Examen Final # 5 Salud Mental

1. Select the priority nursing intervention when caring for a patient after an overdose of amphetamines. a. Monitor vital signs. b. Observe for depression. c. Awaken the patient every 15 minutes. d. Use warmers to maintain body temperature.

2. An 11-year-old diagnosed with ODD becomes angry over the rules at a residential treatment program and begins cursing at the nurse. Select the best method for the nurse to defuse the situation. a. Ignore the child’s behavior. b. Send the child to time-out for 2 hours. c. Take the child to the gym and engage in an activity. d. Role-play a more appropriate behavior with the child.

3. When a patient first began using alcohol, two drinks produced relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same response. Why has this change occurred?. a. Tolerance has developed. b. Antagonistic effects are evident. c. Metabolism of the alcohol is now delayed. d. Pharmacokinetics of the alcohol have changed.

4. A widower tells friends, “I am taking my neighbor out for dinner. It’s time for me to be more sociable again.” Considering the stages of grief described by Kübler-Ross, which stage is evident?. a. Anger. b. Denial. c. Depression. d. Acceptance.

5. A nursing diagnosis appropriate to consider for a patient diagnosed with any of the personality disorders is. a. noncompliance. b. impaired social interaction. c. disturbed personal identity. d. diversional activity deficit.

6. An elderly patient must be physically restrained. Who is responsible for the patient’s safety?. a. The nurse assigned to care for the patient. b. Unlicensed assistive personnel who apply the restraint. c. Family member who agrees to application of the restraint. d. Health care provider who prescribed application of restraint.

7. A patient with fluctuating levels of awareness, confusion, and disturbed orientation shouts, “Bugs are crawling on my legs. Get them off!” Which problem is the patient experiencing?. a. Aphasia. b. Dystonia. c. Tactile hallucinations. d. Mnemonic disturbance.

8. A patient who was widowed 18 months ago says, “I can remember good times we had without getting upset. Sometimes I even think about the disappointments. I am still trying to become accustomed to sleeping in the bed all alone.” The work of mourning. a. is beginning. b. has not begun. c. is at or near completion. d. is progressing abnormally.

9. When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include. a. preoccupation with minute details; perfectionist. b. charm, drama, seductiveness; seeking admiration. c. difficulty being alone; indecisive, submissiveness. d. grandiosity, self-importance, and a sense of entitlement.

10. A patient admitted to an alcohol rehabilitation program tells the nurse, “I’m actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening.” The patient is using which defense mechanism?. a. Denial. b. Projection. c. Introjection. d. Rationalization.

11. A nurse counsels a patient on ways to determine the person’s total sleep requirement. Which instruction would produce the most accurate results?. a. “For 1 full week, record what you remember about your dream content and related feelings as soon as you wake up. Bring the record to your next appointment.”. b. “While off work for 1 week, go to bed at your usual time and wake up without an alarm. Record how many hours you sleep and then average the findings.”. c. “For 2 full weeks, record how much time you sleep each night and rate your daytime alertness on a scale of 1 to 10. Calculate your average alertness score.”. d. “All adults need 7 or 8 hours of sleep to function properly. Let’s design ways to help you reach that goal.”.

12. A parent who is very concerned about a 3-year-old son says, “He likes to play with girls’ toys. Do you think he is homosexual or mentally ill?” Which response by the nurse most professionally describes the current understanding of gender identity?. a. “A child’s interest in the activities of the opposite gender is not unusual or related to sexuality. Most children do not carry cross-gender interests into adulthood.”. b. “It’s difficult to say for sure because the research is incomplete so far, but chances are that he will grow up to be a normal adult.”. c. “The research is incomplete, but many boys play with girls’ toys and turn out normal as adults.”. d. “I am sure that whatever happens, he will be a loving son, and you will be a proud parent.”.

13. While performing an assessment, the nurse says to a patient, “While growing up, most of us heard some half-truths about sexual matters that continue to puzzle us as adults. Do any come to your mind now?” The purpose of this question is to. a. identify areas of sexual dysfunction for treatment. b. determine possible homosexual urges. c. introduce the topic of masturbation. d. identify sexual misinformation.

14. A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child formed a trusting relationship with a shelter volunteer. The child says, “My three friends and I got an A on our school science project.” The nurse can assess that the child. a. displays resiliency. b. has a passive temperament. c. is at risk for PTSD. d. uses intellectualization to deal with problems.

15. Which goal for treatment of alcohol use disorder should the nurse address first?. a. Learn about addiction and recovery. b. Develop alternate coping strategies. c. Develop a peer support system. d. Achieve physiological stability.

16. Which event is most likely to precipitate grief across a community?. a. A local bank is robbed twice in a single month. b. An adolescent shoots the principal of a local high school. c. The elderly pastor of the town’s largest church dies of heart failure. d. Concrete pilings crumble in a bridge important to movement of local traffic.

17. Consider these phenomena: accumulation of -amyloid outside the neurons, neurofibrillary tangles, and neuronal degeneration in the hippocampus. Which health problem corresponds to these events?. a. Huntington’s disease. b. Alzheimer’s disease. c. Parkinson’s disease. d. Vascular dementia.

18. An adolescent was arrested for prostitution and assault on a parent. The adolescent says, “I hate my parents. They focus all attention on my brother, who’s perfect in their eyes.” Which nursing diagnosis is most applicable?. a. Disturbed personal identity related to acting out as evidenced by prostitution. b. Hopelessness related to achievement of role identity as evidenced by feeling unloved by parents. c. Ineffective coping related to inappropriate methods of seeking parental attention as evidenced by acting out. d. Impaired parenting related to inequitable feelings toward children as evidenced by showing preference for one child over another.

19. A patient reports, “Nearly every night I awaken feeling frightened after a bad dream. The dream usually involves being hunted by people trying to hurt me. It usually happens between 4 and 5 AM.” The nurse assesses this disorder as most consistent with criteria for which problem?. a. Sleep deprivation. b. Nightmare disorder. c. Night terror disorder. d. REM sleep behavior disorder.

20. A patient says, “The other nurses won’t give me my medication early, but you know what it’s like to be in pain and don’t let your patients suffer. Could you get me my pill now? I won’t tell anyone.” Which response by the nurse would be most therapeutic?. a. “I’m not comfortable doing that,” and then ignore subsequent requests for early medication. b. “I understand that you have pain, but giving medicine too soon would not be safe.”. c. “I’ll have to check with your doctor about that; I will get back to you after I do.”. d. “It would be unsafe to give the medicine early; none of us will do that.”.

21. An adult has a history of physical violence against family when frustrated, followed by periods of remorse after each outburst. Which finding indicates a successful plan of care? The adult. a. expresses frustration verbally instead of physically. b. explains the rationale for behaviors to the victim. c. identifies three personal strengths. d. agrees to seek counseling.

22. Select the priority outcome for a patient completing the fourth alcohol detoxification program in the past year. Prior to discharge, the patient will. a. state, “I know I need long-term treatment.”. b. use denial and rationalization in healthy ways. c. identify constructive outlets for expression of anger. d. develop a trusting relationship with one staff member.

23. After the death of his wife, a man says, “I can’t live without her … she was my whole life.” Select the nurse’s most therapeutic reply. a. “Each day will get a little better.”. b. “Her death is a terrible loss for you.”. c. “It’s important to recognize that she is no longer suffering.”. d. “Your friends will help you cope with this change in your life.”.

24. A nurse is performing an assessment for a 59-year-old man with a long history of hypertension. What is the rationale for including questions about prescribed medications and their effects on sexual function in the assessment?. a. Sexual dysfunction may result from use of prescription medications for management of hypertension. b. Such questions are an indirect way of learning about the patient’s medication adherence. c. These questions ease the transition to questions about sexual practices in general. d. Sexual dysfunction can cause stress and contribute to increased blood pressure.

25. The family of a child diagnosed with an impulse control disorder needs help to function more adaptively. Which aspect of the child’s plan of care will be provided by an advanced practice nurse rather than a staff nurse?. a. Leading an activity group. b. Providing positive feedback. c. Formulating nursing diagnoses. d. Dialectical behavioral therapy (DBT).

26. A patient has blindness related to conversion (functional neurological) disorder. To help the patient eat, the nurse should. a. establish a “buddy” system with other patients who can feed the patient at each meal. b. expect the patient to feed self after explaining arrangement of the food on the tray. c. direct the patient to locate items on the tray independently and feed self. d. address needs of other patients in the dining room, then feed this patient.

27. An 85-year-old has difficulty walking after a knee replacement. The patient tells the nurse, “It’s awful to be old. Every day is a struggle. No one cares about old people.” Select the nurse’s best response. a. “Everyone here cares about old people. That’s why we work here.”. b. “It sounds like you’re having a difficult time. Tell me about it.”. c. “Let’s not focus on the negative. Tell me something good.”. d. “You are still able to get around, and your mind is alert.”.

28. A patient diagnosed with Alzheimer’s disease calls the fire department saying, “My smoke detectors are going off.” Firefighters investigate and discover that the patient misinterpreted the telephone ringing. Which problem is this patient experiencing?. a. Hyperorality. b. Aphasia. c. Apraxia. d. Agnosia.

29. Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids?. a. Bromocriptine. b. Methadone. c. Disulfiram. d. Naltrexone.

30. A hospitalized patient diagnosed with delirium misinterprets reality. A patient diagnosed with dementia wanders about the home. Which outcome is the priority in both scenarios? The patients will. a. remain safe in the environment. b. participate actively in self-care. c. communicate verbally. d. acknowledge reality.

31. A 76-year-old is indifferent and responds to others only when they initiate an interaction. What form of group therapy would be most useful to promote resocialization?. a. Remotivation. b. Activity group. c. Psychotherapy. d. Reminiscence.

32. A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain?. a. Because severe anxiety concerning eating is expected, objective and subjective data may be unreliable. b. Patient involvement in decision making increases sense of control and promotes adherence to the plan of care. c. Because of increased risk of physical problems with refeeding, the patient’s permission is needed. d. A team approach to planning the diet ensures that physical and emotional needs will be met.

33. Symptoms of withdrawal from opioids for which the nurse should assess include. a. dilated pupils, tachycardia, elevated blood pressure, and elation. b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. c. mood lability, incoordination, fever, and drowsiness. d. excessive eating, constipation, and headache.

34. A nurse will prepare teaching materials for the parents of a child newly diagnosed with ADHD. Information will focus on which medication likely to be prescribed?. a. Paroxetine. b. Imipramine. c. Methylphenidate. d. Carbamazepine.

35. A would be most associated with increased periods of wakefulness in the general population?. a. Summer. b. Winter. c. Spring. d. Fall.

36. A hospitalized patient diagnosed with alcohol use disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n). a. narcotic analgesic, such as hydromorphone. b. sedative, such as lorazepam or chlordiazepoxide. c. antipsychotic, such as olanzapine or thioridazine. d. monoamine oxidase inhibitor antidepressant, such as phenelzine.

37. What is the priority intervention for a patient diagnosed with delirium who has fluctuating levels of consciousness, disturbed orientation, and perceptual alterations?. a. Distraction using sensory stimulation. b. Careful observation and supervision. c. Avoidance of physical contact. d. Activation of the bed alarm.

38. The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should. a. provide long-term care for the patient in a residential facility. b. withdraw the patient from cannabis, then treat the schizophrenia. c. consider each diagnosis primary and provide simultaneous treatment. d. first treat the schizophrenia, then establish goals for substance abuse treatment.

39. A nurse’s neighbor says, “I saw a news story about a man without any known illness who died suddenly after his ex-wife committed suicide. Was that a coincidence, or can emotional shock be fatal?” The nurse should respond by noting that some serious medical conditions may be complicated by emotional stress, including (Select all that apply). a. cancer. b. hip fractures. c. hypertension. d. immune disorders. e. cardiovascular disease.

40. An advance directive gives legally binding direction for health care interventions when a patient. a. has a new diagnosis of cancer. b. is diagnosed with Parkinson’s disease. c. is unable to make decisions for self because of illness. d. diagnosed with amyotrophic lateral sclerosis is unable to speak.

41. A patient with pancreatic cancer says, “I know I am dying, but I am still alive. I want to be in control as long as I can.” Which reply by the nurse shows active listening?. a. “Our staff will do their best to manage your pain.”. b. “Your mind and spirit are healthy, although your body is frail.”. c. “It’s important for you to let others help you to ease their own pain.”. d. “Are you saying you want people to stop focusing on your diagnosis?”.

42. A patient diagnosed with borderline personality disorder self-inflicted wrist lacerations after gaining new privileges on the unit. In this case, the self-mutilation may have been due to. a. an inherited disorder that manifests itself as an incapacity to tolerate stress. b. use of projective identification and splitting to bring anxiety to manageable levels. c. a constitutional inability to regulate affect, predisposing to psychic disorganization. d. fear of abandonment associated with progress toward autonomy and independence.

43. An older adult with Lewy body dementia lives with family. After observing multiple bruises, the home health nurse talked with the daughter, who became defensive and said, “My mother often wanders at night. Last night she fell down the stairs.” Which nursing diagnosis has priority?. a. Risk for injury related to poor judgment, cognitive impairments, and inadequate supervision. b. Wandering related to confusion and disorientation as evidenced by sleepwalking and falls. c. Chronic confusion related to degenerative changes in brain tissue as evidenced by nighttime wandering. d. Insomnia related to sleep disruptions associated with cognitive impairment as evidenced by wandering at night.

44. As a patient admitted to the eating-disorder unit undresses, a nurse observes that the patient’s body is covered by fine, downy hair. The patient weighs 70 pounds and is 5'4" tall. Which term should be documented?. a. Amenorrhea. b. Alopecia. c. Lanugo. d. Stupor.

45. For which behavior would limit setting be most essential? The patient who. a. clings to the nurse and asks for advice about inconsequential matters. b. is flirtatious and provocative with staff members of the opposite sex. c. is hypervigilant and refuses to attend unit activities. d. urges a suspicious patient to hit anyone who stares.

46. Which assessment finding would be likely for a patient experiencing a hallucination? The patient. a. looks at shadows on a wall and says, “I see scary faces.”. b. states, “I feel bugs crawling on my legs and biting me.”. c. reports telepathic messages from the television. d. speaks in rhymes.

47. A 15-year-old ran away from home six times and was arrested for shoplifting. The parents told the Court, “We can’t manage our teenager.” The adolescent is physically abusive to the mother and defiant with the father. Which diagnosis is supported by this adolescent’s behavior?. a. Attention deficit hyperactivity disorder (ADHD). b. Posttraumatic stress disorder (PTSD). c. Intermittent explosive disorder. d. Conduct disorder.

48. A child known as the neighborhood bully says, “Nobody can tell me what to do.” After receiving a poor grade on a science project, this child secretly loaded a virus on the teacher’s computer. These behaviors support a diagnosis of. a. Conduct Disorder. b. Oppositional Deficit Disorder. c. intermittent explosive disorder. d. Attention Deficit Hyperactivity Disorder.

49. A patient asks for information about AA. Select the nurse’s best response. “AA is a. a. form of group therapy led by a psychiatrist.”. b. self-help group for which the goal is sobriety.”. c. group that learns about drinking from a group leader.”. d. network that advocates strong punishment for drunk drivers.”.

50. Which comment by the nurse would best support relationship building with a survivor of intimate partner abuse?. a. “You are feeling violated because you thought you could trust your partner.". b. “I’m here for you. I want you to tell me about the bad things that happened to you.”. c. “I was very worried about you. I knew you were living in a potentially violent situation.”. d. “Abusers often target people who are passive. I will refer you to an assertiveness class.”.