific family dynamics and the usefulness of the sick role|
|c.||the child’s ego and id in terms of her relationship of control|
|d.||personality and where the child is in the developmental cycle|
- A nurse is working with a client who has a psychophysiologic disorder and finds that the client feels tense and angry. The nurse has the client go through deep breathing exercises. The best approach to take next is to have the client do which of the following things?
|a.||stop overreacting and let the anger go|
|b.||identify if the anger is legitimate or not|
|c.||repeat the breathing exercises until tired|
|d.||follow up assertively with others involved|
- When adolescents are struggling with the need for self-identity and independence and have psychosocial stressors of academic demands and interpersonal relationships, what serves best as a buffer against all the demands and stressors?
|a.||peer relationships||c.||a dominant father figure|
|b.||healthy family interactions||d.||a strong and active superego|
- A client is admitted with a diagnosis of “Ineffective Coping.” The nurse will determine that interventions have been successful if the evaluation of the client’s coping reveals:
|a.||client returns to premorbid level of functioning|
|b.||client refuses to attend outpatient psychotherapy|
|c.||client uses maladaptive coping only three times per day|
|d.||client’s vital signs, including B/P, are within normal range|
- Which nursing action would be essential during the initial interview of a client with a stress-related disorder?
|a.||assist the client to develop more effective coping strategies|
|b.||actively listen to what the client says about the physical symptoms|
|c.||discuss referral to an outpatient clinic after discharge from the hospital|
|d.||assure the client that the nurses are well prepared to address the client’s illness|
- The client is receiving an analgesic for chronic pain. Which statement by the client would indicate that the analgesic is effective in reducing the pain?
|a.||“I feel better now. I would like to go to group now.”|
|b.||“People just don’t understand how much pain I feel.”|
|c.||“How is a pill going to help if the pain is in my legs?”|
|d.||“What time will I receive the next dose of the medication?”|
- You are caring for a client with chronic pain. When you walk into the room, the client is crying and tells you that the hot pack is burning. Your initial action would be to:
|a.||contact the physician immediately|
|b.||administer the PRN dose of Demerol for the pain|
|c.||remove the hot pack and assess the skin for possible burn|
|d.||ask the client to describe the pain on a scale from 1 to 10 with 10 meaning severe.|
- A nurse caring for a client who recently lost her job has determined to explore the meaning of the recent job loss. The rationale for this intervention is that it:
|a.||helps the client understand self and present responses|
|b.||demonstrates that the job loss was not the client’s fault|
|c.||helps to avoid dealing with the true cause of the client’s stress|
|d.||provides the nurse an opportunity to refer the client to an unemployment agency|
- Which intervention would have the highest priority when caring for a client with a stress-related disorder?
|a.||providing health education||c.||providing a quiet environment|
|b.||addressing physiological needs||d.||addressing psychological needs|
- The nurse admits a new client to the behavioral medicine unit. The client is diagnosed with a stress-related disorder. During the initial interview, the client provides very short responses to the nurse’s questions. The nurse assesses that the client is very angry. What data would indicate that the nurse’s assessment is correct? Select all that apply.
|a.||sweating||d.||tightly clenched jaw|
|b.||muscle tension||e.||reduced blood pressure|
|c.||reduced heart rate||f.||reduced respiratory rate|
- The nurse conducting discharge planning with a client whose original diagnosis was stress-related disorder. The client would exhibit which of the following as successful coping traits. Select all that apply.
- The nurse is assigned to a client with complaints of chronic pain. Which nursing interventions should be used to reduce pain? Select all that apply.
|b.||apply hot and cold packs|
|c.||teach relaxation techniques|
|d.||administer analgesics as ordered|
|e.||refer for electroconvulsive therapy|
|f.||apply cutaneous stimulation with massage|
- Which of the following nursing actions are appropriate for a client whose nursing diagnosis is disturbed sleep pattern, and the anticipated client outcome is that the client’s normal sleeping pattern returns to optimal level by discharge? Select all that apply.
|a.||maintain quiet environment|
|b.||assess normal sleeping pattern|
|c.||encourage client to keep a sleep log|
|d.||provide warm milk or coffee at bedtime|
|e.||provide health education about sleep hygiene|
|f.||encourage client exercise immediately before going to bed|
CHAPTER 14—THE CLIENT WITH SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
- You are working with a client who often responds to a question or a choice offered with “I don’t know,” or “I don’t care,” has a flat affect, and needs prompting to initiate activities. Your conclusion is that this client is demonstrating which of the following types of symptoms of schizophrenia?
- Which one of the following contributing factors is considered to be the main causative factor in clients with positive symptoms of schizophrenia with little or no evidence of negative symptoms?
|b.||structural defects in the brain|
|c.||highly emotive family members|
|d.||dysregulation of biochemical processes|
- The nurse serving persons from diverse racial and ethnic groups realizes that these individuals often have which of the following outcomes compared to the general population?
|a.||more severe||c.||less severe|
|b.||about the same||d.||much less severe|
- Which of the following actions on the part of a nurse would most help those under the nurse’s care that are from diverse racial and ethnic groups?
|a.||read more about various mental conditions|
|b.||become culturally competent as a mental health provider|
|c.||treat all the clients exactly the same insofar as it is possible|
|d.||have clients reassigned to a nurse’s aide closer to the clients’ racial or ethnic group|
- A nurse teaching a community group about schizophrenia would present which of the following statements as fact?
|a.||men usually have more mood symptoms|
|b.||women usually have an earlier onset than men|
|c.||schizophrenia most often presents in the 20s and 30s|
|d.||schizophrenia often presents in childhood and adolescence|
- You are assigned to care for a client who is from Thailand and who has a diagnosis of schizophrenia. In preparation for working with the family, which is Buddhist, you need first to:
|a.||assess the ability of the client to live alone and to perform activities of daily living|
|b.||review the symptoms of schizophrenia and the course of the disorder in DSM-IV-TR|
|c.||find out who else in the family may have a mental illness, especially schizophrenia|
|d.||gain some understanding of the Buddhist beliefs of the client’s family as related to schizophrenia|
- While talking with a community group about schizophrenia, a nurse is asked by a member of the group about studies suggesting that genetics may be a cause of schizophrenia. The nurse responds that while a number of factors are being studied as possible causes of schizophrenia, some studies have found that when a fraternal twin has schizophrenia, the chance of the other twin developing it are 15% and when an identical twin has schizophrenia, the chance of the other twin developing schizophrenia is:
- The most holistic examination of the development of schizophrenia would use which of the following theories?
|a.||diathesis stress theory||c.||psychodynamic theory|
|b.||substance abuse theory||d.||anatomical systems theory|
- The psychiatric mental health nurse is aware that hallucinations progress through stages including comforting, condemning, threatening, and:
- It is more helpful for nurses to intervene at which of the following stages of a hallucination?
- One of your clients is in the final stage of the hallucinatory process. What intervention is most probably needed here?
|a.||seclusion||c.||one-on-one, staff to client|
|b.||time out||d.||injection of a psychotropic agent|
- When a client has experienced a hallucination but is no longer hallucinating, it is important that the nurse facilitate the client doing which of the following things?
|a.||stay busy||c.||drink extra fluids|
|b.||take a rest or nap||d.||interact with peers|
- One of your clients who has a diagnosis of schizophrenia tells you that he is the king of a foreign land. This is most probably:
|a.||a fact||c.||an illusion|
|b.||a delusion||d.||a hallucination|
- When assessing a child with a diagnosis of autism, the nurse would most expect to find a child who is:
|a.||displaying repetitive movements||c.||engaging and socially intrusive|
|b.||emotionally labile||d.||highly talkative|
- When working with children who have a diagnosis of autism, the nurse will immediately notice that one of the major differences between schizophrenia and autism is that clients with autism are:
|b.||diagnosed much earlier|
|c.||have less dysfunctional patterns|
|d.||have less risk of mental retardation|
- The psychiatric nurse working with families of children with a diagnosis of autistic disorder must keep in mind which of the following as a top priority for the family?
|a.||information on the latest research|
|b.||training on how to teach the autistic|
|c.||periodic respite and support resources|
|d.||assistance in filling out financial aid forms|
- You would most suspect a client is hallucinating when you observe the client:
|a.||talking out loud to the mirror|
|b.||isolating at times and moving lips without sounds|
|c.||carrying out bizarre rituals such as repetitive checking|
|d.||sitting alone in the corner of the dayroom for a long time|
- Current research on the use of newer antipsychotic agents on late-in-life onset of schizophrenia indicates that clients tend to benefit most from:
|a.||catch-up doses of antipsychotic medication|
|b.||higher doses than clients with early-life onset|
|c.||lower, smaller doses of antipsychotic medication|
|d.||the same dose that other schizophrenic clients take|
- You are assigned to work with a 12-year-old child who has been diagnosed with childhood disintegrative disorder. After reviewing your text and other sources of information on this disorder in preparation for caring for this child, you find that it is most likely that your assessment will reveal that this child:
|a.||had no control over bowel and bladder from birth|
|b.||developed symptoms between 2 and 10 years of age|
|c.||regressed in psychomotor skills but not in language skills|
|d.||becomes extremely agitated when objects in a room are moved|
- A parent of a young adult client who is newly diagnosed with schizophrenia asks you how their child can possibly be schizophrenic when the child has never had symptoms of delusions or hallucinations. Your best answer would be:
|a.||“Your child may well be misdiagnosed as this happens quite frequently.”|
|b.||“Your child does have delusions and hallucinations but is hiding these very well.”|
|c.||“The symptoms of delusions and hallucinations will definitely appear at some time.”|
|d.||“A person needs two of five characteristic symptoms of schizophrenia for diagnosis.”|
- A parent asks the nurse if their young adult son with a diagnosis of autistic disorder could also be schizophrenic. The best answer by the nurse would be which of the following?”
|a.||“Schizophrenia is never diagnosed in clients who have a diagnosis of autism.”|
|b.||“Only if there are signs and symptoms of paranoia for at least a 6-month period.”|
|c.||“It is more likely that clients with autism will be diagnosed with anxiety disorders.”|
|d.||“Only if he has prominent delusions or hallucinations for a month, or less if treated.”|
- You are assigned to work with a client who is newly diagnosed with schizophrenia. In assessing this client, you find that the client pays little attention to the surroundings and seems mute at times. You also notice bizarre posturing at times. Which subtype of schizophrenia does this client most likely have?
- A college health nurse is made aware of a student who has displayed some odd behaviors for the past year. For example, the student does not use the doors of the dormitory but instead, always climbs a tree to enter a window of his assigned room. The student has begun isolating from others. The nurse realizes that this student needs further evaluation as these behaviors are classic symptoms of:
|b.||paranoid personality disorder|
|c.||the acute phase of schizophrenia|
|d.||the prodromal phase of schizophrenia|
- The development and use of best mental health nursing practices, the coordination of care within community settings, directing research projects, counseling, and psychotherapy are roles of which of the following nurses?
|a.||experienced licensed practical-vocational nurse|
|b.||advanced practice psychiatric-mental health nurse|
|c.||generalist nurse with courses in psychiatric-mental health nursing|
|d.||registered nurse with on-the-job training in psychotherapy and management|
- Which client should be assessed first?
|a.||the client who is pacing back and forth|
|b.||the client who is sitting quietly in a chair crying|
|c.||the client who is rambling that the FBI is out to get him|
|d.||the client who continuously counts the number of tiles on the floor|
- A client is receiving a traditional antipsychotic medication for his schizophrenia. The nurse would assess for which of the following side effects:
|a.||disturbing nightmares and night sweats|
|b.||gastric reflux and restless leg syndrome|
|c.||hypoglycemia and parasympathetic disorders|
|d.||orthostatic hypotension and autonomic disturbances|
- Before Clozaril is administered to a client with schizophrenia, the nurse should:
|a.||take the client’s temperature|
|b.||measure the client’s intake and output|
|c.||assure that blood work has been completed|
|d.||ask the client to sit quietly for at least 20 minutes|
- Which is the priority of care in the client with catatonic schizophrenia?
|a.||maintenance of nutritional status||c.||medicate for acting out behavior|
|b.||participation in all unit activities||d.||medicate for delusional thinking|
- Your client has been on antipsychotic medications, and he continues to complain of thirst. When you review his chart, you note that he is on fluid restrictions. You determine that the best course of action is to encourage the client to eat hard candy and chew sugar-free gum. The rationale for your action is that:
|a.||the client is fixated at Freud’s oral stage of development|
|b.||the client is just being a pest, and you must treat him the way you would treat a child|
|c.||hard candy and sugar-free gum will enhance the effects of his antipsychotic medications|
|d.||hard candy and sugar-free gum will help with the thirst while limiting excess fluid intake|
- When interviewing a schizophrenic client, the client begins to laugh uncontrollably even though the nurse did not say anything funny. The nurse’s best response would be:
|a.||to state, “You are laughing. Tell me what is happening.”|
|b.||to end the interview because the client is being inappropriate.|
|c.||to state, “Why are you laughing? I didn’t say anything funny.”|
|d.||to contact the physician because the client is not cooperating.|
- Your client is experiencing muscle rigidity, difficulty breathing, and diaphoresis. Upon taking his vital signs, you note an elevated temperature, tachycardia, and elevated blood pressure. Your assessment reveals that the client is experiencing which of the following?
|a.||tardive dyskinesia||c.||extrapyramidal side effects|
|b.||serotonin syndrome||d.||neuroleptic malignant syndrome|
- During a group meeting, you observe that one of your clients is making strange facial gestures while also sucking his lip and smacking. He is also experiencing involuntary movements of both upper and lower extremities. Your assessment would most likely reveal that the client is experiencing:
|a.||tardive dyskinesia||c.||extrapyramidal side effects|
|b.||serotonin syndrome||d.||neuroleptic malignant syndrome|
- When you approach a client diagnosed with schizophrenia and ask the client a question, the client replies, “I need a cigarette. The car is not here. My mother and father are still alive.” The nurse would assess this as an example of which of the following?
|a.||ambivalence||c.||flight of ideas|
|b.||affect impairment||d.||loose association|
- Your client is being placed on an atypical antipsychotic. You anticipate that which of the following negative symptoms of schizophrenia will be reduced? Select all that apply.
|c.||hallucinations||f.||lack of motivation|
- Which of the following medications are considered atypical antipsychotics? Select all that apply.
- Your role as the community nurse caring for clients recently discharged from the hospital after treatment for schizophrenia would include which of the following? Select all that apply.
|a.||finding the client a job|
|b.||promoting social integration|
|c.||enrolling the client in school|
|d.||assisting the client in finding a date|
|e.||monitoring for medication compliance|
|f.||referring the client to possible employment services|
- Which nursing interventions will assist in improving a schizophrenic client’s ability to test reality? Select all that apply.
|a.||assess and support reality|
|b.||provide a stimulating environment|
|c.||administer neuroleptic medications|
|d.||avoid laughing and whispering in front of the client|
|e.||challenge validity of hallucinations and delusions|
|f.||use short, simple sentences when communicating with the client|
CHAPTER 15—THE CLIENT WITH A PERSONALITY DISORDER
- According to Hartman, what is the basis of adaptation?
- When working with clients with a diagnosis of one of the personality disorders, the nurse will find that once a personality trait is established, it is:
|a.||very easy to change||c.||extremely resistant to change|
|b.||impossible to change||d.||often exchanged for another trait|
- Personality disorders are found on which axis in the DSM-IV-TR?
- A nurse learns that the behaviors of people with personality disorders are described as ego syntonic. Which of the following statements best explains ego syntonic?
|a.||serving the ego in a maladaptive manner|
|b.||poorly mediating between the id and superego|
|c.||narcissistic to the point of having no empathy for anyone else|
|d.||comfortable for the individual but usually uncomfortable for others|
- A newly admitted client calls a nurse “honey.” Which of the following responses by the nurse would be best?
|a.||call the client “honey”|
|b.||tell the client to call you by your name|
|c.||ignore the client’s reference to “honey”|
|d.||distance yourself for awhile from the client|
- A fellow nurse complains about a client who has a diagnosed personality disorder, and has been admitted to the general hospital for surgery. Your peer states that the client is very difficult. You realize that, most likely, the behavior your fellow nurse is having difficulty with comes as a result of the client’s need for which of the following:
|b.||love and belonging||d.||order in the midst of chaos|
- The hospital unit you are working in has a client who has a diagnosis of personality disorder. The client tells the doctor that the nurses are not following the doctor’s orders. The client has most likely engaged in which of the following behaviors?
|a.||splitting||c.||truth at all costs|
- A client with borderline personality disorder tells the nurse, “You are the only one who wears gloves and washes your hands. The other nurses don’t wear gloves and most of them don’t wash their hands.” Your best action in this case is:
|a.||to report your peers to the nursing supervisor|
|b.||ask the client to report your peers to the nursing supervisor|
|c.||discuss this accusation with your peers in a group meeting|
|d.||thank the client and state you can do nothing about the other nurses|
- The most common personality disorder found in outpatient and inpatient populations is:
- Margaret Mahler delineated three major developmental stages. The first stage was:
- Mahler named the process in which the child internalizes the primary caregiver and maintains an image of the caregiver when absent which of the following terms?
|a.||absence presence||c.||mind person retention|
|b.||object conservancy||d.||libidinal object consistency|
- Melanie Klein provided a term for the unsuccessful or incomplete resolution of the task of integrating the primary caregiver as a model image. That term is:
|a.||object dysfunction||c.||faulty early object relations|
|b.||model disintegration||d.||image resolution failure|
- Kernberg emphasized that the basis for understanding psychological adaptability and integrity stems from which of the following experiences of an individual?
|b.||the birth experience|
|c.||peer relationships in adolescence|
|d.||relationship with primary caregivers|
- Bowlby looked at people seeking closeness during times of illness as which of the following types of behavior?
- A mother tells the nurse that she is trying to shape her 5-year-old child’s personality and asks the nurse when personality has its origin. The nurse’s response would be:
|a.||about 8 years old|
|b.||in the prenatal period|
|c.||sometime around age 2|
|d.||when the child starts to form sentences|
- When assigned to work with a client who has a personality disorder with aggressive and impulsive behavior, you review the theories of causation and find that these behaviors have been found to be associated with low levels of which of the following neurotransmitters?
- One biological theory of causation for antisocial personality disorder proposes that the person has a nervous system that is unresponsive and renders the person chronically underaroused. According to the theory, this underaroused individual will:
|a.||become aggressive, much like a caged tiger would|
|b.||tend to sleep much more than a person with normal arousal|
|c.||stay very calm under pressure and appear not to experience anxiety|
|d.||seek excitement and be excited during times others would be anxious|
- Which of the following situations is believed to increase the vulnerability of a baby to developing a personality disorder?
|a.||having babysitters during the first year|
|b.||an anxious mother with an anxious baby|
|c.||overfeeding or underfeeding as an infant|
|d.||a father who is seldom available to a baby|
- When assessing a newly admitted client who has a diagnosis of borderline personality disorder, the nurse will primarily need to assess which of the following?
|a.||spiritual beliefs and early religious training|
|b.||history of sexual abuse and childhood traumas|
|c.||quality of early childhood playmates and friendships|
|d.||first-degree relatives with borderline personality disorder|
- As a school nurse, you would expect to see adolescents with early faulty development using which of the following defense mechanisms?
|a.||repression and sublimation||c.||projection and denial|
|b.||rationalization and displacement||d.||reaction formation and undoing|
- A nurse assessing a 1-year-old baby looks for evidence of how well the child is nurtured. Evidence of being well nurtured in a 12-month-old child would consist of:
|a.||doubling the weight and height over the year’s time|
|b.||anecdotes of the mother about the child’s happiness|
|c.||clinging to a caregiver and refusal to let others interact with them|
|d.||happy expectations and an increased number and variety of emotional states|
- When working with a family where the parents are divorcing and the father gets custody of an infant or small child, the nurse will talk with the father about the type of child care provided while he is working, with the top priority being:
|a.||an appropriate substitute mother||c.||proximity to the home and work|
|b.||consistent enforcement of rules||d.||proportion of workers to children|
- Nurses will work with families of toddlers to do which of the following things, as the best developmental approach, when a toddler wanders off from the primary caregiver(s) in a room?
|a.||scold the child||c.||give encouragement|
|b.||read the child a book||d.||make the child sit in a chair|
- When working with a client with paranoid personality disorder, the nurse will find that the client most often resorts to which one of the following defense mechanisms?
- When you learn that you have been assigned to work with a client who has a diagnosis of antisocial personality disorder, you know immediately that your client is at least how many years old?
- Reviewing the record of a child with a diagnosis of conduct disorder, the nurse will most expect to find the essential feature of the disorder documented. This is a repetitive and persistent pattern of behavior that:
|a.||rebels against any parental type authority|
|b.||breaks school, municipal, county, or state laws|
|c.||violates the basic rights of others or major age-appropriate norms or rules|
|d.||is oppositional towards all persons in authority and towards peers to a lesser degree|
- When assigned to work with conduct-disordered youth, the nurse can expect the work to be:
|a.||stimulating and very enjoyable|
|b.||emotionally taxing and challenging|
|c.||mostly working with parents or caregivers|
|d.||easy compared to other personality disorders|
- The main key to working effectively with conduct-disordered youth is:
|a.||use of a reward system for any change in behavior|
|b.||frequent, relatively short sessions with the client(s)|
|c.||establishing rapport and trust with children and families|
|d.||setting firm limits from the first contact and throughout therapy|
- Which of the following factors plays the most crucial and major role in maladaptive behaviors of children and adolescents from the nursing care standpoint?
|a.||poor genetic inheritance|
|b.||dysfunctional family dynamics|
|c.||coming from a single parent home|
|d.||being on public financial assistance|
- When working with an adolescent with a diagnosis of conduct disorder, she calls you “stupid” when you will not agree to take her out for ice cream even though she has not earned this privilege. Your best response is which one of the following responses?
|a.||“It makes me feel unappreciated when you call me stupid.”|
|b.||“You are showing your own stupidity by calling me stupid.”|
|c.||“I will write out for you what you must do to earn ice cream privileges.”|
|d.||“If you don’t want to work with me, just say so and I will leave you alone.”|
- The child with a diagnosis of conduct disorder will benefit most from which of the following goals?
|a.||carry out all hygiene activities without prompting for at least 1 week|
|b.||identify at least one unacceptable behavior in self daily for at least 2 weeks|
|c.||write parents at least one three-page letter twice a week with minimal assistance|
|d.||demonstrate two ways of dealing with conflict and problems without using violence|
- A nurse working with children who have a diagnosis of oppositional defiant disorder and with other children who have a diagnosis of conduct disorder will notice that the main difference between the two is that children with a diagnosis of oppositional defiant disorder:
|a.||tend to come from higher socioeconomic and intelligent families|
|b.||lack self-centered manipulative behaviors seen in conduct disorder|
|c.||are more charming and tend to make friends with peers more easily|
|d.||do not use curse words and offensive language that is seen in conduct disorder|
- Oppositional defiant and conduct disorders co-occur with what proportion of children with attention deficit hyperactivity disorder?
- When working with a child who has a diagnosis of oppositional defiant disorder, the nurse primarily needs to assess the child throughout the period of treatment for which of the following?
|a.||increased level of resistance to the treatment regimen|
|b.||ambivalence and possible hatred toward the parents or caregivers|
|c.||signs of escalating illegal activities which might get the child into court|
|d.||symptoms of depression and level of risk directed at themselves or others|
- You are talking with an adolescent client who has just admitted to having suicidal thoughts. At this point, your best approach is to:
|a.||call the local community mental health clinic for assistance|
|b.||escort the client home and have a talk with the client’s primary caregivers|
|c.||have the adolescent client call the parents or primary caregivers and talk with them|
|d.||find out if the client has a plan, how lethal the method is, and whether there is immediate access|
- The school nurse has been working with an adolescent who has a diagnosis of a personality disorder and is admitted to a psychiatric facility for diagnostic purposes before entering a residential treatment facility. The nurse is aware that the overall aim of residential care is to:
|a.||provide a temporary model home for the adolescent|
|b.||give the parents time to think and change by themselves|
|c.||minimize acting-out behaviors and increase ego strength|
|d.||provide the client with sufficient time away from the parents|
- Which of the following drugs is given to children and adolescents with aggressive-hostile behaviors because it has fewer side effects?
|a.||lithium (Lithobid)||c.||chlorpromazine (Thorazine)|
|b.||haloperidol (Haldol)||d.||trifluoperazine (Stelazine)|
- While working with the family of a young adult who has antisocial behaviors, one of the parents asks the nurse if this behavior will get worse over time. The best answer by the nurse would be which of the following?
|a.||“The behaviors will probably stay about the same as they are now.”|
|b.||“Yes, it will definitely get worse due to the loss of brain cells over time.”|
|c.||“The literature on antisocial behaviors suggests that this behavior lessens with time.”|
|d.||“Some people get better and some get worse depending on the amount of treatment.”|
- A nurse is working with a client who has a diagnosis of paranoid personality disorder. Which of the following things must the nurse be most attentive to at all times?
|a.||offering choices||c.||nonverbal behaviors|
|b.||keeping her word||d.||confronting manipulative behavior|
- You are assigned to work with a client who has a diagnosis of paranoid personality disorder. You calmly approach this client while observing the client mainly for signs of:
|a.||trust and acceptance||c.||mood and major mood changes|
|b.||suspiciousness or fear||d.||increased agitation and aggression|
- While working with a client who has a diagnosis of paranoid personality disorder, the nurse sees the client begin to pace, speak loudly, and clench his jaw. The best approach by the nurse would be to:
|a.||direct the client to speak quieter, stop pacing, and to relax|
|b.||take the client outside to work off some extra energy and to tire herself|
|c.||speak softly and calmly and get the client to move to a quiet, yet observable, area|
|d.||continue working with the client, ignoring the observed behavior, but making a note of it|
- When assessing the client with a diagnosis of schizoid personality disorder, you will find a pervasive pattern of detachment from social relationships and, additionally, which of the following?
|a.||extreme anger when sufficiently provoked by others|
|b.||a restricted range of emotional expression with others|
|c.||seeking approval from no more than two other persons|
|d.||more than the average interest in sexual activity with strangers|
- A nurse is preparing to teach health to a group of clients who have personality disorders. The nurse realizes that the client with a diagnosis of histrionic personality disorder will most likely need some direction, or redirection, for exhibiting which of the following typical behaviors during the session?
|a.||hiding in the group and acting as if hoping not to be called on to speak|
|b.||restlessness and difficulty sitting still, difficulty being quiet, and inattentive|
|c.||acting as if the group rules are for others and as if she is more important than others|
|d.||attempting to be the center of attention, being sexually suggestive, and being dramatic|
- You admit a new client to the unit and, upon initial assessment, find the client’s remarks to reveal a grandiose sense of self-importance. The client is preoccupied with ideas of making it big in the stock market and being highly successful because of her power. The client seems to have little or no empathy for others and has a sense of entitlement, immediately indicating that the rules are for other people. The behaviors you have identified are characteristics of which of the following personality disorders?
- When working in an outpatient clinic with a client who has a diagnosis of avoidant personality disorder, the nurse would work on developing a trusting relationship and, in addition, which of the following as a priority with this client?
|a.||teach relaxation techniques|
|b.||teach communication skills|
|c.||explore early childhood experiences|
|d.||assign the client to initiate one-on-one interactions|
- You are assigned to a client with schizotypal personality disorder. Your assessment would most likely reveal which of the following behaviors?
|a.||seeks attention and engages in erratic behavior|
|b.||withdrawn and engages in odd, eccentric behavior|
|c.||overtly psychotic and experiencing hallucinations and delusions|
|d.||active participation in activities with other clients and staff|
- You visit an elderly client currently living in a senior facility. The client says to you, “I feel like a failure. My life has been a waste because I never really accomplished anything.” You assess that your client is experiencing:
- A client tells the nurse, “I have to find a new apartment and I don’t know where to go.” An initial therapeutic response would be:
|a.||“You don’t know where to go.”|
|b.||“Why do you need to find a new apartment?”|
|c.||“You should ask one of your relatives if you could stay with them.”|
|d.||“If you cannot find a place, you can stay with me a few days.”|
- A new nursing graduate is assigned to a unit where many of the clients have been diagnosed with personality disorders. A priority for this nurse would be to:
|a.||attend several hospital-sponsored in-service programs on psychiatric disorders|
|b.||determining whether the facility is paying her enough to work with these clients|
|c.||examine her own feelings about caring for individuals with personality disorders|
|d.||join a major nursing organization such as the American Psychiatric Nurses Association|
- A major nursing goal when caring for a client with obsessive-compulsive personality disorder is:
|a.||decreasing maladaptive behaviors|
|b.||ignoring client’s compulsive behaviors|
|c.||increasing client’s dependence on the staff|
|d.||informing the client that compulsive behaviors are distasteful|
- The nurse interested in conducting research on personality disorders should know that since the publication of the DSM-IV-TR the growth of literature reporting studies on personality disorders is:
|a.||increasing||c.||about the same|
- The nurse working with the parents of a child diagnosed with oppositional defiant behavior would encourage the parents to:
|a.||avoid the use of negative reinforcing behaviors|
|b.||understand that nothing can be done to address the child’s illness.|
|c.||allow the child more privileges than other siblings since the client’s needs are greater|
|d.||make an appointment with the school to discuss why the mother is the cause of the child’s illness|
- A nursing instructor wants to evaluate whether a student knows the difference between schizotypal personality and schizophrenia. Which response by the student would indicate that the student understands?
|a.||“The schizophrenic will have less personality disorganization.”|
|b.||“There basically isn’t any difference between the two disorders.”|
|c.||“The person with schizotypal personality will have stronger interpersonal relationships.”|
|d.||“The person with schizophrenia experiences psychosis, but the person with schizotypal personality does not.”|
- A nurse who is planning activities for a group of adolescents recognizes that the adolescents are in a transition to adulthood. Which of the following activities promote development of adult behaviors? Select all that apply.
|a.||attending a play at the local theater|
|b.||playing ping-pong with a staff member|
|c.||going to the local bowling alley to bowl|
|d.||preparing for a picnic for clients and staff|
|e.||watching an episode of the television show Growing Pains|
|f.||participation on a planning committee for a unit birthday party|
- Which of the following behaviors would most likely be revealed when the nurse interviews the parents of a client with oppositional defiant disorder? Select all that apply.
|a.||frequent use of profanity|
|b.||difficulty controlling temper|
|c.||frequent arguing with parents|
|d.||caring attitude and supportive of others|
|e.||popular with classmates and teacher|
|f.||refusal to do chores and homework|
CHAPTER 16—THE CLIENT WITH DELIRIUM, DEMENTIA, AMNESTIC, AND OTHER COGNITIVE DISORDERS
- One of your assigned adult clients is diagnosed with a cognitive disorder. From your review in preparation for caring for this client, you realize that this client has a clinically significant:
|a.||thought disorder that may have begun years ago, perhaps as early as preschool|
|b.||loss of neuronal functioning which can affect voluntary muscles as well as memory|
|c.||deficit in memory which is a significant change from a previous level of functioning|
|d.||loss of judgment and ability to work complex math, language, and science problems|
- The family of one of your older clients is interested in what normally happens to brain cells as people age. Your best answer would be that, after age 50, the brain cells:
|a.||lose their capacity to transmit rapidly and there is a loss of many cognitive abilities|
|b.||die at a rapidly increasing rate which is not overcome by the rate of replacement|
|c.||shrink somewhat due to the progressive loss of the percentage of water in the body with aging|
|d.||die at a rate of 1% per year which may slow transmission but does not measurably affect cognition|
- A normal, healthy, older adult has been coming to the same clinic for 30 years. In reviewing the record, and from assessing this older adult, the nurse will expect to find which of the following changes compared to the early assessments?
|b.||decrease in reaction time|
|c.||increase in intelligence and wisdom|
|d.||better short-term and long-term memory|
- The advanced practice nurse is working with an older client who presents with “confusion.” This nurse is aware that, before prescribing or helping clients manage their medications, he must as a top priority:
|a.||assess the client’s ability to pay for the medications and to obtain them|
|b.||develop a plan to make certain that the client gets the medication on a regular basis|
|c.||explain the importance of all medications prescribed to the client’s family members|
|d.||assess fat to lean body mass, water balance, and changes in liver and kidney function|
- The most common, potentially irreversible organic syndrome that the nurse will encounter in practice is:
- A nurse hears the term “excess disability” used in regard to one of the nurse’s assigned clients. After reviewing the textbook in preparation for caring for this client, the nurse knows that “excess disability” is best defined as:
|a.||two or more probable irreversible dementias|
|b.||disability which causes the client to lose hope|
|c.||more disability than the client can deal with using familiar coping mechanisms|
|d.||a potentially reversible dementia superimposed on a probable irreversible dementia|
- When caring for a client, the nurse finds that the client has a disturbance of consciousness and has had a change in cognition. Which of the following findings would be necessary for this client to meet the diagnostic criteria for delirium?
|a.||rapid onset over hours to days|
|b.||has been present for a month or more|
|c.||symptoms remain constant and do not fluctuate|
|d.||unrelated to consequences of a general medical condition|
- While delirium can occur at any age, the nurse is aware that it is especially common in clients over age 60 and in which of the following age groups?
- When caring for clients in the hospital, long-term care facility, or other settings, a nurse finds a client who is having difficulty remembering, a short attention span, excessive sensitivity to light and sound, drowsiness, anxiety, disproportionate fatigue, and vivid dreams. This client is exhibiting which of the following types of signs and symptoms of dementia?
- When a nurse first detects some of the signs or symptoms of delirium in a client, the nurse will first:
|a.||take vital signs and assess for physiological problems|
|b.||have a discussion with the nursing supervisor about what to do|
|c.||call the physician immediately to report the signs and symptoms of delirium|
|d.||check with other caregivers to see if the client has had these symptoms many times before|
- You are admitting a client to the surgical unit. You overhear the client’s friends talking about the considerable amount of alcoholic beverage consumed daily by your client. Which of the following actions is your top priority?
|a.||notifying the client’s physician of what you have learned|
|b.||verifying the amount of alcohol consumed with the client|
|c.||letting the friends know they cannot bring alcohol to the hospital|
|d.||advising the client that there is to be no alcohol while in the hospital|
- An older client comes to the clinic presenting headaches. The client is certain this is due to a brain tumor. While keeping an open mind, you realize that primary brain tumors are less common in the older adult with the exception of:
- The nurse is particularly careful to protect older clients from developing a subarachnoid or subdural hematoma resulting from falls. Which of the following statements represents the primary reason why older clients are more susceptible to developing subarachnoid or subdural hematoma?
|a.||blood flow is slowed through the brain as a person ages|
|b.||the blood vessels of the brain become weakened with advancing age|
|c.||as a person ages, the blood becomes thicker due to less water retention|
|d.||cerebral atrophy allows the brain to bounce around against its bony cage|
- What is usually the longest time period over which a subdural hematoma may develop?
|a.||2 days||c.||2 weeks|
|b.||4 days||d.||3 months|
- The school nurse is leading a discussion group about mental retardation. The nurse mentions that the cause is often unknown but that causes of mental retardation are most often grouped into which two main factors?
|a.||heredity and acquired||c.||reversible and irreversible|
|b.||permanent and temporary||d.||nutritional and nonnutritional|
- The most common form of dementia in adults that will be seen by nurses in their practices is associated with which of the following disorders or problems?
- You are assigned to work with a client who has just had his intelligence measured by a trained psychologist using a standardized test. The client’s intelligence quotient (IQ) was measured as 100. You are aware that an IQ of 100 represents:
|a.||an average IQ||c.||a considerably above-average IQ|
|b.||a slightly below-average IQ||d.||a considerably below-average IQ|
- You are assigned to work with a client who is diagnosed as moderately retarded. After researching information on mental retardation, you realize that this client’s intelligence quotient (IQ) most likely falls into which of the following ranges?
- When a nurse speaks to a group of expectant mothers, one of the mothers asks, “What can expectant mothers do that would prevent most of the cases of mental retardation in newborns?” The nurse’s best answer would be which of the following?
|a.||eat balanced meals||c.||abstain from alcohol|
|b.||rest during the day||d.||avoid being in a crowd|
- When reviewing the chart of an adult client who has a diagnosis of mental retardation and after interviewing the family, you would most likely expect to find which of the following pieces of information related to your client’s history of mental retardation?
|a.||problems during the first trimester|
|b.||onset of mental retardation before age 18|
|c.||little or no impairment in adaptive functioning|
|d.||a history of physical or sexual abuse before age 6|
- Which of the following statements would be best for a nurse to use in teaching about epilepsy?
|a.||epilepsy involves the decreased discharging of groups of brain cells|
|b.||it is a group of symptoms that have different causes in different individuals|
|c.||there is a loss of consciousness after stiffening of muscle groups in the body|
|d.||it is a disease in which there is a slow sporadic and transient disturbances of mental function|
- You have just observed one of your assigned clients going through the various stages of a grand mal seizure. One phase you observed involved the head and neck being thrown back with the back arched and the extremities in maximum extension. When charting this phase, you will describe what you saw and can refer to it as which of the following stages?
- When observing and later describing the phases of a grand mal seizure, you are aware that the clonic phase ends when the:
|a.||body stiffening begins|
|b.||jerking of muscle groups begins|
|c.||muscle groups stop their stiffening|
|d.||client appears to be in a deep coma|
- The family of one of your assigned clients who has been found to have epileptic disturbances of the frontal lobe describes the client periodically wandering as if in a fugue state. This type of behavior is most likely associated with:
|a.||petit mal epilepsy|
|c.||anxiety associated with epileptic seizures|
|d.||the post-ictal stage of grand mal seizures|
- The school nurse discussing epilepsy and the various types of seizures will talk with teachers about petit mal seizures. Which of the following statements could the nurse present as true?
|a.||“There are actually three known types of petit mal seizures.”|
|b.||“The child will not lose consciousness during a petit mal seizure.”|
|c.||“Children will lose bladder and/or bowel control with this seizure.”|
|d.||“Children always recall this type of seizure and are often embarrassed.”|
- The nurse working with a client who has a diagnosis of Alzheimer’s disease is aware that the average course of the disease is how many years?
- Which of the following biochemical abnormalities was found to be associated with Alzheimer’s disease in the mid 1970s?
|a.||a decrease in dopamine in the area of the amygdala|
|b.||dysregulation in the hypothalamic-pituitary-adrenal axis|
|c.||an increase in glucose in frontal lobe areas of the brain and the spinal column|
|d.||reduced choline acetyltransferase (CAT) in the hippocampus and cerebral cortex|
- A nurse reviewing the research literature on Alzheimer’s disease (AD) will find that in late-onset AD, research findings have:
|a.||been controversial and not conclusive|
|b.||not revealed any chromosomal abnormalities|
|c.||revealed a genetic abnormality in chromosome 19|
|d.||found genetic abnormalities in chromosomes 1 and 21|
- You are assessing a client who has stage 2 of Alzheimer’s disease. Which of the following findings would you most likely expect to find in stage 2?
|a.||loss of long-term memory|
|b.||frequent use of confabulation|
|c.||lack of awareness of deficits|
|d.||oriented to person, place, and thing but not to time|
- When working with a client who is in stage 4 of Alzheimer’s disease, using a four-stage description of symptoms, the nurse will primarily need to write and carry out which of the following interventions?
|a.||provide socialization activities with the family|
|b.||thicken liquids and feed the client at mealtime|
|c.||reorient the client to person, place, time, and things|
|d.||assist the client in carrying out activities of daily living|
- The earliest drug used to slow the progression of Alzheimer’s disease was tacrine (Cognex, THA) which is not used as much as newer drugs mainly because of which of the following reasons?
|a.||Tacrine was very expensive.|
|b.||It did not reduce symptoms.|
|c.||Side effects included gastrointestinal and liver abnormalities.|
|d.||It required frequent lab tests for a variety of blood dyscrasias.|
- An advanced practice nurse is asked for advice on how to best help clients on the Alzheimer’s unit who have night awakening, purposeful wandering, agitation, and panic at times. The current practice is to restrict the clients from napping during the day. The advanced practice nurse, using Hall’s model, will most likely use several interventions including:
|a.||continue prohibition of daytime naps|
|b.||keep the client up until at least 11 p.m.|
|c.||provide activities that will tire the client more|
|d.||avoid fatiguing and over-stimulating the client|
- When assigned to work with a client who is suffering from Pick’s disease or other frontal lobe syndromes, the biggest concern of the nurse is:
|a.||allowing the client to maintain a sense of control|
|b.||getting enough nutrition into a client who forgets to eat|
|c.||maintaining safety of the client and those around the client|
|d.||providing a sense of being loved and belonging somewhere|
- The best way to reduce the need for one-to-one supervision for clients with a diagnosis of frontal lobe syndrome is to:
|a.||secure the client in a wheelchair or stationary chair most of the day|
|b.||allow the client to wander freely without any interruptions, if at all possible|
|c.||provide a series of nonstop activities during the day to keep the client distracted|
|d.||provide a structured, calm, low-stimulus environment with few day-to-day changes|
- A client is found to be unable to perceive a common scene as a whole. While understanding bits and pieces of the environment, the client cannot comprehend “the big picture.” This client has which of the following syndromes?
|a.||visual agnosia||c.||field disturbance|
- In a classic case documented by Sacks in 1984, a professor mistook his wife’s hand for a hat. The professor was suffering from:
- When working with a client who has visual agnosia, the caregivers can best help the client by doing which of the following things?
|a.||introducing oneself frequently||c.||using a reminder blackboard|
|b.||wearing a name tag all of the time||d.||consistently wearing a colorful hat|
- When you serve a meal to a client with visual agnosia, you most need to:
|a.||let the client feed himself||c.||completely feed the client|
|b.||supervise and assist the client||d.||thicken all liquids for the client|
- Clients with corticobasal ganglionic degeneration (CBGD) who have contracted hands have been treated with which of the following to relax the contractures?
|b.||Gamma globulin||d.||cortisone injections|
- When working with a client who has a bitemporal syndrome, the nurse must foremost realize that this client has:
|a.||the ability to function independently with minimal supervision|
|b.||little or no recall of the passage of time and what has occurred recently|
|c.||good short-term memory and can be relied on for information about activities|
|d.||increased aggression and needs one-on-one supervision to prevent injury to others|
- The client with diffuse Lewy body variant (DLBV) will have symptoms that are often mistaken for:
|c.||Alzheimer’s disease with Parkinsonian features|
|d.||schizotypal progressing to paranoid schizophrenia|
- When assessing a client with a diagnosis of Huntington’s disease (HD) in the later stages with severe cognitive defects, you will also most likely find which of the following classic symptoms?
- Which of the following characteristic symptoms of Creutzfeldt-Jakob disease (CJD) would you expect to see when bathing a client, and especially if you accidentally create a loud noise by knocking something off the bedside stand?
- The course of Creutzfeldt-Jakob disease is:
|a.||one of remissions and exacerbations over years|
|b.||mild and, generally, chronic over a normal lifetime|
|c.||a short course with death often occurring within 2 years|
|d.||varied, with some people having a mild course and others a severe course|
- A nurse is presenting an educational talk on AIDS. Which of the following statements can the nurse present as true about AIDS dementia complex?
|a.||“There are no early symptoms of AIDS dementia complex.”|
|b.||“AIDS dementia complex is often misdiagnosed as epilepsy.”|
|c.||“Before clinical symptoms occur, cerebral atrophy may be seen on the CT scan.”|
|d.||“Behavioral changes are generally responsive to an antidepressant medication.”|
- Alzheimer’s disease has distinctive brain lesions without any known physiologic basis. Because there is no known physiologic basis, Alzheimer’s disease is considered which of the following?
|a.||primary dementia||c.||tertiary dementia|
|b.||secondary dementia||d.||generalized dementia|
- Which intervention would have the highest priority for a client with delirium?
|a.||maintaining client safety|
|b.||providing nutritional substitutes|
|c.||providing adequate rest periods|
|d.||orienting client to time, place, and person.|
- An elderly client in stage II of Alzheimer’s disease was found wandering on the hospital grounds. Which of the following nursing diagnoses would be a priority to address this behavior?
|a.||wandering related to Alzheimer’s disease|
|b.||acute confusion related to unfamiliar surroundings|
|c.||impaired motor coordination related to aging process|
|d.||risk for injury related to impaired judgment and cognitive deficits|
- The nurse admits a client in an acute episode of delirium. Which of the following is an appropriate outcome for this client? Client will:
|a.||experience no more than two nightmares each night|
|b.||drink two glasses of warm milk and exercise before going to bed each night|
|c.||have decreased confusion as evidenced by orientation to person, place, and time|
|d.||develop a close personal relationship with one staff member before being discharged|
- You are assigned to an elderly client experiencing dementia. Which of the following nursing interventions will you plan to improve the client’s level of orientation?
|a.||Provide the client with a clock and a calendar for the room|
|b.||Speak loudly and rapidly to the client when giving instructions|
|c.||Turn on a television so the client can watch the soap operas|
|d.||Assign the client to a room with another client in end-stage Alzheimer’s disease|
- A nursing student asks her instructor “What is the major difference between dementia and delirium?” Which response by the instructor is correct?
|a.||“Dementia has a fast onset and the prognosis is good.”|
|b.||“Dementia has a slow onset and the prognosis is poor.”|
|c.||“Delirium has a slow onset and the prognosis good.”|
|d.||“Delirium has a fast onset and the prognosis is poor.”|
- Which of the following diseases can cause dementia? Select all that apply.
|a.||Pick’s disease||d.||Huntington’s disease|
|b.||Crohn’s disease||e.||Alzheimer’s disease|
|c.||Parkinson’s disease||f.||Creutzfeldt-Jakob disease|
- The physician informs the family of a client with dementia that the plan is to place the client on a medication to slow the progress of the dementia for 2 to 4 months. The nurse knows the client will most likely be placed on which of the following medications? Select all that apply.
|a.||tacrine (Cognex)||d.||donepezil (Aricept)|
|b.||phenytoin (Dilantin)||e.||rivastigmine (Exelon)|
|c.||haloperidol (Haldol)||f.||galantamine (Reminyl)|
- The nurse is assessing a client in stage III of Alzheimer’s disease. The assessment would most likely reveal which of the following symptoms? Select all that apply.
- The nursing care plan for a client with dementia would include strategies to address which of the following? Select all that apply.
|c.||peaceful vivid dreams|
|d.||sensitivity to light and sound|
|e.||complaints of memory loss|
|f.||bradycardia and low blood pressure|
CHAPTER 17—THE CLIENT WITH ATTENTION-DEFICIT DISORDER
- When the school nurse talks with parents about attention-deficit hyperactivity disorder (ADHD), the nurse will share that the incidence of occurrence in males:
|a.||is equal to that in females||c.||is double that of females|
|b.||falls below that of females||d.||exceeds females by a 4 to 1 ratio|
- Symptoms of attention-deficit hyperactivity disorder are usually first noticed by parents and nurses at which of the following times?
- While teaching parents about attention-deficit hyperactivity disorder (ADHD), the nurse gets a question from a parent. “What causes attention-deficit hyperactivity disorder?” The nurse will respond that the most common identifiable factor in children who develop ADHD is:
|b.||birth trauma||d.||exposure to lead|
- A nurse reporting to peers about some of the latest research conducted at the Child Psychiatry Branch of the National Institute of Mental Health on attention deficit hyperactivity disorder (ADHD) will relate that recent studies involving positron emission tomography (PET) and functional MRIs have found which of the following in their studies of the brains of clients with ADHD?
|a.||slightly smaller size of the brain itself and a reduced overall surface area|
|b.||areas of the brain with increased sensitivity for a variety of the neurotransmitters|
|c.||cool areas within the frontal lobe of the brain indicating reduced electrical activity|
|d.||structural and functional differences in frontal lobes, basal ganglia, and the cerebellum|
- In the 1970s, there was a major shift in the focus of research, diagnosis, and treatment for attention deficit hyperactivity disorder. The shift was from a focus on the core problem being excessive activity to a core problem of:
- When reviewing the history of a child with attention-deficit hyperactivity disorder, the nurse will find that the child, in order to meet the DSM-IV-TR criteria for this diagnosis, must have had some hyperactive-impulsive or inattention symptoms causing impairment before which of the following ages?
- The nurse is reviewing the chart of a child and finds that the Conners’ Parent-Teacher Rating Scale has been completed. The nurse is aware that this scale measures:
|a.||inattention, impulsivity, and hyperactivity|
|b.||the child’s response to negative reinforcement|
|c.||the amount of time to complete specific tasks|
|d.||ability to delay gratification and emotional responses|
- A nurse working with parents of children with attention-deficit hyperactivity disorder will most need to stress that the child will:
|a.||often avoid activities that require concentration|
|b.||have poor personal boundaries and are intrusive|
|c.||often lose the tools or assignments for homework|
|d.||respond positively to rewards and not to punishment|
- Adults with attention-deficit hyperactivity disorder will often present with which of the following complaints?
|a.||difficulty sitting still||c.||sleep disturbances|
|b.||interpersonal problems||d.||inability to be organized|
- The goals of treatment when working with a client who has a diagnosis of attention-deficit hyperactivity disorder are:
|a.||medication compliance in the 95% to 100% range|
|b.||reduction of disruptive symptoms and improvement in relationships|
|c.||cessation of hyperactivity and increased attention span to a normal level|
|d.||insight into the causes and treatment of attention-deficit hyperactivity disorder|
- When first implementing treatment with a child with ADHD, which of the following would be the best initial goal of treatment?
|a.||get all homework in on time||c.||complete an assignment correctly|
|b.||increase total work completed||d.||no incidences of interrupting others|
- The school nurse is working with the school psychologist, the teacher, and parents to set up a token reward system for the child with ADHD. This system will work best if implemented:
|a.||only at school and for school-related activities that are carried out at home|
|b.||across multiple settings addressing areas of functioning specific to the setting|
|c.||by one caregiver who is able to be consistent and firm in extinguishing behaviors|
|d.||by a teacher who has had special behavior modification training by a school psychologist|
- The school nurse working with an adolescent who has a diagnosis of attention-deficit hyperactivity disorder will most likely suggest which of the following strategies to the parents?
|a.||talk with the child about undesired behaviors and repeat this frequently|
|b.||stop undesirable behavior immediately with severe consequences for the behavior|
|c.||decide what behaviors you want from your teenager and put them in a written plan|
|d.||allow teen responsibility and involvement in developing a behavior management plan|
- You are working with a 6-year-old child who is diagnosed with attention-deficit hyperactivity disorder (ADHD) who tends to do things like climbing to great heights and running away from caregivers in the store. Which of the following nursing diagnoses would most likely be the top priority for this child?
|a.||potential for injury related to impulsivity|
|b.||alteration in attention process, etiology unknown|
|c.||alteration in motor activity, overactive, etiology unknown|
|d.||potential for alterations in nutrition, less than body requirements related to excess motor activity|
- When working with children and adolescents who have a diagnosis of attention-deficit hyperactivity disorder (ADHD) and their parents, which of the following interventions would be most helpful to the clients?
|a.||family therapy||c.||psychoeducation groups|
|b.||Insight-oriented groups||d.||individual psychotherapy|
- The school nurse is teaching psychosocial interventions to parents and teachers working with children who have attention-deficit hyperactivity disorder (ADHD). The nurse will most likely teach the parents and teachers to do which of the following things?
|a.||ignore mildly inappropriate behavior and praise positive behaviors|
|b.||be firm and stop even the smallest deviation from expected behaviors|
|c.||have the child write down all the things they are not to do and all the consequences|
|d.||put all consequences for bad behavior in writing and post it where the child can see it|
- An advanced practice nurse working with a child who is diagnosed with attention-deficit hyperactivity disorder must most do which of the following things before prescribing a medication?
|a.||check the price of the drug|
|b.||identify any existing comorbid conditions|
|c.||look up the medication in a current drug book|
|d.||find out if the school nurse will help administer the medication|
- The advanced practice nurse will reserve which of the following medications for use only when first-line medications have failed?
- The advanced practice nurse has prescribed a psychostimulant for a child with a diagnosis of attention-deficit hyperactivity disorder. The child begins to have eye blinking, shoulder shrugging, and is making a barking noise. The parents ask the nurse to explain these new behaviors. The best answer by the nurse would be which one of the following?
|a.||“Psychostimulant medication can unmask, but not cause, tics.”|
|b.||“Your child is under a lot of stress which is causing these tics.”|
|c.||“It is a coincidence that your child has developed tics at this time.”|
|d.||“While the medication does cause tics initially, they will go away soon.”|
- The nurse will educate the parents about the side effects of psychostimulants when prescribed for their child. The nurse will tell the parents that the most common side effects are difficulty sleeping, headache, and which one of the following?
|a.||constipation||c.||reduction in appetite|
|b.||blurred vision||d.||vocal and facial tics|
- The advanced practice nurse will do which of the following things before starting a child with a diagnosis of attention-deficit hyperactivity disorder on a course of pemoline (Cylert)?
|a.||get an EEG reading|
|b.||get an EKG reading|
|c.||make certain that kidney function is normal|
|d.||make certain that hepatic function is normal|
- A child with a diagnosis of attention-deficit hyperactivity disorder is started on a course of clonidine. This medication will help with which of the following problems?
|a.||inattention and dissociating at times|
|b.||tic disorders, aggression, and impulsivity|
|c.||associated mood disturbances and anxiety|
|d.||focusing, concentration, and sleep disorders|
- When working with parents who are administering psychostimulants to a child, the nurse will suggest the best time to give the medication is:
|a.||before meals||c.||after the supper snack|
|b.||after breakfast or lunch||d.||at bedtime|
- When working with a teacher to develop strategies for helping a child with attention-deficit hyperactivity disorder, the school nurse will endorse or suggest which of the following strategies?
|a.||let the child know what behavior is not desired|
|b.||give the child all the instructions for a complex task|
|c.||provide an inconsistent routine with stimulating diversity|
|d.||tape cue cards with important reminders to the child’s desk|
- The nurse caring for an adolescent with ADHD plans to teach the client various methods to promote health. Which of the following would be a priority area to include in the teaching plan?
|a.||study skills||c.||sexual behavior|
|b.||substance abuse||d.||relaxation techniques|
- The nurse is planning nursing interventions that will address inattention problems experienced by children with ADHD. An effective nursing intervention would be to teach the children to:
|a.||repeat what they have heard|
|b.||set limits on their behavior|
|c.||cooperate with other children|
|d.||expect rewards after accomplishments|
- You are caring for a client diagnosed with ADHD. You conduct a mental status exam for which of the following reasons?
|a.||It is hospital policy and required by all accrediting agencies.|
|b.||It assists the nurse in practicing skills of assessment and care planning.|
|c.||It provides a means for identifying family strengths and areas needing improvement in family dynamics.|
|d.||It provides data about the client’s current mental health, judgments, cognitive function, thought process, impulse control, insight, and strengths.|
- Nursing interventions for a child with ADHD would include which of the following? Select all that apply.
|a.||limit setting on behavior|
|b.||provide reduced caloric diet|
|c.||provide for a consistent routine|
|d.||use restraints to reduce impulsive behavior|
|e.||encourage family involvement in care|
|f.||provide reinforcement for positive behaviors|
- Baseline assessment of ADHD would include which of the following? Select all that apply.
|a.||CBC||d.||height and weight|
|c.||EEG||f.||behavioral assessment scale|
- The nurse is developing a plan of care for a child with ADHD. Which of the following drugs is considered a psychostimulant that would possibly be administered? Select all that apply.
- Which nursing diagnoses are appropriate for a client with ADHD?
|c.||disturbed sleep pattern|
|d.||impaired social interaction|
|e.||risk for injury related to impulsivity|
|f.||imbalanced nutrition: less than body requirements|
- Adults with ADHD would demonstrate which of the following? Select all that apply.
|b.||high frustration tolerance|
|c.||forgetfulness, frequently loses things|
|d.||well organized with good planning skills|
|e.||highly developed time management skills|
|f.||difficulty initiating or completing projects|
- The nursing assessment of a child with attention-deficit hyperactivity disorder (ADHD) would most likely reveal which of the following characteristic behaviors? Select all that apply.
|c.||hyperactivity||f.||difficulties with gratifications|
- The nurse caring for clients with attention-deficit hyperactivity disorder (ADHD) understands that which of the following can cause the disorder? Select all that apply.
|f.||fetal exposure to alcohol and drugs|
CHAPTER 18—THE CLIENT WITH A DISSOCIATIVE DISORDER
- According to Sullivan, dissociation is:
|a.||an anecdote for hopelessness|
|b.||an anxiety-reducing mechanism|
|c.||withdrawing from other people|
|d.||a way to escape extreme boredom|
- Janet postulated that traumatic events are stored in the memory in which of the following ways?
|a.||similar to normal events|
|b.||embedded through many synapses|
|c.||differently from normal events|
|d.||concurrently with sensory stimuli|
- The core conflict in a person experiencing trauma is the wish to deny the experience while at the same time wishing to:
|a.||enjoy and celebrate it||c.||cling to the experience|
|b.||proclaim it to everybody||d.||intensify the experience|
- The school nurse is asked by a teacher to explain the major difference between a student’s spacing out in class and a pathological dissociation. The best answer by the school nurse would be:
|a.||“Spacing out is a temporary interlude in life, whereas dissociation lasts a lifetime.”|
|b.||“Pathological dissociation is involuntary, while spacing out is a voluntary experience.”|
|c.||“In pathological dissociation the self is disconnected from the experience, while in spacing out the self is not lost.”|
|d.||“People who space out manage their own lives far better than those who dissociate.”|
- When assessing persons who have dissociative identity disorder, the nurse keeps in mind that the vast majority of persons with this disorder will reveal which of the following occurrences in their childhood?
|a.||child abuse||c.||loss of a parent|
|b.||major illness||d.||suicide of a relative|
- Dissociative disorders are prevalent in which of the following places?
|a.||in larger cities||c.||mainly in North America|
|b.||around the world||d.||mostly in the poverty areas|
- According to Sullivan’s theory of personality development, experiences that elicit disapproval from others and result in a high degree of anxiety for a person constitute what Sullivan referred to as:
|a.||the “bad-me”||c.||the “other me”|
|b.||the injured self||d.||the dissociated self|
- Experiences that are extremely overwhelming to a child and elicit little or no soothing from others are part of the self that is kept in the unconscious according to Sullivan’s theory of personality development. Sullivan called this aspect of the self:
|a.||“not-me”||c.||“the bad child”|
|b.||“other me”||d.||“the lost child”|
- A nurse is working with a client who was abused by her father as a child. She dissociated the abuse experience and her feelings about it in order to survive psychologically and physically. The nurse is aware that this client will likely do which of the following things when she is angry?
|a.||destroy the property of others|
|b.||self-mutilate and dissociate|
|c.||be verbally abusive and aggressive|
|d.||hurt anyone around her physically|
- The nurse working with a dissociating client needs to keep in mind that limit setting or confrontation will cause the client to perceive the nurse in which of the following roles?
- You are assigned to work with a client with a dissociative disorder that presents with a number of somatic complaints. Which of the following will be your top priority?
|a.||assess the client’s physical status|
|b.||find out about the dissociative symptoms|
|c.||get a history of any psychiatric treatment|
|d.||determine which medications the client is taking|
- The nurse needs to be aware that clients often perceive nurses’ attention to their physical complaints to be:
|a.||uncomfortable||c.||a trigger for dissociation|
|b.||helpful and soothing||d.||unnecessary and unnatural|
- When working with an adolescent who has been abused physically and sexually, the nurse learns that the other parent was not comforting and was, in fact, unavailable and distant. The client describes having felt all alone and helpless. The nurse at this point will begin to suspect that the victim has:
|a.||homicidal thoughts||c.||attached to the abuser|
|b.||planned to run away||d.||detached from the family|
- In working with a client who has been abused as a child, the nurse will realize that when the client is in any relationship that signals danger, the client will display which of the following behaviors?
|a.||sexual acting out, lack of insight, poor judgment|
|b.||attachment alternated with distancing (self-mutilation and dissociation)|
|c.||anger and aggression toward others, particularly against those who are close|
|d.||attempts to hold onto the relationship at any cost regardless of personal harm|
- When a client who has been abused recreates old family patterns or threatens or is self-destructive, and the nurse experiences one’s self as a victim or a powerless bystander, which of the following actions would be best on the part of the nurse?
|a.||seek help from someone qualified in the supervision of therapy|
|b.||tell the client what they are doing and ask them to stop it immediately|
|c.||advise the client that you are not helping them and suggest a new therapist|
|d.||assist the client in identifying present needs and thinking about how to get them met|
- When working with children, nurses will often encounter a child who has an imaginary companion. Having an imaginary companion exemplifies what Putnam termed:
|a.||the fantasy childhood||c.||normative dissociation|
|b.||quasi-normal behavior||d.||predissociative behavior|
- Having an imaginary playmate should not be considered pathological unless it:
|a.||is carried into adolescence||c.||lasts more than 2 years|
|b.||is associated with child abuse||d.||interferes with parental bonding|
- The nurse working with children who have a dissociative disorder will find that these children most often have difficulties at school mainly because of which one of the following problems?
|a.||aggression toward other children|
|b.||forgetting homework and test responses|
|c.||difficulties sitting in their assigned seats|
|d.||taking too many sick days and staying home|
- When working with an adolescent who has a diagnosis of dissociative disorder and who is acting out sexually and doing self-mutilation at times, the nurse instructs the adolescent to journal. In this instance, the major purpose of journaling is to:
|a.||help with memory lapses||c.||provide insight into past abuses|
|b.||keep the client goal directed||d.||decrease the acting out of feelings|
- An adolescent client with a diagnosis of dissociative disorder is doing some greatly increased switching between alters. The nurse is aware that this most likely means the client is:
|a.||being pushed too hard in therapy and the therapist needs to slow the pace|
|b.||losing control over the various alters, some of which are vying for control|
|c.||getting prepared and ready to integrate all the alters into one integrated personality|
|d.||experiencing some environmental or interpersonal triggers similar to the past trauma|
- The person with dissociative amnesia will have the inability to recall which of the following things?
|a.||events in the immediate past|
|b.||significant personal information|
|c.||information about significant others|
|d.||skills such as balancing a checkbook|
- When the nurse encounters a person who has dissociative fugue, the nurse will find that this person has had a sudden, unexpected:
|a.||development and the appearance of a new alter|
|b.||feeling of being detached and floating in the air|
|c.||change to a completely new personality, new life, and new identity|
|d.||travel from the usual environment with some loss of recall of the past|
- When assessing a client with dissociative identity disorder, the nurse is most likely to find the client describing which of the following things?
|a.||feeling everything is speeded up, as if in a manic state|
|b.||a total loss of control over life and relationships with others|
|c.||finding purchases or belongings for which they cannot account|
|d.||being able to identify and call on all the alters, at will, for protection|
- The advanced practice nurse will provide a client with dissociative disorder the essential skill of relapse prevention. Relapse prevention refers to developing skills to:
|a.||avoid getting into an abusive relationship|
|b.||interrupt the stimulation of a dissociative episode|
|c.||avoid using drugs and alcohol to deal with feelings|
|d.||prevent resuming a relationship with an original abuser|
- The primary form of treatment for dissociative disorders is:
|b.||light therapy||d.||individual therapy|
- A client is admitted to a mental health unit with a diagnosis of dissociative fugue. The client left home 2 days earlier and was found in another city yesterday, and he has no memory of traveling to the other city. After the initial interview, the client’s spouse asks the nurse about the loss of memory. Which statement made by the nurse is appropriate?
|a.||“Your spouse must be unhappy in the marriage and is seeking a way out.”|
|b.||“The loss of memory regarding the travel experience is common with this disorder.”|
|c.||“The fugue state occurred because your spouse has developed an alternate personality.”|
|d.||“I’m sure your spouse remembers the traveling but just doesn’t want to talk about it right now.”|
- A young adult diagnosed with a dissociative disorder was recently admitted to your unit. As the primary nurse, which intervention would receive priority in caring for the client?
|a.||administering psychotropic drugs to the client|
|b.||exploring the client’s reason for the dissociative behavior|
|c.||developing a trusting therapeutic relationship with the client|
|d.||suggesting alternate methods of dealing with stressful events|
- A client admitted to the hospital with a diagnosis of dissociative fugue tells the nurse that he is feeling very anxious. In this situation, the nurse would anticipate that the physician will order which of the following?
|a.||a tricyclic||c.||a benzodiazepine|
|b.||a phenothiazine||d.||an atypical antipsychotic|
- You a caring for a client diagnosed with a dissociative disorder. The client tells you that he feels detached from his body. You would interpret the client’s experience as an example of:
- A young man is brought to the hospital by the police after being found wandering in an unsafe neighborhood. The physical examination reveals that the man is essentially healthy but is unable to remember any facts regarding his life or why he was wandering around. The nurse realizes that the client is demonstrating which of the following?
|a.||dissociative fugue||c.||an acute psychotic episode|
|b.||dissociative amnesia||d.||dissociative identity disorder|
- Nursing interventions for the nurse generalist caring for a client with a dissociative disorder would include:
|a.||prepare for ECT|
|b.||administer ordered medication|
|c.||administer ice baths to jog memory|
|d.||assess for level of danger to self and others|
|e.||help client to develop adaptive coping skills|
|f.||conduct psychotherapy sessions with the client|
- Which of the following would be an appropriate nursing diagnosis for a client diagnosed with dissociative amnesia? Select all that apply.
|b.||caregiver role strain|
|c.||risk for self-directed violence|
|d.||severe anxiety related to acute stress|
|e.||altered thought process related to psychosis|
|f.||altered nutrition; more than body requirements|
- Nursing interventions to address the client outcome of “client maintains progressively longer experience of here and now reality” would include which of the following?
|a.||teach the client the basic structure of journaling|
|b.||solve all of the client’s interpersonal problems|
|c.||support the client’s use of projection and suppression|
|d.||support the client’s use of various grounding techniques|
|e.||discourage the client from interacting with any family member|
|f.||review the nursing care plan and sleep patterns with the client on a regular basis|
- The nurse is evaluating the therapeutic milieu. Which of the following nursing interventions would be implemented in a therapeutic milieu which supports safety for a client with a dissociative disorder? Select all that apply.
|a.||explore with client how the need to feel safe is met|
|b.||explore with family members the methods they use to cope with the client’s behavior|
|c.||support the client in stating when another client’s behavior seems similar to past abuse|
|d.||teach staff members effective methods for creating a safe environment for the client|
|e.||encourage the client to have child alters come out only in the privacy of the client’s room|
|f.||develop a plan with the client to contain violent or self-destructive alters when and if they come out|
CHAPTER 19—THE CLIENT AT RISK OF SUICIDAL AND SELF-DESTRUCTIVE BEHAVIORS
- What percentage of persons who commit suicide have been found to have a mental illness at the time of their death?
- Which of the following factors place a person with major depression more at risk for completed suicide?
- One of your co-workers admits a client who attempted suicide by overdosing. The co-worker says the client is not really suicidal and that she just wants attention. Your best response would be to:
|a.||point out that 20% to 30% of those who kill themselves have made previous attempts|
|b.||help the co-worker develop a care plan to reduce secondary gains from the attempt|
|c.||suggest that the team give this client a lot more attention and saturate her need|
|d.||agree that as long as someone is talking about suicide they are unlikely to complete it|
- You notice that one of your assigned clients who has been very depressed suddenly seems to have more energy. The client’s significant other expresses relief that the client is better and wants to have the client discharged from the hospital. Your best course of action would be to:
|a.||advise the significant other that they must wait until the physician comes|
|b.||notify the physician about this sudden change in energy level and chart it|
|c.||check with the client to see if she wants you to call the physician about discharge|
|d.||ask the client about any suicidal ideation and educate the significant other about suicide|
- Self-mutilation mainly accomplishes which of the following things for the person who engages in it?
|a.||attention that is greatly sought but not forthcoming from other people|
|b.||production of pain which punishes and takes away some of the guilt feelings|
|c.||reduction of serotonin available at the receptor sites in critical areas of the brain|
|d.||stimulation of the opiate system in the brain resulting in production of endorphins|
- Freud’s conceptualization of suicide is best described in which one of the following statements?
|a.||a dream gone bad, becoming the worst living and dying nightmare|
|b.||self-murder as a response to guilt over aggressive impulses toward object relations|
|c.||outward aggression toward the parents while feeling inwardly loving toward parents|
|d.||a move by a person’s “bad” side to overpower the “good” side of the internalized person|
- Karl Menninger postulated that suicide is:
|a.||fear of failure||c.||anger turned inward|
|b.||a way to get even||d.||aggression misplaced|
- A nurse is working with the family of a person who committed suicide as part of a cult pact. Using Durkheim’s definitions of four types of suicide, which type of suicide would best fit this suicide?
- The nurse working with clients from a variety of cultures and ethnic groups is aware that the suicide rate in the United States is highest in persons from, or descended from, which of the following groups?
|a.||Southern Europeans||c.||Northern Europeans|
|b.||Native Americans||d.||Central and South Americans|
- Looking at North American and Alaskan Native tribes, studies have supported the idea that suicide rates in these groups are:
|a.||consistent within the tribes|
|b.||mainly high from elderly members killing themselves|
|c.||lowest in tribes that practice their traditional rituals|
|d.||decreased rapidly over the past 10 years|
- Which of the following biochemical problems has been most suspected of contributing to suicidal ideation?
|a.||low levels of serotonin||c.||high levels of dopamine|
|b.||low levels of testosterone||d.||high levels of aldosterone|
- The nurse talking with a community group about suicide shares the information that one group of people makes fewer attempts per completed suicide. This group is:
|b.||young adults||d.||older adults|
- In addition to carefully assessing the elderly for suicide ideation because of high rates of completed suicides among members of various subgroups of elderly, the nurse is also aware that elderly persons who completed suicides most often did which of the following things prior to their suicide?
|a.||made a visit to a health care worker|
|b.||injured or killed a health care worker|
|c.||failed to reveal intent even when asked|
|d.||carried a weapon with them at all times|
- A client with a diagnosis of borderline personality disorder takes an overdose of pills and calls one of the family members to take her to the emergency room. The family member asks the nurse if persons with borderline personality disorder ever actually commit suicide. The best answer by the nurse would be which of the following?
|a.||“The risk is about the same as for someone in the general population.”|
|b.||“The risk is similar to that of people diagnosed with major depression.”|
|c.||“Only when they expect someone to rescue them and that person is not available.”|
|d.||“Rarely, as people with this diagnosis use suicide threats to hang onto relationships.”|
- Nurses working with depressed clients will most often write a nursing diagnosis which is a fundamental predictor of suicide. The diagnosis that is the most fundamental predictor of suicide is:
|b.||hopelessness||d.||risk for injury to self|
- When a nurse asks a suicidal client questions about past suicide attempts, the client will most likely:
|a.||keep very quiet and refuse to say anything|
|b.||deny any past suicide attempts and any present ideation about suicide|
|c.||change the subject and talk at length about a variety of topics but not about suicide|
|d.||provide information for developing nursing interventions to prevent future attempts|
- A nurse asks a client, “Are you thinking of hurting yourself?” The client responds, “No,” and then commits suicide. The client most likely responded with “no” because of which of the following reasons?
|a.||to put a stop to the questioning by the nurse|
|b.||the idea of hurting self did not apply to suicide|
|c.||in a regressed state, “no” was easier to say than “yes”|
|d.||the client was not opposed to lying and lied to the nurse|
- A nurse determines that a client is planning to kill herself. The nurse’s next question needs to be which of the following?
|a.||“Are your affairs in order?”|
|b.||“What method do you plan to use?”|
|c.||“Have you planned for someone to rescue you?”|
|d.||“How will your family feel about you doing this?”|
- A nurse is working with a client who has recently experienced the loss of a job and is depressed. Which of the following interventions would be most helpful in reducing the risk of suicide?
|a.||arrange for someone to stay with the client at night|
|b.||provide teaching about the importance of medication compliance|
|c.||assist the client in developing a plan to stay alcohol- and drug-free|
|d.||advise the family to remove all firearms and other means for suicide|
- When children talk about wanting to kill themselves, parents need most to:
|a.||get help for the child and take the idea of suicide seriously|
|b.||reduce the amount of television that the child views daily|
|c.||send the child to her room for a time out and to think|
|d.||ignore this kind of attention-seeking behavior in their child|
- When a nurse assesses a child and finds that the child exhibits little fear or dislike of death but has some preoccupation with death, the nurse will conclude that this child’s behavior is most probably:
|a.||normal||c.||based on television|
|b.||high risk for suicide||d.||similar to parents’ views|
- Behaviors of suicidal children have been identified and include play that is repetitive, dangerous, and reckless, involves acting out fantasies of death or aggression, and are inappropriate for the developmental stage. The nurse observing such behaviors in a child will conclude that the child:
|a.||is suicidal||c.||could be suicidal or normal|
|b.||is likely to be suicidal||d.||is abnormal and possibly suicidal|
- In adolescence, which of the following behaviors might contribute greatly to increasing risk for suicide?
|a.||joining a gang||c.||not being in the “in” crowd|
|b.||disclosing homosexuality||d.||being from an overprotective family|
- When the nurse has assessed an adult client, found them to be highly suicidal, and has managed to get the client admitted to an inpatient psychiatric treatment facility, the nurse then realizes that the client:
|a.||is safe from committing suicide|
|b.||will be alright when discharged|
|c.||can still commit suicide if determined to do so|
|d.||is unlikely to commit suicide while in the hospital|
- When there is a suicide on the psychiatric inpatient unit, nurses and other health care workers can best deal with this by:
|a.||having a psychological autopsy|
|b.||providing an hour of therapy for all|
|c.||showing happy movies on the ward|
|d.||allowing everyone a mental health day|
- You are assigned to a suicidal client. Your assessment will include exploring the spiritual domain of the client’s life. The spiritual assessment is conducted in order to determine if:
|a.||the client is being punished by God for not believing in Him|
|b.||the client’s religion is one that you are familiar with and feel comfortable discussing|
|c.||the client belongs to a religion that prohibits suicide; a relationship with God may foster hope|
|d.||the client is in the appropriate facility which would support the client’s religious beliefs and practices|
- A nursing instructor is evaluating a student nurse’s understanding of suicide. The instructor will determine that a student understands if the student makes which of the following comments?
|a.||“An individual who attempts suicide usually has a flaw in her personality.”|
|b.||“People who attempt suicide are hopeful, but they just don’t have enough support.”|
|c.||“Suicide is a very selfish act, and I don’t feel sorry for anyone who tries to hurt themselves.”|
|d.||“A person who attempts suicide lacks the effective coping skills needed to deal with stressors.”|
- An adolescent girl is admitted to the hospital after a suicide attempt. The client’s mother tells the nurse the client had been very despondent ever since they moved to the city because she had not made any friends at school or in the neighborhood. According to Durkheim, the client’s suicidal attempt would be considered:
- A new graduate nurse assigned to a client admitted for depression asks the charge nurse, “Do I have to ask the client if she has had any thoughts of hurting herself?” The best response by the charge nurse would be which of the following?
|a.||“Yes, you do have to ask her. Your job depends on it.”|
|b.||“No, you don’t have to ask her. She probably is not suicidal.”|
|c.||“No, you don’t have to ask if it makes you feel uncomfortable.”|
|d.||“Yes, it is important to assess if the client is having any suicidal ideations.”|
- The nurse working on a male adolescent unit will develop nursing interventions based on the fact that which client has the highest risk potential for suicide?
|a.||a 13-year-old Hispanic|
|b.||a 14-year-old Caucasian|
|c.||a 15-year-old African American|
|d.||a 16-year-old Native American Indian|
- The nurse is caring for a client who is on strict suicide precautions. This would require which action by the nurse?
|a.||remaining with the client at all times|
|b.||assessing the client every 15 minutes|
|c.||observing the client at least once per hour|
|d.||charting on the client at least once per shift|
- You are assigned to the emergency room when a client is admitted for attempted suicide. What should you do first?
|a.||address the client’s physical needs|
|b.||explore the client’s normal coping mechanisms|
|c.||ascertain whether the client really wanted to die|
|d.||determine if this is the client’s first suicide attempt|
- A young woman is brought to the emergency room after a suicide attempt. The family explains to the nurse that the client is to be deported back to her homeland because her visa has expired. The client and family had pleaded with the authorities to let her stay in America because her country is in civil unrest. This morning the client received a letter informing her that her request had been denied. Fearing the return to her homeland, the client tried to kill herself. According to Durkheim, this type of suicide would be considered:
- The nurse assessing a client who was admitted to the hospital after an attempted suicide knows that some of the sociocultural factors contributing to suicide include which of the following? Select all that apply.
|a.||alcoholism||d.||poor support system|
|b.||living alone||e.||poor impulse control|
|c.||poverty status||f.||genetic predisposition|
- A new graduate nurse has been asked to attend a psychological autopsy of a client who committed suicide. The nurse asks a colleague what is involved in a psychological autopsy. The colleague would most likely identify which of the following? Select all that apply.
|a.||review of the client’s behavior before death|
|b.||interviews with family and significant others|
|c.||determining absence or presence of substance abuse|
|d.||discussion of the client’s medical and psychiatric history|
|e.||deciding whether the nursing staff should be charged with negligence|
|f.||identifying significant family history concerning suicide and mental illness|
CHAPTER 20—THE CLIENT EXHIBITING AGGRESSION, HOSTILITY, AND VIOLENCE
- According to Fernandez (1999), which group of health care workers is at greatest risk for physical assault?
|b.||female nurses||d.||male nurses and doctors|
- Aggressive and violent behaviors are more common among clients experiencing:
|a.||anxiety disorders||c.||personality disorders|
|b.||psychotic disorders||d.||substance abuse disorders|
- A nurse who practices with the belief that a client’s aggressive behavior is a result of role modeling would most likely follow which psychodynamic theories?
|a.||biochemical theories||c.||psychodynamic theories|
|b.||social learning theories||d.||neuroendocrine theories|
- Contemporary neurophysiologic studies suggest which areas of the brain are linked to aggressive and violent behaviors?
|a.||frontal lobe||c.||occipital lobe|
|b.||temporal lobe||d.||parietal lobe|
- The prevalence and nature of a client’s aggression and violence in health care:
|a.||is a recent occurrence|
|b.||has decreased in the past 10 years|
|c.||has long been minimized and neglected|
|d.||has been a major topic of research since the early 20th century|
- Which of the following statements is correct?
|a.||The incidence of client aggression and violence is equal.|
|b.||Client aggression occurs more often than client violence.|
|c.||Client violence occurs more often than client aggression.|
|d.||Clients very seldom demonstrate aggression and violence.|
- According to a 1999 study of health care workers in a Vancouver ED, respondents reported a 1-year prevalence rate of:
|a.||52% for physical assault and 57% for physical threat|
|b.||61% for physical assault and 79% for physical threat|
|c.||75% for physical assault and 80% for physical threat|
|d.||92% for physical assault and 97% for physical threat|
- Which is the priority when caring for potentially hostile, aggressive, or violent clients?
|a.||providing a safe environment for self, clients, and others|
|b.||administering a prescribed medication to address the client’s behavior|
|c.||exploring with the client reasons for the hostility, aggression, or violence|
|d.||assisting the client to develop alternative methods for expressing feelings|
- You have been caring for a client who previously was described by other nurses as being extremely hostile. If your client is moving towards recovery and recognizes the hostility, your assessment would most likely reveal which of the following?
|a.||Hostility will probably increase.|
|b.||Hostility will probably decrease.|
|c.||Hostility will remain unchanged.|
|d.||Hostility will progress to violence.|
- The nurse on a psychiatric unit assessing a newly admitted client for potential violent behavior knows that when comparing violence among men and women with psychiatric disorders, research suggests that:
|a.||women are violent more often than men|
|b.||men are violent more often than women|
|c.||there is no gender difference in terms of violence|
|d.||women use more physical aggression than men|
- You are caring for a client who is very angry. The client’s mental and motor activity have increased. Your assessment would reveal that the client is most likely experiencing which of the following?
- A nurse whose care is based on a belief that aggression is a basic drive (like thirst) would be following whose theories?
|a.||Erik Erikson||c.||Sigmund Freud|
|b.||Dorothea Orem||d.||Abraham Maslow|
- The psychiatric nurse planning care for clients is aware that violent behaviors occur:
|a.||across all age groups|
|b.||most often with adolescents with juvenile records|
|c.||less often with elderly clients experiencing dementia|
|d.||most often with children who have developmental disorders|
- Workplace violence occurs:
|a.||anywhere||c.||in any outpatient clinic|
|b.||in the emergency room||d.||on the inpatient psychiatric unit|
- A client becomes very agitated and begins to use profane language in a very loud tone of voice. The best response by the nurse is to:
|a.||ignore the client|
|b.||yell back at the client|
|c.||speak calmly and softly|
|d.||tell the client the behavior is childish|
- You walk into an examination room only to realize that the client is holding a weapon. What should you do first?
|a.||Take the weapon away from the client.|
|b.||Have security take the weapon away from the client.|
|c.||Ask the client to place the weapon on a desk or on the floor.|
|d.||Ignore the fact that the client has a weapon and continue to provide care.|
- An employer’s major responsibility is to:
|a.||provide a safe working environment|
|b.||screen any client seeking service from the facility|
|c.||install metal detectors at the entrance of the hospital|
|d.||hire twice the number of security guards to assure safety|
- The nurse manager over an emergency department is conducting an in-service program on workplace violence. The nurse manager would evaluate the employees as understanding the causes of workplace violence if they identify which of the following? Select all that apply.
|a.||loud noises||d.||helpful and pleasant staff|
|b.||long waiting periods||e.||poor environmental design|
|c.||ignoring a client’s request||f.||speaking calmly and softly|
- Hostile clients may demonstrate which of the following behaviors? Select all that apply.
- You are the charge nurse on a psychiatric unit. One of the new clients is very angry and agitated. The client rushes into the nurses’ station where you are standing and begins to yell and curse at you. What interventions would be appropriate to de-escalate the situation? Select all that apply.
|a.||Use common sense.|
|b.||Use active listening.|
|c.||Give suggestions, not orders.|
|d.||Be concerned about personal safety.|
|e.||Avoid using threatening body language.|
|f.||Remain calm and convey being in control.|
- Data from several studies exploring the risk of violence in inpatient psychiatric facilities found that violence most likely occurs during which periods? Select all that apply.
|b.||visiting hours||e.||client transport|
|c.||bathing hours||f.||during change of shifts|
- Which of the following are true about hostility? Select all that apply.
|a.||It is a response to a threat.|
|b.||It never results in violence.|
|c.||It is always an inappropriate act.|
|d.||It is a response to invasion of privacy.|
|e.||It demonstrates a basic character flaw.|
|f.||It is an attempt to avoid facing situations of helplessness.|
- Assessment of a violent client would most likely reveal which of the following? Select all that apply.
|a.||withdrawn behavior||d.||frequent mood swings|
|b.||openness to others||e.||poor interpersonal skills|
|c.||a history of violence||f.||respect for authority figures|
- A nurse manager is charged with planning for staff safety in the new Emergency Department. His plans should include which of the following? Select all that apply.
|a.||training only nursing personnel on safety measures|
|b.||providing security escorts to the parking lot at night|
|c.||reducing the size of waiting areas to discourage the potential of loitering|
|d.||developing waiting areas to accommodate and assist visitors and clients|
|e.||designing the triage area, emergency rooms, and other public areas to reduce the risk of assault|
|f.||establishing a call system that alerts teams to assist staff involved in potential and actual violent situations|
- Nurses working on psychiatric units should be prepared to de-escalate or diffuse potentially violent situations. To prepare for these situations, nurses can do a self-assessment. Questions that may be asked in the self-assessment include which of the following? Select all that apply.
|a.||“How am I reacting?”||d.||“How is my tone of voice?”|
|b.||“How’s my body language?”||e.||“Do I like the client as a person?”|
|c.||“What are my “gut” feelings?”||f.||“Am I wearing anything attractive?”|
CHAPTER 21—THE CLIENT WITH A SUBSTANCE-RELATED DISORDER
- The Harrison Act of 1914 did which of the following?
|a.||stopped the sale of syringes to the public through mail-order sales|
|b.||controlled the quality and sale of prescription drugs to protect the public|
|c.||regulated the manufacture, distribution, and prescription of opiate substances|
|d.||made possession or sale of a determined amount of marijuana a federal offense|
- What was the purpose of the 18th Amendment to the Constitution of the United States?
|a.||prohibit the sale of intoxicating liquors to minor children|
|b.||control the quality, manufacture, and sale of intoxicating liquors|
|c.||prohibit the sale, manufacture, and transportation of intoxicating liquors|
|d.||place a federal tax on cigarettes and liquor in all the states of the United States|
- Abuse of drugs other than alcohol was first widespread in this country in the:
- While working with young adult clients, you find them discussing the fact that they need more and more of the substances they are abusing just to get the same effect. These clients are experiencing:
- A key indicator of addiction, which you can apply when assessing a client you suspect of having an addiction to a substance, is:
|a.||calling in sick on Monday mornings|
|b.||loss of control over frequency or amount of use|
|c.||bragging about the amount of alcohol consumed|
|d.||having withdrawal symptoms when use is stopped|
- When working with the family of a client who has a substance-related disorder, you primarily need to teach the family that the client’s problem with substances is:
|a.||caused by the family dynamics which are somewhat dysfunctional|
|b.||a result of a lack of moral teaching and a lack of insight and judgment|
|c.||due to neurobiological dysfunction and is a legitimate medical problem|
|d.||a societal problem caused by availability of substances and peer pressure|
- A young adult male is admitted for detoxification from poly substance abuse. The family wants to know the potential seriousness of withdrawal from these substances. The best answer from the nurse would be that withdrawal:
|a.||will not be uncomfortable due to the medications given to prevent complications|
|b.||varies according to specific substances used, amount used, and the person’s biology|
|c.||will be tough and potentially life threatening as more than one substance was abused|
|d.||will not even be recalled by the person during detoxification as an amnesiac will be given|
- A young adult abuses crack cocaine just before being in an automobile accident. Friends who come to the hospital a little over an hour later reveal the crack cocaine use. The nurse realizes that the peak time for onset of withdrawal after last use is:
|a.||past since it is within an hour||c.||4 to 6 hours|
|b.||soon since it is within 2 to 3 hours||d.||7 to 9 hours|
- A young adult smokes marijuana on a regular basis but abstains for 2 weeks. This young adult then asks a nurse how long a person has to abstain from using marijuana to be reasonably certain they are not going to have it show up in a drug screen for employment. The correct answer by the nurse would be which of the following?
|a.||2 days||c.||more than 2 weeks|
|b.||7 days||d.||more than 5 weeks|
- A young adult is admitted to the substance abuse treatment unit. You learn that she thought she should “shoot up” before coming to the hospital. You realize that the peak time for onset of withdrawal for last heroin use is how many hours?
|a.||1 to 2||c.||6 to 9|
|b.||3 to 5||d.||10 to 12|
- When interviewing a person for possible admission to the substance abuse treatment unit, you find the client saying that the drinking is just social and not a problem, and that the admission is just to satisfy the spouse who is threatening divorce. The spouse describes the amount of drinking as sufficient enough to cause work to be missed at least 1 day a week and to have resulted in the third charge of driving while intoxicated. The nurse suspects that this discrepancy in stories is due to the client’s using which of the following defense mechanisms?
- A nurse is working with a client who describes in a group session that she fell asleep “drunk” (intoxicated) every night in her driveway after spending the evening in a bar. Later, the client claims that she really does not have a problem and she wants to go home because she misses her bed and sleeping with her husband. The best response by the nurse would be which of the following responses?
|a.||“It must be difficult being away from your husband.”|
|b.||“Does your husband think you are ready to come home?”|
|c.||“I’m surprised you recall your bed since you described sleeping drunk in your car.”|
|d.||“The treatment program is 14 days and you need the full 14 days to get into recovery.”|
- A nurse is working with clients in an outpatient drug treatment program. The nurse has worked hard with a particular female client and is certain the client will do well in the Alcoholics Anonymous Program (AA). The day before completion of the program, the client relapses and goes on a drinking binge with a peer. The nurse needs to have which of the following understandings in regard to the cause of the relapse experienced by the client?
|a.||AA needed to be started a lot sooner in the program|
|b.||substance dependence is a chronic relapsing disorder|
|c.||the treatment program was not right for the client and it failed|
|d.||the relapse probably could have been avoided by better assessment|
- The school nurse teaching parents about alcohol and other drug abuse will advise parents that the most used and abused substance in all age groups is:
- A parent tells the school nurse that she doesn’t think many adolescents use marijuana. The school nurse’s best response would be which of the following?
|a.||“You are correct in that marijuana use usually begins in college.”|
|b.||“No information is available about marijuana use in adolescents.”|
|c.||“Adolescents actually don’t use much marijuana as they prefer to use inhalants.”|
|d.||“One-third of adolescents have been found to have used marijuana by the 12th grade.”|
- The school nurse talking with parents about the incidence of school-age children smoking cigarettes will describe the approximate percentage of students, 12 years old and older, smoking cigarettes as which of the following?
- The nurse discussing alcohol abuse and dependence with adult women will explain that women progress from abuse to dependency more rapidly than men. When one in the group asks “Why,” the nurse will provide the current theory on the reason. That theory is:
|a.||men have a greater amount of alcohol dehydrogenase in their gastric mucosa|
|b.||women have more fat cells for attachment of the fat-soluble portion of ethanol|
|c.||more men than women work outside the home, giving women more time to drink|
|d.||women have a greater tendency to become dependent on people, which transfers to drugs|
- One of your fellow nurses tells you of her plan to specialize in the treatment of “just alcohol-related disorders.” You realize that it will be proven impossible to restrict a practice to just alcohol-related disorders because of which of the following reasons?
|a.||there are few or no treatment programs for those who abuse just alcohol|
|b.||treatment facilities normally do not hire someone just for alcohol treatment|
|c.||nurses who work only with alcohol-related disorders get burned out quickly|
|d.||the incidence of dual diagnosis is over 70% in those who are alcohol dependent|
- Participants in alcohol treatment programs are given educational classes on the effect of alcohol on the body. The nurse leading these educational classes would share that:
|a.||if you avoid drinking before 5 or 6 p.m., you can avoid medical problems|
|b.||most alcoholics can manage to avoid medical problems if they do not skip meals|
|c.||alcohol-related liver disease is one of the top four causes of in-hospital mortality|
|d.||alcoholics who have medical problems would have had them even if they did not drink|
- The prison nurse is aware that the percentage of prisoners who were involved with drugs or alcohol is:
- Nurses working with Native American Indians realize that alcohol-related death rates for this group compared to all the other racial groups in the United States combined are approximately:
|a.||half as high||c.||about the same|
|b.||One-third as high||d.||about six times higher|
- You are assigned to work with a client who is hospitalized with medical complications of polydrug use. The health care team is helping the client find a drug treatment program to go into after discharge. You will work with this client to get them to accept responsibility for:
|a.||having developed the disease of addiction|
|b.||the medical complications developed by abusing drugs|
|c.||participating in the management of the disease of addiction|
|d.||all the difficulties they have put their significant others through|
- A nurse is working with a group of substance-dependent people who are in early recovery. One in the group discusses that her plan on discharge is to go back to fishing with her old friends who use and abuse alcohol and other substances. Her plan for staying in recovery is to take lots of nonalcoholic drinks along. The best response by the nurse is to:
|a.||suggest the group member take along someone else who is in recovery|
|b.||reinforce the idea of having lots of soft drinks on the trip and to stay hydrated|
|c.||commend the group member for making a good plan to avoid the trap of using again|
|d.||point out that old drug hangouts and people with whom they used can trigger cravings or use|
- One of your clients is abusing a drug that is short acting and the client often experiences withdrawal several times a day. Each withdrawal produces a rise in stress hormones and related neurotransmitters resulting in an outpouring of stress hormones and symptoms of anger, tension, and irritability. The client gets immediate short-lived relief by using the drug. The drug this client is using is most likely which of the following?
- You are working with the wife of a client who is abusing various substances. The wife describes calling her husband’s workplace to report that he is sick when, in fact, he is withdrawing from earlier drug and alcohol abuse. The nurse will point out to the wife that she is engaging in which one of the following behaviors often found in families of addicted or drug-abusing persons?
- When teaching clients about the metabolism of alcohol, the nurse will teach that the liver can metabolize how many alcoholic drinks containing 12 grams of alcohol in an hour?
- An average-sized woman of about 120 pounds brags to the nurse that she drank 18 beers at a party. The nurse will most importantly need to point out to the client that:
|a.||she must have a remarkable system for alcohol metabolism|
|b.||it is a matter of very bad judgment to drink so much alcohol|
|c.||after 15 to 18 drinks, she has exceeded the legal limit for intoxication|
|d.||women her size often go into respiratory depression and death after only 10 drinks|
- Which of the following statements will the nurse make in talking with groups about the effects of alcohol?
|a.||drinking beer is not as bad as drinking bourbon or scotch whiskey|
|b.||women can drink as much as men and get the same level of intoxication|
|c.||alcohol is both water and fat soluble and goes throughout the entire body|
|d.||drinking more alcohol without having ill effects means you are a better drinker|
- When a person comes into a treatment program for alcoholism, the nurse and treatment team can expect the symptoms of withdrawal to peak how long after the last drink?
|a.||24 hours||c.||72 hours|
|b.||48 hours||d.||96 hours|
- The nurse working with clients who are likely to go through alcohol withdrawal syndromes realizes which one of the following drugs is the drug of choice for managing alcohol withdrawal syndrome according to the American Society of Addiction Medicine’s evidence-based practice guidelines?
|a.||benzodiazepines, such as diazepam (Valium)|
|b.||phenothiazines, such as chlorpromazine (Thorazine)|
|c.||dibenzodiazepine, such as clozapine (Clozaril)|
|d.||antipsychotics, such as haloperidol (Haldol)|
- Which of the following symptoms is found early in the course of delirium tremens and can indicate the development of delirium tremens in a person withdrawing from alcohol?
- The nurse working with a client who is withdrawing from alcohol receives a doctor’s order for multiple vitamins and thiamine, 100 mg daily. The nurse realized that the thiamine is ordered mainly to prevent which one of the following conditions?
|a.||irritable leg syndromes||c.||Wernicke’s encephalopathy|
|b.||nervousness and anxiety||d.||deficiency of intrinsic factor|
- You are working with a client who has been diagnosed with Wernicke-Korsakoff syndrome. In reviewing this syndrome in preparation for caring for this client, you learn that clients with this condition usually:
|a.||recover when thiamine is administered|
|b.||have an inability to learn new material|
|c.||are oriented during the course of the syndrome|
|d.||have little or no residual effects after recovery|
- When working with hospitalized clients in recovery from addiction who are in pain, and for whom a range of medication and frequency has been ordered by the attending physician, the nurse needs to:
|a.||give p.r.n. pain medication as ordered and needed, before the pain gets too bad|
|b.||use the least amount and frequency of p.r.n. medication for addicts in recovery|
|c.||use relaxation techniques and self-hypnosis to replace the use of any pain medication|
|d.||try to get the client with chemical addiction in recovery not to use any pain medication|
- A client is referred to the methadone clinic and receives levomethadyl acetate hydrochloride (LAAM). The nurse working with this client realizes that LAAM is:
|a.||a drug which is given prior to starting on a course of methadone treatment|
|b.||a drug which potentiates the effects of methadone and is given concurrently|
|c.||a long-acting derivative of methadone with a duration of action up to 72 hours|
|d.||a drug which will cause the client to get very ill if they use heroin while on the drug|
- A client displays these symptoms: talkativeness, hypervigilence, suspiciousness, hallucinations, appetite suppression, and she appears cachectic. These symptoms most match those of someone on which of the following drugs?
- Which of the following drugs is a client most likely on when the following symptoms are present: elevated mood, slurred speech, slowed reflexes, ataxia, disorientation, hallucinations, lethargy, and a strange breath odor?
- Which of the following is a priority nursing intervention when caring for a client experiencing withdrawal from an abused substance?
|a.||offer small sips of water|
|b.||monitor vital signs frequently|
|c.||involve the family in the treatment plan|
|d.||engage the client in pleasant conversation|
- A client receiving Antabuse for treatment of alcoholism has just returned from a 1-day pass. Which of the following would indicate to the nurse that the client has ingested alcohol?
|a.||severe flushing, hypotension, dyspnea, and chest pain|
|b.||nausea, headache, hypertension, tachycardia, and leg pain|
|c.||headache, hypertension, bradycardia, tachypnea, and chest pain|
|d.||nausea, vomiting, hypertension, tinnitus, tachycardia, and tachypnea|
- The client is receiving Antabuse therapy. From which of the following activities would the nurse discourage the client?
|a.||eating foods high in tyramine|
|b.||drinking beverages high in citric acid|
|c.||going out in the sun without sunglasses|
|d.||using aftershave lotion that contains alcohol|
- Which nursing intervention is priority for a client withdrawing from an addictive substance?
|a.||providing for client safety|
|b.||addressing nutritional needs|
|c.||involving the family in the treatment|
|d.||assisting the client to cope with the addiction|
- Your client is detoxing from cocaine and begins to experience craving. An appropriate nursing intervention would be to have the client:
|a.||spend some time in meditation|
|b.||get involved in an exercise program|
|c.||watch an interesting movie on the television|
|d.||use cocaine one additional time to reduce the craving|
- During discharge instructions, the nurse teaches the client about drug abuse. The nurse will determine that the client understands substance abuse if she identifies which of the following? Select all that apply.
|a.||“I will attend my AA and NA meetings on a regular basis.”|
|b.||“I don’t think that I will relapse again, I have control over this problem.”|
|c.||“My buddies will think I’m a wimp if I don’t have an occasional beer with them.”|
|d.||“Instead of going to the bars on Friday nights, I think I will take my family to the movies.”|
|e.||“I know that I don’t have to worry because I know that I have been cured of my addiction.”|
|f.||“My family has agreed to go to family therapy with me so that we can work on our problems.”|
- Your client returned from a 1-day pass. You would suspect that she had smoked cannabis if she experienced which of the following? Select all that apply.
|e.||decreased heart rate|
|f.||reduced perception of color and sound|
- A client is admitted with an opiate overdose. The nurse would assess for overdose of which of the following? Select all that apply.
- The nurse assessing a client withdrawing from alcohol would most likely find which of the following? Select all that apply.
- The nurse caring for a client would recognize that some of the medical consequences of alcoholism include which of the following? Select all that apply.
|a.||brain atrophy||d.||esophageal varices|
|c.||elevated lipids||f.||thiamine deficiency|
CHAPTER 22—THE CLIENT WITH AN EATING DISORDER
- The school nurse is talking with a group of teens about the risk of getting an eating disorder. Which of the following groups, worldwide, will the nurse point to as being at greatest risk for developing eating disorders?
- Bulimia nervosa first appeared in the Diagnostic and Statistical Manual in which of the following versions?
- The parent of a child with anorexia nervosa asks the nurse, “How common is anorexia nervosa?” The nurse will respond that this disorder is currently known to affect young women of ages 12 to 25 in which of the following percentages?
- When reporting on duty, you learn that you have a newly assigned client who has alexithymia. After looking this up in preparation for caring for this client, you realize that your approach will most probably need to be based on which of the following?
|a.||mistrust of self and others|
|b.||extreme and frequent manipulation of others|
|c.||great medical knowledge of an eating disorder|
|d.||self-induced symptoms of binging and purging|
- The school nurse is made aware of a young student who has symptoms of anorexia nervosa. The nurse’s best course of action is to:
|a.||observe the student over the school year|
|b.||talk with the student about the dangers of anorexia|
|c.||put the student in a support group to build up self-esteem|
|d.||talk with the parents and urge them to get a medical evaluation|
- When working with clients who have a diagnosis of anorexia nervosa, the nurse will realize that the mortality rate is higher for people with lower weight and which of the following factors?
|a.||being a male|
|c.||older age at first presentation for treatment|
|d.||a first-degree relative with anorexia nervosa|
- After assessing a client, the nurse suspects this client has bulimia nervosa. Which of the following symptoms best alerted the nurse to be suspicious that this client has bulimia nervosa?
|a.||overweight||c.||erosion of dental enamel|
|b.||underweight||d.||sunken eyes and cheeks|
- A nurse discovers that a client who has a diagnosis of bulimia nervosa is using syrup of ipecac to purge. The nurse will advise this client that using syrup of ipecac is a high-risk behavior mainly because of its:
|a.||neurotoxicity||c.||corrosive effect on the stomach|
|b.||cardiotoxicity||d.||corrosive effect on the esophagus|
- When working with clients with eating disorders, the nurse is aware that binge eating disorder differs from bulimia nervosa in that people suffering from a binge eating disorder:
|a.||do not engage in purging or compulsive exercise|
|b.||have joined at least two weight reduction programs|
|c.||weigh at least two times the normal weight for height|
|d.||do not have impairment in work and social functioning|
- A 1-year-old child is eating dirt and leaves while playing in the yard. The mother asks the nurse about this behavior. The nurse will advise the mother that this behavior is indicative of:
|b.||normal behavior||d.||lead poisoning|
- The nurse will advise the parents of a 16-month-old child who is eating dirt and feces that they should prevent the child from eating these substances for which of the following reasons?
|a.||Toxoplasma or Toxocara infection can result.|
|b.||Dirt and feces can irritate the digestive system.|
|c.||Constipation can result from eating dirt and feces.|
|d.||The child’s ego may be hurt from being socially rejected.|
- The mortality rate reported for rumination disorder is:
- A nurse is assigned to care for an infant suspected of having rumination disorder. The nurse will look for the characteristic behavior of:
|a.||hypervigilance and scanning the environment|
|b.||constantly chewing, similar to a cow chewing a cud|
|c.||straining and arching the back with the head held back|
|d.||frequently spitting the breast or bottle nipple from the mouth|
- When a nurse reviews the literature on rumination disorder, the nurse will find that this disorder must meet the criteria of:
|a.||accompanied by other gastrointestinal problems|
|b.||episodes of projectile vomiting with each feeding|
|c.||weight loss of at least 10% of body weight|
|d.||development following a period of normal functioning|
- When working with a client who has coexisting personality disorder and an eating disorder, what characteristics would you most expect to find?
|a.||isolative behaviors and passive aggressiveness|
|b.||aggression to self and others and impulsiveness|
|c.||lack of social skills and difficulty relating to others|
|d.||narcissistic and extreme obsessive-compulsiveness|
- What percentage of adult women with eating disorders also report unwanted sexual experiences as children or adults?
|a.||5% to 15%||c.||30% to 50%|
|b.||20% to 25%||d.||60% to 80%|
- When teaching about the neurobiological theories on the causation of eating disorders, the nurse will describe the current research supporting a neurobiological theory that postulates which of the following causes for eating and related disorders?
|a.||serotonin (5-HT) dysregulation|
|b.||an increase in dopamine receptors|
|c.||a decrease in epinephrine|
|d.||dysregulation of GABA|
- In 1999, a study of twins by Fairburn et.al. reported that the heritability of anorexia nervosa is about:
- In the psychoanalytic framework, the anorectic client is described as:
|a.||being anal retentive||c.||narcissistically in love with self|
|b.||having a death wish||d.||abhorring his own sexuality|
- The nurse studying the family system theorists’ views of the familial factors in anorexia or bulimia will find these theorists describing the family system in which of the following ways?
|a.||discouraging the development of independence and autonomy|
|b.||a single-parent family isolated from extended family and friends|
|c.||overinvested in helping the client to deal with the eating disorder|
|d.||normal functioning family with a minimum of interactional problems|
- Minuchin identified characteristics often present in the families of children with eating disorders as which of the following characteristics?
|a.||laissez-faire with no discipline or order|
|b.||rigidity, enmeshment, overprotectiveness|
|c.||chaotic with little or no parenting behaviors|
|d.||troubled with addictions and enabling behaviors|
- When a boy or girl present with childhood anorexia symptoms, what coexisting problem is usually present and needs to be addressed?
|b.||social phobia||d.||conduct disorder|
- The school nurse should suspect a coexisting eating disorder in an adolescent who has a diagnosis of diabetes when the nurse has which of the following findings upon reviewing the history and doing an assessment?
|a.||fluctuating weight with large gains and losses within a month|
|b.||eating alone, refusing to eat with others, or refusing to talk about what is being eaten|
|c.||overinvestment in exercise and sports programs in and out of the school system|
|d.||history of multiple incidents of DKA and problems regulating blood glucose levels|
- The best form of treatment for the person with an eating disorder is:
|a.||the team approach with several professional members|
|b.||group therapy with others who have an eating disorder|
|c.||a series of sessions of individual therapy with an advanced practice nurse|
|d.||traditional Freudian psychotherapy twice a week over a period of several years|
- A solution-focused approach works well for a client with an eating disorder because this therapy:
|a.||emphasizes progress and future possibilities|
|b.||focuses on the present, not the past or the future|
|c.||resolves all past mistakes before moving to the present|
|d.||deals mainly with lessons in problem-solving techniques|
- The advanced practice nurse prescribes mirtazapine (Remeron) for a client who has a diagnosis of anorexia nervosa and whose health status is greatly compromised. The nurse has most likely chosen this medication because of which of the following reasons?
|a.||It does not cause kidney and liver complications.|
|b.||It does not interfere with the client getting enough REM sleep.|
|c.||It is a far more effective antidepressant than other medications available.|
|d.||Its well-known tendency to quickly add weight when taken as prescribed.|
- When admitting a client with bulimia nervosa, the nurse must take away the client’s laxatives at the hospital. The nurse will also add a nursing intervention to encourage fluid intake of 6 to 8 glasses of water each day and to include planned exercise periods. The nurse adds these interventions for which of the following reasons?
|a.||The nurse wants to teach the client healthy habits.|
|b.||Abrupt cessation of laxatives will cause constipation.|
|c.||To keep the client focused on the water and exercise, not on the laxatives.|
|d.||To reduce the client’s weight by a more acceptable method than by using laxatives.|
- A nursing intervention to encourage proper nutrition for a client diagnosed with anorexia nervosa is to do which of the following?
|a.||force feed the client|
|b.||push fluids between meals|
|c.||provide six small meals per day|
|d.||provide a diet high in fats and carbohydrates|
- The nurse’s assessment of a client with anorexia nervosa would most likely reveal which of the following?
- An important nursing intervention when caring for an adolescent with an eating disorder is to:
|a.||involve the adolescent in the treatment plan|
|b.||support the adolescent’s ineffective coping behavior|
|c.||remind the adolescent that their parents have the control|
|d.||discourage the adolescent from interacting with other clients|
- Your client has an eating disorder and a history of excessive laxative use in an attempt to lose weight. A primary health concern related to the laxative use is which of the following?
|a.||electrolyte imbalance||c.||impaired mobility|
|b.||respiratory insufficiency||d.||knowledge deficit|
- The nurse caring for a client with anorexia nervosa will evaluate that treatment has been effective if which of the following outcomes is achieved?
|a.||Client purges only three times a day.|
|b.||Client verbalizes a decreased need to please others.|
|c.||Client verbalizes dissatisfaction with body weight.|
|d.||Client continues to use ineffective coping mechanisms.|
- A 15-year-old client is admitted to the psychiatric unit with a diagnosis of anorexia nervosa. The nursing plan of care should be reflective of a client in which state of development according to Erikson?
|a.||Intimacy vs. Isolation||c.||Generativity vs. Stagnation|
|b.||Identity vs. Role confusion||d.||Autonomy vs. Shame and doubt|
- Nursing interventions for a client with an eating disorder would include which of the following? Select all that apply.
|a.||take daily weights|
|b.||promote a sense of well-being|
|c.||encourage socialization with others|
|d.||limit setting on inappropriate behavior|
|e.||teach visualization and guided imagery techniques|
|f.||support development of effective coping mechanisms|
- The nurse caring for clients with eating disorders identifies several diagnoses that address problems experienced by these clients. Which of the following are common nursing diagnoses used with ED? Select all that apply.
|a.||constipation related to erratic eating patterns|
|b.||disturbed body image related to fear of weight gain|
|c.||powerlessness related to lack of control over food avoidance|
|d.||anxiety related to fear of weight gain as evidenced by rituals associated with food intake|
|e.||imbalanced nutrition: less than body requirements related to dysfunctional eating patterns|
|f.||imbalanced nutrition: more than body requirements related to dysfunctional eating patterns|
- Which of the following might be assessed with a client with an eating disorder? Select all that apply.
|b.||amenorrhea||e.||constipation and bloating|
|c.||mild anemia||f.||major neurological disturbances|
- The nurse assessing a client with an eating disorder would also assess for which of the following possible disorders? Select all that apply.
|a.||substance abuse||d.||Alzheimer’s disease|
|b.||anxiety disorders||e.||personality disorders|
|c.||obsessional traits||f.||depressive disorders|
CHAPTER 23—THE CLIENT WITH A SLEEP DISORDER
- The nurse assessing vital signs at the beginning of the day shift is assessing the temperature when it is at which of the following points in the day?
|b.||highest||d.||between mid and high|
- When working with clients who are on a dopamine blocking agent, the nurse will notice which of the following when monitoring the client’s sleep patterns?
|a.||chronic insomnia||c.||difficulty getting to sleep|
|b.||increased sleeping time||d.||wakening during the night|
- A client in recovery from amphetamine addiction informs the night nurse of several vivid dreams during the night. The nurse realizes that this client has had these vivid dreams due to increased:
|a.||REM sleep||c.||stage 4 sleep|
|b.||stage 1 sleep||d.||norepinephrine levels|
- During REM sleep, the metabolism does which of the following as compared to a state of wakefulness?
|a.||stays the same||c.||increases by 20%|
|b.||decreases by 50%||d.||decreases slightly|
- A nurse working with an older client realizes that, compared to younger clients, these clients:
|a.||tend to get more total sleep|
|b.||have less difficulty falling asleep|
|c.||spend more time in delta and REM sleep|
|d.||are less likely to tolerate sleep deprivation|
- You are assigned to care for a client who has a diagnosis of chronic insomnia. Chronic insomnia means your client has a sleep disturbance lasting at least which of the following lengths of time?
|a.||3 weeks||c.||6 months|
|b.||6 weeks||d.||12 months|
- A nurse is assigned to work with a client who has a diagnosis of narcolepsy. After reviewing this disorder in preparation for caring for the client, the nurse is aware that the incidence of this condition is:
|a.||the same as delayed sleep phase syndrome|
|b.||approximately 10% of the general population|
|c.||greater than that of obstructive sleep disorders|
|d.||about 0.02% to 0.05% of the general population|
- Sleep deprivation is associated with increased slow wave sleep resulting in which of the following changes in hormone secretion the following day?
|a.||increased secretion of thyroxine|
|b.||reduction in the release of ACTH|
|c.||increase in aldosterone and testosterone secretion|
|d.||reduction in growth hormone and cortisol secretion|
- While working with a client who has a diagnosis of narcolepsy, the nurse discovers the client is having signs and symptoms of sleep paralysis. Which of the following signs and symptoms did the nurse most likely find which match those of sleep paralysis?
|a.||inability to move or speak just prior to and after awakening|
|b.||inability to awake without extreme sensory stimulation|
|c.||not changing or moving from the original sleep position|
|d.||maintaining a statuelike posture during the sleep period|
- Researchers looking at the effect of sleep disorders on depression suggested that sleep deprivation will:
|a.||have virtually no effect on depression at all|
|b.||provide a temporary relief from depression|
|c.||cause depression to last a longer period of time|
|d.||make depression much worse in symptomatology|
- The family of a client with narcolepsy asks the nurse to explain what causes narcolepsy. The nurse will report that recent research has found that in narcolepsy there is/are:
|a.||enlarged adrenal glands|
|b.||a dysregulation of serotonin|
|c.||critical cells missing from the hypothalamus|
|d.||oversecretion of adrenocorticotrophin (ACTH)|
- The nurse assessing the sleep patterns of clients with a diagnosis of bipolar I or major depressive episodes will find that these clients tend to have which of the following sleep problems?
|a.||lack of stage 1 sleep||c.||difficulty achieving REM sleep|
|b.||lack of stage 3 sleep||d.||difficulty falling asleep at night|
- The nurse is working with a client who is being assessed for fibromyalgia. Which of the following findings would best help make the diagnosis of fibromyalgia?
|a.||daytime drowsiness||c.||chronic insomnia for 6 months|
|b.||increased time in REM sleep||d.||lack of stage 4 non-REM sleep|
- The nurse working with clients who have chronic obstructive pulmonary disease and coronary artery disease is aware that the risk of a major cardiovascular event occurring in this population is most increased when the client has which of the following problems?
|c.||delayed sleep phase syndrome|
|d.||Substance-induced sleep disorders|
- The nurse working with a client who has been sleeping poorly and is sleep deprived will assess the client and find that the common cause will be which of the following problems?
|a.||sleep apnea||c.||drinking water at night|
|b.||excess stress||d.||blocked sinus passages|
- When working with female clients who are taking female hormones, the nurse will most likely advise the client to do which of the following things to improve sleep?
|a.||limit caffeine to early in the day|
|b.||take replacement calcium at night|
|c.||take a multiple vitamin in the morning|
|d.||drink a glass of whole milk at bedtime|
- When working with a hospitalized client who has an acute myocardial infarction, it is most important to initiate which of the following interventions?
|a.||passive range of motion||c.||soft music and backrubs|
|b.||turning the client hourly||d.||taking vital signs every 2 hours|
- You are assigned to work with a client who has periodic limb movement disorder. In assessing this client, you will find that the client has which of the following signs and symptoms?
|a.||random knee jerk and arm flap movements during sleep|
|b.||pain in the muscles of the leg which causes restless legs|
|c.||motor movements during sleep and akathesia in the daytime|
|d.||periodic inability to move the limbs at all during time of sleep|
- Restless leg syndrome is usually associated with which of the following disorders?
|a.||renal failure and iron deficiency anemia|
|b.||Third-degree burns and severe dehydration|
|c.||fibromyalgia and systemic lupus erythematosus|
|d.||myocardial infarction and cardiac insufficiency|
- Nurses working with hospitalized clients with immune disorders will want to initiate interventions to enhance restorative sleep mainly because of which of the following reasons?
|a.||the rested client will be better able to be independent for a longer time|
|b.||the client will be difficult to deal with and will not understand the teaching if tired|
|c.||the treatment regimen is exhausting and the client needs to recover each day|
|d.||sleep deprivation is associated with deceased neutrophils and natural killer T cells|
- When working with older adults to prevent sleep disturbances, the nurse will suggest which of the following activities?
|a.||go to sleep in a warm room with the minimum tolerable covering|
|b.||take a very warm bath and drink a glass or two of wine before going to bed|
|c.||exercise early in the day, get some bright light exposure, and develop a routine|
|d.||go to bed early and if not asleep in 30 minutes, take diphenhydramine (Benadryl)|
- The nurse working with clients who have acute insomnia will recognize that the current mainstay treatment for acute insomnia is which of the following interventions?
|a.||trazodone (Desyrel)||c.||diphenhydramine (Benadryl)|
|b.||temazepam (Restoril)||d.||secobarbital sodium (Seconal)|
- A client with sleep deprivation tells the nurse that she sleeps better if she exercises hard just before going to bed. The best response by the nurse would be:
|a.||“Exercise before bedtime is stimulating and it changes your sleep pattern.”|
|b.||“Exercise and sleep are an individual matter and apparently this works for you.”|
|c.||“If you gradually slow down, rather than quitting at the peak, it will be all right.”|
|d.||“You are right to exercise before bed since it is just a myth that exercise interferes with sleep.”|
- Sleep disturbances are very common. Research has shown that the most common self-medication technique used is which of the following?
- The nurse should be aware that which of the following medications has a side effect of rebound insomnia?
|a.||zaleplon (Sonata)||c.||trazodone (Desyrel)|
|b.||zolpidem (Ambien)||d.||temazepam (Restoril)|
- You are assigned to a client who is experiencing anxiety. The anxiety interferes with the client’s getting a restful night’s sleep. An outcome objective for this client would be which of the following?
|a.||Falls asleep with some difficulty|
|b.||Sleeps through the night consistently|
|c.||Uses sleep aides to promote sleep at night|
|d.||Able to talk with the nurse regarding sleep complaints|
- A client tells the nurse that she used to dream all the time. Recently, she has not experienced dreaming. When examining the client’s medications, the nurse determines that the lack of dreams is related to which of the following medications?
- You are the nurse researcher in a sleep lab. Assessment reveals that several of the clients have rapid eye movement. What should your immediate reaction be?
|a.||contact your immediate supervisor for further instructions|
|b.||do nothing, this is normal and indicates that the clients are dreaming|
|c.||contact the physician on call immediately because the client is seizing|
|d.||administer a hypnogenic and wait 1 hour, then reassess the client’s condition|
- Nursing interventions to promote restful sleep include which of the following? Select all that apply.
|a.||provide a backrub before bedtime|
|b.||encourage the client to void before bedtime|
|c.||administer diuretics 1 hour before bedtime|
|d.||offer the client a cup of coffee before bedtime|
|e.||provide the client with loose-fitting nightwear|
|f.||administer analgesics 30 minutes before bedtime|
- The nurse works on a unit that has clients with various sleep disorders. The nurse knows that the physiologic changes which occur during NREM sleep include which of the following? Select all that apply.
|a.||pulse rate increases||d.||blood pressure increases|
|b.||skeletal muscles relax||e.||cardiac output increases|
|c.||growth hormone levels peak||f.||BMR increases 10% to 30%|
- You are assessing a client who has experienced insomnia for several days. Your assessment would most likely reveal which of the following? Select all that apply.
|a.||irritability||d.||difficulty falling asleep|
|b.||refreshing sleep||e.||alert and oriented during the day|
|c.||daytime sleepiness||f.||waking up frequently during night|
- Factors that interfere with the normal sleep patterns of older adults include which of the following? Select all that apply.
|d.||side effects of medications|
|e.||loss of spouse or close friend|
|f.||confusion related to delirium or dementia|
- Nursing diagnoses for a client with a sleep disorder would include which of the following? Select all that apply.
|c.||fatigue related to insufficient sleep|
|d.||risk for injury related to somnambulism|
|e.||activity intolerance related to sleep deprivation|
|f.||risk for impaired gas exchange related to sleep apnea|
CHAPTER 24—THE CLIENT WITH A SEXUAL DISORDER
- When teaching about sexuality, the nurse would discuss sexual experimentation as something that:
|a.||is to be avoided||c.||usually pleasures one partner|
|b.||is almost always a bad thing||d.||expands one’s knowledge base|
- If we are in the middle of a third sexual revolution, as some theorists suggest, what mindset is at the core of this revolution?
|a.||sexual variation is to be celebrated|
|b.||sexual health is a basic human right|
|c.||experimentation in sexuality is good|
|d.||sexual behavior can be life threatening|
- The World Association for Sexology adopted which of the following documents in 1999?
|a.||Standards for Sexologists|
|b.||Declaration of Sexual Rights|
|c.||Sexologist Certification Requirements|
|d.||Guidelines for Acceptable Sexual Practices|
- During a holistic assessment of a couple, the husband shares with the nurse that after he climaxes, he cannot seem to get aroused for at least 24 hours while his wife is often aroused much sooner. The best response by the nurse would be:
|a.||“Unlike women, men have a refractory period where they can’t get aroused.”|
|b.||“You may have some work to do with a therapist to get rid of old ideas about sex.”|
|c.||“Your wife is probably more sexual in nature and has more sexual needs than you.”|
|d.||“You need to communicate more with your wife to let her know what arouses you.”|
- When working with couples having difficulty conceiving, the nurse will most want to be certain that this couple:
|a.||know what the signs of ovulation are|
|b.||is free of sexually transmitted diseases|
|c.||has been trained in how to take a temperature|
|d.||is aware of how to keep their stress levels down|
- Which of the following is a basic sexual right according to the World Association for Sexology?
|a.||the right to sexual health care|
|b.||freedom to talk publicly about sex|
|c.||freedom to publish sexual materials|
|d.||the right to engage in sexual variations|
- The nurse working to prevent the spread of chlamydia in the community will be most effective by:
|a.||providing clients with a list and discussing the bad effects of having chlamydia|
|b.||asking clients to be sexually abstinent until they are married and with one partner|
|c.||teaching clients to recognize the early symptoms of this sexually transmitted disease|
|d.||teaching clients the reasons for using protection and knowing a partner’s sexual history|
- The American Nurses Association’s position on birth control for adolescents is:
|a.||that adolescents need to practice strict abstinence|
|b.||to leave sexual education and birth control to the parents|
|c.||not formed as it is still being researched and will be released in 2003|
|d.||supportive of birth control knowledge and access for adolescents and older|
- While the school nurse is talking about sexually transmitted diseases to a hygiene class, one of the students asks how chlamydia is treated. Which of the following answers would be the best on the part of the nurse?
|b.||oral nystatin||d.||there is no treatment|
- The nurse talking with sexually active people will share that two-thirds of all new cases of sexually transmitted diseases in the United States are caused by Trichomonas vaginalis and which one of the following?
|b.||herpes||d.||human papillomavirus (HPV)|
- With respect to working with clients about sexual issues, which of the following must the nurse primarily possess before being able to do quality checks on the nursing care he delivers?
|a.||extensive training in working with a wide variety of sexual pathologies|
|b.||knowledge of community social mores about a variety of beliefs and practices|
|c.||awareness of his own attitudes, values, and beliefs regarding sexual health|
|d.||credentials from the World Association of Certified Advanced Nurse Practice Sexologists|
- A nurse is working with a client who is paralyzed from the waist down. When the client wants information about oral sex, the nurse has a strong reaction and leaves the room without responding. This nurse’s best course of action is to:
|a.||ask the supervisor to assign another nurse to this client|
|b.||tell the client to talk with the social worker or clergy about this topic|
|c.||seek outside help to work through and resolve sexual issues and themes|
|d.||get someone else to explain about oral sex and perform other nursing duties with this client|
- When you find yourself in disagreement with some of the client’s expressed sexual values or beliefs, which approach would be best on your part?
- While assessing the sexual history of a couple, you learn that the wife has a difficult time initiating sexual activity and the husband wants her to. You find yourself identifying with the wife’s position as this is similar to your own current experience. Which of the following courses of action would be best?
|a.||talk to a psychiatric nurse specialist or sexologist and discuss your issues|
|b.||enlist the help of your husband and conquer your own problem through him|
|c.||read a sex manual and design some exercises for the wife to try with her husband|
|d.||let the wife know you understand how she feels as this is similar to your experience|
- Kaplan, who worked as a sex therapist, proposed an alternative model to the Masters and Johnson model. Kaplan’s initial model was divided into two phases which were vasocongestion and which of the following stages?
- A couple has been dating and want to advance to a new level of intimacy. They seek the advice of the nurse by asking the question, “What is the most important ingredient of intimacy, or what do we need to do in order to have a feeling of closeness?” The best answer by the nurse is to suggest that at the heart of intimacy is appropriate and well-planned:
|a.||gift giving||c.||sexual intercourse|
|b.||self-disclosure||d.||more time together|
- When scientists studied the hypothalamus on positron emission tomography (PET) scans of the brain to determine if there were any differences in men and women which might explain sexual orientation, what did they find?
|a.||the overall hypothalamic area was about 67% larger in females|
|b.||the stria terminalis was emitting more red heat in men than in women|
|c.||one specialized area of the stria terminalis was about 44% larger in men|
|d.||there were no significant differences found in the hypothalamus of men and women|
- Some rewards, like food and sex, are considered primary. Primary means that these rewards:
|a.||are at Maslow’s first level||c.||come first before all others|
|b.||are intrinsically rewarding||d.||can be traded for other rewards|
- When working with a client who is being treated for premature ejaculation, the sexologist would most likely prescribe and teach the client to:
|a.||fantasize something unpleasant during the sexual act|
|b.||masturbate a few hours before initiating sex with a partner|
|c.||use a constricting device on the penis to prevent ejaculation|
|d.||use masturbation exercises to identify the point of inevitability|
- In 1996, Congress passed welfare reform legislation including 50 million dollars a year for 5 years made available to the states for which of the following types of sexual education?
|b.||condom use||d.||contraceptive medicines|
- When a couple is having difficulties with the sexual aspect of their lives, the nurse will most often find that the problem is:
|a.||too many stressors||c.||failure to communicate|
|b.||narcissistic behavior||d.||boredom with the same partner|
- When teaching groups about HIV infection in women, the nurse will emphasize which of the following facts?
|a.||African American women have the lowest rate of HIV infection|
|b.||women mainly got HIV infection years ago from blood transfusions|
|c.||the rate of HIV infection has remained low in women over 20 years|
|d.||HIV cases in women have risen and 50% were infected heterosexually|
- While a nurse is teaching about HIV infection, a member of the audience asks what percentage of people with HIV are women. The nurse will answer that in 1999, it was reported as:
- When working with a couple regarding their sexual difficulties, the wife informs the nurse that during sexual intercourse her husband asks her if his penis is “big enough.” The nurse is aware that this husband is doing which of the following things?
- When is it appropriate for a nurse to ask about past experiences of sexual abuse?
|a.||only when one of the clients brings it up|
|b.||in every cas and early in the course of work|
|c.||only if the nurse is very comfortable asking|
|d.||when it makes a difference in the choice of treatment|
- When working with clients in regard to assisting them in disclosing their feelings about sexual desire in relationship to their partner, which of the following would be most helpful?
|c.||Schnarch’s concept of wanting|
|d.||Seligman’s learned helplessness theory|
- When couples engage in sadomasochism, this means that:
|a.||they are involved in group sexual activities involving strange sexual practices|
|b.||the couple is into bondage activities involving tying or chaining each other up|
|c.||the sadist degrades, humiliates, or inflicts pain on a partner who claims to enjoy it|
|d.||each member of the couple likes to inflict pain, and they take turns inflicting pain on each other|
- One of your clients experiencing depression and taking an antidepressant medication complains of lack of libido and inability to get aroused or maintain an erection. Your best response would be which one of the following?
|a.||“Perhaps your doctor could give you a weekend holiday from your medication.”|
|b.||“As soon as your mood improves, you will notice your libido greatly improving.”|
|c.||“You actually need to use all your energy right now to deal with your depression.”|
|d.||“Some medications such as bupropion (Wellbutrin) have fewer sexual side effects.”|
- A nurse teaching about the myths of sexuality will expose which of the following?
|a.||children will ask parents or guardians about sexuality when the time is right|
|b.||individuals can remain sexually healthy and active throughout their lifetime|
|c.||homosexuality is not classified in the diagnostic manual as a sexual paraphilia|
|d.||individuals are responsible for their own level of sexual desire in a relationship|
- A parent asks the nurse working in a pediatric clinic at what age children become certain of their being either male or female. The nurse will base the answer on experience and an awareness that psychologists believe that gender constancy is developed by which of the following ages?
|a.||12 months||c.||5 to 7 years|
|b.||2 to 4 years||d.||8 to 10 years|
- A client hears the term “transgendered” and asks the nurse what this means. The best response by the nurse would be which of the following explanations?
|a.||“This term describes the distinct period in which a sex change is taking place.”|
|b.||“It covers people whose sense of self clashes with their original biological gender.”|
|c.||“It occurs when a person has changed from being a father to a mother or vice versa.”|
|d.||“This is a new term which is being used for homosexuals in order to reduce the stigma.”|
- The nurse doing a sexual history on a client hears the client describing pain during and after intercourse. The nurse is aware that the DSM-IV-TR has a diagnostic category of sexual pain disorders. In assessing this client further, the nurse will keep in mind that to meet the criteria for a sexual pain disorder, this client’s signs and symptoms:
|a.||must be persistent or recurrent|
|b.||can be due to a medical disorder|
|c.||cannot involve pain prior to intercourse|
|d.||has to cause major distress for the partner|
- A client asks a nurse what is meant by the term “paraphilia.” The best answer by the nurse would be which of the following?
|a.||“This is a term to cover any object or equipment used in sexual activities.”|
|b.||“It has to do with using children as sexual partners or for sexual stimulation.”|
|c.||“This is an umbrella term for variations in sexual behavior that are problematic.”|
|d.||“It means that a person does not have a preference of gender for a sexual partner.”|
- An appropriate outcome objective for a client who states to the nurse, “I’m ugly, overweight, and not too smart. I have never been asked on a date. I probably couldn’t even get a rapist to attack me.”
|a.||Client will verbalize positive self-statements.|
|b.||Client will call a dating service to find a mate.|
|c.||Client will resign self to always being alone.|
|d.||Client will understand the illness and report the symptoms|
- An 18-year-old woman comes to the clinic to obtain birth control pills. She has never been sexually active and will be married in 2 weeks. She asks the nurse several questions about the side effects of birth control pills and whether they will interfere with sexual performance. An appropriate nursing diagnosis for this client is:
|a.||ineffective coping||c.||sexual health disturbance|
|b.||knowledge deficit||d.||unresolved expectations of marriage|
- An appropriate outcome objective for a client experiencing a sexual disorder would be:
|a.||nurse will refer client to a sex therapist|
|b.||physician will prescribe medication for impotence|
|c.||client will report absence of pain during intercourse|
|d.||nurse will provide education regarding medical condition|
- A couple comes to the clinic and expresses concern that the husband is unable to maintain an erection for sufficient time to please his wife. The best response by the nurse would be:
|a.||“Is it true that he has been unable to satisfy you?”|
|b.||“I know what you mean. You must be really feeling incompetent.”|
|c.||“I will refer you to a psychiatrist. You must have a mental problem.”|
|d.||“We must first determine the source of the problem and then we will talk about some possible solutions.”|
- During a physical examination, the nurse discovers that the client’s clitoris prepuce has been excised. The client’s glands and labia minora remain. The nurse would assess this as which type of female genital mutilation (FGM) according to the World Health Organization (WHO)?
|a.||Type I||c.||Type III|
|b.||Type II||d.||Type IV|
- An adolescent is rushed to the ED after undergoing female genital mutilation (FGM). Her temperature is elevated and she is in shock. The parents tell the nurse, “This is our custom. It is a matter of family honor. We must assure that she remains pure until she marries.” The nurse knows that FGM is an illegal procedure in the United States. The nurse’s priority action would be:
|a.||contact the police immediately|
|b.||provide physical care to the client|
|c.||call the nursing supervisor for help|
|d.||have security escort the parents out of the hospital|
- A client comes to the Women’s Clinic due to a vaginal discharge. She tells the nurse that she loves men and just cannot get enough sex. The best response by the nurse is to:
|b.||ask the client if she really needs sex that bad|
|c.||tell the client that she is being very promiscuous|
|d.||refer the client to a priest so that she can confess her sins|
- A 33-year-old woman comes to the clinic and shares with the nurse her concerns of never being married or having children. The nurse recognizes that the client is in which of Erikson’s developmental stages?
|a.||Intimacy vs. Isolation||c.||Identity vs. Role Confusion|
|b.||Ego Integrity vs. Despair||d.||Autonomy vs. Doubt and Shame|
- A client states to the nurse, “My husband is getting older and it is more difficult for him to maintain an erection.” What is the best documentation by the nurse?
|a.||“Husband is impotent.”|
|b.||“Client dissatisfied with husband’s sexual performance.”|
|c.||“Husband and wife have a sex problem which must be addressed.”|
|d.||“Client states that her husband is getting older and it is more difficult for him to maintain an erection.”|
- A client states to the nurse, “I’m ugly, overweight, and not very smart. I have never been asked out on a date. I don’t think anyone could ever really love me.” An appropriate nursing diagnosis for this client would be:
|a.||low self-esteem||c.||depression due to aging|
|b.||knowledge deficit||d.||anxiety due to no sexual partner|
CHAPTER 25—THE CLIENT WHO SURVIVES VIOLENCE
- When working with clients who are survivors of violence, the nurse and other health care workers must guard most against which of the following?
- When teaching about the statistics of the incidence of violence and abuse, the nurse will point out that these statistics are:
- The 1999 national child abuse statistics reported by the states indicated that the greatest percentage of survivors suffered from which of the following problems of abuse?
|b.||sexual abuse||d.||physical abuse|
- The nurse working with children who have been abused will find from experience as well as research that the primary perpetrators of child maltreatment are:
|a.||day care providers||c.||friends of the family|
|b.||parents or guardians||d.||neighbors of the family|
- The nurse teaching parents about the prevention of physical abuse to infants and children will advise parents that the leading cause of death and disability among maltreated children results from which of the following behaviors by caregivers?
|b.||hitting an infant or child|
|c.||shaking an infant or child|
|d.||keeping a child too hot or too cold|
- When the nurse in the pediatric unit or the pediatric clinic assesses a child and finds bruises that are inconsistent with the parents’ explanations, the nurse needs most to:
|a.||give the parents the benefit of doubt|
|b.||suspect and report possible child abuse|
|c.||realize children do have bizarre accidents|
|d.||ask the parents if they are abusing the child|
- A nurse working in the children’s unit of the hospital is assigned to work with a child diagnosed with Munchausen syndrome by proxy. From reviewing this diagnosis prior to caring for the child, the nurse will realize that a parent of this child has been found to have done which of the following things?
|a.||given the child substances to induce physical signs of illness and sought medical treatment|
|b.||ignored the child’s basic needs for shelter, food, and clothing because of her own narcissistic needs|
|c.||physically abused the child and then forced the child to say that the injuries were an accident|
|d.||claimed the child was ill when the child was actually well and that the parent had made the physical diagnosis|
- You are working in a hospital pediatric unit. You see a particular child admitted several times with unexplained high fevers and notice that the mother is overly doting. You would most likely suspect which of the following is taking place?
|c.||Munchausen syndrome by proxy|
|d.||overanxious new parent syndrome|
- When working with perpetrators or victims of sexual abuse, the nurse keeps in mind that sexual abuse of a child involves sexual contact with a person who is of which of the following ages?
|a.||5 or more years older than the child victim|
|b.||the legal age to be tried in court as an adult|
|c.||over the age of reason which is approximately 8 years old|
|d.||any age whatsoever when sexual contact is initiated with a child|
- The school nurse working on programs to prevent sexual abuse of children is aware of the fact that the boys most at risk of sexual abuse are boys who are:
|a.||from white families||c.||living with their fathers|
|b.||younger than age 13||d.||from middle income families|
- The school nurse and others working with boys who have been sexually abused most often find which of the following barriers to timely and appropriate intervention?
|a.||parents sabotaging any efforts at intervention|
|b.||school officials sabotaging intervention efforts|
|c.||reluctance of the boys to talk about the sexual abuse|
|d.||perpetrators threatening to hurt the person intervening|
- While talking with a child who came to the school nurse’s office with a stomachache, the nurse hears the child describing her brother having sexual intercourse with her. Which of the following terms would be the most precise legal term to describe this activity?
- Nurses must become familiar with their state laws regarding sexual activity performed on or perpetrated on children by relatives because of which of the following reasons?
|a.||The child and family may need to be advised of their rights.|
|b.||The nurse could get sued by the perpetrator or the victim.|
|c.||The reporting of sexual abuse by nurses is mandated in some states.|
|d.||The laws regarding what constitutes incest varies from state to state.|
- A nurse serving with a team that is working with victims of intimate partner violence (IVP) will find that female clients are most likely to be in which of the following age ranges?
|a.||46 to 56||c.||25 to 34|
|b.||35 to 45||d.||16 to 24|
- When working with women who are at high risk for intimate partner violence (IVP), the nurse will advise these women that the percentage of female homicide victims killed by their spouses, boyfriends, or former partners is:
- When working with women who are at high risk for intimate partner violence (IVP), the nurse will discuss with these women the fact that recent findings have confirmed that 64% of women raped, physically assaulted, or stalked were the victims of:
|a.||current or former husbands, partners, boyfriends, or dates|
|b.||neighbors or casual acquaintances met in everyday settings|
|c.||strangers with long histories of assaulting, raping, or stalking women|
|d.||members of their own families of origin such as fathers, brothers, or cousins|
- When doing an initial assessment of a client who claims to have been the victim of sexual abuse, the nurse finds that the client is overly compliant and exhibits very little emotion. The nurse will suspect that the client is exhibiting behavior which is indicative of:
|a.||a person who is lying to get some attention|
|b.||one of the usual behaviors of sexual abuse victims|
|c.||one of the usual behaviors of borderline personality disorder|
|d.||someone who has been abused many times over a long period of time|
- When working with female survivors of intimate partner violence, the nurse will select as a priority which of the following interventions?
|a.||advocate on behalf of the woman and any children|
|b.||ensure a safe location for the woman and any children|
|c.||respect the woman’s right and ability over her life choices|
|d.||hold the perpetrator responsible for the abuse and stopping it|
- The survivor of intimate partner violence is describing feelings of extreme anger and the desire to get revenge and to inflict injury upon the perpetrator. The best response by the nurse would be which of the following responses?
|a.||“Most people don’t have quite as much anger as you seem to have at this time.”|
|b.||“I hear you describing your anger and thinking about revenge. Please continue.”|
|c.||“Perhaps you would feel better if you could forgive the perpetrator for these acts.”|
|d.||“It is all right to be angry, but perhaps a little less anger and revenge would be better.”|
- When working with victims of elder abuse, the nurse will be working with victims who are over which of the following ages?
- The community health nurse, and any nurse in any setting, who is screening for elder abuse will keep in mind that the profile of the abused older adult most often includes which of the following characteristics?
|b.||social||d.||having substantial savings|
- When visiting a family in which the nurse suspects elder abuse is occurring, the nurse needs most to prepare for the visit by doing which of the following things?
|a.||notifying local law enforcement|
|b.||notifying the agency for the elderly|
|c.||locating low-cost mental health care|
|d.||finding respite care and other resources|
- A nurse is working with a client who is being abused by her spouse. As the nurse prepares the client to go to a safe place with her children, the nurse realizes that research has strongly suggested that abused women tend to view leaving violence in which of the following ways?
|a.||as an ambivalent event which is joyous on one hand, yet sad on the other hand|
|b.||as a form of loss of a sense of security and with grieving over this loss of security|
|c.||with a great sense of relief and a feeling like a weight being lifted off their shoulders|
|d.||with fear and a sense that something awful is about to happen to them and their children|
- One of your nurse peers shares concern that one of her clients is living in an abusive situation but will not leave. The best response to your colleague would be:
|a.||“Abused clients will leave the abusive relationship when it feels safe to leave.”|
|b.||“You should see if you can get your client into a shelter for survivors of abuse.”|
|c.||“Perhaps the client would leave the relationship if you could loan her some money.”|
|d.||“It is difficult to work with abused clients as they don’t want to leave the perpetrator.”|
- You are interviewing a woman to obtain a health history prior to hospital admission. Each time you ask a question, the husband answers and he refuses to let his wife be examined without his being present. Which of the following actions would be best on your part?
|a.||conduct a cultural assessment before proceeding further|
|b.||notify and turn the situation over to the primary physician|
|c.||notify your supervisor that you may have an abusive husband situation|
|d.||insist on talking with the wife alone even if you have to get security involved|
- The nurse is working on a unit which cares for children who have been abused. Because small children may not be able to express what has happened with them, which of the following forms of therapy would be implemented?
|a.||play therapy||c.||group therapy|
|b.||individual therapy||d.||family therapy|
- A 12-year-old girl goes to see the school nurse regarding her stomachache. While talking with the nurse, the girl mentions that she will never go to college like the nurse. The nurse questions this comment and the girl replies, “I’m not smart like you. My mother says I am as dumb as a rock and won’t amount to anything. She said I’m just like my worthless father.” The nurse’s assessment of the girl’s statement would be that the girl is possibly a victim of:
- The police bring a group of children to your child abuse unit at a local hospital. He tells you that a raid was made at a local drug house and the five children ages 2 months to 7 years were huddled in the back room. The nurse’s assessment revealed that all of the children were wearing dirty and ragged clothing. Each child was severely underweight for his or her age. Blood work revealed that all of the children suffered from anemia. The assessment revealed that the children were victims of:
- A nurse is working in the emergency room when a young woman comes in. The woman has several bruises and minor cuts on her face and arms. Further assessment reveals old scars and bruises over most of her body. What is the first action the nurse should take?
|a.||admit the client to the hospital where she will be safe|
|b.||contact the supervisor on call to determine your next step|
|c.||call the police immediately and have the husband arrested|
|d.||document the client’s injuries using a body map and photographs|
- You are preparing a teaching plan for a group of inmates at the local correctional facility. Each of them has been imprisoned for spousal abuse. Which of the following statements is true regarding abuse?
|a.||the abuser has a need to control|
|b.||the victim most likely caused the abuse|
|c.||the victims liked the abuse that was received|
|d.||the abusers were from supportive and happy families|
- You are caring for an elderly client who was admitted to your unit after being abused by her daughter. The client is very frail and has several bruises on her arms and legs. A priority nursing intervention would be to:
|a.||respect the client’s right to make her own decisions|
|b.||spend time with the client to promote expression of feelings|
|c.||assess the client’s potential for suicide and any suicidal ideations|
|d.||refer the client for counseling if she verbalizes suicidal ideation plan|
- A client is admitted to the hospital with several bruises and cuts to her face. The physical exam and x-rays revealed older scars and previous broken bones. While talking with the nurse, the client expresses guilt feels for causing her husband to hit her. She states that she had been neglectful and did not have his dinner ready when he arrived home from work. The best response by the nurse would be:
|a.||“No one has the right to abuse another person.”|
|b.||“Maybe you should have ordered a pizza for dinner.”|
|c.||“Were you too busy to have his dinner ready on time?”|
|d.||“I know what you mean. My husband would be upset too.”|
- The immediate emotional effects of abuse on adolescents would include which of the following? Select all that apply.
|a.||fears and phobias||d.||poor peer relationships|
|b.||psychotic processes||e.||concentration difficulties|
|c.||self-destructive acts||f.||self-deprecating thoughts|
- The community nurse visits a woman who has been a victim of abuse. The nurse would include which of the following when conducting individual therapy with the woman? Select all that apply.
|a.||safety plan||d.||past history of abuse|
|b.||coping skills||e.||attitudes toward violence|
|c.||cultural considerations||f.||meaning of ascribed events|
- Nursing diagnoses which apply to families of victims of abuse would include which of the following? Select all that apply.
|a.||impaired parenting||d.||chronic low self-esteem|
|b.||risk for family support||e.||interrupted family process|
|c.||family abuse tolerances||f.||compromised family coping|
CHAPTER 26—INDIVIDUAL PSYCHOTHERAPY
- One of your assigned clients tells you of being scheduled for an initial visit with a nurse psychotherapist and asks you to explain the educational preparation of a nurse psychotherapist. You would advise the client to ask the individual nurse psychotherapist they will be seeing what his preparation is, and that your understanding of the minimum preparation is a:
|a.||nursing license as a vocational nurse and several years of experience working with the mentally ill|
|b.||Bachelor’s degree in nursing with some additional courses in psychiatry and supervised counseling experience|
|c.||Master’s degree with national certification as an advanced practice psychiatric-mental health nurse|
|d.||Doctoral degree in nursing or a lesser degree in nursing and a Doctoral degree in psychology.|
- When a client asks you what a nurse psychotherapist might have to offer that would be different from psychotherapists of another discipline, your best answer would be that the nurse psychotherapist would offer not only the usual base of mental health care but also:
|a.||an approach based on a trusting relationship|
|b.||a problem-solving approach unique to nursing|
|c.||individual care with nursing care, empathy, and attention|
|d.||a cost-effective type of care focusing on the whole person|
- A client tells you that his nurse psychotherapist uses eclecticism. You realize that the therapist is using which of the following treatment approaches?
|a.||two or more theories which show promise to effectively meet the client’s needs|
|b.||Gestalt approaches developed by Carl Rogers along with solution-oriented work|
|c.||energy force field theories developed by Martha Rogers who was a nurse theorist|
|d.||combination psychotherapy and electric shock therapy while working with a psychiatrist|
- After working with clients who have a mental illness diagnosis and a high rate of recidivism, you find that you have lost the belief that people with mental illness can change their behaviors. You assess your attitude and determine that your best course of action is to:
|a.||talk with a friend about your lost faith in this group’s ability to change|
|b.||seek help from a professional to renew your belief that all people can change|
|c.||accept your attitude that people with chronic mental illness cannot change as normal|
|d.||find a nursing position that does not require you to work with people with mental illness|
- The nurse psychotherapist will most utilize which of the following in the psychotherapeutic process to promote the client’s health, growth, and development of adaptive coping behaviors?
|a.||assessment skills||c.||nursing care plan books|
|b.||psychometric testing||d.||the therapeutic relationship|
- One of your assigned clients who is seeing a psychoanalyst twice a week describes the psychoanalyst using a technique called free association. You realize that free association involves the client’s:
|a.||saying the first thing that comes to mind in response to words or phrases|
|b.||determining the agenda for the therapy and working on self-determined goals|
|c.||speaking nonstop after receiving sodium amytal to reduce unconscious inhibitions|
|d.||talking about whatever comes to mind as the therapist listens without taking notes|
- The nurse will advise the client as to the usual length of various types of psychotherapy and what the various psychotherapies involve. Which of the following types of psychotherapy would you say usually lasts the longest?
|a.||reality therapy||c.||behavior modification|
- A client begins reacting to his psychoanalyst in much the same way that he reacted to his father in the past. This behavior on the part of the client represents:
|a.||transference||c.||a control issue|
|b.||a lasting habit||d.||countertransference|
- The nurse psychotherapist has to cancel an appointment with a client when another client attempts suicide. The client whose appointment was cancelled reacts with anger and feelings of rejection. The nurse psychotherapist points out that in previous sessions the client had described similar emotions when, years previously, the client’s mother turned her attention to the client’s newborn sibling. The client’s anger and feelings of rejection in this case are examples of which of the following:
|b.||free association||d.||conscious aggression|
- A nurse psychotherapist finds himself reacting in an overly kind and concerned manner toward a client who reminds him of his father. Which of the following actions does the psychotherapist need to take if following the theories of Freud?
|a.||utilize these issues in the therapy|
|b.||confront the client for behaving in a childlike way|
|c.||overcome or minimize these feelings toward the client|
|d.||self-disclose to the client your insight into this behavior|
- When a nurse psychotherapist has reactions to a client in a dream or fantasy, which of the following actions would be best on the part of the nurse psychotherapist?
|a.||accept that dreams are one of the best ways to work on issues|
|b.||share the dream with the client and use it in the therapy work|
|c.||seek help during a professional supervision session or psychoanalysis|
|d.||ignore the dream or fantasy as nothing important to be concerned about|
- When working with clients having a variety of diagnoses and presenting problems, the nurse therapist would most consider using brief psychotherapy for a client who has:
|a.||grief reaction||c.||suicide ideation|
|b.||acute psychosis||d.||bipolar disorder|
- In the first session with a client, the nurse psychotherapist using brief psychotherapy is setting the number of sessions with the client. The number of sessions they will agree on will most likely not exceed which of the following?
- The nurse psychotherapist has chosen to use behavioral therapy on a client who has presented with a fear of flying. The nurse has most likely selected behavioral therapy based on a belief that this client’s behavior:
|a.||is part of a symptom complex</t|