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141 Cards in this Set
- Front
- Back
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What is a somatic symptom disorder? |
client has physical symptoms suggesting medical disease without demonstrable organic pathology or pathophysiological mechanism |
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What are the types of somatic symptom disorders? |
* Somatic Symptoms Disorder * Illness Anxiety Disorder * Conversion Disorder |
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Describe somatic symptoms disorder |
* History of many physical complaints beginning before 30 years of age * occurs over several years * result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning * high stress in life * more common in lower socioeconomic or rural areas |
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Describe illness anxiety disorder |
* A preoccupation with the fear of contracting, or the belief of having, a serious disease. * The fear becomes disabling and persists despite reassurance that no organic pathology can be detected. * Not a conscious belief. Often have had or Family member died from a medical condition |
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Describe conversion disorder |
A loss of or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder or pathophysiological mechanism. They tend to not be disturbed by the condition. |
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What are some examples of conversion disorder? |
* Blindness * Paralysis * Aphonia (can't talk) * Pseudocyesis (false pregnancy) |
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What is the etiology of somatic symptom disorders? |
* Genetics may play a role * Decreased levels of serotonin and endorphins may also play a role (particularly the pain disorder) |
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What are the three kinds of gains associated with a somatic symptom disorder? |
* Primary gain - Does not have to deal with current responsibilities * Secondary gain - Attention * Tertiary gain - the family does not have to deal with communication issues, they focus on the patient |
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A client is experiencing pain that has no organic etiology. This pain allows the client to avoid going to work at a job he hates. What best describes what this client is experiencing? A. The client is experiencing altered social interaction. B. The client is experiencing disturbed thought processes. C. The client is experiencing primary gain. D. The client is experiencing secondary gain. |
C. Primary gain - not going to work |
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A client, experiencing lower extremity paralysis, is admitted to a medical unit. Extensive tests confirm disability but rule out any underlying organic pathology. The nurse concludes that this is most suggestive of which disorder? A. Conversion disorder B. Illness anxiety disorder C. Malingering – factitious disorder (faking it) D. Somatic symptom disorder |
A. Conversion disorder. No use of his legs with no organic pathology |
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What are the types of dissociative disorders? |
* Dissociative Amnesia * Dissociative Identity Disorder * Depersonalization / DerealizationDisorder |
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What is dissociative amnesia? |
There is no physical trauma, but is often associated with a traumatic event. Cannot recall important personal data. No medical condition or substance use. Three kinds: * Localized - cannot remember around, say a car accident. Temporary * selective - may be missing part of an event * generalized - complete, have no idea who they are |
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According to psychodynamic theory, which primary defense mechanism would the nurse expect to find in a client with dissociative amnesia? A.Suppression B.Sublimation C.Displacement D.Repression |
D. repression - unconscious |
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What is dissociative fugue?
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Symptoms of dissociative fugue might include the following: Sudden and unplanned travel away from home. Inability to recall past events or important information from the person's life. Confusion or loss of memory about his or her identity, possibly assuming a new identity to make up for the loss. |
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Describe dissociative identity disorder |
* Characterized by existence of two or more personalities within a single individual (multiple personality disorder) * Transition from one personality to another usually sudden, often dramatic, and usually precipitated by stress * Often created to cope with major trauma as a child |
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Describe depersonalization disorder |
Characterized by persistent feelings of * Unreality - don’t feel like themselves (outside themselves) * Detachment from oneself or one’s body * Observing oneself from outside the body |
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What nursing diagnoses could be used for somatic symptom disorder? |
* Ineffective coping * Deficient knowledge * Chronic pain |
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What nursing diagnosis could be used for illness anxiety disorder? |
* Fear (of serious disease) |
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What nursing diagnoses could be used for conversion disorder? |
* Disturbed sensory perception * Self-care deficit |
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Describe factitious disorder |
Making up medical conditions for attention (used to be Munchausen's syndrome). Done to someone else, is Factitious disorder by proxy (was Munchausen's by proxy) |
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What nursing diagnosis would be used for factitious disorder? |
Ineffective coping |
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What would the outcomes be for the nursing care of a patient with somatic symptom disorder? |
* Copes effectively without resorting to physical symptoms * Verbalizes relief from pain * Has decreased frequency of physical complaints and interprets bodily sensations rationally * Is free of physical disability |
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What is the nursing process (planning and implementation) for a patient with a somatic symptom disorder? |
* aimed at relief of discomfort from the physical symptom * Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than preoccupation with physical symptoms (exercise, calming music, relaxation, etc) |
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When working with a client diagnosed with a somatic symptom disorder, which is the most appropriate nursing action? A.Avoid discussing social and personal problems. B.Focus on the physical symptoms. C.Always meet the client’s dependency needs. D.Gradually minimize time focusing on physical symptoms. |
D. Gradually minimize time focusing on symptoms |
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What nursing diagnoses could be used for dissociative amnesia? |
* Disturbed thought processes * Powerlessness |
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What nursing diagnoses could be used for depersonalization disorder? |
* Ineffective coping * Disturbed sensory perception |
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What nursing diagnoses could be used or Dissociative Identity disorder? |
* Risk for suicide * Disturbed personal identity |
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What is the nursing care of a patient with dissociative disorder? |
* aimed at restoring normal thought process * Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than dissociation from the environment |
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What are the outcomes planned for a patient with a dissociative disorder? |
* Can recall events associated with stressful situation * Can recall all events of past life * Can verbalize anxiety that precipitated the dissociation * Can demonstrate coping methods to avert dissociative behaviors * Verbalizes existence of multiple personalities * Is able to maintain a sense of reality during stressful situations |
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What are the medical treatment modalities for somatic symptoms disorders? |
* Individual psychotherapy
* Group psychotherapy * Behavior therapy * EMDR * Psychopharmacology (antidepressants or anxiolytics) |
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What are the medical treatment modalities for dissociative disorders? |
* Individual psychotherapy * Hypnosis * Integration therapy (DID) * Cognitive Therapy * Group/Family Therapy * Psychopharmacology |
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What is abreaction? |
Bringing someone with a dissociative disorder through repressed trauma again. They often feel as though they are being traumatized again. Often done through hypnosis. |
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What is integration? |
Uniting the personalities of a patient with dissociative identity disorder into the whole being again. |
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A 52-year-old client states, “My husband is upset because I don’t enjoy sex as much as I used to.” Which priority client data should a nurse consider most relevant as she completes the patient assessment ? A. Patient history of hysterectomy B. Date of last menstrual cycle C. Use of birth control methods D. Religious background |
A. History of hysterectomy |
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What is the sexual response cycle? |
* Desire * Excitement * Orgasm * Resolution |
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What are the sexual dysfunction disorders? |
* Sexual Desire Disorders * Hypoactive sexual desire * Sexual Aversion Disorder * Sexual Arousal Disorders (Male & Female) * Orgasm disorders * Sexual Pain disorders |
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What are the orgasm disorders? |
* Inhibited female orgasm - Anorgasmia * Inhibited male orgasm - Retarded ejaculation * Premature ejaculation |
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What are the sexual pain disorders? |
* Dysparunia - when sex hurts * Vaginismus - so much spasming that it cannot be penetrated |
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A client widowed 2 years ago reports a fear of intimacy due to an inability to achieve and sustain an erection due to missing his wife. He has become less social. Which correctly written nursing diagnosis should be prioritized for this client? A. Risk for situational low self-esteem AEB inability to achieve orgasm B. Sexual dysfunction R/T dysfunctional grieving AEB inability to experience an erection C. Social isolation R/T low self-esteem AEB refusing to engage in dating activities D. Disturbed body image R/T penile flaccidity AEB client statements |
B. Sexual dysfunction r/t dysfunctional grieving a/e/b inability to experience an erection |
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What are the paraphilias? |
* Exhibitionism– someone who likes to show and to watch (flasher) * Fetishism– obsession about a particular body part * Frotteurism – when someone rubs up again a stranger * Pedophilia– someone who inappropriately likes children, antidepressants can help as well as depro-provera (birth control) * Sexual Masochism– enjoys pain * Sexual Sadism– enjoys giving pain * Voyeurism– someone who likes to watch |
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What is the treatment for paraphilias? |
* Cognitive behavioral- Aversive conditioning/Covert sensitization- exposed to noxious odors or anxiety producing scenes during sexual fantasies in an effort to reduce the fantasies * Pharmacological-Depo-Provera- PO or IM long lasting- decrease libido * SSRI’s/ SNRI’s |
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A nurse is assessing a client diagnosed with pedophilia. What would differentiate this sexual disorder from a sexual dysfunction? A. Symptoms of sexual dysfunction include inappropriate sexual behaviors, whereas symptoms of a sexual disorder include impairment in normal sexual response. B. Symptoms of a sexual disorder include inappropriate sexual behaviors, whereas symptoms of sexual dysfunction include impairment in normal sexual response. C. Sexual dysfunction can be caused by increased levels of circulating androgens, whereas levels of circulating androgens do not affect sexual disorders. D. Sexual disorders can be caused by decreased levels of circulating androgens, whereas levels of circulating androgens do not affect sexual dysfunction. |
B Dysfunction is there a problem of normal performing, disorder is when there is non-consenting involvement. |
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What is gender identity disorder? |
* Gender dysphoria-discomfort with one’s own sex and consistent * Therapy is intensive - Sex re-assignment-two specialist therapists agree identification with the opposite sex - 18 or older - must Live one year as sex of choice |
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A nurse is working with a client diagnosed with pedophilia.Which client outcome is appropriate for the nurse to expect during the first week of hospitalization? A. The client will verbalize an understanding of the importance of follow-up care. B. The client will implement several relapse-prevention strategies. C. The client will identify triggers that lead to inappropriate behaviors. D. The client will attend aversion therapy groups. |
C. Client will identify triggers |
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What is the role of the nurse regarding sexual disorders? |
* Nurses may best become involved in the primary prevention process. * The focus of primary prevention in sexual disorders is to intervene in the home life or other facets of childhood in an effort to prevent problems from developing. * An additional concern of primary prevention is to assist in the development of adaptive coping strategies to deal with stressful life situations. |
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A nursing instructor is teaching a class about normal human sexuality. Which of the following information should be included? A.Gender identity develops during adolescence. B.Sexual drives remain consistent throughout the life span. C.Many medications can impact sexual functioning. D.The Elderly have little interest in sexual activity. |
C. Medications such as antihypertensives, antidepressants and others can cause sexual dysfunction. |
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What are the different types of personality disorders? |
* Paranoid personality disorder * Schizoid Personality disorder * Schizotypal Personality disorder * Antisocial Personality disorder * Borderline Personality disorder * Histrionic Personality disorder * Narcissistic Personality disorder * Avoidant Personality disorder * Dependent Personality disorder * Obsessive - Compulsive personality disorder |
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Describe paranoid personality disorder |
* Pervasive, persistent, and inappropriate mistrust of others. * Assume others are out to hurt or exploit them. * More common in men. * Insensitive to others * does not accept own responsibility for behavior * attributes shortcomings to others |
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Describe schizoid personality disorder |
* cannot form personal relationships * more in men * emotionally cold and aloof * possible hereditary factor * childhood was bleak, cold and lacked nurturing |
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Describe schizotypal personality disorder |
* A worse form of schizoid personality disorder * Patient is aloof and isolated, apathetic, bland * they have magical thinking * they have ideas of reference * they have illusions * they have depersonalization * exhibit bizarre speech pattern * possible hereditary factors * possible physiological differences * childhood was indifferent and formal causing discomfort with personal affection |
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Describe antisocial personality disorder |
* Exploitative * socially irresponsible * without remorse * disregard for the rights of others * doesn't maintain employment * fails to conform to the law * manipulates others for personal gain * fails to develop stable relationships * person to be afraid of |
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Describe borderline personality disorder |
* Characterized by a pattern of intense and chaotic relationships with affective instability * Fluctuating and extreme attitudes regarding other people * Highly impulsive * Emotionally unstable * Directly and indirectly self-destructive * Lacks a clear sense of identity * very manipulative - will split the staff * more women than men |
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Describe histrionic personality disorder |
* Behavior is: Excitable Emotional Colorful Dramatic Extroverted (drama queen) * attention seeking * strongly dependent * difficulty paying attention to detail * gregarious * seductive * possible hereditary factors * possible link to noradrenergic and serotonergic systems |
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Describe the narcissistic personality disorder |
* exaggerated sense of self-worth * lacks empathy * believe they have the inalienable right to receive special consideration * overly self centered * Exploit others in an effort to fulfill their own desires * Mood, which is often grounded in grandiosity, is usually optimistic, relaxed, cheerful, and carefree * criticism from others may cause rage, shame or humiliation * as child, fears, failure or needs were met with disdain * Donald Trump to a "T" |
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Describe Avoidant Personality disorder |
* Socially withdrawn * extreme sensitivity to rejection * equal among men and women * awkward in social situations * want close relationships but avoid them for fear of rejection * perceived as timid, cold, withdrawn, strange * lonely and feel unwanted * no clear cause * parental rejection, biological, genetic factors |
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When assessing a client diagnosed with narcissistic personality disorder, the nurse expects to identify which characteristic behavior? A.Odd beliefs and magical thinking B.Grandiose sense of self importance C.Pattern of intense and chaotic relationships D.Submissive and clinging behaviors |
B. Grandiose sense of self importance |
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Describe dependent personality disorder |
* relies on others for support * common * more common in women (and youngest of siblings) * lack self confidence * easily hurt by criticism * avoids positions of responsibility * assume passive roles in relationships * Stimulation and nurturance are experienced exclusively from one source |
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Describe obsessive compulsive personality disorder |
* inflexible * work over pleasure * common * more common in men (and oldest siblings) * socially polite and formal * rank - conscious (authority figures) * calm on the surface, but conflicted, hostile and ambivalent underneath * frequently punished and controlled by parents |
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A client diagnosed with a personality disorder is cold,aloof, and avoids others on the unit. The nurse recognizes that this behavioris symptomatic of which personality disorder? A.Schizoid personality disorder B.Dependent personality disorder C.Borderline personality disorder D.Antisocial personality disorder |
A. Schizoid |
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A client diagnosed with borderline personality disorder is admitted to a psychiatric unit. Which behavior pattern would the nurse expect to observe? A.Social isolation B.Suspiciousness of others C.Bizarre speech patterns D.Generates conflict among the staff |
D. generates conflict among the staff |
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In assessing a client diagnosed with borderline personality disorder, which characteristic would the nurse expect toobserve? A.Predictability B.Controlled anger C.Little tolerance for being alone D.Stable and satisfactory relationships |
C. Little tolerance for being alone |
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An individual, with a history of antisocial personality disorder, was arrested for driving under the influence of alcohol and causing a serious car accident. Which comment on this behavior would be expected? A.“It's not my fault.” B.“I'm too ashamed to talk about it.” C.“I just don't remember doing it.” D.“I'm really sorry about all the people I've hurt.” |
A. Not my fault. Antisocials don't accept responsibility for their own behavior |
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Which personality disorders are seen most often in the unit? |
Antisocial and borderline personalities. |
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What are the nursing diagnoses that could be used for borderline personality disorder? |
1. Risk for self-mutilation 2. Risk for suicide 3. Risk for other-directed violence 4. Complicated grieving 5. Impaired social interaction 6. Disturbed Personality identity 7. Anxiety 8. Chronic low self esteem |
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What are the nursing diagnoses that could be used for antisocial personality disorder? |
1. Risk for self-directed violence 2. Defensive coping 3. Chronic Low self esteem 4. Ineffective Health Maintenance |
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What are some other names for antisocial personality disorder? |
* Sociopathic behavior * Psychopathic behavior |
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When is antisocial personality disorder mainly seen in the clinical setting? |
* It is usually only seen in clinical settings when these individuals are admitted by court order for psychological evaluation. * They are most frequently encountered in prisons, jails, and rehabilitation services. |
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What is the aim for nursing interventions for borderline personality disorder? |
* Protection of the client from self-harm * assist the client to advance in the development of personality by confronting his or her true source of internalized anger |
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What is the aim for nursing interventions for antisocial personality disorder? |
* protecting others from the client’s aggression and hostility * delay gratification by setting limits on unacceptable behavior |
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What are Kubler-Ross' stages of grief? |
1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance |
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What are John Bowlby's stages of grief? |
1. Numbness or protest 2. Disequilibrium 3. Disorganization or despair 4. Reorganization |
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What are William Worden's stages of grief? |
Task I: Accepting the reality of the loss Task II: Working through the pain of grief Task III: Adjusting to an environment that has changed because of the loss Task IV: Emotionally relocating what has been lost and moving on with life |
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How long does acute grief typically last? |
6 to 8 weeks |
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Describe the grief process. |
* Is very individual * May last for many years * Anticipatory grieving (grieving before the loss has actually occurred) may shorten the process |
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What makes the grief process more difficult? |
* The bereaved person was strongly dependent * The relationship was an ambivalent one * The individual has experienced a number of recent losses * The loss is that of a young person * The bereaved person’s health is unstable * The bereaved person perceives some responsibility for the loss |
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What are the maladaptive responses to grief? |
* Delayed - remains fixed in denial stage * Distorted - remains fixed in anger stage or all normal grieving symptoms are exaggerated (cannot perform ADLs) * Chronic - loss of self esteem which ultimately precipitates depression |
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What are the concepts of death for a child from birth to age 2? |
Cannot understand death but can experience the feelings of loss and separation |
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What are the concepts of death for a child from ages 3 to 5? |
* Have some understanding about death but have difficulty distinguishing between fantasy and reality; believe death is reversible |
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What are the concepts of death for a child from ages 6 to 9? |
* Beginning to understand the finality of death; difficult to perceive their own death; normal grief reactions include regressive and aggressive behaviors |
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What are the concepts of death for a child from ages 10 to 12? |
* Understand that death is final and eventually affects everyone; feelings of anger, guilt, and depression are common; may require reassurance of their own safety |
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What are the concepts of death for an adolescent? |
* Usually able to view death on an adult level * Have difficulty perceiving their own death * May or may not cry; may withdraw * May exhibit acting-out behaviors |
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What happens to elderly adults and loss? |
* A time in life of the convergence of many losses * May lead to“bereavement overload” * Bereavement overload may result in depression |
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Describe hospice |
* Patient is considered "terminal" with less than 6 months to live
* The patient or family chooses not to receive aggressive curative care * Focuses or "care" vs. "cure" * Expenses are covered by Medicare, Medicaid or most private health insurers |
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Describe Palliative Care |
* Ideally begins at the time of diagnosis of a serious illness * No life expectancy requirement * Can be used to complement curative care * Expenses are covered by philanthropy, fee-for-service, direct hospital support * For pediatric patients, care is provided through mandates from the Affordable Care Act |
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What is the Chinese American concept of death? |
* Centered on Ancestor worship * They fear death and avoid references to it * Do not openly express their emotions |
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What is the Japanese American concept of death? |
* Dominant religion is Buddhism * Body is prepared by close family members * Cremation is common |
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What is the Jewish American concept of death? |
* Traditional Judaism believes in an afterlife * A dying person is never left alone * No wake and no viewing are part of a Jewish funeral * Cremation is prohibited * 7-day period beginning with the burial is called a shiva, during which mourners think only about the deceased |
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What are the Native American concept of death? |
* The Navajo of the Southwest conduct a cleansing ceremony before burial to prevent the spirit of the dead person from trying to assume control of someone else’s spirit * Dead are buried with their shoes on the wrong feet and rings on their index fingers * Do not express grief openly and are reluctant to touch the body of a dead person |
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What are the two main types of advance directives? |
* Living Will * Durable power of attorney |
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Why would an advanced directive not be honored? |
* Not available at the time treatment decisions need to be made * The advance directive is not clear * The healthcare proxy is unsure of theclient’s wishes |
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A client receives a diagnosis of cancer. The client tells a nurse, “The doctor must've mixed my chart up withsomeone else's.” Which stage of grief should the nurse identify when caring for this client? A. Denial B. Bargaining C. Anger D. Depression |
A. Denial |
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A client receives a terminal illness diagnosis. The client tells the nurse, “I know I will die from this, but if I only live to see my daughter's wedding, it will be OK.” Which stage of grief should the nurse identify when caring for this client? A.Denial B. Bargaining C. Anger D. Depression |
B. Bargaining |
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What is anorexia nervosa? |
A morbid fear of obesity with symptoms of * gross distortion of body image * preoccupation with food * refusal to eat |
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What does 'emaciated' mean? |
Excessively thin |
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How is weight loss accomplished with anorexia nervosa? |
* reduced food intake * excessive exercise * vomiting * use of laxatives or diuretics |
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What symptoms occur when weight loss is excessive? |
* hypothermia * bradycardia * hypotension * edema * lanugo * amenorrhea |
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What is bulimia nervosa? |
an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time (binging), followed by inappropriate compensatory behaviors to rid the body of the excess calories, possibly by vomiting, laxatives, enemas, excessive exercise, fasting among others. Typically occurs in late adolescence or early adulthood with estimates up to 4 percent of young women |
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What is the BMI criteria for anorexia nervosa? |
* Mild: greater than or equal to a BMI of 17 * Moderate: 16 to 16.99 * Severe: 15 - 15.99 * Extreme: less than 15 |
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A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy? A. Even if my anxiety improves, I will need to continue this therapy for 6 weeks. B. The therapist will focus on my past relationships during our sessions. C. Psychoanalysis will help me reduce my anxiety by changing my behavior. D. This therapy will address my conscious feelings about stressful experiences. |
B. Classical psychoanalysis places a common focus on past relationships to identify the cause of the anxiety disorder. |
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A Nurse is discussing free association as a therapeutic tool with a client who has major depression disorder. Which of the following client statements indicates understanding of this technique? A. I will write down my dreams as soon as I wake up. B. I may begin to associate my therapist with important people in my life. C. I can learn to express myself in a nonaggressive manner. D. I should say the first thing that comes to mind. |
D. Free Association is the spontaneous, uncensored verbalization of whatever comes to a client's mind. |
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A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following are appropriate to include in the plan of care? Select all that apply. A. Priority restructuring B. Monitoring thoughts C. Diaphragmatic breathing D. Journal keeping E. Meditation |
A, B & D |
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A nurse is caring for a client who has a new prescription for disulfiram (Antabuse) for the treatment of his alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting if he drinks alcohol. This form of treatment is an example of which of the following? A. Aversion therapy B. flooding C. Biofeedback D. Dialectical behavior therapy |
A. Aversion therapy pairs a maladaptive behavior with unpleasant stimuli to promote a change in behavior. |
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A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following is appropriate when implementing this form of therapy? A. Demonstrate riding in an elevator, and then ask the client to imitate the behavior. B. Advise the client to say "stop" out loud every time he begins to feel an anxiety response related to an elevator. C. Gradually expose the client to an elevator while practicing relaxation techniques. D. Stay with the client in an elevator until his anxiety response diminishes. |
C. Systematic desensitization is the planned, progressive exposure to anxiety-provoking stimuli. During this exposure, relaxation techniques suppress the anxiety response. |
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A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. I can promote my client's sense of control by establishing a schedule. B. Self-assessment will help me cope with emotional reactions to client care C. I should practice limit-setting to help prevent client manipulation. D. Maintaining professional boundaries is a priority of client care. |
A. Rather than establishing a schedule, the nurse should ask for the client's input and offer realistic choices to promote the client's sense of control. |
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A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? A. I'm scared that you're going to leave me. B. I'll go to group therapy if you'll let me smoke. C. I need to feel that everyone admires me. D. I sometimes feel better if I cut myself |
A. Clients who have avoidant personality disorder often have a fear of abandonment. Therefore, this type of statement is expected. |
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A charge nurse is preparing a staff education session on personality disorders. Which of the following should be included as personality characteristics associated with all of the personality disorders? Select all that apply. A. Difficulty in getting along with other members of a group. B. Belief in the ability to become invisible during times of stress. C. Display of defense mechanisms when routines are changed. D. Claiming to be more important than other persons. E. Difficulty understanding why it is inappropriate to have a personal relationship with staff. |
A, C, E |
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A nurse is caring for a client who has borderline personality disorder. The client says "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms? A. Regression B. Splitting C. Undoing D. Identification |
B. Splitting occurs when a person is unable to see both positive and negative qualities at the same time. The client who has borderline personality disorder tends to see a person as all bad one time and all good another time. |
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A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. When assessing this client, which of the following are expected findings? Select all that apply. A. Demonstrates extreme anxiety when placed in a social situation B. Has difficulty making even simple decisions C. Attempts to convince other clients to give him their belongings D. Becomes agitated if his personal area is not neat and orderly E. Blames others for his past and current problems |
C. Exploitation and manipulation of others E. Failure to accept personal responsibility |
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A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions are appropriate for the nurse to include in the assessment? Select all that apply. A. What is your relationship like with your family? B. Why do you want to lose weight? C. Would you describe your current eating habits? D. At what weight do you believe you will look better? E. Can you discuss your feelings about your appearance? |
A, C, E |
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A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? A. Life isn't worth living if I gain weight. B. Don't pretend like you don't know how fat I am. C. If I could be skinny, I know I'd be popular D. When I look in the mirror, I see myself as obese. |
A. This statement reflects the cognitive distortion of catastrophizing because the client's perception of her appearance or situation is much worse than her current condition. |
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A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? Select all that apply. A. Amenorrhea B. Hypokalemia C. Mottling of the skin D. Slightly elevated body weight E. Presence of lanugo on the face |
B. Hypokalemia is expected due to vomiting D. This is a typical weight for a bulimic. The others are expected findings of anorexia nervosa. |
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A nurse is caring for a client who has bulimia nervosa and who has stopped purging behavior. The client tells the nurse that she is afraid she is going to gain weight. Which of the following is an appropriate response by the nurse? A. Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet. B. Instead of worrying about your weight, try to focus on other problems at this time. C. I understand you have concerns about your weight, but first, let's talk about your recent accomplishments. D. You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you. |
C. This statement acknowledges the client's concern and then focuses the conversation on the client's accomplishments, which can promote client self-esteem and self-image. |
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A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following nursing actions is appropriate to include in the client's plan of care? A. Allow the client to select preferred meal times. B. Establish consequences for purging behavior. C. Provide the client with a high-fat diet at the start of treatment. D. Implement one-to-one observation during meal times. |
D. The nurse should closely monitor the client during and after meals to prevent purging. |
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A nurse is reviewing a newly admitted client's medical record. Which of the following documents is a directive for medical treatment based on the client's wishes? A. Advance directives B. Living will C. Informed Consent D. Durable power of attorney for health care. |
B. Living wills are documents that direct medical treatment based on the client's wishes. |
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A charge nurse is reviewing Kubler-Ross: Five Stages of Grief with a group of newly licensed nurses. Which of the following should the charge nurse include in the teaching. Select all that apply. A. Endurance B. Denial C. Bargaining D. Anger E. Depression |
B, C, D, E |
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A nurse is working with a client who has recently lost his mother. The nurse recognizes that which of the following factors influence grief and coping ability? Select all that apply. A. Interpersonal relationships B. Culture C. Birth Order D. Size of family E. Prior experience with loss |
A, B and E are factors which influence grief and ability to cope. |
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A nurse is discussing normal uncomplicated grief with a client who recently lost a child. Which of the following statements made by the client requires additional intervention? A. I may experience feelings of resentment. B. I may withdraw from others. C. It is possible to experience changes in sleep. D. It is possible to experience suicidal thoughts. |
D. Suicidal ideations are associated with dysfunctional grieving. Therefore, this response requires additional nursing interventions. |
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A nurse is caring for a client who lost his mother to cancer last month. Which of the following statements made by the nurse is a non-therapeutic response? A. You sound angry. Anger is a normal feeling associated with loss. B. Tell me more about how you are feeling. C. I understand just how you feel. I felt the same when my mother died. D. Let's discuss how you have been coping. |
C. This is the correct option. This is a closed ended non-therapeutic response. This is an example of minimizing feelings. The nurse implies that she knows just how the client feels which we know is not always true. |
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What ages is typically affected by anorexia nervosa? |
occurs predominantly in girls and women ages 12 to 30 years |
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What is obesity defined as? |
a body mass index of 30 or greater |
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How many Americans are overweight? |
68.5% with 35% in the obese range |
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Which is characteristic of the diagnosis of anorexia nervosa? A.Obsession with weight gain B.Body image disturbance C.Disregard for the feelings of others D.Healthy family relationships |
B. Body Image Disturbance |
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Describe a girl afflicted with bulimia. |
* Average weight range * May have depression, anxiety or abuse substances * May have dehydration or electrolyte imbalances due to excessive vomiting or laxative or diuretic abuse. |
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Which assessment finding would the nurse expect in clients diagnosed with bulimia? A.They are below normal weight. B.They binge when they experience hunger. C.They will be highly motivated to seek help. D.They are within their normal weight range. |
D. They are within normal weight range. |
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What are obese people at higher risk for? |
• Hyperlipidemia • Diabetes mellitus • Osteoarthritis • Angina • Respiratory insufficiency |
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What is Binge Eating Disorder? |
•The individual binges on large amounts of food, as in bulimia nervosa. •BED differs from bulimia nervosa in that the individual does not engage in behaviors to rid the body of the excess calories. •Can lead to obesity |
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What are the nursing diagnoses for eating disorders? |
* Imbalanced nutrition:less than body requirements related to refusal to eat * Deficient fluid volume (risk for or actual) related to decreased fluid intake, self-induced vomiting, and laxative and/or diuretic abuse * Ineffective denial related to delayed ego development and fear of losing the only aspect of life over which he or she perceives some control (eating) * Imbalanced nutrition:more than body requirements related to compulsive overeating * Disturbed body image/low self-esteem related to retarded ego development, dysfunctional family system, or feelings of dissatisfaction with body appearance * Anxiety (moderate to severe) related to feelings of helplessness and lack of control over life events |
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A client is 5’8’’ tall and weighs 105pounds. The client has been taking laxatives daily, and self-induces vomiting after eating. Which is the priority nursing diagnosis for this client? A.Ineffective denial B.Disturbed body image C.Low self-esteem D.Imbalanced nutrition: less than body requirements |
D.Imbalanced nutrition: less than body requirements |
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What is nursing care of the client with an eating disorder aimed at? |
* restoring nutritional balance. * Emphasis is also placed on helping the client gain control over life situations in ways other than inappropriate eating behaviors. * Self-esteem and positive self-image are promoted in ways that relate to aspects other than appearance. |
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What psychopharmacology would be used for anorexia nervosa? |
* Fluoxetine (Prozac) * Clomipramine (Anafranil) * Cyproheptadine (Periactin) * Chlorpromazine (Thorazine) * Olanzapine (Zyprexa) |
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What psychopharmacology would be used for bulimia nervosa? |
* Fluoxetine (Prozac) * Imipramine (Tofranil) * Desipramine (Norpramine) * Amitriptyline (Elavil) * Nortriptyline (Aventyl) * Phenelzine (Nardil) |
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What psychopharmacology would be used for binge eating disorder? |
* Topiramate (Topamax) |
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What psychopharmacology would be used for obesity? |
* Fluoxetine (Prozac) * Various anorexiants (CNS stimulants) stimulants suppress the appetite * Lorcaserin (Belviq) * Phentermine/topiramate (Qsymia) |
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How does behavior modification work with patients with anorexia or bulimia? |
For the program to be successful, the client must perceive that he or she is in control of the treatment. |
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For treatment of anorexia. Successes have been observed when the client: |
* Is allowed to contract for privileges based on weight gain * Has input into the care plan * Clearly sees what the treatment choices are |
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For treatment of anorexia. Success is expected when the client has control over: |
* Eating * Amount of exercise pursued * Whether to induce vomiting |
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For treatment of anorexia. Success is expected when the client and staff agree about: |
* Goals * System of rewards |
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What are the clusters for personality disorders and what do they mean? |
* Cluster A are odd, eccentric thinking, or behavior, personality disorders * Cluster B are dramatic, overly emotional or unpredictable thinking, or behavior, personality disorders * Cluster C are anxious, fearful thinking, or behavior, personality disorders |
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What personality disorders are part of Cluster A? |
* Paranoid * Schizoid * Schizotypal |
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What personality disorders are part of Cluster B? |
* Antisocial * Borderline * Narcissistic |
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What personality disorders are part of Cluster C? |
* Avoidant * Dependent * Obsessive-Compulsive |
