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TEST BORRADO, QUIZÁS LE INTERESEVarcolis # 5

COMENTARIOS ESTADÍSTICAS RÉCORDS
REALIZAR TEST
Título del test:
Varcolis # 5

Descripción:
Siquiatria

Autor:
Jossue
(Otros tests del mismo autor)

Fecha de Creación:
26/06/2019

Categoría:
Ciencia

Número preguntas: 211
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Temario:
A patient comes to the crisis clinic after an unexpected job termination. The patient paces, sobs, cringes when approached, and responds to questions with only shrugs or monosyllables. Choose the nurse’s best initial comment to this patient. “Everything is going to be all right. You are here at the clinic and the staff will keep you safe.” “I see you are feeling upset. I’m going to stay and talk with you to help you feel better.” “You need to try to stop crying and pacing so we can talk about your problems.” “Let’s set some guidelines and goals for your visit here.”.
A patient is seen in the clinic for superficial cuts on both wrists. Initially the patient paces and sobs but after a few minutes, the patient is calmer. The nurse attempts to determine the patient’s perception of the precipitating event by asking: “Tell me why you were crying.” “How did your wrists get injured?” “How can I help you feel more comfortable?” “What was happening when you started feeling this way?”.
A patient comes to the crisis center saying, “I’m in a terrible situation. I don’t know what to do.” The triage nurse can initially assume that the patient is suicidal. anxious and fearful. misperceiving reality. potentially homicidal.
An adolescent comes to the crisis clinic and reports sexual abuse by an uncle. The adolescent told both parents about the uncle’s behavior, but the parents did not believe the adolescent. What type of crisis exists? Maturational Tertiary Situational Organic.
While conducting the initial interview with a patient in crisis, the nurse should speak in short, concise sentences. convey a sense of urgency to the patient. be forthright about time limits of the interview. let the patient know the nurse controls the interview.
An adult seeks counseling after the spouse was murdered. The adult angrily says, “I hate the beast that did this. It has ruined my life. During the trial, I don’t know what I’ll do if the jury doesn’t return a guilty verdict.” What is the nurse’s highest priority response? “Would you like to talk to a psychiatrist about some medication to help you cope during the trial?” “What resources do you need to help you cope with this situation?” “Do you have enough support from your family and friends?” “Are you having thoughts of hurting yourself or others?”.
Six months ago, a woman had a prophylactic double mastectomy because of a family history of breast cancer. One week ago, this woman learned her husband was involved in an extramarital affair. The woman tearfully says to the nurse, “What else can happen?” What type of crisis is this person experiencing? Maturational Mitigation Situational Recurring.
A woman said, “I can’t take anymore! Last year my husband had an affair and now we don’t communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she’s quitting college.” What is the nurse’s priority assessment? Identify measures useful to help improve the couple’s communication. The patient’s feelings about the possibility of having a mastectomy Whether the husband is still engaged in an extramarital affair Clarify what the patient means by “I can’t take anymore.”.
Six months ago, a woman had a prophylactic double mastectomy because of a family history of breast cancer. One week ago, this woman learned her husband was involved in an extramarital affair. The woman says tearfully, “What else can happen?” If the woman’s immediate family is unable to provide sufficient support, the nurse should suggest hospitalization for a short period. ask what other relatives or friends are available for support. tell the patient, “You are a strong person. You can get through this crisis.” foster insight by relating the present situation to earlier situations involving loss.
A woman says, “I can’t take anymore. Last year my husband had an affair and now we do not communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she’s quitting college and moving in with her boyfriend.” Which issue should the nurse focus on during crisis intervention? The possible mastectomy The disordered family communication The effects of the husband’s extramarital affair Coping with the reaction to the daughter’s events.
A patient who is visiting the crisis clinic for the first time asks, “How long will I be coming here?” The nurse’s reply should consider that the usual duration of crisis intervention is 1 to 2 weeks. 3 to 4 weeks. 4 to 6 weeks. 8 to 12 weeks.
A student falsely accused a college professor of sexual intimidation. The professor tells the nurse, “I cannot teach nor do any research. My mind is totally preoccupied with these false accusations.” What is the priority nursing diagnosis? Ineffective denial related to threats to professional identity Deficient knowledge related to sexual harassment protocols Impaired social interaction related to loss of teaching abilities Ineffective coping related to distress from false accusations.
Which communication technique will the nurse use more in crisis intervention than traditional counseling? Role modeling Giving direction Information giving Empathic listening.
Which situation demonstrates use of primary intervention related to crisis? Implementation of suicide precautions for a depressed patient Teaching stress-reduction techniques to a first-year college student Assessing coping strategies used by a patient who attempted suicide Referring a patient diagnosed with schizophrenia to a partial hospitalization program.
A victim of intimate partner violence comes to the crisis center seeking help. Crisis intervention strategies the nurse applies will focus on supporting emotional security and reestablishing equilibrium. long-term resolution of issues precipitating the crisis. promoting growth of the individual. providing legal assistance.
After celebrating the fortieth birthday, an individual becomes concerned with the loss of youthful appearance. What type of crisis has occurred? Reactive Situational Maturational Body image.
Which scenario is an example of a situational crisis? The death of a child from sudden infant death syndrome Development of a heroin addiction Retirement of a 55-year-old person A riot at a rock concert.
Which agency provides coordination in the event of a terrorist attack? Food and Drug Administration (FDA) Environmental Protection Agency (EPA) National Incident Management System (NIMS) Federal Emergency Management Agency (FEMA).
During the initial interview at the crisis center, a patient says, “I’ve been served with divorce papers. I’m so upset and anxious that I can’t think clearly.” Which comment should the nurse use to assess personal coping skills? “In the past, how have you handled difficult or stressful situations?” “What would you like us to do to help you feel more relaxed?” “Tell me more about how it feels to be anxious and upset.” “Can you describe your role in the marital relationship?”.
An adult has cared for a debilitated parent for 10 years. The health care provider recently recommended transfer of the parent to a skilled nursing facility. The adult says, “I’ve always been able to care for my parents. Nursing home placement goes against everything I believe.” Successful resolution of this adult’s crisis will most closely relate to resolving the feelings associated with the threat to the person’s self-concept. ability of the person to identify situational supports in the community. reliance on assistance from role models within the person’s culture. mobilization of automatic relief behaviors by the person.
The principle most useful to a nurse planning crisis intervention for any patient is that the patient is experiencing a state of disequilibrium. is experiencing a type of mental illness. poses a threat of violence to others. has high potential for self-injury.
A nurse assesses a patient in crisis. Select the most appropriate question for the nurse to ask to assess this patient’s situational support. “Has anything upsetting occurred in the past few days?” “Who can be helpful to you during this time?” “How does this problem affect your life?” “What led you to seek help at this time?”.
An adult comes to the crisis clinic after termination from a job of 15 years. The patient says, “I don’t know what to do. How can I get another job? Who will pay the bills? How will I feed my family?” Which nursing diagnosis applies? Hopelessness Powerlessness Chronic low self-esteem Interrupted family processes.
A troubled adolescent pulled out a gun in a school cafeteria, fatally shot three people and injured many others. Hundreds of parents come to the school after hearing news reports. After police arrest the shooter, which action should occur next? Ask police to encircle the school campus with yellow tape to prevent parents from entering. Announce over the loudspeakers, “The campus is now secure. Please return to your classrooms.” Require parents to pass through metal detectors and then allow them to look for their children in the school. Designate zones according to the alphabet and direct students to the zones based on their surnames to facilitate reuniting them with their parents.
At the last contracted visit in the crisis intervention clinic, an adult says, “I’ve emerged from this a stronger person. You helped me get my life back in balance.” The nurse responds, “I think we should have two more sessions to explore why your reactions were so intense.” Which analysis applies? The patient is experiencing transference. The patient demonstrates need for continuing support. The nurse is having difficulty terminating the relationship. The nurse is empathizing with the patient’s feelings of dependency.
Emergency response workers arrive in a community after a large-scale natural disaster. What is the workers’ first action? Report to the incident command system (ICS) center. Determine whether the community is safe. Establish teams of workers with varied skills. Evaluate actions completed by local law enforcement.
A nurse driving home after work comes upon a serious automobile accident. The driver gets out of the car with no apparent physical injuries. Which assessment findings would the nurse expect from the driver immediately after this event? (Select all that apply.) Difficulty using a cell phone Long-term memory losses Fecal incontinence Rapid speech Trembling.
A team of nurses report to the community after a category 5 hurricane devastates many homes and businesses. The nurses provide emergency supplies of insulin to persons with diabetes and help transfer patients in skilled nursing facilities to sites that have electrical power. Which aspects of disaster management have these nurses fulfilled? (Select all that apply.) Preparedness Mitigation Response Recovery Evaluation.
Which behavior best demonstrates aggression? Stomping away from the nurses’ station, going to the hallway, and grabbing a tray from the meal cart. Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and sobbing. Telling the primary nurse, “I felt angry when you said I could not have a second helping at lunch.” Telling the medication nurse, “I am not going to take that, or any other, medication you try to give me.”.
Which clinical scenario predicts the highest risk for directing violent behavior toward others? Major depressive disorder with delusions of worthlessness Obsessive-compulsive disorder; performs many rituals Paranoid delusions of being followed by alien monsters Completed alcohol withdrawal; beginning a rehabilitation program.
A patient was arrested for breaking windows in the home of a former domestic partner. The patient’s history also reveals childhood abuse by a punitive parent, torturing family pets, and an arrest for disorderly conduct. Which nursing diagnosis has priority? Risk for injury Ineffective coping Impaired social interaction Risk for other-directed violence.
A confused older adult patient in a skilled nursing facility was asleep when unlicensed assistive personnel (UAP) entered the room quietly and touched the bed to see if it was wet. The patient awakened and hit the UAP in the face. Which statement best explains the patient’s action? Older adult patients often demonstrate exaggerations of behaviors used earlier in life. Crowding in skilled nursing facilities increases an individual’s tendency toward violence. The patient learned violent behavior by watching other patients act out. The patient interpreted the UAP’s behavior as potentially harmful.
A patient is pacing the hall near the nurses’ station, swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say: “What is going on?” “Please be quiet and sit down in this chair immediately.” “I’d like to talk with you about how you’re feeling right now.” “You must go to your room and try to get control of yourself.”.
A patient who was responding to auditory hallucinations earlier in the morning now approaches the nurse shaking a fist and shouts, “Back off!” and then goes to the dayroom. While following the patient into the dayroom, the nurse should make sure there is adequate physical space between the nurse and patient. move into a position that places the patient close to the door. maintain one arm’s length distance from the patient. begin talking to the patient about appropriate behavior.
An intramuscular dose of antipsychotic medication needs to be administered to a patient who is becoming increasingly more aggressive and refused to leave the day room. The nurse should enter the day room and say, “Would you like to come to your room and take some medication your health care provider prescribed for you?” accompanied by three staff members and say, “Please come to your room so I can give you some medication that will help you regain control.” and place the patient in a basket-hold and then say, “I am going to take you to your room to give you an injection of medication to calm you.” accompanied by a male security guard and tell the patient, “Come to your room willingly so I can give you this medication, or the guard and I will take you there.”.
After an assault by a patient, a nurse has difficulty sleeping, startles easily, and is preoccupied with the incident. The nurse said, “That patient should not be allowed to get away with that behavior.” Which response poses the greatest barrier to the nurse’s ability to provide therapeutic care? Startle reactions Difficulty sleeping A wish for revenge Preoccupation with the incident.
The staff development coordinator plans to teach use of physical management techniques for use when patients become assaultive. Which topic should the coordinator emphasize? Practice and teamwork Spontaneity and surprise Caution and superior size Diversion and physical outlets.
An adult patient assaulted another patient and was then restrained. One hour later, which statement by the restrained patient requires the nurse’s immediate attention? “I hate all of you!” “My fingers are tingly.” “You wait until I tell my lawyer." “The other patient started the fight.”.
Which is an effective nursing intervention to assist an angry patient learn to manage anger without violence? Help a patient identify a thought that produces anger, evaluate the validity of the belief, and substitute reality-based thinking. Provide negative reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence is present. Use aversive conditioning, such as popping a rubber band on the wrist, to help extinguish angry feelings. Administer an antipsychotic or antianxiety medication.
Which assessment finding presents the greatest risk for violent behavior directed at others? Severe agoraphobia History of spousal abuse Bizarre somatic delusions Verbalized hopelessness and powerlessness.
An emergency code was called after a patient pulled a knife from a pocket and threatened, “I will kill anyone who tries to get near me.” The patient was safely disarmed and placed in seclusion. Justification for use of seclusion was that the patient was threatening to others. was experiencing psychosis. presented an undeniable escape risk. presented a clear and present danger to others.
A patient sat in silence for 20 minutes after a therapy appointment, appearing tense and vigilant. The patient abruptly stood, paced back and forth, clenched and unclenched fists, and then stopped and stared in the face of a staff member. The patient is demonstrating withdrawal. working though angry feelings. attempting to use relaxation strategies. exhibiting clues to potential aggression.
A patient with multi-infarct dementia lashes out and kicks at people who walk past in the hall of a skilled nursing facility. Intervention by the nurse should begin by gently touching the patient’s arm. asking the patient, “What do you need?” saying to the patient, “This is a safe place.” directing the patient to cease the behavior.
A cognitively impaired patient has been a widow for 30 years. This patient frantically tries to leave the facility, saying, “I have to go home to cook dinner before my husband arrives from work.” To intervene with validation therapy, the nurse will say: “You must come away from the door.” “You have been a widow for many years.” “You want to go home to prepare your husband’s dinner?” “Your husband gets angry if you do not have dinner ready on time?”.
A patient with a history of anger and impulsivity was hospitalized after an accident resulting in multiple injuries. The patient loudly scolds nursing staff, “I’m in pain all the time but you don’t give me medicine until YOU think it’s time.” Which nursing intervention would best address this problem? Teach the patient to use coping strategies such as deep breathing and progressive relaxation to reduce the pain. Talk with the health care provider about changing the pain medication from prn to patient-controlled analgesia. Tell the patient that verbal assaults on nurses will not shorten the wait for analgesic medication. Talk with the patient about the risks of dependency associated with overuse of analgesic medication.
A patient has a history of impulsively acting-out anger by striking others. Select the most appropriate intervention for avoiding similar incidents. Teach the patient about herbal preparations that reduce anger. Help the patient identify incidents that trigger impulsive anger. Explain that restraint and seclusion will be used if violence occurs. Offer one-on-one supervision to help the patient maintain control.
A patient with severe burn injuries is irritable, angry, and belittles the nurses. As a nurse changes a dressing, the patient screams, “Don’t touch me! You are so stupid. You will make it worse!” Which action by the nurse will best help to diffuse the patient’s anger? Stop the dressing change and say, “I will leave the supplies so that you can change your own dressing.” Continue the dressing change and say, “This dressing change is necessary because you were careless with fire.” Discontinue the dressing change, tell the patient, “I will return when you gain control of yourself,” and leave the room. Continue the dressing change and say, “Dressing changes are needed to prevent infection. What are your ideas about how to make it less painful?”.
Which medication from the medication administration record should a nurse administer to provide immediate intervention for a psychotic patient whose aggressive behavior continues to escalate despite verbal intervention? Lithium Trazodone Olanzapine Valproic acid.
An emergency department nurse realizes that the spouse of a patient is becoming increasingly irritable while waiting. Which intervention should the nurse use to prevent further escalation of the spouse’s anger? Offer the waiting spouse a cup of coffee. Explain that the patient’s condition is not life threatening. Periodically provide an update and progress report on the patient. Suggest that the spouse return home until the patient’s treatment is complete.
Which information from a patient’s record would indicate marginal coping skills and the need for careful assessment of the risk for violence? A history of academic problems. family involvement. childhood trauma. substance abuse.
Family members describe the patient as “a difficult person who finds fault with others.” The patient verbally abuses nurses for their poor care. The most likely explanation lies in poor childrearing that did not teach respect for others. automatic thinking leading to cognitive distortions. a personality style that externalizes problems. delusions that others wish to deliver harm.
A new patient acts out so aggressively that seclusion is required before the admission assessment is completed or orders written. Immediately after safely secluding the patient, which action is the nurse’s priority? Complete the physical assessment. Notify the health care provider to obtain a seclusion order. Document the incident objectively in the patient’s medical record. Explain to the patient that seclusion will be discontinued when self-control is regained.
A patient with a history of command hallucinations approaches the nurse yelling obscenities. Which nursing actions are most likely to be effective in deescalation for this scenario? (Select all that apply.) Stating the expectation that the patient will stay in control. Asking the patient, “Do you want to go into seclusion?” Telling the patient, “You are behaving inappropriately.” Offering to provide the patient with medication to help. Speaking in a firm but calm voice.
A nurse directs the intervention team who places an aggressive patient in seclusion. Before approaching the patient, which actions will the nurse direct team members to take? (Select all that apply.) Appoint a person to clear a path and open, close, or lock doors. Quickly approach the patient and take the closest extremity. Select the person who will communicate with the patient. Move behind the patient when the patient is not looking. Remove jewelry, glasses, and harmful items.
Which central nervous system structures are most associated with anger and aggression? (Select all that apply.) Amygdala Cerebellum Basal ganglia Temporal lobe Prefrontal cortex.
Because an intervention was required to control a patient’s aggressive behavior, the nurse plans a critical incident debriefing with staff members. Which topics should be the primary focus of this discussion? (Select all that apply.) Patient behaviors associated with the incident Genetic factors associated with aggression Intervention techniques used by the staff Effects of environmental factors Theories of aggression.
Which comment by the nurse would best support relationship building with a survivor of intimate partner abuse? “You are feeling violated because you thought you could trust your partner.” “I’m here for you. I want you to tell me about the bad things that happened to you.” “I was very worried about you. I knew you were living in a potentially violent situation.” “Abusers often target people who are passive. I will refer you to an assertiveness class.”.
An 11-year-old reluctantly tells the nurse, “My parents don’t like me. They said they wish I was never born.” Which type of abuse is likely? Sexual Physical Emotional Economic.
What feelings are most commonly experienced by nurses working with abusive families? Outrage toward the victim and discouragement regarding the abuser Helplessness regarding the victim and anger toward the abuser Unconcern for the victim and dislike for the abuser Vulnerability for self and empathy with the abuser.
Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence? Self-awareness enhances the nurse’s advocacy role. Strong negative feelings interfere with assessment and judgment. Strong positive feelings lead to healthy transference with the victim. Positive feelings promote the development of sympathy for patients.
The parents of a 15-year-old seek to have this teen declared a delinquent because of excessive drinking, habitually running away, and prostitution. The nurse interviewing the patient should recognize these behaviors often occur in adolescents who have been abused. are attention seeking. have eating disorders. are developmentally delayed.
What is a nurse’s legal responsibility if child abuse or neglect is suspected? Discuss the findings with the child’s parent and health care provider. Document the observation and suspicion in the medical record. Report the suspicion according to state regulations. Continue the assessment.
Several children are seen in the emergency department for treatment of various illnesses and injuries. Which assessment finding would create the most suspicion for child abuse? The child who has complaints of abdominal pain. repeated middle ear infections. bruises on extremities. diarrhea.
An 11-year-old says, “My parents don’t like me. They call me stupid and say they wish I were never born. It doesn’t matter what they think because I already know I’m dumb.” Which nursing diagnosis applies to this child? Chronic low self-esteem related to negative feedback from parents Deficient knowledge related to interpersonal skills with parents Disturbed personal identity related to negative self-evaluation Complicated grieving related to poor academic performance.
An adult has recently been absent from work for 3-day periods on several occasions. Each time, the individual returned wearing dark glasses. Facial and body bruises were apparent. What is occupational health nurse’s priority assessment? Interpersonal relationships Work responsibilities Socialization skills Physical injuries.
A young adult has recently had multiple absences from work. After each absence, this adult returned to work wearing dark glasses and long-sleeved shirts. During an interview with the occupational health nurse, this adult says, “My partner beat me, but it was because I did not do the laundry.” What is the nurse’s next action? Call the police. Arrange for hospitalization. Call the adult protective agency. Document injuries with a body map.
A patient tells the nurse, “My husband lost his job. He’s abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me.” What risk factor was most predictive for the husband to become abusive? History of family violence Loss of employment Abuse of alcohol Poverty.
An adult tells the nurse, “My partner abuses me when I make mistakes, but I always get an apology and a gift afterward. I’ve considered leaving but haven’t been able to bring myself to actually do it.” Which phase in the cycle of violence prevents this adult from leaving? Tension-building Acute battering Honeymoon Stabilization.
After treatment for a detached retina, a survivor of intimate partner abuse says, “My partner only abuses me when I make mistakes. I’ve considered leaving, but I was brought up to believe you stay together, no matter what happens.” Which diagnosis should be the focus of the nurse’s initial actions? Risk for injury related to physical abuse from partner Social isolation related to lack of a community support system Ineffective coping related to uneven distribution of power within a relationship Deficient knowledge related to resources for escape from an abusive relationship.
A survivor of physical spousal abuse was treated in the emergency department for a broken wrist. This patient said, “I’ve considered leaving, but I made a vow and I must keep it no matter what happens.” Which outcome should be met before discharge? The patient will facilitate counseling for the abuser. name two community resources for help. demonstrate insight into the abusive relationship. reexamine cultural beliefs about marital commitment.
An older adult with Lewy body dementia lives with family and attends a day care center. A nurse at the day care center noticed the adult had a disheveled appearance, strong odor of urine, and bruises on the limbs and back. What type of abuse might be occurring? Psychological Financial Physical Sexual.
An older adult diagnosed with Alzheimer’s disease lives with family in a rural area. During the week, this adult attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this adult most vulnerable to abuse? Multiple caregivers Alzheimer’s disease Living in a rural area Being part of a busy family.
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? Risk for injury related to poor judgment, cognitive impairments, and inadequate supervision Wandering related to confusion and disorientation as evidenced by sleepwalking and falls Chronic confusion related to degenerative changes in brain tissue as evidenced by nighttime wandering Insomnia related to sleep disruptions associated with cognitive impairment as evidenced by wandering at night.
An older woman diagnosed with Alzheimer’s disease lives with family and attends day care. After observing poor hygiene, the nurse talked with the caregiver. This caregiver became defensive and said, “It takes all my energy to care for my mother. She’s awake all night. I never get any sleep.” Which nursing intervention has priority? Teach the caregiver about the effects of sundowner’s syndrome. Secure additional resources for the mother’s evening and night care. Support the caregiver to grieve the loss of the mother’s cognitive abilities. Teach the family how to give physical care more effectively and efficiently.
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 expresses frustration verbally instead of physically. explains the rationale for behaviors to the victim. identifies three personal strengths. agrees to seek counseling.
Which referral will be most helpful for a woman who was severely beaten by intimate partner, has no relatives or friends in the community, is afraid to return home, and has limited financial resources? A support group A mental health center A women’s shelter Vocational counseling.
A 10-year-old cares for siblings while the parents work because the family cannot afford a babysitter. This child says, “My father doesn’t like me. He calls me stupid all the time.” The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources as priorities to stabilize the home situation? (Select all that apply.) Parental sessions to teach childrearing practices Anger management counseling for the father Continuing home visits to give support A safety plan for the wife and children Placing the children in foster care.
A nurse assists a victim of intimate partner abuse to create a plan for escape if it becomes necessary. Which components should the plan include? (Select all that apply.) Keep a cell phone fully charged. Hide money with which to buy new clothes. Have the phone number for the nearest shelter. Take enough toys to amuse the children for 2 days. Secure a supply of current medications for self and children. Assemble birth certificates, Social Security cards, and licenses. Determine a code word to signal children when it is time to leave.
A community health nurse visits a family with four children. The father behaves angrily, finds fault with the oldest child, and asks twice, “Why are you such a stupid kid?” The wife says, “I have difficulty disciplining the children. It’s so frustrating.” Which comments by the nurse will facilitate an interview with these parents? (Select all that apply.) “Tell me how you discipline your children.” “How do you stop your baby from crying?” “Caring for four small children must be difficult.” “Do you or your husband ever spank your children?” “Calling children ‘stupid’ injures their self-esteem.”.
The nurse at a university health center leads a dialogue with female freshmen about rape and sexual assault. One student says, “If I avoid strangers or situations where I am alone outside at night, I’ll be safe from sexual attacks.” Choose the nurse’s best response. “Your plan is not adequate. You could still be raped or sexually assaulted.” “I am glad you have this excellent safety plan. Would others like to comment?” “It’s better to walk with someone or call security when you enter or leave a building.” “Sexual assaults are more often perpetrated by acquaintances. Let’s discuss ways to prevent that.”.
A woman was found confused and disoriented after being abducted and raped at gunpoint by an unknown assailant. The emergency department nurse makes these observations about the woman: talking rapidly in disjointed phrases, unable to concentrate, indecisive when asked to make simple decisions. What is the woman’s level of anxiety? Weak Mild Moderate Severe.
After an abduction and rape at gunpoint by an unknown assailant, which assessment finding best indicates that a patient is in the acute phase of the rape-trauma syndrome? Decreased motor activity Confusion and disbelief Flashbacks and dreams Fears and phobias.
A nurse interviews a patient abducted and raped at gunpoint by an unknown assailant. The patient says, “I shouldn’t have been there alone. I knew it was a dangerous area.” What is the patient’s present coping strategy? Projection Self-blame Suppression Rationalization.
An emergency department nurse prepares to assist with evidence collection for a sexual assault victim. Prior to photographs and pelvic examination, what documentation is important? The patient’s vital signs Consent signed by the patient Supervision and credentials of the examiner Storage location of the patient’s personal effects.
A nurse in the emergency department assesses an unresponsive victim of rape. The victim’s friend reports, “That guy gave her salty water before he raped her.” Which question is most important for the nurse to ask of the victim’s friend? “Does the victim have any kidney disease?” “Has the victim consumed any alcohol?” “What time was she given salty water?” “Did you witness the rape?”.
A rape victim says to the nurse, “I always try to be so careful. I know I should not have walked to my car alone. Was this attack my fault?” Which communication by the nurse is most therapeutic? Support the victim to separate issues of vulnerability from blame. Emphasize the importance of using a buddy system in public places. Reassure the victim that the outcome of the situation will be positive. Pose questions about the rape and help the patient explore why it happened.
A rape victim tells the nurse, “I should not have been out on the street alone.” Select the nurse’s most therapeutic response. “Rape can happen anywhere.” “Blaming yourself increases your anxiety and discomfort.” “You are right. You should not have been alone on the street at night.” “You feel as though this would not have happened if you had not been alone.”.
The nursing diagnosis Rape-trauma syndrome applies to a rape victim in the emergency department. Select the most appropriate outcome to achieve before discharging the patient. The memory of the rape will be less vivid and less frightening. The patient is able to describe feelings of safety and relaxation. Symptoms of pain, discomfort, and anxiety are no longer present. The patient agrees to a follow-up appointment with a rape victim advocate.
A rape victim visited a rape crisis counselor weekly for 8 weeks. At the end of this counseling period, which comment by the victim best demonstrates that reorganization was successful and the victim is now in recovery? “I have a rash on my buttocks. It itches all the time. “Now I know what I did that triggered the attack on me.” “I’m sleeping better although I still have an occasional nightmare.” “I have lost 8 pounds since the attack, but I needed to lose some weight.”.
A nurse interviews a 17-year-old male victim of sexual assault. The victim is reluctant to talk about the experience. Which comment should the nurse offer to this victim? “Male victims of sexual assault are usually better equipped than women to deal with the emotional pain that occurs.” “Male victims of sexual assault often experience physical injuries and are assaulted by more than one person.” “Do you have any male friends who have also been victims of sexual assault?” “Why do you think you became a victim of sexual assault?”.
A nurse works at rape telephone hotline. Communication with potential victims should focus on explaining immediate steps victims should take. providing callers with a sympathetic listener. obtaining information for law enforcement. arranging counseling.
A nurse cares for a rape victim who was given a drink that contained flunitrazepam by an assailant. Which intervention has priority? Monitoring for coma. seizures. hypotonia. respiratory depression.
Before a victim of sexual assault is discharged from the emergency department, the nurse should notify the victim’s family to provide emotional support. offer to stay with the patient until stability is regained. advise the patient to try not to think about the assault. provide referral information verbally and in writing.
A victim of a sexual assault who sits in the emergency department is rocking back and forth and repeatedly saying, “I can’t believe I’ve been raped.” This behavior is characteristic of which stage of rape-trauma syndrome? The acute phase reaction The long-term phase A delayed reaction The angry stage.
A victim of a sexual assault comes to the hospital for treatment but abruptly decides to decline treatment and leaves the facility. While respecting the person’s rights, the nurse should say, “You may not leave until you receive prophylactic treatment for sexually transmitted diseases.” provide written information about physical and emotional reactions the person may experience. explain the need and importance of infectious disease and pregnancy tests. give verbal information about legal resources in the community.
An unconscious teenager is treated in the emergency department. The teenager’s friends suspect the teenager was drugged and raped at a party. Priority action by the nurse should focus on preserving rape evidence. maintaining physiological stability. determining what drugs were ingested. obtaining a description of the rape from a friend.
A victim of a violent rape was treated in the emergency department. As discharge preparation begins, the victim says softly, “I will never be the same again. I can’t face my friends. There is no reason to go on.” Select the nurse’s most appropriate response. “Are you thinking of harming yourself?” “It will take time, but you will feel the same as before the attack.” “Your friends will understand when you explain it was not your fault.” “You will be able to find meaning from this experience as time goes on.”.
When an emergency department nurse teaches a victim of rape-trauma syndrome about reactions that may occur during the long-term phase, which symptoms should be included? (Select all that apply.) Development of fears and phobias Decreased motor activity Feelings of numbness Flashbacks, dreams Syncopal episodes.
A patient was abducted and raped at gunpoint by an unknown assailant. Which nursing interventions are appropriate while caring for the patient in the emergency department? (Select all that apply.) Allow the patient to talk at a comfortable pace. Place the patient in a private room with a caregiver. Pose questions in nonjudgmental, empathetic ways. Invite the patient’s family members to the examination room. Put an arm around the patient to demonstrate support and compassion.
An emergency department nurse prepares to assist with examination of a sexual assault victim. What equipment will be needed to collect and document forensic evidence? (Select all that apply.) Camera Body map DNA swabs Pulse oximeter Sphygmomanometer.
Which aspects of assessment have priority when a nurse interviews a rape victim in an acute setting? (Select all that apply.) Coping mechanisms, the patient is using The patient’s previous sexual experiences The patient’s history of sexually transmitted diseases Signs and symptoms of emotional and physical trauma Adequacy and availability of the patient’s support system.
A rape victim tells the emergency nurse, “I feel so dirty. Help me take a shower before I get examined.” The nurse should (Select all that apply.) arrange for the victim to shower. explain that bathing destroys evidence. give the victim a basin of water and towels. offer the victim a shower after evidence is collected. explain that bathing facilities are not available in the emergency Department.
Which scenarios describe completed rape? (Select all that apply.) A husband forces vaginal sex when he comes home intoxicated from a party. The wife objects. A woman’s lover pleads with her to have oral sex. She gives in but later regrets the decision. A person is beaten, robbed, and forcibly subjected to anal penetration by an assailant. A dentist gives anesthesia for a procedure and then has intercourse with the unconscious patient. A perpetrator grabs a potential victim, tears off most of her clothing, and fondles her breasts before she escapes.
An adult says to the nurse, “The cancer in my neck spread in only 2 months. I’ve been cursed my whole life. Maybe if I had been more generous with others ...” Considering the stages of grief described by Kübler-Ross, which stage is evident? Anger Denial Depression Bargaining.
Four teenagers died in an automobile accident. Six months later, which behavior by the parents best demonstrates acceptance of the tragedy? The parents who isolate themselves at home. return immediately to employment. forbid other teens in the household to drive a car. create a scholarship fund at their child’s high school.
After a spouse’s death, an adult repeatedly says, “I should have recognized what was happening and been more helpful.” This adult is experiencing a. depression. b. bargaining. c. anger. d. guilt. depression. bargaining. anger. guilt.
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? Anger Denial Depression Acceptance.
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. “Each day will get a little better.” “Her death is a terrible loss for you.” “It’s important to recognize that she is no longer suffering.” “Your friends will help you cope with this change in your life.”.
A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, “If you had given him your undivided attention, he would still be alive.” Which analysis applies? The comment warns of a malpractice suit. Anger is a phenomenon experienced during grief. The wife had conflicted feelings about her husband. In some cultures, grief is expressed solely through anger.
A wife received news that her husband died of heart failure and called her family to come to the hospital. She angrily tells the nurse who cared for him, “He would still be alive if you had given him your undivided attention.” Select the nurse’s most therapeutic action. Say, “I understand you are feeling upset. I will stay with you until your family comes.” Say, “Your husband’s heart was so severely damaged that it could no longer pump.” Say, “I will call my supervisor to discuss this matter with you.” Hold the spouse’s hand in silence until the family arrives.
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 is beginning. has not begun. is at or near completion. is progressing abnormally.
A bystander was killed during a robbery 2 weeks ago. His widow, who is diagnosed with schizoaffective disorder, cries spontaneously when talking about his death. Select the nurse’s most therapeutic response. “Are you hearing voices at night?” “I am worried about how much you are crying. Your grief over your husband’s death has gone on too long.” “This loss is harder to accept because of your mental illness. I will refer you to a partial hospitalization program.” “The unexpected death of your husband must be very painful. I am glad you are able to talk to me about your feelings.”.
A patient with a new diagnosis of cancer says, “My father died of pancreatic cancer. I took care of him during his illness, so I know what is ahead for me.” Which nursing diagnosis applies? Anticipatory grieving Ineffective coping Ineffective denial Spiritual distress.
A nurse talks with a woman who recently learned that her husband died while jogging. Select the appropriate statement for the nurse. a. “At least your husband did not suffer.” b. “It’s better to go quickly as your husband did.” c. “Your husband’s loss must be very painful for you.” d. “You will begin to feel better after you get over the shock.” “At least your husband did not suffer.” “It’s better to go quickly as your husband did.” “Your husband’s loss must be very painful for you.” “You will begin to feel better after you get over the shock.”.
Family members ask the nurse, “What can we say when our loved one says, ‘Death is coming soon?’” To promote communication, which response could the nurse suggest for family members? “We feel sad when we think about life without you.” “We have not given up on getting you well.” “We think you will be around for a long time yet.” “Let’s talk about the good memories we have.”.
Which finding indicates successful completion of an individual’s grief and mourning? For 2 years after her husband’s death, a widow has kept her husband’s belongings in their usual places. After 15 months, a widower realistically remembers both the pleasures and disappointments of his relationship with his wife. Three years after her husband’s death, the widow talks about her husband as if he is alive and weeps when others mention his name. Eighteen months after a spouse’s death, an adult says, “I have never cried or had feelings of loss, even though we were very close.”.
A child drowned while swimming in a local lake 2 years ago. Which behavior best indicates the child’s parents are mourning in an effective way? The parents forbid their other children from going swimming. keep a place set for the deceased child at the family dinner table. sealed their child’s room exactly as the child left it 2 years ago. throw flowers on the lake at each anniversary date of the accident.
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? “Our staff will do their best to manage your pain.” “Your mind and spirit are healthy, although your body is frail.” “It’s important for you to let others help you to ease their own pain.” “Are you saying you want people to stop focusing on your diagnosis?”.
A terminally ill patient says, “I know I will never get well, but,” and the patient’s voice trails off. Select the most therapeutic response by the nurse. “What do you hope for?” “Do you have questions about what is happening?” “You are not going to get well. It is healthy that you accept that.” “When you have questions, it is best to talk to the health care provider.”.
A hospice patient tells the nurse, “Life has been good. I am proud of being self-educated. I overcame adversity and always gave my best. I intend to die as I lived.” The nurse planning care for this patient would recognize the importance of a. providing aggressive pain and symptom management. b. helping the patient reassess and explore existing conflicts. c. assisting the patient to focus on the meaning in life and death. d. supporting the patient’s use of own resources to meet challenges. providing aggressive pain and symptom management. helping the patient reassess and explore existing conflicts. assisting the patient to focus on the meaning in life and death. supporting the patient’s use of own resources to meet challenges.
A widow repeatedly tells details of finding her elderly husband not breathing, performing cardiopulmonary resuscitation, and seeing him pronounced dead. Family members are concerned and ask, “What can we do?” The nurse should counsel the family that they should express their feelings to the widow and ask her not to retell the story. the retelling should be limited to once daily to avoid unnecessary stimulation. repeating the story and her feelings is a helpful and necessary part of grieving. retelling of memories is expected as part of the aging process.
A staff nurse asks a hospice nurse, “Who should be referred for hospice care?” Select the best response. “Hospice is for terminally ill patients diagnosed with cancer.” “Patients in the end stage of any disease are eligible for hospice.” “Hospice is designed to care for patients experiencing end-stage renal disease.” “Patients diagnosed with degenerative neurological diseases are eligible for hospice after paralysis occurs.”.
Which event is most likely to precipitate grief across a community? A local bank is robbed twice in a single month An adolescent shoots the principal of a local high school The elderly pastor of the town’s largest church dies of heart failure Concrete pilings crumble in a bridge important to movement of local traffic.
Which actions by a nurse are most appropriate when caring for a hospice patient? (Select all that apply.) Giving choices Fostering personal control Explaining curative options Supporting the patient’s spirituality Offering interventions that convey respect Providing answers to the patient’s questions about spirituality.
Which patients meet criteria for hospice services? (Select all that apply.) A 92-year-old diagnosed with acute pneumonia and late-stage Alzheimer’s disease A 54-year-old diagnosed with glioblastoma and life expectancy of 8 to 10 weeks A 16-year-old with type 1 diabetes, multiple infections, and substance abuse A 74-year-old newly diagnosed with chronic obstructive pulmonary disease (COPD) and life expectancy of 2 years A 36-year-old diagnosed with multiple sclerosis complicated by major depressive disorder and pain associated with muscle spasms.
As death approaches, a patient diagnosed with AIDS says, “I do not have enough energy for many visitors anymore and I am embarrassed about how I look. I only want to see my parents and sister.” Which actions should the nurse take? (Select all that apply.) Encourage the patient to reconsider this decision so that interested and caring friends can provide support. Support the patient to share the request with the parents and sister. Assist family to inform the patient’s friends of the request. Suggest that the patient discuss these wishes with clergy. Place a “No Visitors” sign on the patient’s door.
One month ago, an adult died from cancer. Family members now gather at the adult’s home to dispose of the deceased’s belongings. Which comments demonstrate the family member is coping with the loss in an effective way? (Select all that apply.) “Her possessions still have her scent. We should dispose of them.” “Let’s take turns selecting items of hers we would each like to have.” “When I die, I hope someone who loved me goes through my things.” This was her favorite jacket. If we donate it to charity, someone else can enjoy it too.” “We’re violating her privacy by looking through her things. Let’s call a charity to come pick up everything.”.
A student nurse visiting a senior center says, “It’s depressing to see these old people. They are weak and frail. I doubt any of them can engage in a discussion.” The student is expressing reality. ageism. empathy. vulnerability.
A nurse plans an educational program for staff of a home health agency specializing in care of the elderly. Which topic is the highest priority to include? Pain assessment techniques for older adults Psychosocial stimulation for those who live alone Preparation of psychiatric advance directives in the elderly Ways to manage disinhibition in elderly persons with dementia.
Select the best comment for a nurse to begin an interview with an elderly patient. “I am a nurse. Are you familiar with what nurses do?” “Hello. I am going to ask you some questions to get to know you better.” “You look comfortable and ready to participate in an admission interview. Shall we get started?” “Hello. My name is _______ and I am a nurse. How you would like to be addressed by staff?”.
Which information is most important to obtain during assessment of an older adult diagnosed with health problems? Functional ability and emotional status Chronological age and sexual function Economic status and sources of income Developmental history, interests, and activities.
A 75-year-old patient comes to the clinic reporting frequent headaches. As the nurse begins the interaction, which action is most important? Complete a neurological assessment. Determine whether the patient can hear as the nurse speaks. Suggest that the patient lie down in a darkened room for a few minutes. Administer medication to relieve the patient’s pain before continuing the assessment.
Which statement about aging provides the best rationale for focused assessment of elderly patients? The elderly are usually socially isolated and lonely. Vision, hearing, touch, taste, and smell decline with age. The majority of elderly patients have some form of early dementia. As people age, thinking becomes more rigid and learning is impaired.
A nurse assesses an elderly patient. The nurse should complete the Geriatric Depression Scale if the patient answers which question affirmatively. “Would you say your mood is often sad?” “Are you having any trouble with your memory?” “Have you noticed an increase in your alcohol use?” “Do you often experience moderate to severe pain?”.
A health care provider writes these new prescriptions for a resident in a skilled nursing facility: 2 g sodium diet, restraint as needed, limit fluids to 1800 mL daily, continue antihypertensive medication, milk of magnesia 30 mL PO once if no bowel movement for 3 days. The nurse should question the fluid restriction. question the order for restraint. transcribe the prescriptions as written. assess the resident’s bowel elimination.
An elderly patient must be physically restrained. Who is responsible for the patient’s safety? The nurse assigned to care for the patient Unlicensed assistive personnel who apply the restraint Family member who agrees to application of the restraint Health care provider who prescribed application of restraint.
A new nurse asks, “My elderly patient’s CT scan of the head shows many Lewy bodies are present. What should I do about assessing for pain?” Select the best response from the nurse manager. “Ask the patient’s family if they think the patient is experiencing pain.” “Use a visual analog scale to help the patient determine the presence and severity of pain.” “There are special scales for assessing patients with dementia. Let’s review how to use them.” “The perception of pain is diminished by this type of dementia. Focus your assessment on the patient’s mental status.”.
An advance directive gives legally binding direction for health care interventions when a patient has a new diagnosis of cancer. is diagnosed with Parkinson’s disease. is unable to make decisions for self because of illness. diagnosed with amyotrophic lateral sclerosis is unable to speak.
A patient asks, “What advantage does a durable power of attorney for health care have over a living will?” The nurse should reply, “A durable power of attorney for health care gives your agent authority to make decisions during any illness if you are incapacitated.” can be given only to a relative, usually the next of kin, who has your best interests at heart.” can be used only if you have a terminal illness and become incapacitated.” cannot be implemented until 30 days after the documents are signed.”.
A physically frail elderly patient with mild cognitive impairments needs services of a facility that can provide supervision and safety as well as recreation and social interaction. The family cares for this patient during the evening and night. Which type of facility should the nurse suggest to meet this patient’s needs? a. Adult day care program b. Skilled nursing facility c. Partial hospitalization d. Group home Adult day care program Skilled nursing facility Partial hospitalization Group home.
A 79-year-old white male tells a nurse, “I have felt very sad lately. I do not have much to live for. My family and friends are all dead, and my own health is failing.” The nurse should analyze this comment as normal pessimism of the elderly. evidence of risks for suicide. a call for sympathy. normal grieving.
In a sad voice, an elderly patient tells the nurse of the recent deaths of a spouse and close friend. The patient has no other family and only a few acquaintances in the community. The nurse’s priority is to determine whether which nursing diagnosis applies to this patient? Risk for suicide related to recent deaths of significant others Anxiety related to sudden and abrupt lifestyle changes Social isolation related to loss of existing family Spiritual distress related to anger with God.
When making a distinction as to whether an elderly patient has confusion related to delirium or another problem, what information would be of particular value? a. Evidence of spasticity or flaccidity b. The patient’s level of motor activity c. Medications the patient has recently taken d. Level of preoccupation with somatic symptoms Evidence of spasticity or flaccidity The patient’s level of motor activity Medications the patient has recently taken Level of preoccupation with somatic symptoms.
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. “Everyone here cares about old people. That’s why we work here.” “It sounds like you’re having a difficult time. Tell me about it.” “Let’s not focus on the negative. Tell me something good.” “You are still able to get around, and your mind is alert.”.
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? Orientation Activity group Psychotherapy Reminiscence.
A nurse assesses four patients between the ages of 70 and 80. Which patient has the highest risk for alcohol abuse? The patient who consumes 1 glass of wine nightly with dinner. began drinking alcohol daily after retirement and says, “A few drinks keep my mind off my arthritis.” drank socially throughout adult life and continues this pattern, saying “I’ve earned the right to do as I please.” abused alcohol between the ages of 25 and 40 but now abstains and occasionally attends Alcoholics Anonymous (AA).
A nurse wants to assess for suicidal ideation in an elderly patient. Select the best question to begin this assessment. "Are there any things going on in your life that would cause you to consider suicide?” “What are your beliefs about a person’s right to take his or her own life?” “Do you think you are vulnerable to developing a depressed mood?” “If you felt suicidal, would you tell someone about your feelings?”.
A community health nurse visits an elderly person whose spouse died 6 months ago. Two vodka bottles are in the trash. When the nurse asks about alcohol use, this person says, “I get lonely and drink a little to help me forget.” Select the nurse’s most therapeutic intervention. Assess whether this patient is drinking and driving. Advise the person not to drink alone because the risks for injury increase. Teach the person about risks for alcoholism and suggest other coping strategies. Arrange for the person to attend an AA meeting for older adults.
Discharge planning begins for an elderly patient hospitalized for 2 weeks diagnosed with major depressive disorder. The patient needs ongoing assessment and socialization opportunities as well as education about medication and relapse prevention. The patient lives with a daughter, who works during the week. Select the best referral for this patient. Behavioral health home care A skilled nursing facility Partial hospitalization A halfway house.
A patient living in community housing for the elderly says, “I don’t go to the senior citizen’s club. They play cards and talk about the past because that’s all they can do.” The nurse analyzes these remarks to represent a. failure to achieve developmental tasks. b. thinking associated with ageism. c. hypercritical behavior. d. paranoid thinking. failure to achieve developmental tasks. thinking associated with ageism. hypercritical behavior. paranoid thinking.
A nurse plans a staff education program for employees of a senior living community. Which topic has priority? a. Late-onset schizophrenia b. Depression and suicide c. Dementia d. Delirium Late-onset schizophrenia Depression and suicide Dementia Delirium.
An older adult patient was diagnosed with schizophrenia at age 18. A nurse at the outpatient medication clinic interviews this patient. Which communication strategy will be most helpful? Ask questions that can be answered with “yes” or “no.” Ask clear, simple questions using concrete language. Use silence often and let the patient take the lead. Use open-ended, indirect questions.
An elderly patient brings a bag of medications to the clinic. The nurse finds bottles of medications as well as assorted pills in no containers in the bag. What is the nurse’s priority action? Dispose of all medications that are not in properly labeled bottles. Confer with a family member about the patient’s management of medication. Engage the patient in education about safe storage and labeling of medication. Ask the patient to name the purpose and date of expiration of each medication not in a bottle.
The highest priority for assessment by nurses caring for older adults who self-administer medications is use of multiple drugs with anticholinergic effects. overuse of medications for erectile dysfunction. missed doses of medications for arthritis. trading medications with acquaintances.
A nurse and social worker co-lead a reminiscence group for eight old-old and centenarian adults. Which activity is appropriate to include in the group? Mild aerobic exercise Singing a song from World War II Discussing national leadership during the Vietnam War Identifying the most troubling story in today’s newspaper.
A nurse and social worker co-lead a reminiscence group for eight young-old adults. Which activity is most appropriate to include in the group? Mild aerobic exercise Singing a song from World War II Discussing national leadership during the Vietnam War Identifying the most troubling story in today’s newspaper.
A nurse leads a staff development session about ageism among health care workers. What information should the nurse include about the consequences of ageism? (Select all that apply.) Failure of the elderly to receive necessary medical information Development of public policy that discriminates against the elderly Staff shortages because caregivers prefer working with younger adults The perception that elderly consume a smaller share of medical resources More ancillary than professional personnel discriminate with regard to age.
A nurse assessing an elderly patient for depression and suicide potential should include questions about mood as well as (Select all that apply.) personal hygiene. increased appetite. sleep pattern changes. evidence of grandiosity. increased concerns with bodily functions.
Which assessment findings would alert the nurse that an older patient may have an increased risk for development of geriatric alcohol abuse? (Select all that apply.) Mild recent memory impairment Eighth grade education Death of spouse Retirement Loneliness.
Which remarks by a 72-year-old patient should prompt the nurse to assess for depression? (Select all that apply.) “Lately I have had a lot of aches and pains and just haven’t felt very well.” “People are in and out of my room all day and all night taking my things.” “Don’t ask me to eat. I can’t because my stomach is upset all the time.” “I’m eating more than usual, and I am sleeping about 6 hours a night.” “Life seems more organized now that I don’t live in my own home.”.
Which beliefs by a nurse facilitate provision of safe, effective care for older adult patients? (Select all that apply.) Sexual interest declines with aging. Older adults are able to learn new tasks. Aging results in a decline in restorative sleep. Older adults are prone to become crime victims. Older adults are usually lonely and socially isolated.
After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This patient now requires continual direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of side effects of antipsychotic medications. dependency caused by institutionalization. cognitive deterioration from schizophrenia. stress associated with acclimation to the community.
An adult diagnosed with a serious mental illness (SMI) says, “I do not need help with money management. I have excellent ideas about investments.” This patient usually does not have money to buy groceries by the middle of the month. The nurse assesses the patient as demonstrating rationalization. identification. anosognosia. projection.
Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with SMI? Clubhouse model Cognitive-behavioral therapy (CBT) Assertive community treatment (ACT) Cognitive enhancement therapy (CET).
An outpatient diagnosed with schizophrenia tells the nurse, “I am here to save the world. I threw away the pills because they make God go away.” The nurse identifies the patient’s reason for medication nonadherence as poor alliance with clinicians. inadequate discharge planning. dislike of medication side effects. thought disturbances associated with the illness.
An outpatient diagnosed with schizophrenia attends programming at a community mental health center. The patient says, “I threw away the pills because they keep me from hearing God.” Which response by the nurse would most likely to benefit this patient? “You need your medicine. Your schizophrenia will get worse without it.” “Do you want to be hospitalized again? You must take your medication.” “I would like you to come to the medication education group every Thursday.” “I noticed that when you take the medicine, you are able to keep the job you wanted.”.
A homeless individual diagnosed with SMI and a history of persistent treatment nonadherence plans to begin attending the day program at a community mental health center. Which intervention should be the team’s initial focus? Teach appropriate health maintenance and prevention practices. Educate the patient about the importance of treatment adherence. Help the patient obtain employment in a local sheltered workshop. Interact regularly and supportively without trying to change the patient.
A hospitalized patient diagnosed with schizophrenia has a history of multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply first as the patient transitions from hospital to community? Administer a second-generation antipsychotic to help negative symptoms. Use a quick-dissolving medication formulation to reduce “cheeking.” Prescribe a long-acting intramuscular antipsychotic medication. Involve the patient in decisions about which medication is best.
The sibling of a patient who was diagnosed with a SMI asks why a case manager has been assigned. The nurse’s reply should cite the major advantage of the use of case management as: “The case manager can modify traditional psychotherapy for homeless patients so that it is more flexible.” “Case managers coordinate services and help with accessing them, making sure the patient’s needs are met.” “The case manager can focus on social skills training and esteem building in the real world where the patient lives.” “Having a case manager has been shown to reduce hospitalizations, which prevents disruption and saves money.”.
A family discusses the impact of a seriously mental ill member. Insurance partially covers treatment expenses, but the family spends much of their savings for care. The patient’s sibling says, “My parents have no time for me.” The parents are concerned that when they are older, there will be no one to care for the patient. Which response by the nurse would be most helpful? Acknowledge their concerns and consult with the treatment team about ways to bring the patient’s symptoms under better control. Give them names of financial advisors that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one. Refer them to crisis intervention services to learn ways to manage caregiver stress and provide titles of some helpful books for families. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent.
A patient diagnosed with a SMI lives independently and attends a psychosocial rehabilitation program. The patient presents at the emergency department seeking hospitalization. The patient has no acute symptoms but says, “I have no money to pay my rent or refill my prescription.” Select the nurse’s best action. Involve the patient’s case manager to provide crisis intervention. Send the patient to a homeless shelter until housing can be arranged. Arrange for a short in-patient admission and begin discharge planning. Explain that one must have active psychiatric symptoms to be admitted.
The nurse wants to enroll a patient with poor social skills in a training program for patients diagnosed with schizophrenia. Which description accurately describes social skills training? Patients learn to improve their attention and concentration. Group leaders provide support without challenging patients to change. Complex interpersonal skills are taught by breaking them into simpler behaviors. Patients learn social skills by practicing them in a supported employment setting.
A patient diagnosed with a SMI died suddenly at age 52. The patient lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, “How could this happen?” Which response by the nurse accurately reflects research and addresses the family’s question? “A certain number of people die young from undetected diseases, and it’s just one of those sad things that sometimes happen.” “Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight.” “We will have to wait for the autopsy to know what happened. There were some medical problems, but we were not expecting death.” “We are all surprised. The patient had been doing so well and saw the nurse every other week.”.
Many persons brought before a criminal court have mental illness, have committed minor offenses, and are off medications. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate? “Sometimes a little time in jail makes a person rethink what they’ve been doing and puts them back on the right track.” “Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses.” “Arresting these people helps them in the long run. Sometimes we cannot hospitalize them, but in jail they will get their medication.” “Research suggests that special mental health courts do not make much difference so far, but outpatient commitment does seem to help.”.
A nurse’s neighbor says, “My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions?” Select the nurse’s best response. “NAMI offers a family education series that you might find helpful.” “Since your sister is noncompliant, perhaps it’s time for her to be changed to injectable medication.” “You have done all you can. Now it’s time to put yourself first and move on with your life.” “You cannot help her. Would it be better for you to discontinue your relationship?”.
SMI is characterized as any mental illness of more than 2 weeks’ duration. a major long-term mental illness marked by significant functional impairments. a mental illness accompanied by physical impairment and severe social problems. a major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities.
Which nursing diagnosis is likely to apply to an individual diagnosed with a SMI who is homeless? Insomnia Substance abuse Chronic low self-esteem Impaired environmental interpretation syndrome.
A patient diagnosed with schizophrenia tells the community mental health nurse, “I threw away my pills because they interfere with God’s voice.” The nurse identifies the etiology of the patient’s ineffective management of the medication regime as inadequate discharge planning. poor therapeutic alliance with clinicians. dislike of antipsychotic medication side effects. impaired reasoning secondary to the schizophrenia.
A patient living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the patient was prohibited from returning to the apartment. The landlord said, “You cause too much trouble.” What problem is the patient experiencing? Grief Stigma Homelessness Nonadherence.
A person diagnosed with a SMI enters a shelter for the homeless. Which intervention should be the nurse’s initial priority? Find supported employment. Develop a trusting relationship. Administer prescribed medication. Teach appropriate health care practices.
A homeless patient diagnosed with a SMI became suspicious and delusional. Depot antipsychotic medication began and housing was obtained in a local shelter. One month later, which statement by the patient indicates significant improvement? “They will not let me drink. They have many rules in the shelter.” “I feel comfortable here. Nobody bothers me.” “Those shots make my arm very sore.” “Those people watch me a lot.”.
For patients diagnosed with SMI, what is the major advantage of case management? The case manager can modify traditional psychotherapy. With one coordinator of services, resources can be more efficiently used. The case manager can focus on social skills training and esteem building. Case managers bring groups of patients together to discuss common problems.
The parent of a seriously mentally ill adult asks the nurse, “Why are you making a referral to a vocational rehabilitation program? My child won’t ever be able to hold a job.” Which is the nurse’s best reply? “We make this referral to continue eligibility for federal funding.” “Are you concerned that we’re trying to make your child too independent?” “If you think the program would be detrimental, we can postpone it for a time.” “Most patients are capable of employment at some level, competitive or supported.”.
A consumer at a rehabilitative psychosocial program says to the nurse, “People are not cleaning up behind themselves in the bathrooms. The building is dirty and cluttered.” How should the nurse respond? Encourage the consumer to discuss it at a meeting with everyone. Hire a professional cleaning service to clean the restrooms. Address the complaint at the next staff meeting. Tell the consumer, “That’s not my problem.”.
A person diagnosed with a SMI living in the community was punched, pushed to the ground, and robbed of $7 during the day on a public street. Which statements about violence and SMI in general are accurate? (Select all that apply.) Persons with SMI are more likely to be violent. SMI persons are more likely to commit crimes than to be the victims of crime. Impaired judgment and social skills can provoke hostile or assaultive behavior. Lower incomes force SMI persons to live in high-crime areas, increasing risk. SMI persons experience higher rates of sexual assault and victimization than others. Criminals may believe SMI persons are less likely to resist or testify against them.
The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal? (Select all that apply.) Maintain stable and consistent staff. Increase the length of medication education groups. Stress that without treatment, illnesses will worsen. Prescribe drugs in smaller but more frequent dosages. Make it easier to access prescribers and pay for drugs. Require adherence in order to participate in programming.
A person diagnosed with SMI has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse? (Select all that apply.) Discourage potentially stressful activities such as groups or volunteer work. Develop written plans that will help the patient remember what to do in a crisis. Help the patient identify and anticipate events that are likely to be overwhelming. Encourage health-promoting activities such as exercise and getting adequate rest. Accompany the patient to a NAMI support group.
A patient diagnosed with SMI was living successfully in a group home but wanted an apartment. The prospective landlord said, “People like you have trouble getting along and paying their rent.” The patient and nurse meet for a problem-solving session. Which options should the nurse endorse? (Select all that apply.) Coach the patient in ways to control symptoms effectively. Seek out landlords less affected by the stigma associated with mental illness. Threaten the landlord with legal action because of the discriminatory actions. Encourage the patient to remain in the group home until the illness is less obvious. Suggest that the patient list a false current address in the rental application. Have the case manager meet with the landlord to provide education about mental illness.
An adult patient tells the case manager, “I don’t have bipolar disorder anymore, so I don’t need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I’m bored and don’t have any friends.” Where should the nurse refer the patient? (Select all that apply.) Psychoeducational classes Vocational rehabilitation Social skills training A homeless shelter Crisis intervention.
Which statements most clearly indicate the speaker views mental illness with stigma? (Select all that apply.) “We are all a little bit crazy.” “If people with mental illness would go to church, their problems would be solved.” “Many mental illnesses are genetically transmitted. It’s no one’s fault that the illness occurs.” “Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people.” People with mental illness are lazy. They get government disability checks instead of working.”.
A person diagnosed with bipolar disorder ran out of money, did not refill a lithium prescription, and then relapsed. After assaulting several people in the community, this person was convicted and sentenced. Prior to parole, which outcome has priority for the correctional nurse to achieve? The person agrees in writing to continue lithium therapy. is reestablished on an appropriate dose of lithium. lists community resources for prescription assistance. agrees to a follow-up appointment in an outpatient clinic.
An inmate was diagnosed with posttraumatic stress disorder (PTSD) caused by severe sexual abuse. One day this inmate sees a person with characteristics similar to the perpetrator, has a flashback, and then attacks the person. Correctional officers place the inmate in restraint. The correctional nurse should anticipate that the inmate would react to restraint by committing to counseling to reduce the incidence of flashbacks. becoming less likely to assault others during future flashbacks. gradually calming and returning from the flashback to reality. becoming more frightened, agitated, and combative.
An inmate was diagnosed with PTSD caused by severe sexual abuse. One day this inmate sees a person with similar characteristics to the perpetrator, has a flashback, and then attacks the person. Correctional officers place the inmate in restraint. Which action by the correctional nurse is most appropriate? Plan to meet with the inmate for debriefing after release from the required period of restraint. Support use of restraints as needed to control violent outbursts and assure the safety of all inmates. Contact a supervisor authorized to make an exception to the restraint policy and explain why an alternate response is needed. Confront the correctional officers who initiated the restraint, explain the inappropriateness of this action, and request the inmate’s release.
As a nurse in the prison clinic changes the dressing on an inmate’s wound, the inmate says, “You know I never did anything, right? I am totally innocent any crime.” Select the nurse’s best response. “I hear that same comment from most of the inmates here.” “Whether you are innocent or guilty is of no concern to me.” “Your innocence or guilt is the Court’s decision, not my decision.” “I trust you to tell me the truth. I will document your comments in your medical record.”.
A large group of inmates are in line up at the prison clinic window for medication administration. One inmate near the end of the line calls out to the nurse using slang terms about the nurse’s sexuality. What is the nurse’s best action? Call for a guard to place the offending inmate in seclusion. Ignore the comment and continue medication administration. Ask the other inmates, “What do you think about those comments?” Postpone the current medication administration until later in the day.
A psychiatric clinical nurse specialist works with a defendant as a competency evaluator. A staff member asks, “Why are you spending so much time with that defendant? You spend one-to-one time and write volumes. Usually, we give defendants some medication and return them to court.” Select the clinical nurse specialist’s most appropriate response. “My role is to be an advocate for the defendant, so I have to know him well and build a trusting relationship.” “My focus is providing intensive psychotherapy to ensure the defendant becomes competent before returning to court.” “The specialized assessments I make on behalf of the Court require very lengthy and detailed interviews, so it takes a lot of time.” “I spend the time observing, assessing, and documenting competency, writing a report, and preparing expert testimony for the Court.”.
During arraignment, a defendant behaves bizarrely, fails to respond to the judge’s questions, and shouts obscenities. The judge orders an evaluation by a forensic nurse examiner. Which information provided by the examiner will be most important to the Court at this time? The defendant’s mental state at the time of the crime The defendant’s competence to proceed with trial The cause of the defendant’s courtroom behavior The defendant’s history and cognitive abilities.
A psychiatric forensic nurse examiner was asked by a defendant’s attorney to determine the defendant’s legal sanity. What is the priority task of the nurse examiner? Determine if the defendant understands the charges and can assist the attorney with the defense. Complete a risk assessment to determine if the defendant is a danger to self or others. Reconstruct the defendant’s mental state and motives at the time of the crime. Collect and compile evidence to determine whether a crime occurred.
Select the best question for a psychiatric forensic nurse examiner to ask when assessing the legal sanity of an individual charged with a crime. “Tell me about what you were thinking at the time of the alleged crime.” “What would you do if you heard a fire alarm going off where you live?” “At this time, are you having any experiences that others might think strange?” “Do you feel as though you would like to harm yourself or anyone else at the present time?”.
In which circumstance would a psychiatric forensic nurse examiner determine it appropriate for a defendant and attorney to consider the insanity defense? At the time of the crime, the defendant shot a drug dealer who tried to overcharge for cocaine. acted on auditory hallucinations of the voice of God commanding, “Kill the children.” tampered with the brakes on his wife’s car after discovering she had an extramarital affair. was frightened because of a home robbery the preceding night, assumed a family member was another burglar, and shot him.
A nurse testifies about care provided to a patient in the 8 hours before a successful suicide. The nurse responds to questions about observations regarding the patient’s behavior as well as interventions performed and documented during the shift. In what capacity was this nurse testifying? Forensic nurse examiner Expert witness Fact witness Consultant.
The highest degree of credibility is required by a nurse who provides testimony before the Court as a(n) fact witness expert witness. correctional nurse. critical care nurse.
The psychiatric forensic nurse provides this description of work responsibilities: “I use knowledge of psychopathology as I investigate and reconstruct crimes and then try to understand a criminal’s reasoning process. This allows me to compile information on what type of individual would have most likely committed the crime.” The work the nurse describes is that of a competency therapist. hostage negotiator. forensic examiner. criminal profiler.
A correctional nurse plans a health education series for prison inmates. Which topic is most important for the nurse to include in this series? Sleep hygiene Personal grooming Social skills training Assertive communication.
Health problems most commonly encountered by correctional nurses are routine infections and minor trauma. chronic medical and psychiatric disorders. similar to the non-incarcerated population. injuries acquired during arrest or incarceration.
A guard tells an inmate diagnosed with schizophrenia to ask the desk officer for a mop and bucket, then get some water from the shower area and mop the kitchen and hall. The inmate does not comply. The guard becomes angry and cancels the inmate’s recreation time. Which action by the correctional nurse is most appropriate? Document the inmate’s response as indicative of resistance and psychopathology. Do not intervene. Intervention is not part of a correctional nurse’s scope of practice. Confer with the prison psychiatrist regarding reevaluation of this inmate’s antipsychotic medication regime. Explain to the guard that this inmate has difficulty following multiple instructions. Suggest stating one idea at a time.
A new nursing graduate obtained licensure as a registered nurse. This nurse searched unsuccessfully for employment in desired settings and, after a year, accepted a position in a forensic facility. One year later, which statement by the nurse best demonstrates successful adaptation to the role? “I am surprised by how challenging the position is and how many skills I have developed.” “I have told a few of my former classmates about my job but not my former nursing faculty.” “I plan to work here another year and then try again to get a position in a major medical center.” “I think it’s better not to post my position or name of my employer on my social network page.”.
Which statement about the practice of correctional nursing is accurate? Because the majority of inmates are younger than 40 years of age, most have lower rates of chronic illnesses than the general population. Correctional nurses work primarily with medically ill persons rather than persons with psychiatric or substance abuse disorders. More persons diagnosed with mental illness receive treatment services in prisons than in inpatient psychiatric facilities. Correctional nurses commonly provide holistic and comprehensive care for the incarcerated population.
Which credential would be expected of an expert witness in the area of forensic psychiatric nursing? 3 years of experience in an inpatient psychiatric facility 10 years of experience in community health nursing Educational preparation of an associate degree in nursing Publication of three articles in peer-reviewed psychiatric nursing journals.
A psychiatric forensic nurse assigned to a hostage negotiation tactical team is deployed when an individual takes several hostages. Which tasks apply to the nurse’s role on the team? (Select all that apply.) Assess released hostages. Negotiate with the perpetrator. Direct strategies for police deployment. Assess the mental status of the perpetrator. Suggest communication techniques to a negotiator.
Which characteristics best qualify a nurse for employment as a forensic psychiatric nurse? (Select all that apply.) Incorporation of “street smarts” into clinical practice Comfortable in a variety of practice settings Desire to punish perpetrators of crime Able to think clearly under stress Autonomous and self-sufficient Critical care skills.
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