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100 Cards in this Set
- Front
- Back
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Which of the following neurotransmitters do alcohol and other CNS depressants affect?
a. GABA (gamma-aminobutyric acid) b. Serotonin c. Ach (acetylcholine) d. Histamine |
A. GABA (gamma-aminobutyric acid)
alcohol and other CNS depressants act on GABA receptors and increase bioavailability of glutamate, norepinephrine, and dopamine |
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___ is characterized by loss of control of substance consumption, substance use despite associated problems, and tendency to relapse
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Addiction
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A patient was admitted to the mental health facility for presence of withdrawal symptoms. During assessment, the patient stated “I’ve been drinking a 6-pack of beer every day for a year since my wife left me after I was diagnosed with pancreatic cancer. I tried to stop drinking but I just can’t.” Which diagnosis would be most appropriate for the client?
a. Substance abuse b. Substance dependence c. Substance-induced delirium d. Substance codependency |
B. Substance dependence
substance dependence is manifested by the following within a 12-month period: presence of tolerance of the drug, presence of withdrawal symptoms, unsuccessful or persistent desire to cut down use of drug, and substance use despite knowledge of recurrent physical or psychological problems |
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A nurse is doing assessments on patients in the chemical dependency/detox unit of the hospital. Which of the following situations require immediate attention or intervention from the nurse?
a. A patient showing no signs of withdrawal symptoms b. A recently discharged patient who was readmitted due to relapse c. Naloxone (Narcan) is prescribed PRN to a patient with a history of heroin overdose d. Patient with a history of alcohol abuse reported taking Xanax for anxiety |
d. Patient with a history of alcohol abuse reported taking Xanax for anxiety
alcohol when taken with a benzodiazepine (e.g., Xanax) produces synergistic effects – which results in far greater CNS depression and may lead to death if left untreated. |
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____ occurs when a person’s physiological reaction to a drug decreases with repeated administrations of the same dose
a. Withdrawal b. Intoxication c. Tolerance d. Flashbacks |
c. Tolerance
Tolerance is defined as the decreased physiological reaction to a drug with repeated administrations of the same dose |
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____ is defined by physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in amount.
a. Withdrawal b. Intoxication c. Tolerance d. Flashbacks |
a. Withdrawal
withdrawal causes physical or psychological signs or symptoms to occur when a drug that has been taken for a long time is stopped or drastically reduced in amount. |
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Naloxone (Narcan) is often given to people who have overdosed on an opiate (usually heroin) to:
a. Increase dopamine release b. Decrease serotonin activity c. Bind to GABA receptors to produce a calming effect d. Reverse respiratory and CNS depression |
d. Reverse respiratory and CNS depression
Naloxone, an opiate antagonist, reverses repiratory and CNS depression and is used to treat heroin (CNS depressant) overdose |
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____ are misinterpretations, usually of a threatening nature, of objects in the environment
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Illusions
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Signs and symptoms of alcohol poisoning include [select all that apply]:
a. Hyperalertness b. Irritability c. Clammy skin d. Inability to arouse e. Cyanotic fingernails or gums |
c. Clammy skin
d. Inability to arouse e. Cyanotic fingernails or gums signs of alcohol poisoning include, clammy skin, inability to arouse, cyanotic fingernails and gums. Hyperalertness, and irritability are signs of alcohol withdrawal |
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7 – 48 hours after cessation of alcohol intake, the nurse should be aware of the presence of what symptom of alcohol withdrawal?
a. Hallucinations b. Seizures c. Increased hunger d. Presence of a “hangover” |
b. Seizures
grand mal seizures may appear 7 – 48 hours after cessation of alcohol intake, particularly in people with a history of seizures |
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A patient with a history of heroin abuse will manifest which signs or symptoms of intoxication? [select all that apply]
a. Constricted pupils b. Dilated pupils c. Slurred speech d. Drowsiness e. Excessive motor activity |
a. Constricted pupils
c. Slurred speech d. Drowsiness signs and symptoms of heroin (CNS depressant) intoxication include constricted pupils, slurred speech, and drowsiness Dilated pupils and excessive motor activity are some of the signs of CNS stimulant (cocaine, crack, ampethamine) abuse |
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A nurse is doing a post-surgery assessment on a patient after administering a dose of Hydromorphone (Dilaudid) for pain. The patient showed signs of difficulty breathing, and drowsiness. Further assessment by the nurse show constricted pupils and decreased blood pressure. Which of the following interventions should the nurse do?
a. Call the doctor and request for an increased dose of the drug b. Encourage patient to do deep breathing exercises c. Record findings and acknowledge the drug reaching its therapeutic effect d. Hold the medication, alert the doctor, and prepare to administer a narcotic antagonistic drug |
d. Hold the medication, alert the doctor, and prepare to administer a narcotic antagonistic drug
the patient is showing signs and symptoms of opiate intoxication which might eventually lead to respiratory depression or arrest, convulsions, or death if not treated. The nurse should withhold the drug, contact the physician, and prepare to administer a narcotic antagonist (Narcan) |
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The two main effects of cocaine and crack are ____ and ____
a. Anesthetic ; stimulant b. Depressant; anesthetic c. Anesthetic ; hallucinogenic d. Hallucinogenic ; stimulant |
a. Anesthetic ; stimulant
As an anesthetic, cocaine blocks conduction of electrical impulses involved in sensory transmission, primarily pain transmission. It also acts as a stimulant for both sexual arousal and violent behavior |
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Which of the following interventions / situations isn’t an appropriate treatment for LSD overdose?
a. Avoid “talking down” on the patient b. Keep patient in a room with minimal light, sound and activity c. Speak slowly and clearly in a low voice d. Administering diazepam for extreme anxiety or tension |
a. Avoid “talking down” on the patient
possible treatments for LSD overdose include keeping patient in a room with low stimuli (minimal sound, light, and activity, “talk down” patient, speak slowly and clearly in a low voice, and giving diazepam for severe anxiety or tension |
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Which of the following is not true regarding date rape drugs?
a. The drugs cause relaxation of voluntary muscles b. The drugs rapidly produce disinhibition c. Alcohol inhibits their effects d. Can cause anterograde amnesia |
c. Alcohol inhibits their effects
date rape drugs cause relaxation of muscles, anterograde amnesia, and produce inhibition. Alcohol potentiates the effects of the drug. |
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Which patient response to the question, "Have you ever drunk more alcohol or used more drugs than you meant to?" should immediately cause the nurse to assess further?
a. “I have drunk alcohol before but have never let myself get drunk.” b. “I figured you’d ask me about that.” c. “Yes, I did that once and will never do it again.” d. “No, I have never used drugs or alcohol.” |
b. “I figured you’d ask me about that.”
Although all statement may cause the nurse to assess further within the context of the conversation, rationalizations, slow, prolonged responses, and automatic responses such as “I figured you’d ask me about that” serve as red flags that further assessment must be done right away to provide clarification. |
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____ is a normal emotional response to the perception of frustration of desires, threat to ones needs (emotional or physical), or a challenge
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Anger
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____ is harsh physical or verbal action that reflects rage, hostility, and potential for physical or verbal destructiveness
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Aggression
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____ is an objectionable act that involves intentional use of force that results in, or has the potential to result in, injury to another person
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Violence
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A patient is showing signs of aggression and hostility towards staff and other patients. Which of the following assessment factors would be the best indicator of violence for the patient?
a. Patient is a 23 year old male b. A history of violence is indicated c. Patient showing signs of increased anxiety and tension d. History of alcohol or drug intoxication |
b. A history of violence is indicated
although a demographic risk factor is indicated (23 year old male), the history of violence is the single best predictor of future violence |
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Which of the following will not ensure staff safety when dealing with an aggressive or angry patient?
a. Providing feedback if a patient’s behavior begins to escalate b. Stand directly in front of the client when talking to them c. Avoid wearing dangling earrings or necklaces d. Always know the layout of the area |
b. Stand directly in front of the client when talking to them
nurses or other staff shouldn’t stand directly in front of the client as this position could be interpreted as confrontational. Providing feedback (“You seem very upset”) allows exploration of the patient’s feelings and may lead to de-escalation of the situation |
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Which of the following conditions does not justify the use of restraints or seclusion on a patient showing violent and aggressive behavior?
a. Restraints / seclusion are used before trying other types of interventions b. Restraints / seclusion are used if the patient presents a clear and present danger to self or others c. Restraints / seclusion are used when less-restrictive methods have been tried and failed |
a. Restraints / seclusion are used before trying other types of interventions
restraint or seclusion can only be used when less-restrictive methods have been tried and failed, and if the patient presents a clear and present danger to self and others |
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During group therapy, the nurse announced that the gym would be closed for the day due to construction. One of the patients stood up and started shouting and swearing at the nurse. Which of the following rationale would the nurse consider regarding the patient’s behavior?
a. The patient is expressing his anger which may reduce tension and prevent the client from physically acting out b. It is a major indicator that the client may become physically aggressive c. The patient’s behavior is acceptable if directed at staff but not when directed at other clients d. the behavior can be attributed to lack of parental controls applied at an early age |
b. It is a major indicator that the client may become physically aggressive
Physical aggression is preceded by anger, which may be expressed by swearing and shouting, pacing, and other menacing behaviors |
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Nurses coping with angry clients may find it helpful to remember that anger and aggression begin as feelings of:
a. confidence b. vulnerability c. competence d. isolation |
b. vulnerability
stages of anger and aggression begins with feelings of vulnerability then progresses to uneasiness, anxiety, anger, aggression, and eventually end in violence |
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The stage in the cycle of violence where the abuser, at least initially, feels remorseful and apologetic and may bring presents, make promises, and tell the victim how much he or she is loved.
a. Tension-building stage b. Tertiary stage c. Honeymoon stage d. Repentance stage |
c. Honeymoon stage
the honeymoon stage may be characterized by kindness and loving behaviors. The abuser, at least initially, feels remorseful and apologetic and may bring presents, make promises, and tell the victim how much he or she is loved |
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In the honeymoon stage, the abuser shows loving behavior such as bringing gifts, flowers, and doing special things for the victim. What specific defense mechanism identifies the abuser’s behavior?
a. Undoing b. Reaction formation c. Compensation d. Conversion |
a. Undoing
undoing involves feeling guilty and trying to do something to undo the harm that may have been inflicted. It is trying to reverse or undo a feeling by acting in some opposite or compensatory manner. |
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Which of the following statements isn’t true regarding the effects of family violence on adolescents?
a. Poorer coping and social skills b. Fewer incidence of dissociative identity disorder c. Poor impulse control d. Reports more psychopathological changes |
b. Fewer incidence of dissociative identity disorder
adolescents who are victims of abuse have a higher incidence of dissociative identity disorder, reports more psychopathological changes, poor impulse control, and poorer coping / social skills |
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The greatest risk for violence toward a victim is when:
a. The abuser suspects the victim of doing something wrong b. The abuser assumes complete control over the victim c. The victim admits to doing something wrong d. The victim attempts to leave the abusive situation / partner |
d. The victim attempts to leave the abusive situation / partner
risk for violence towards the victim escalates when the victim makes a move towards independence, or attempt to leave the relationship |
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A 17 year old female patient is in the emergency room with complains of insomnia and “back pain”. During assessment, the nurse noted some bruises, and some cuts on the patient’s back. The patient stated “my dad accidentally hit my back with his golf club. He said he was sorry.” Which of the following should the nurse consider when assessing for possible family abuse?
a. Don’t assume that the patient did nothing wrong b. Avoid asking open-ended questions so patient won’t feel pressured to answer in detail c. Try to “prove” abuse by accusations or demands d. Ask open-ended questions to elicit more information |
d. Ask open-ended questions to elicit more information
establishing trust is crucial if the patient is to feel comfortable enough to self-disclose. Reassure the patient that he or she did nothing wrong. Asking questions that are open-ended and require a descriptive response can be less threatening and elicit more information than questions that can be answered with a yes or no. |
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Which of the following statements is/are true regarding family abuse? [select all that apply]
a. The victim’s behavior often causes violence b. Victims of abuse could leave if they really wanted to c. Pregnancy protects a woman from abuse d. Family abuse is more prevalent in poorly educated, low socioeconomic background e. Battering frequently begins or escalates during pregnancy |
e. Battering frequently begins or escalates during pregnancy
pregnancy may trigger or increase violence due to the added responsibility that the baby demands. The victim’s behavior isn’t the cause of violence. Violence is the abuser’s pattern of behavior. There are numerous factors influencing a decision to leave, including fear of injury or death, financial independence, etc. Abuse occurs on families of all socioeconomic, religious, cultural, and educational backgrounds |
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Which of the following nursing diagnosis would the nurse give priority first regarding a patient who is a victim of partner abuse?
a. Ineffective coping skills b. Risk for suicide c. Chronic low self-esteem d. Anxiety |
b. Risk for suicide
a person experiencing violence may feel desperate to leave yet be trapped in a detrimental relationship, and suicide may seem like the only option |
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A couple is at a clinic visit with their son, who has Tourette's syndrome. Which statement would be assessed as a risk factor for family violence?
a. "Our son is really a good little boy but it isn't easy to discipline him at home and in school." b. "My husband lost his job and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." c. "Your teaching helped us understand our son's disorder and not to be ashamed of his inability to control the tics in public." d. "We have become active in the support group but still find the suggestions difficult to put into practice." |
b. "My husband lost his job and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs."
. Job loss, financial problems, and a child who is "different" and has special needs should alert the nurse to the risk for family violence since all these factors contribute to a crisis situation |
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The nurse has referred a battered woman to the battered women's shelter and believes the woman left the emergency department to go there. An hour later the woman's husband comes to the emergency department and pleads with the nurse to tell him his wife's whereabouts. The nurse should:
a. refuse to provide any information. b. inform him that no information can be given for a minimum of 24 hours. c. call law enforcement to arrest the husband for the assault and battery of his wife. d. give him the telephone number, but not the address, of the shelter. |
a. refuse to provide any information.
The nurse must respect the client's right to confidentiality. Whether the questioner asks pleadingly or in a demanding way, the answer must be the same. |
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A person experiencing violence from a spouse may feel trapped in a detrimental relationship. Which of the following would be the most likely symptom that the woman would report as an attempt to escape the situation?
a. The client states she needs help because when she calls the police to arrest her husband but they do nothing. b. The client states that she has recently made a suicide attempt. c. The client relates that she is taking alcohol as a way to escape. d. The client states she has recently become more aggressive toward her husband so that she will not be physically beaten by him |
b. The client states that she has recently made a suicide attempt.
A person experiencing violence may feel so trapped in a detrimental relationship, yet so desperate to get out, that suicide may seem the only answer. A suicide attempt may be the presenting symptom in the emergency department. At least 10% of abused women attempt suicide. The other reports are not realistic for a woman who is being abused |
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Which if the following statements is/are true about rape? [select all that apply]
a. Most women are raped by strangers b. Rape is usually an impulsive act c. There are a growing number of male rape victims d. Rape is a sexual act e. It is an act of violence using sex as a weapon |
c. There are a growing number of male rape victims
e. It is an act of violence using sex as a weapon Rape is a violent crime. Sex is only the medium for perpetrating the crime. It is also a violent expression of aggression, anger, and need of power The majority of rape victims (69%) are raped by someone they know Most rapes are planned; over 50% involve a weapon |
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A rape victim experiencing the acute phase of rape-trauma syndrome would express which of the following behaviors?
a. Intrusive thoughts b. Increased emotional lability c. Disorganization d. Increased activity |
c. Disorganization
the acute phase of rape-trauma syndrome occurs immediately after the assault and may last for 2 – 3 weeks. During this phase, there is a great deal of disorganization in the person’s lifestyle, and somatic symptoms are common. All the other choices are long-term reorganization phase experiences |
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To provide discharge treatment and support, the nurse should realize that the most common result of acquaintance rape is the development of:
a. an eating disorder. b. anxiety and fear of men. c. symptoms of sexual distress. d. a paranoid psychosis |
c. symptoms of sexual distress.
Women who have been raped by acquaintances frequently develop symptoms that prevent them from participating in normal sexual relations. Sexual distress is more common among women who have been sexually assaulted by intimates; fear and anxiety are more common in those assaulted by strangers. Depression occurs in both groups. |
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A nurse in the pediatric unit of the hospital is about to do an assessment on a 2 year old patient. One of the following orders is to “rule out Autism”. Which of the following characteristics would the nurse note to indicate presence of autistic disorder? [select all that apply]
a. absence of stereotypical and repetitive motor mannerisms b. child exhibits odd movement patterns c. language and speech delayed d. child initiates interest in social activities e. stereotypical or repetitive use of language |
b. child exhibits odd movement patterns
c. language and speech delayed e. stereotypical or repetitive use of language presenting symptoms of autism include impairment in communication (language and speech delay, stereotypical / repetitive use of language), impairment in social interactions, and markedly restricted, stereotypical patterns of behavior (odd movement patterns) |
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Which of the following statements is true regarding Asperger’s disorder?
a. It has an earlier onset than autism b. There are no significant delay in cognitive or language development c. There are no restricted and repetitive patterns of behavior and interests d. No familial pattern present |
b. There are no significant delay in cognitive or language development
Asperger’s disorder has a later onset than autism. Although there is no significant delay in cognitive or language development, restricted and repetitive patterns of behavior and familial patterns are present. |
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A nursing diagnosis that should be considered for a child with attention deficit hyperactivity disorder is:
a. Risk for injury b. Anxiety c. Defensive coping d. Impaired verbal communication |
a. Risk for injury
The child's marked hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, and so forth. |
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The mother of a pediatric patient approached the nurse and told her “I’m concerned my daughter has ADHD”. The nurse should know that in order to be diagnosed with ADHD, a child must have:
a. Consistent developmental level w/ no academic, social, occupational impairment b. The symptoms present before age 7 and in at least two settings c. No symptoms present before age 7 d. Exhibited moderate gross motor activity that becomes more pronounced as the child grows |
b. The symptoms present before age 7 and in at least two settings
in order to diagnose a child with ADHD, symptoms must be present before age 7 and be present in at least two different settings (at home, school, etc.) |
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A nurse is teaching a patient with ADHD about his medication, Methylphenidate (Ritalin). Which of the following statements isn’t true regarding the drug?
a. Sustained release tablets should be swallowed whole – do not crush, break or chew b. The drug may cause growth suppression c. There is a high risk for abuse and / or misuse of the drug d. Drug should be taken after the last meal in the evening |
d. Drug should be taken after the last meal in the evening
insomnia is a common side effect of the drug, so it should be taken no later than 4:00 in the afternoon to avoid night time sleep disturbance |
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A 7-year-old male who has met earlier normal expectations in cognitive and language development develops a fascination with the bus schedule in his neighborhood and has difficulty establishing friendships with other school children. Which condition should the nurse anticipate?
a. Asperger’s Disorder b. Mild autism c. Severe autism d. Rhett’s disorder |
a. Asperger’s Disorder
While autistic disorders typically appear during a child’s first 3 years of life, Asperger’s disorder appears to have a later onset. Individuals with Asperger’s disorder often develop idiosyncratic interests and have problems with social relationships upon entering school. Rhett’s disorder is only observed in females, with an onset before 4 years of age. |
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Which of the following nursing diagnosis has the highest priority for an individual with anorexia?
a. Chronic low self esteem b. Social isolation c. Imbalanced nutrition d. Ineffective coping |
c. Imbalanced nutrition
imbalanced nutrition: less than body requirements is usually the most appropriate initial nursing diagnosis for anorexia. |
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A subjective symptom the nurse would expect to note during assessment of a client with anorexia nervosa is:
a. Hypotension b. Lanugo c. Cool, clammy skin d. Fear of gaining weight |
d. Fear of gaining weight
all the other options are objective symptoms of a client with anorexia nervosa |
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Which of the following is not a clinical presentation of bulimia nervosa? [select all that apply]
a. Dental caries / tooth erosion b. Low weight c. Parotid swelling d. “Russell’s sign” |
b. Low weight
Many bulimics are at or near normal weight, whereas individuals with anorexia nervosa are underweight. |
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A patient with anorexia reported to the nurse with complains of muscle weakness, tremors, and severe abdominal pain a couple of minutes after dinner. The nurse would initiate immediate intervention because the client is experiencing:
a. Withdrawal syndrome b. Allergic reaction to the food c. Refeeding syndrome d. Cognitive distortions |
c. Refeeding syndrome
refeeding syndrome is a potentially catastrophic treatment complication involving metabolic alteration in serum electrolytes, vitamin deficiencies, and sodium retention within initiation of therapeutic nutrition. |
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Bupropion (Prozac) while seemingly effective is contraindicated in patients who purge because of:
a. The potential to cause ulcers b. An increase risk in seizures c. Historically poor patient compliance d. Long term effects on liver function |
b. An increase risk in seizures
Bupropion (Prozac) while seemingly effective is contraindicated in patients who purge because of an increased risk of seizures. |
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Which of the following statements is not true regarding self-injury?
a. Behavior is followed by shame, guilt, and remorse b. A form of suicidal attempt c. Presents a momentary sense of calm and release of tension d. It is an impulsive behavior |
b. A form of suicidal attempt
self-injury is not a suicide attempt – it is most often done to relieve anxiety |
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A realistic short-term goal for the first week of hospitalization for a client with anorexia nervosa whose weight is 65% of normal weight would be: By end of week 1 the client will:
a. Gain a maximum of 3 lb. b. discuss fears and feelings about gaining weight c. verbalize awareness of sensation of hunger d. develop a pattern of normal eating behavior |
a. Gain a maximum of 3 lb.
The critical outcome during hospitalization is weight gain. A maximum of 3 pounds weekly is considered sufficient initially. |
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Which of the following statements is not true regarding depression in the older adults?
a. The demographic group with the highest rate of suicide is white males over the age of 75 years b. Depression in the older adults is often unidentified because of comorbid medical conditions c. Depression is a normal part of aging d. Depression that is accompanied by psychosis carries a higher risk of suicide |
c. Depression is a normal part of aging
Depression isn’t a normal part of aging and is often unidentified because of comorbid medical conditions. |
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A 65 year old patient who was diagnosed with UTI suddenly becomes irritable, confused, and fighting with staff. The staff would assess the patient with delirium. Which of the following statements is true regarding delirium?
a. It has a chronic and ongoing onset b. It is always caused by an underlying condition c. There are no treatments available for delirium d. Benzodiazepines are used to treat patients experiencing delirium |
b. It is always caused by an underlying condition
Delirium is always secondary to a general medical condition. It has an acute onset and treatment begins with identifying the cause. Benzodiazepines are often avoided due to side effects and possible worsening of delirium |
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Which of the following statements is true regarding dementia?
a. It has a sudden, acute onset b. It is reversible with proper and timely treatment c. Can cause depression in the older adults d. Can be caused as a result of some other pathological process |
d. Can be caused as a result of some other pathological process
dementia is the progressive and irreversible deterioration of cognitive functioning and global impairment of intellect. It has a slow, gradual onset and can be caused as a result of some other pathological process (thiamine deficiency, anemia, HIV, hypothyroidism) |
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A person with stage 3 Alzheimer’s disease shows which of the following behaviors?
a. Short term memory loss b. Withdrawn social activities c. Stupor and coma d. Wandering |
d. Wandering
Wandering is common in stage 3 (ambulatory dementia) Alzheimer’s disease |
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Psychosis, paranoia, delusions are common in what stage of Alzheimer’s disease?
a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4 |
c. Stage 3
At stage 3 (moderate to severe) Alzheimer’s disease, the person is often unable to identify familiar objects or people, needs repeated instructions or directions to perform the simplest tasks. Agitation, psychosis, violence, paranoia, and delusions are commonly seen |
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A nurse in the geriatric/dementia unit noticed her 70 year old patient has his clothes backwards and wears his underwear over his pants. Considering the behavioral manifestations of Alzheimer’s disease, the nurse would note the behavior as:
a. Confabulation b. Ataxia c. Apraxia d. Disturbance in executive functioning |
c. Apraxia
Apraxia is characterized by the loss of purposeful movement in the absence of motor or sensory impairment. The person is unable to perform once-familiar and purposeful tasks (such as putting on clothes properly) Disturbance in executive functioning is characterized by the inability for planning, organizing, and abstract thinking Confabulation is the creation of stories or answers in place of actual memories; an unconscious attempt to maintain self-esteem Ataxia is the lack of muscle coordination during voluntary movements |
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Which of the following statements about medications for Alzheimer’s disease is true? [select all that apply]
a. Cure the cause of Alzheimer’s disease by inhibiting the degeneration / breakdown of Acetylcholine and maintain normal levels of glutamate b. Delay cognitive progression of dementia c. Improves behavior, cognition, function d. Assist with some of the behavioral symptoms |
b. Delay cognitive progression of dementia
c. Improves behavior, cognition, function d. Assist with some of the behavioral symptoms The drugs work by inhibiting the degeneration / breakdown of Acetylcholine and maintain normal levels of glutamate. There is currently no cure for Alzheimer’s disease. The drugs don’t cure but rather, delay cognitive progression of dementia. The drugs also improve behavior, cognition, and function. |
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Which of the following describes the role of the psychiatric liaison nurse?
a. Nursing consultant in managing psychosocial concerns b. Researches new psychiatric treatment concepts c. Act as legal representative of a client in court d. Advocate for nurses who want to pursue an advanced nursing degree |
a. Nursing consultant in managing psychosocial concerns
The psychiatric liaison functions as a consultant to other nurses in managing psychosocial concerns and as a clinician who works directly to help the patients deal more effectively with physical and emotional problems |
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The nurse in the ICU was talking to a lady who just found out that her mom has been diagnosed with a terminal illness. The lady expressed her frustration at the doctor who gave the diagnosis. Afterward, the lady approached the nurse and stated “I don’t know what I’m going to do without my mom. I feel lost.” The nurse would know that the lady is experiencing:
a. Ambivalence b. Countertransference c. Withdrawal d. Anticipatory grief |
d. Anticipatory grief
anticipatory grief begins once a life-threatening diagnosis has been received or curative efforts are stopped. The future loss is being mourned in advance as people acknowledge the importance of the dying person, adjust their lives to accommodate the intervening time, and foresee how their futures will be altered by the loss |
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____ encompasses all of an individual’s reactions to loss. It includes depressed mood, insomnia, anxiety, poor appetite, loss of interest, guilt, dreams about the deceased, and poor concentration
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Grief
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Which of the following statements best describes a woman, whose husband just died of a stroke, experiencing sensations of somatic distress during bereavement?
a. “How could he leave me like this? How could he?” b. “I just can’t seem to function. I have a hard time doing simplest tasks” c. “I should have made him go to the doctor sooner.” d. “I’m feeling weak and numb on my right side” |
d. “I’m feeling weak and numb on my right side”
During sensations of somatic distress, the person may experience pain or discomfort that may be identical to the symptoms experienced by the dead person. Normally, symptoms are brief |
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The family of the terminally ill patient asks the nurse what “hospice care” is. The most appropriate answer the nurse should tell the family is:
a. Hospice consists of doctors and nurses that focus on the treatment of the patient’s illness b. Hospice care focuses on maintaining and stabilizing the patient’s condition until a cure is available c. Hospice care focuses on holistic physical and comfort care for the terminally ill patient d. Hospice provides home care services for the patient when the family isn’t available |
c. Hospice care focuses on holistic physical and comfort care for the terminally ill patient
Hospice and palliative care focus on patient’s physical and emotional comfort and offer holistic support for the dying persons and their families |
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An 18 year old patient in the PICU who was 4 weeks pregnant, had a miscarriage. The patient tearfully expressed her feelings to the nurse and mentioned that her friends and family didn’t know she was pregnant. The nurse would note the patient’s grieving as:
a. Maladaptive grief b. Disenfranchised grief c. Dysfunctional grief d. Normal bereavement |
b. Disenfranchised grief
Disenfranchised grief is experienced by the person when the loss is not or cannot be openly acknowledged, publicly mourned, or socially supported. For example, grief over deaths by abortion or miscarriage, suicide and substance abuse, death of friends, divorced partners, or even animal companions |
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According to the continuum of psychiatric mental health treatment, a locked inpatient unit is an example of:
a. transitional outpatient treatment b. ongoing outpatient treatment c. most acute treatment d. intensive outpatient treatment |
c. most acute treatment
a locked inpatient unit is an example of the most acute treatment community mental health centers are ongoing outpatient treatment options PHP, psychiatric home care, intensive substance abuse programs are intensive outpatient treatments Psychosocial rehabilitation programs are part of the transitional outpatient treatment |
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Which of the following disorders would be included on Axis I of the DSM IV-TR?
a. Major depression, schizophrenia, and alcoholism b. Narcissistic, borderline, and paranoid personality disorders c. Diabetes type I or II, Parkinson’s disease, and seizure disorders d. Mental retardation and psychosocial stressors such as divorce |
a. Major depression, schizophrenia, and alcoholism
Axis 1 refers to the collection of signs and symptoms that make up a particular disorder (e.g., schizophrenia, depression) Axis 2 refers to personality disorders and mental retardation (e.g., narcissistic, borderline) Axis 3 indicates any general medical conditions relevant to the medical disorder (e.g., diabetes, Parkinson’s disease) Axis 4 describes psychosocial and environmental problems that may affect diagnosis, treatment, and prognosis or the mental disorder (psychosocial stressors such as divorce) |
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The role of the psychiatric nurse is:
a. help patient prepare a support system that will promote mental health on discharge from the hospital b. diagnosing and treating of human responses to actual or potential mental health problems c. provide assistance to patients in meeting basic needs and also help the community to remain supportive, safe, and healthy d. provide medical diagnosis and treatments on a consultation basis |
b. diagnosing and treating of human responses to actual or potential mental health problems
the psychiatric nurse’s roles include diagnosing and treating responses to psychiatric disorders and promote mental health through assessment, diagnosis, and treatment social workers help patients prepare a support system that will promote mental health on discharge from the hospital mental health workers function under direction and supervision of RNs to provide assistance to patients in meeting basic needs and also help the community to remain supportive, safe, and healthy physicians provide medical diagnosis and treatments on a consultation basis |
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A nurse in a mental health facility is assigned to take care of a patient from an East Asian background. One important factor about the culture that the nurse should remember regarding patient care is:
a. The patient’s culture value autonomy, independence and self reliance b. The patient’s culture believes that there is separation of mind and body c. The patient’s culture believes that disease is lack of harmony with nature d. The patient’s culture value family interdependency and group decision making |
d. The patient’s culture value family interdependency and group decision making
eastern tradition value family interdependence and group decision making Western tradition believes on individuality, valuing autonomy, independence and self reliance Indigenous cultures believe that disease is caused by lack of harmony with nature |
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The nurse assesses the wellness beliefs and values of a client from another culture best when asking:
a. "How can I help you get better?" b. "What do you think is making you ill?" c. "What do you think will make you better?" d. Did you do something to cause the illness?" |
b. "What do you think is making you ill?"
Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness. |
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A client who is to be discharged the next day tells the nurse that once he's released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take?
a. Call the client's wife and report the threat b. Report the incident to the client's therapist and document c. Immediately cancel the client's discharge d. None, because no explicit threat has been made |
b. Report the incident to the client's therapist and document
The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse reports to the treatment team, and the mandated reporter (usually the professional leader of the team) is responsible for notifying the person against whom the threat was made. |
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A nurse is doing an assessment on a patient in a mental health facility. During the assessment, the nurse noticed the patient is becoming restless, continuously tapping her foot, and fidgeting. According to Peplau, the patient is experiencing what level of anxiety?
a. Mild anxiety b. Moderate c. Severe anxiety d. Panic |
a. Mild anxiety
Persons who experience mild anxiety show symptoms like tapping their feet, fidgeting, restlessness, or irritability. A person who has moderate anxiety have symptoms like increased pulse, respiratory rate, and may demonstrate selective inattention Someone who has severe anxiety experience somatic symptoms (headache, nausea, dizziness), may experience hyperventilation and a sense of impending doom or dread Behavior resulting from panic may be manifested as pacing, running, shouting, screaming, or withdrawal |
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A man reacts to news of the death of a loved one by saying, “no, I don’t believe you. The doctor said he was fine.” Is displaying what type of defense mechanism?
a. Rationalization b. Dissociation c. Denial d. Undoing |
c. Denial
denial involves escaping unpleasant anxiety-causing thoughts, feelings, wishes, or needs by ignoring their existence |
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a nurse is doing an assessment on a patient who has been experiencing anxiety symptoms for 6 months. The patient reported worrying about getting fired from his job, and constantly checking on his kids to make sure they are alright. The patient also mentioned having trouble sleeping and wakes up often during the night. The patient shows signs and symptoms of what type of anxiety disorder?
a. Obsessive compulsive disorder b. Panic disorder c. Generalized anxiety disorder d. Post traumatic stress disorder |
c. Generalized anxiety disorder
excessive anxiety or worry about numerous things lasting for 6 months, and sleep disturbance are signs of GAD. |
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Duloxetine (Cymbalta), an antidepressant also used as an anxiety medication can cause what primary side effect?
a. Blurred vision b. Constipation c. Tachycardia d. Hypertension |
d. Hypertension
SNRIs (serotonin-norepinephrine reuptake inhibitors) such as Duloxentine (Cymbalta) can cause hypertension Blurred vision, constipation, and tachycardia are all side effects of Tricyclics – imipramine (Tofanil) |
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A client is diagnosed with schizoid personality disorder. The symptoms that support the diagnosis includes: [select all that apply]
a. Emotional detachment, shows indifference to praise or criticism b. Very emotional, attention seeking, and dramatic c. Having odd beliefs, magical thinking, and perceptual distortions d. Distrust and suspiciousness towards others |
a. Emotional detachment, shows indifference to praise or criticism
persons who have schizoid PD experience emotional detachment and show indifference to praise or criticism Histrionic people are very emotional, attention seeking, and dramatic Schizotypical PD is expressed in odd characteristics such as having odd beliefs, magical thinking and perceptual distortions Distrust and suspiciousness towards others is characterized in persons who have paranoid PD |
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Characteristic behaviors the nurse will assess in the antisocial client are
a. perfectionism, preoccupation with detail, and verbosity b. deceitfulness, impulsiveness, and lack of empathy. c. avoidance of interpersonal contact and preoccupation with being criticized. d. need for others to assume responsibility for decision-making and seeks nurture. |
b. deceitfulness, impulsiveness, and lack of empathy.
Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others |
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Splitting is the primary defense or coping style used by persons with what type of PD?
a. Histrionic b. Narcissistic c. Borderline d. Antisocial |
c. Borderline
splitting is the primary defense used by persons with Borderline PD where the person labels one person as “all good” while the other is “all bad” |
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Social inhibition, low self esteem, avoidance of all situations requiring social contact and fear of rejection are all characteristics of what personality disorder?
a. Antisocial b. Avoidant c. Paranoid d. Narcissistic |
b. Avoidant
. the central characteristics of individuals who have avoidant PD, are an extreme sensitivity to rejection and robust avoidance of interpersonal situations |
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A client has been diagnosed with dependent personality disorder. Which behavior descriptions can the nurse expect to assess?
a. Odd, eccentric b. Anxious, fearful c. Dramatic, emotional, erratic d. Disoriented, disorganized |
b. Anxious, fearful
Dependent personality disorder has a primary feature of extreme dependency in a close relationship, with an urgent search to find a replacement when one relationship ends. These individuals have difficulty making independent decisions and are constantly seeking reassurance. They have deeply held convictions of personal incompetence, with the fear that they cannot survive on their own. They frequently seek treatment for anxiety or mood disorders related to a loss. |
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The priority nursing intervention for a client with borderline personality disorder is to:
a. respect the client's need for social isolation b. protect other clients from manipulation c. assess for suicidal and self-mutilating behaviors d. provide clear, consistent limits and boundaries |
c. assess for suicidal and self-mutilating behaviors
One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress |
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You are about to interview a newly admitted patient on your inpatient mental health unit. This is his first experience with psychiatric treatment. Which of the following interventions would be appropriate for this patient? [select all that apply]
a. Ensure that the individual understands his rights as a patient on your unit b. Carefully check all clothing and possessions for potentially dangerous items c. Discuss outpatient care options for after discharge d. Anticipate and address possible increased anxiety and shame |
a. Ensure that the individual understands his rights as a patient on your unit
b. Carefully check all clothing and possessions for potentially dangerous items d. Anticipate and address possible increased anxiety and shame checking for items that might be dangerous to this or other patients is one of the first and most important nursing interventions in a new admission situation. They may also be anxious, embarrassed, or ashamed about their condition and/or being on a mental health unit. Anxiety can increase patient distress and lead to behavioral concerns such as agitation or resistance; it should be assessed and addressed early in treatment. Ensuring that new patients understand their rights as mental health clients is also an essential nursing duty. Discharge planning should start early, but insufficient information is available at this time to begin such planning, and other concerns take a priority immediately after admission |
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Opinion that one’s own beliefs, values and practices are the best, preferred, or the only way (culturally inappropriate nursing care)
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Ethnocentrism
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a person who experience anhedonia:
a. Lacks the ability to experience joy or pleasure in living b. Lacks energy or passivity c. Experiences excessive amount of sleepiness d. Experiences delusions or hallucinations |
a. Lacks the ability to experience joy or pleasure in living
anhedonia describes a person’s lack of ability to experience joy or pleasure in living and is a hallmark of depression anergia is the lack of energy or passivity hypersomnia describes an excessive amount of sleepiness delusional or psychotic major depression is a severe form of mood disorder and characterized by delusions or hallucinations |
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a patient in a mental health facility was diagnosed with depression and a history of suicidal ideation was started on a low dose antidepressant. 3 days later, the patient reported having a lot of energy to do things and always having a “good mood”. The nurse taking care of the patient would take note that the patient’s sudden change in behavior indicates:
a. That the antidepressant drug has reached therapeutic effect b. The patient can be sent home due to the improved behavior c. An increased suicide potential due to sudden elevated mood d. The patient is experiencing another mental disorder and must be reassessed immediately |
c. An increased suicide potential due to sudden elevated mood
patients diagnosed with depression that show a sudden elevated mood, or energy are at a high risk for suicidal attempts – a depressed suicidal person may suddenly appear better after making a decision to end their life |
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Which patient statement indicates learned helplessness?
a. “I hate myself” b. “It's all my fault that my husband left me for another woman” c. “Everyone in the world is just out to get me.” d. “I am a horrible person.” |
b. “It's all my fault that my husband left me for another woman”
Learned helplessness often occurs during depression if the person feels no control over the outcome of a situation. By blaming herself, the patient has taken accountability for her husband’s actions and assigned blame to herself |
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A patient with depression who usually takes an SSRI type of antidepressant is now going to switch to an MAOI antidepressant. One important information the nurse should tell the patient about the drugs is:
a. The patient should take one of each type of medication everyday b. The patient may combine both medications if the patient wishes to do so c. The patient should discontinue all SSRIs for 2 – 5 weeks before starting the MAOI d. Patient should take both SSRIs and MAOIs for 2 - 5 weeks to receive full therapeutic effect of the drugs |
c. The patient should discontinue all SSRIs for 2 – 5 weeks before starting the MAOI
patient must discontinue the SSRIs for 2-5 weeks before switching to the MAOI to prevent central serotonin syndrome |
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A nurse is taking care of a patient who was recently diagnosed with bipolar disorder, which of the following characteristics or symptoms of the patient that would support the diagnosis? [select all that apply]
a. Highly distractible b. Inflated self esteem or grandiosity c. Patient is withdrawn, not talking too much d. Patient has poor judgment – impulsivity, lack of control |
a. Highly distractible
b. Inflated self esteem or grandiosity d. Patient has poor judgment – impulsivity, lack of control someone who has bipolar disorder is highly distractible, has an inflated self esteem or grandiosity, more talkative than usual, and has poor judgment |
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What signs and symptoms should the nurse expect to assess if a client taking an MAO antidepressant ingests foods containing tyramine?
a. bradycardia and increased thirst b. Muscle stiffness and shuffling gait c. Headache and palpitations d. Confusion and sore throat |
c. Headache and palpitations
headache, palpitations, and sudden elevation of blood pressure are some of the symptoms of a hypertensive crisis related to tyramine consumption. Muscle stiffness and shuffling gait are related to extrapyramidal side effects of antipsychotics |
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A nurse is tasked to do an assessment on a patient who has bipolar disorder. Which of the following questions should the nurse ask the patient in order to get a good patient assessment?
a. “what have you been working on since this morning?” b. “when is the last time you ate or slept?” c. “what do you want to do today?” d. “when is the last time you talked with your primary physician?” |
b. “when is the last time you ate or slept?”
One of the most important assessments for someone who has bipolar disorder is to ask when the patient last ate or slept. Patients with bipolar disorder may become hyperactive and non-stop physical activity and lack of sleep and food can lead to physical exhaustion and even death if not treated |
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A nurse in the mental health facility is planning to care for a client who is experiencing the acute phase of bipolar disorder. Which of the following interventions is/are appropriate for the nursing care plan for the client? [select all that apply]
a. Maintaining medication compliance b. Psychoeducational teaching for the client and the family c. Medication stabilization and safety d. Prevent relapse |
c. Medication stabilization and safety
during the acute phase, planning focuses on medically stabilizing the patient while maintaining safety. Planning for the continuation phase focuses on maintaining medication compliance and psychoeducational teaching for the client and the family. During the maintenance phase, planning focuses on preventing relapse and limiting the severity and duration of future episodes. |
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Patients with bipolar disorder who take lithium are also taking what type of medication as initial treatment of acute mania until the lithium takes effect?
a. Antipsychotics b. Antiarrythmias c. Antidepression d. Anticoagulant |
a. Antipsychotics
lithium usually takes 7 – 14 days to reach therapeutic levels. An antipsychotic / benzodiazepine can be used to prevent exhaustion, coronary collapse, and death until lithium reaches therapeutic levels |
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A 35 year old male client who’s taking lithium for bipolar disorder calls his healthcare provider and complains of nausea and vomiting, polyuria, and muscle weakness. The most appropriate response that the healthcare provider tells the client is:
a. “It’s just a mild side effect of the drug. It will subside in a couple of days.” b. “You should limit your food and fluid intake so you won’t experience those side effects.” c. “You should stop taking the medication and go to the hospital as soon as possible” d. “That means the medication isn’t working appropriately so we should increase the dosage of your medication” |
c. “You should stop taking the medication and go to the hospital as soon as possible”
the patient should withhold the medication and go to the healthcare facility because the patient is experiencing early signs of lithium toxicity |
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When a client experiences 4 or more mood episodes in a 12 month period, the client is said to be:
a. Cyclothymic b. Rapid-cycling c. Dysynchronous d. Incongruent |
b. Rapid-cycling
Rapid cycling infers 4 or more mood episodes in a 12 month period as well as more severe symptoms |
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Which side effects commonly occur in clients who are taking SSRI antidepressants?
a. Extrapyramidal side effects b. Anticholinergic effects c. Neuroleptic malignant effects d. Gastrointestinal disturbances |
d. Gastrointestinal disturbances
GI disturbances such as nausea and diarrhea, as well as genitourinary side effects such as sexual dysfunction, are common with SSRIs. Anticholinergic effects are more common with tricyclic antidepressants than with SSRI antidepressants. Extapyramidal side effects are common with the traditional antipsychotic medications. Neuroleptic malignant syndrome can be fatal. It is a serious side effect of antipsychotic medications. |
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A nursing care plan is needed for a patient with bipolar disorder who’s currently in the maintenance phase of the illness. The nurse should know that the focus of the care plan should be:
a. Counseling, and psychoeducation teaching for the client b. Maintain safety, and avoid self-injury c. Maintain medication compliance d. Prevent relapse |
d. Prevent relapse
the overall outcomes for the maintenance phase focus on prevention of relapse and limitation of severity and duration of future episodes In the acute phase, the focus is on maintaining safety and avoiding self-injury Counseling, psychoeducation, and maintaining medication compliance are the goals focused on the continuation phase |
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A nurse in a mental health unit is about to administer antipsychotic medication to a patient with schizophrenia. Which of the following interventions is appropriate for the client regarding the condition?
a. Provide high-calorie foods b. Limit / monitor water intake c. Limit patient interaction with others d. Restraints / seclusion precautions |
b. Limit / monitor water intake
polydipsia can lead to fatal water intoxication characterized by seemingly insatiable thirst resulting in dangerous intake of water. Factors contributing to excess water intake include dry mouth due to antipsychotic medication, and compulsive behavior |
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Which of the following patient characteristics indicate presence of positive symptoms of schizophrenia?
a. Patient is easily distracted and inattentive b. Patient expresses loss of motivation and blunted affect c. Patient stated “I am the best doctor in here. I can cure everyone” d. Patient shows few recreational interests and physical anergia |
c. Patient stated “I am the best doctor in here. I can cure everyone”
positive symptoms of schizophrenia manifests as delusions, hallucinations, and paranoia Negative symptoms manifest as blunted affect, anhedonia, asocial, and attention deficits |
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A mental health nurse is listening to her start-of-shift report when a patient with schizophrenia approached the nurse and told her “The devil is standing beside me and won’t leave me alone” the most appropriate response the nurse should tell patient should be:
a. “There is no one standing beside you. It’s all in your head.” b. “I don’t see the devil standing beside you, but I understand how upsetting that must be for you.” c. “if you have been good and followed the nurse’s orders, the devil wouldn’t have to follow you” d. “You must’ve missed taking your medications because you’re hallucinating again” |
b. “I don’t see the devil standing beside you, but I understand how upsetting that must be for you.”
hallucinations are real to the person who is experiencing them. The focus of the nurse should be to understand the patient’s experiences and responses. Respond to the patient in a nonthreatening and nonjudgmental manner. Don’t negate the patient’s experience, but offer your own perceptions. |
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A mental health nurse is giving his end-of-shift report when a patient with schizophrenia approached the nurse and told him “the doctor is here to see me and he’s come to kill me” the most appropriate response the nurse should tell the patient should be:
a. “It is true the doctor wants to see you, but he wants to talk to you about your treatment. Would you feel more comfortable talking to him in the day room?” b. “Don’t be so silly. Doctors don’t kill their patients” c. “You shouldn’t think badly about your doctor. He’s here to help you” d. “What makes you think that your doctor is here to kill you?” |
a. “It is true the doctor wants to see you, but he wants to talk to you about your treatment. Would you feel more comfortable talking to him in the day room?”
it is never useful to debate or attempt to dissuade the patient regarding the delusion. Doing so can intensify the retention of irrational beliefs and cause the patient to view you as rejecting or oppositional. However, it is helpful to clarify misguided interpretations and gently suggest, as tolerated, a more reality-based perspective. |
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The purpose for a nurse periodically performing the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has schizophrenia is early detection of:
a. cholestatic jaundice b. pseudoparkinsonism c. tardive dyskinesia d. acute dystonia |
c. tardive dyskinesia
An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia. |
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A patient is started on Seroquel, an atypical antipsychotic. Which of the following disadvantages the nurse should discuss with the patient regarding the medication?
a. The medication doesn’t treat negative symptoms (anergia, anhedonia) b. The medication can cause anticholinergic effects (urinary retention, tachycardia) c. The medication can cause metabolic syndrome (weight gain, altered glucose metabolism) d. The medication can cause extrapyramidal side effects (pseudoparkinsonism, tardive dyskinesia) |
c. The medication can cause metabolic syndrome (weight gain, altered glucose metabolism)
atypical antipsychotics (Seroquel, Abilify, Zyprexa) diminish negative and positive symptoms of schizophrenia and are often chosen as first-line antipsychotics. One significant disadvantage of the drug is they have a tendency to cause metabolic syndrome which includes weight gain and altered glucose metabolism All the other choices pertain to the traditional antipsychotics (Thorazine, Haldol, Prolixin) |
