Ivcc Nur 1210 - Ch 12, 22, 23, 24 Review Questions (Eep)

Front 1

TRUE/FALSE

Intergenerational transmission process suggests thatfamily violence is a pattern of behavior learned from one generation to thenext.

Back 1

TRUE

Front 2

TRUE/FALSE

Rape most commonly occurs in a woman’sneighborhood, often inside or near her home.

Back 2

TRUE

Front 3

TRUE/FALSE

Adolescent suicide has not been correlated withbullying.

Back 3

FALSE

Front 4

TRUE/FALSE

Depression and suicidal behavior are common insurvivors of abuse.

Back 4

TRUE

Front 5

TRUE/FALSE

The classification of sodomy as a crime canimpede same-sex victims reporting partner abuse.

Back 5

TRUE

Front 6

__________ is the repeated and persistentattempts to impose unwanted communication or contact with another person.

Back 6

Stalking

Front 7

__________ is the malicious or ignorantwithholding of physical, emotional, or educational necessities to a dependent’swell-being.

Back 7

Neglect

Front 8

Spouse battering, child abuse, elder abuse, andmarital rape are examples of __________ violence.

Back 8

Family

Front 9

The __________ phase in the cycle of violence isa period in which the perpetrator expresses remorse and regret.

Back 9

Honeymoon

Front 10

Date rape, also known as __________ rape, canoccur on a first date or when the two individuals have known each other forsome time.

Back 10

Acquaintance

Front 11

TRUE/FALSE

Autistic disorder is more commonly diagnosed inboys than girls.

Back 11

TRUE

Front 12

TRUE/FALSE

Attention-deficit hyperactivity disorder is notseen in adults owing to the fact that children outgrow it.

Back 12

FALSE

Front 13

TRUE/FALSE

Time-out is a form of punishment used to help incontrolling children’s behavior.

Back 13

FALSE

Front 14

TRUE/FALSE

Encopresis is the repeated voiding of urineduring the day or night into the clothing or the bed by a child who ischronologically or developmentally 5 years of age.

Back 14

FALSE

Front 15

TRUE/FALSE

Rumination is the repeated regurgitation andrechewing of food.

Back 15

TRUE

Front 16

__________ disorder is more commonly diagnosedin girls and involves a loss of motor skills and the development of stereotypedmovements.

Back 16

Rett's

Front 17

__________ play involves the use of playtechniques that aid in understanding the child’s thoughts and feelings and helpin communication.

Back 17

Therapeutic

Front 18

Symptoms of __________ disorder involveaggression, destruction of property, deceitfulness, theft, and seriousviolation of rules.

Back 18

Conduct

Front 19

A(n) __________ is a sudden, rapid, recurrent,nonrhythmic, stereotyped motor movement or vocalization.

Back 19

Tic

Front 20

In __________ communication disorder, a childhas difficulty communicating with others verbally or through sign language.

Back 20

Expressive

Front 21

TRUE/FALSE

During intermittent explosive disorder (IED),physical injury does not occur.

Back 21

FALSE

Front 22

TRUE/FALSE

Disruptive behavior associated with ODD is moreintense in the home than in other settings.

Back 22

TRUE

Front 23

TRUE/FALSE

Treatment for IED includes the antidepressant,fluoxetine (Prozac).

Back 23

TRUE

Front 24

TRUE/FALSE

As many as 30% to 50% of children diagnosed withconduct disorder are diagnosed with antisocial personality disorder as adults.

Back 24

TRUE

Front 25

TRUE/FALSE

There is no genetic risk for conduct disorder.

Back 25

FALSE

Front 26

__________ disorder is characterized bypersistent behavior that violated social norms, rules, law, and the rights ofothers.

Back 26

Conduct

Front 27

__________ is a retreat to a neutral place soclients can regain self-control.

Back 27

Time-out

Front 28

For limit setting to be effective, the __________must have meaning for clients.

Back 28

Consequences

Front 29

__________ in following the plan for a clientdiagnosed with conduct disorder is essential to decrease manipulation.

Back 29

Consistency

Front 30

Children and adolescents with ODD and conductdisorder may be diagnosed with __________ personality disorder as adults.

Back 30

Antisocial

Front 31

TRUE/FALSE

Agnosia is the impaired ability to execute motorfunctions despite intact motor abilities.

Back 31

FALSE

Front 32

TRUE/FALSE

Repeated head injuries can lead to progressivedementia.

Back 32

TRUE

Front 33

TRUE/FALSE

Adult children who care for a parent with dementiacan experience role reversal, which increases the risk of them developing amental health concern.

Back 33

TRUE

Front 34

TRUE/FALSE

Delirium is an irreversible condition that has aslow onset.

Back 34

FALSE

Front 35

TRUE/FALSE

In caring for a confused client with dementia,the nurse can use distraction by shifting the client’s attention and energy toa more neutral topic.

Back 35

TRUE

Front 36

An individual with __________ dementiademonstrates a pattern of abrupt changes in functioning alternating withplateaus in functioning.

Back 36

Vascular

Front 37

__________ is the tendency for individuals withdementia to make up answers to fill gaps in their memory.

Back 37

Confabulation

Front 38

An effective intervention with dementia is__________ therapy, which involves aiding the client to think about orpersonally relate to significant past experiences.

Back 38

Reminiscence

Front 39

The ability to plan, abstractly think, andmonitor or stop complex behavior is known as __________ functioning.

Back 39

Executive

Front 40

__________ disease is characterized by atrophyof cerebral neurons, the presence of senile plaque deposits, and enlargement ofthe third and fourth ventricles.

Back 40

Alzheimer's

Front 41

Whilewalking home from school, 7-year-old Jimmy and his older brother, Michael, wereattacked by three boys from Michael’s class. The three boys pushed Michael intoa cement wall and hit him in the stomach, calling him “stupid.” When Michaelreached up to straighten his glasses, one of the boys snatched the glasses fromMichael, threw them to the ground, and stomped on them. When Jimmy began tocry, one of the boys spit on Jimmy as the three boys fled into the nearby parklaughing and yelling, “stupid, stupid, stupid!”

Whatsigns/symptoms might indicate that Jimmy is disturbed by the bullying and ishaving trouble coping?

Back 41

Relationshipdifficulties such as not wanting to be with his older brother, Michael, or notwanting to go to school; poor grades; trouble with eating or sleeping;increased aggression; low mood; anxiety and/or fear; eventual drug/alcoholabuse; and bullying others would all be signs that Jimmy is not coping with theincidence of bullying.

Front 42

While walking home from school, 7-year-old Jimmy and his older brother, Michael, were attacked by three boys from Michael’s class. The three boys pushed Michael into a cement wall and hit him in the stomach, calling him “stupid.” When Michael reached up to straighten his glasses, one of the boys snatched the glasses from Michael, threw them to the ground, and stomped on them. When Jimmy began to cry, one of the boys spit on Jimmy as the three boys fled into the nearby park laughing and yelling, “stupid, stupid, stupid!”

Outlinea plan of care to assist Jimmy with coping with the bullying.

Back 42

AllowJimmy to talk about the abuse/bullying. Encourage expression of hisfeelings––even negative feelings. Report the abuse/bullying to police andschool officials. Involve Jimmy in counseling––meetings with the schoolcounselor might be a good place to start. Assist Jimmy with identifyingalternate responses to the bullying boys that empower Jimmy in a situation thatinvolves bullying.

Front 43

Connor is a7-year-old child in the first grade this year. He was enrolled in a privateschool out of the desperation of his parents to find a way to control hisbehavior. Last year Connor was in preschool. His teachers complained about hisinappropriate behavior almost every day. They would send notes home withConnor. These complaints led to many parent–teacher meetings. The teacher saidthat Connor has difficulty paying attention, is easily distracted, andfrequently loses things. He was found climbing on the ledge of a wall in theboys’ bathroom. He talks excessively and interrupts in others’ conversations.He does not sit still in class and is always fidgeting with something. He hadto be corrected so often in class that the other children began to ignore himand often made fun of him.

Since moving to the private school, there was someimprovement in his behavior because the class size was limited to 15 students.As time went by, though, Connor began to fall back into his usual inattention,impulsiveness, and hyperactivity. It was suggested that Connor be evaluated atthe mental health clinic. The nurse assesses Connor’s behavior in the play areaduring his first visit to the clinic. She observes him talking constantly tothe other children. When he is not talking, he is jumping from chair to chair.He does not seem to play with any particular toy; instead he goes from one toyto another, never spending much time with any one of them.

Giveexamples of assessment data the nurse would use to form a nursing diagnosis forConnor, who has ADHD.

Back 43

Examples ofassessment data after observation of the child’s behaviors in the play areawould be the following:

· Level of physical activity

· Attention span

· Talkativeness

· Impulse control

· Ability to follow directions

The essential feature of ADHD is a persistentpattern of inattention or hyperactivity and impulsivity.

Front 44

Connor is a 7-year-old child in the first grade this year. He was enrolled in a private school out of the desperation of his parents to find a way to control his behavior. Last year Connor was in preschool. His teachers complained about his inappropriate behavior almost every day. They would send notes home with Connor. These complaints led to many parent–teacher meetings. The teacher said that Connor has difficulty paying attention, is easily distracted, and frequently loses things. He was found climbing on the ledge of a wall in the boys’ bathroom. He talks excessively and interrupts in others’ conversations. He does not sit still in class and is always fidgeting with something. He had to be corrected so often in class that the other children began to ignore him and often made fun of him.

Since moving to the private school, there was some improvement in his behavior because the class size was limited to 15 students. As time went by, though, Connor began to fall back into his usual inattention, impulsiveness, and hyperactivity. It was suggested that Connor be evaluated at the mental health clinic. The nurse assesses Connor’s behavior in the play area during his first visit to the clinic. She observes him talking constantly to the other children. When he is not talking, he is jumping from chair to chair. He does not seem to play with any particular toy; instead he goes from one toy to another, never spending much time with any one of them.

Citethree interventions that coincide with the three nursing diagnoses chosen forplanning care for Connor.

Back 44

Interventionsfor ADHD include a combination of medication, behavioral interventions, andparental education. Three interventions that can be related to the threenursing diagnoses above are

· Stopping unsafe behavior

· Giving positive feedback for meetingexpectations

· Giving clear directions about acceptable andunacceptable behavior

Front 45

Jordanis a 15-year-old male who was brought into the school nurse’s office for burnson his hands after he stole and set fire to a classmate’s table that theclassmate had made in technology class. Jordan has a reputation at school forfrequently getting into trouble. The teachers have expressed concern thatJordan bullies the other kids at school. He is often challenging of authorityfigures such as the school principle, the school safety officer, and teachers.His mother has had to notify the school on three separate occasions this yearthat Jordan has run away. Jordan’s father is not available as he is currentlyserving time in prison for auto theft.

Theschool nurse suspects that Jordan has a conduct disorder. What additionalinformation would be necessary in order to support this diagnosis?

Back 45

Familyhistory and an assessment of parenting would be important factors to consider.Assessment of Jordan’s social relationships, coping, alcohol and substanceuse/abuse, social and family supports, academic achievement,self-concept/self-esteem, and general physical health would also need to beassessed. Additionally, it would be important to assess whether Jordanexperiences any guilt or remorse for the destruction and hurt he causes.

Front 46

Jordanis a 15-year-old male who was brought into the school nurse’s office for burnson his hands after he stole and set fire to a classmate’s table that theclassmate had made in technology class. Jordan has a reputation at school forfrequently getting into trouble. The teachers have expressed concern thatJordan bullies the other kids at school. He is often challenging of authorityfigures such as the school principle, the school safety officer, and teachers.His mother has had to notify the school on three separate occasions this yearthat Jordan has run away. Jordan’s father is not available as he is currentlyserving time in prison for auto theft.

Whattreatment options are available to present to Jordan and his mother?

Back 46

Earlyintervention and prevention are essential to Jordan’s prognosis. As Jordan isan adolescent, individual therapy is most appropriate. Screening and subsequenttreatment for any underlying alcohol and drug use/abuse are also vitallyimportant. Conflict resolution and family therapy are additional treatmentoptions that should be offered to Jordan and his mother.

Front 47

Johnis a 77-year-old gentleman diagnosed with vascular dementia. His wife has beencaring for him at home as his disease process progressed. She sought help withhis care when he began to nap during the day and stay awake all night. Hewandered around the house all night long. He became confused and often did notremember how to get to the bathroom. On one occasion, he became agitatedbecause he realized his clothes were missing and he could not find them. Therewere times when he forgot that he had eaten and wondered when dinner was beingserved. Grooming, dressing, and simple toileting became issues. John’s wiferesearched the Internet for information about dementia. She could not believe whatwas happening to her husband. His disease process was progressing quickly bythis time. The couple’s three sons were unsupportive and did not help providecare for their father during his illness. John’s wife was alone to care for herhusband. She admitted John to a nursing home for care while she continued towork.

Basedon the above information, what needs does John’s wife exhibit and how can sheobtain the help she desperately needs?

Back 47

The needs of caregivers caring for a family member with progressivedementia can be met through the implementation of the following interventions:

· Education about the disease process and how thedisease changes the lives of both the client and the caregiver. Supporting thecaregiver is an important component of providing care at home to clients withdementia. Caregivers must learn how to meet the client’s physiologic andemotional needs and to protect him or her from injury. Areas for teachinginclude monitoring the client’s health, avoiding alcohol and recreationaldrugs, ensuring adequate nutrition, scheduling regular checkups, gettingadequate rest, promoting activity and socialization, and helping the client tomaintain independence as much as possible.

· Caregivers must have an ongoing relationshipwith a knowledgeable health professional; the client’s physician can makereferrals to other health-care providers. Depending on the situation, thatperson may be a nurse, care manager, or social worker. He or she can provideinformation, support, and assistance during the time that home care isprovided. Because the care that clients need changes as the dementiaprogresses, this education by the nurse, care manager, or social worker isongoing.

· Support: Caring for a client with dementia canbe emotionally and physically exhausting and stressful for the caregiver. Rolestrain becomes an issue when the demands of providing care threaten tooverwhelm the caregiver. Sometimes family members disagree about care for theclient. The primary caregiver may believe that other family members shouldvolunteer to help without being asked, but other family members may believethat the primary caregiver chose to take on the responsibility and do not feelobligated to help out regularly. Whatever the feelings are among familymembers, it is important for them all to express their feelings and ideas andto participate in caregiving according to their own expectations. Many familiesneed assistance to reach this type of compromise.

· Indications of role strain include constantfatigue that is unrelieved by rest, increased use of alcohol or other drugs,social isolation, inattention to personal needs, and inability or unwillingnessto accept help from others. In some situations, role strain can contribute tothe neglect or abuse of clients with dementia. Case management can help arrangerespite care for the caregiver of the dementia client.

· Grief counselors can help the caregiver dealwith his or her feelings of loss and grief through the grieving process.Support groups are available in the community and give caregivers an outlet toexpress their feelings. They also are able to learn from others who arestruggling with some of the same problems as they are. Support groups can helpthem to express frustration, sadness, anger, guilt, or ambivalence; all thesefeelings are common. Attending a support group regularly also means thatcaregivers have time with people who understand the many demands of caring fora family member with dementia. When a close member of the family loses his orher ability to live a normal life, the caregiver begins a journey throughgrieving for the loss of the person he or she once knew.

· Children of parents with dementia may findthemselves as caregivers and experience difficulty with role reversal. They maybe uncomfortable or depressed about having to bathe, feed, or change diapersfor parents. Health-care providers should be available to provide counsel forthe caregiver.

· The local chapter of the National Alzheimer’sAssociation and area hospitals and public health agencies also can helpcaregivers to locate community resources.

· Caregivers need support to maintain personal lives.They need to continue to socialize with friends and to engage in leisureactivities or hobbies rather than focus solely on the client’s care. Caregiverswho are rested and happy and have met their own needs are better prepared tomanage the rigorous demands of the caregiver role.

Front 48

John is a 77-year-old gentleman diagnosed with vascular dementia. His wife has been caring for him at home as his disease process progressed. She sought help with his care when he began to nap during the day and stay awake all night. He wandered around the house all night long. He became confused and often did not remember how to get to the bathroom. On one occasion, he became agitated because he realized his clothes were missing and he could not find them. There were times when he forgot that he had eaten and wondered when dinner was being served. Grooming, dressing, and simple toileting became issues. John’s wife researched the Internet for information about dementia. She could not believe what was happening to her husband. His disease process was progressing quickly by this time. The couple’s three sons were unsupportive and did not help provide care for their father during his illness. John’s wife was alone to care for her husband. She admitted John to a nursing home for care while she continued to work.

John’swife worries that as she is experiencing some short-term memory difficultiessuch as word finding and general forgetfulness, she may have dementia too. Whatinterventions can you suggest to John’s wife to help reduce her risk fordementia?

Back 48

Mostlikely, John’s wife is experiencing short-term memory problems related to thestress and sleep deprivation she has from taking care of her husband, ratherthan from an underlying dementia. However, you could provide John’s wife withsuggestions to reduce her risk for dementia by engaging in regular activitiesthat stimulate her brain functioning such as word games, math puzzlers, orcrossword challenges. Also encourage her to regularly participate in physicalactivities during her leisure time and to continue to engage in social networkactivities. These interventions will assist her with her physical, emotional,and intellectual health, as well as ensure that she has a social supportnetwork.

Front 49

A coherent elderly woman has been financiallyand emotionally abused by her adult children for the past several years, buthas failed to report the abuse to anyone. Which is the most likely reason thatthe woman neglects to report the abuse?

A. She is emotionally close to her children and does not want to bring them harm.

B. She has no financial resources to hire legal representation against her children.

C. She cannot claim abuse if there is no evidence of physical harm. D. Laws do not provide protection against abuse when the suspect(s) is/are family members.

Back 49

A. Sheis emotionally close to her children and does not want to bring them harm.

Response Feedback: Elders are often reluctant to report abuse, even when they can, because the abuse usually involves family members whom the elder wishes to protect. Victims also often fear losing their support and being moved to an institution.

Front 50

A female college student comes to the counselingcenter and tells the nurse she is afraid of her boyfriend. She states, “He isso jealous and overprotective; he wants to know where I am and who I'm withevery minute.” Which of the following is most likely true of the situation?

A. The student's boyfriend is simply insecure and needs reassurance.

B. This is a situation requiring a restraining order.

C. This is characteristic of the tension-building phase of the violence cycle.

D. The student is overreacting.

Back 50

C. This is characteristic of the tension-buildingphase of the violence cycle.

Response Feedback: In tension building, the abuser attempts to establish complete control over all the person's actions. It is more appropriate for the nurse to listen to the client, rather than to judge whether the client is overreacting. This may or may not require a restraining order. The student's boyfriend is insecure and needs reassurance, but that is not the only concern.

Front 51

A nurse is working with a client who has ahistory of repeated abusive intimate relationships. The nurse has difficultyunderstanding why a woman would repeatedly enter into relationships withabusive partners. When working with this client, the nurse can best maintain atherapeutic relationship through which of the following approaches?

A. Keeping focused on the client's feelings about her life situation

B. Not prying into the details of the client's private life

C. Convincing the client to develop a self-rescue plan

D. Honestly asking the client why she repeats the cycles of victimization

Back 51

A. Keepingfocused on the client's feelings about her life situation

Response Feedback: Nurses may believe that a woman who stays in an abusive relationship might deserve or enjoy the abuse or that abuse between husband and wife is private. The nurse may also feel horror or revulsion. Because clients often watch for the nurse's reaction, containing these feelings and focusing on the client's needs are important. The nurse must be prepared to listen to the client's story, no matter how disturbing, and support and validate the client's feelings with comments such as “That must have been terrifying” or “Sounds like you were afraid for your life.” The nurse must remember that he or she cannot fix or change things; the nurse's role is to listen and convey acceptance and support for the client.

Front 52

A school nurse is educating a group ofadolescent girls about rape and sexual assault. The nurse evaluates thestudents' understanding when they report which of the following as a high-riskfactor regarding the incidence of rape?

A. The highest incidence of rape occurs in adolescents and young adult women.

B. A victim is at highest risk in unfamiliar neighborhoods.

C. Most rapes are committed by strangers.

D. Most rapes are random acts of violence.

Back 52

A. Thehighest incidence of rape occurs in adolescents and young adult women.

Response Feedback: Only 20% of rapes are committed by strangers. A phenomenon called date rape (acquaintance rape) may occur on a first date, on a ride home from a party, or when the two people have known each other for some time. It is more prevalent near college and university campuses. The highest incidence is in girls and women 16 to 24 years of age. Rape most commonly occurs in a woman's neighborhood, often inside or near her home. Most rapes are premeditated.

Front 53

A woman has just presented at the emergencydepartment after being raped. The initial nursing action would be to

A. provide emotional support.

B. refer her to a rape crisis hotline.

C. perform a nursing history and physical as quickly as possible.

D. encourage her to file charges immediately.

Back 53

A. provideemotional support.

Response Feedback: In the emergency setting, the nurse is an essential part of the team in providing emotional support to the victim. The nurse should allow the woman to proceed at her own pace and not rush her through any interview or examination procedures. Giving back to the victim as much control as possible is important. Ways to do so include allowing her to make decisions, when possible, about whom to call, what to do next, what she would like done, and so on.

Front 54

A woman is in treatment for an anxiety disorder.Her history reveals that she was sexually abused repeatedly by her husband.Which of the following interventions would be appropriate in relation to thispiece of data?

A. Encourage her to talk about feelings related to the abuse.

B. Help her explore her role in perpetuating the abuse.

C. Request an anxiolytic to reduce her anxiety levels.

D. Avoid discussing the abuse so as not to upset her.

Back 54

A. Encourageher to talk about feelings related to the abuse.

Response Feedback: Encourage the client to talk about his or her experience(s); be accepting and nonjudgmental of the client's accounts and perceptions. Retelling the experience can help the client to identify the reality of what has happened and help to identify and work through related feelings. Do not imply that the client is responsible for the abuse.

Front 55

A young female immigrant presents in the ruralhealth clinic with facial bruising and a fractured nose. The client isreluctant to give details of the nature of her injuries. Which of the followingshould be a consideration in providing care for this client?

A. Immigrants have expedited access to public legal services.

B. She may fear deportation if she seeks public assistance.

C. Most views regarding domestic violence are universal across cultures.

D. The nurse should ignore the details and focus on treatment.

Back 55

B. Shemay fear deportation if she seeks public assistance.

Response Feedback: Battered immigrant women face legal, social, and economic problems different from US citizens who are battered and from people of other cultural, racial, and ethnic origins who are not battered: The battered woman may come from a culture that accepts domestic violence. She may believe she has less access to legal and social services than do US citizens. If she is not a citizen, she may be forced to leave the United States if she seeks legal sanctions against her husband or attempts to leave him. She is isolated by cultural dynamics that do not permit her to leave her husband; economically, she may be unable to gather the resources to leave, work, or go to school. Language barriers may interfere with her ability to call 911, learn about her rights or legal options, and obtain shelter, financial assistance, or food. The nurse must treat the whole person and encourage the client to share the details in order to protect the client's safety and well-being. ation-nnC

Front 56

A young woman telephones the emergencydepartment and loudly tells the nurse, “I've been raped! Please help me!” Whichof the following is the priority for the nurse to determine?

A. If the client was in a safe place, her condition, and if transportation is available

B. If the client had bathed, douched, or changed clothes

C. If the client knew her assailant, knew her location, and had notified the police

D. If the client has insurance, if she could get to the hospital by herself, and if pregnancy is a possibility

Back 56

A. Ifthe client was in a safe place, her condition, and if transportation isavailable

Response Feedback: If the client is injured, she may need immediate medical attention; if she is in a safe place, she can talk to the nurse on the phone. All other questions can wait until the client's safety is ensured.

Front 57

The community health nurse meets with the familymembers of an elderly client. The nurse includes which of the following in theplan of care as a preventive measure to guard against elder abuse?

A. Reassure the primary caregiver that he or she in the best position to provide care to the elder

B. Assist in the transfer of legal authority for elder care to the primary caregiver

C. Provide the primary caregiver with additional resources to meet the elder's needs

D. Teach the primary caregiver skills to meet all of the elder's needs

Back 57

C. Providethe primary caregiver with additional resources to meet the elder's needs

Response Feedback: Elder abuse may develop gradually as the burden of care exceeds the caregiver's physical or emotional resources. Relieving the caregiver's stress and providing additional resources may help to correct the abusive situation and keep the caregiving relationship intact.

Front 58

The nurse at a university health services clinic has been asked to meet with a freshman class of women about warning signs of relationship violence. The nurse points out which of the following danger signs the students should be alert for in a date?

A. Views you as superior to himself

B. Acts indifferent to your life choices

C. Is excessively jealous

D. Dislikes your fiends

Back 58

C. Is excessively jealous

Response Feedback: Warning signs of relationship violence include gets jealous for no reason; tells you with whom you may be friends or how you should dress, or tries to control other elements of your life; does not view you as an equal: sees himself as smarter or socially superior; is angry or threatening to the point that you have changed your life or yourself so you would not anger him.

Front 59

The nurse is assessing an elderly female in the emergency department. There are many bruises present on her body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next?

A. Notify the physician that abuse is suspected

B. Ask the client when and how the bruises occurred

C. Call the nursing supervisor immediately

D. Follow the facility's policy and procedures for reporting abuse

Back 59

B. Ask the client when and how the bruises occurred

Response Feedback: The nurse should not assume the bruises were caused by abuse; the client's explanation is an important step in the assessment of potential abuse. A nurse must assess for abuse prior to getting the supervisor and physician involved. Reporting abuse would be initiated after a thorough assessment.

Front 60

The nurse is caring for a 16-year-old boy with a history of sexual abuse. What might the nurse expect to assess with this client?

A. The client will easily share his concerns with the nurse.

B. The client will experience long-term emotional trauma.

C. The client will have high self-esteem.

D. The client will have no ill effects due to his age.

Back 60

B. The client will experience long-term emotional trauma.

Response Feedback: Nightmares and flashbacks are common in people who were abused as children regardless of their current age. The client may have ill effects irrespective of the age. The client will likely have low self-esteem. The client will likely have difficulty relating to anyone, including the nurse.

Front 61

The nurse is collecting assessment data on a client who is suspected to be a victim of violence. Which assessment data would support the suspicion that the client is a victim of abuse? Select all that apply.

A. The client is in charge of the family finances.

B. There is a moderate amount of alcohol use in the home.

C. The client has few friends.

D. The client holds a dominant role in the family.

E. The client reports that the father was abusive during childhood.

Back 61

B. There is a moderate amount of alcohol use in the home.

C. The client has few friends.

E. The client reports that the father was abusive during childhood.

Response Feedback: One characteristic of violent families is social isolation. Members of these families keep to themselves and usually do not invite others into the home or tell them what is happening. If the client reports that the father was abusive during childhood, that would support the suspicion that the client is a victim of abuse. The abusive family member almost always holds a position of power and control over the victim. The abuser exerts not only physical power but also economic and social control. Substance abuse, especially alcoholism, has been associated with family violence.

Front 62

The nurse is discussing expectations of raising a child with a pregnant teenager expecting her first baby. The father will not be a participant in the parenting. Which of the following statements made by the expectant mother would be of greatest concern to the nurse?

A. “I was raised with very strict discipline.”

B. “I am going to rely on my sisters for a lot of help raising my baby.”

C. “I am not sure how I am going to pay for all the things my child will need.”

D. “My child will love me unlike my parents ever did.”

Back 62

D. “My child will love me unlike my parents ever did.”

Response Feedback: In some instances, the parent feels the need to have children to replace his or her own faulty and disappointing childhood; the parent wants to feel the love between child and parent that he or she missed as a child. The reality of the tremendous emotional, physical, and financial demands that comes with raising children usually shatters these unrealistic expectations. When the parent's unrealistic expectations are not met, abuse often follows. Having a support system and a sense of discipline can contribute to effective parenting. Financial worries may be a concern, but relying on a baby to meet emotional needs is a high-risk dynamic for child abuse.

Front 63

The nurse is involved in a community education program for new parents and plans to include information on child abuse. The nurse will teach the parents that the most common form of child abuse is which of the following?

A. Emotional abuse

B. Neglect

C. Sexual abuse

D. Physical abuse

Back 63

B. Neglect

Response Feedback: Sixty-four percent of child maltreatment victims suffered neglect; 16% were physically abused; 8.8% were sexually abused; 6.6% were psychologically or emotionally abused; and 2.2% were medically neglected. Also, 15% suffered “other” types of maltreatment such as abandonment, physical threats, and congenital drug addiction.

Front 64

The nurse is working in the emergency department with a woman who was raped 1 hour ago. Which of the following is most important for the nurse to remember when planning care?

A. The woman may feel threatened by some of the procedures.

B. The nurse will need to make decisions for this client.

C. Evidence collection according to procedures is not as important as treating the client's injuries.

D. The client should set aside any angry feelings until physical care is completed.

Back 64

A. The woman may feel threatened by some of the procedures.

Response Feedback: Many of the examination procedures, such as a pelvic exam, may cause the woman to feel violated again. The client needs emotional support and evidence collection as well as physical care. It would not be appropriate for the nurse to make decisions for this client.

Front 65

The nurse is working with a client at the battered women's shelter who is in a violent and abusive relationship. The client is considering a separation and asks the nurse, “What do you think about that?” Which is the best response by the nurse?

A. “If you leave, maybe he'll see that he has to change his behavior.”

B. “Batterers never change, so it would be best for you to leave.”

C. “You may be in more physical danger after you leave him.”

D. “If you don't leave, he'll think you're going to continue to endure his abuse.”

Back 65

C. “You may be in more physical danger after you leave him.”

Response Feedback: Statistics indicate that violence increases when the victim attempts to leave or end the relationship. It is not appropriate for the nurse to offer advice such as this. It is not the victim's fault whether the victim stays or not. “If you leave, maybe he'll see that he has to change his behavior,” is not appropriate as it minimizes the situation.

Front 66

The pediatric nurse is caring for a 15-month-old child recently admitted to the hospital for a fractured femur. Which of the following data obtained during the assessment would raise the nurse's suspicion that the child has suffered physical abuse?

A. Both parents reporting the exact same details pertaining to the injurious event

B. The injury occurring several days before the parents sought treatment

C. The parents appearing overprotective of the child

D. Bruises over the child's bony prominences

Back 66

B. The injury occurring several days before the parents sought treatment

Response Feedback: Warning signs of abused/neglected children include serious injuries such as fractures, burns, or lacerations with no reported history of trauma; delay in seeking treatment for a significant injury; the child or a parent giving a history inconsistent with severity of injury; inconsistencies or changes in the child's history during the evaluation by either the child or the adult; unusual injuries for the child's age and level of development, such as a fractured femur in a 2-month-old or a dislocated shoulder in a 2-year-old; high incidence of urinary tract infections; bruised, red, or swollen genitalia; tears or bruising of the rectum or vagina; and evidence of old injuries not reported, such as scars, fractures not treated, and multiple bruises that the parent/caregiver cannot explain adequately.

Front 67

The school nurse is teaching a health classabout recognizing the signs of abusive relationships. The nurse describes thecycle of violence. The nurse would document effective teaching if the studentsidentify the cycle of violence to be which of the following patterns? Selectthe order in which the events occur.

A. Tension building

B. Honeymoon period

C. Violent behavior

D. Period of remorse

Back 67

A, C, D, B

Response Feedback: The tension-building phase begins; there may be arguments, stony silence, or complaints from the husband. The tension ends in another violent episode after which the abuser once again feels regret and remorse and promises to change. This cycle continually repeats itself. Each time, the victim keeps hoping the violence will stop.

Front 68

Which characteristic of the abuser should the nurse look for when completing the family assessment of a victim on intimate partner violence?

A. An ability to feel remorse for the abuse

B. An inflated sense of self-esteem

C. Needy and possessive of the partner

D. Encourages the partner to have a life outside the intimate relationship

Back 68

C. Needy and possessive of the partner

Response Feedback: An abusive husband often believes his wife belongs to him (like property) and becomes increasingly violent and abusive if she shows any sign of independence, such as getting a job or threatening to leave. Typically, the abuser has strong feelings of inadequacy and low self-esteem as well as poor problem-solving and social skills. He is emotionally immature, needy, irrationally jealous, and possessive. By bullying and physically punishing the family, the abuser often experiences a sense of power and control. Therefore, the violent behavior often is rewarding and boosts his self-esteem. A typical pattern of abuse exists: Usually, the initial episode of battering or violence is followed by a period of the abuser expressing regret, apologizing, and promising it will never happen again.

Front 69

Which of the following are common behavioral andemotional responses to abuse? Select all that apply.

A. Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships.

B. It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

C. One third of abusive men are likely to have come from violent homes.

D. The victim caused the abuse.

E. Dependency on the abuser is a common trait found in victims of domestic violence.

Back 69

A. Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships.

B. It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

C. One third of abusive men are likely to have come from violent homes.

E. Dependency on the abuser is a common trait found in victims of domestic violence.

Response Feedback: One third of abusive men are likely to have come from violent homes. Women who grew up in violent homes are 50% more likely to expect or accept violence in their own relationships. Dependency on the abuser is a common trait found in victims of domestic violence. The victim may believe that he or she caused the abuse, but this is not accurate. It is critical for the nurse to demonstrate acceptance after hearing about the abuse so that the victim may begin to gain self-acceptance.

Front 70

Which of the following are commoncharacteristics of violent families regardless of the type of abuse thatexists? Select all that apply.

A. Social isolation

B. Victim instigates

C. Intergenerational transmission

D. Alcohol and other drug abuse

E. Abuse of power and control

Back 70

A. Social isolation

C. Intergenerational transmission

D. Alcohol and other drug abuse

E. Abuse of power and control

Response Feedback: Research studies have identified some common characteristics of violent families regardless of the type of abuse that exists. They include social isolation, abuse of power and control, alcohol and other drug abuse, intergenerational transmission. The victim does not instigate abuse. TKoC

Front 71

Which of the following are common reasons whyabused women remain with the abusive partner? Select all that apply.

A. The abused person believes that she is unable to function without her husband.

B. The abused person is afraid that the abuser will kill her if she tries to leave.

C. The abused person is convinced that she has been abusive toward the abuser at some point and that the abuse is her fault.

D. The abused person has low self-esteem and defines her success as a person by the ability to make the relationship work.

E. The abused person is personally and financially dependent on the abuser.

Back 71

A. The abused person believes that she is unable to function without her husband.

B. The abused person is afraid that the abuser will kill her if she tries to leave.

D. The abused person has low self-esteem and defines her success as a person by the ability to make the relationship work.

E. The abused person is personally and financially dependent on the abuser.

Response Feedback: Dependency is the trait most commonly found in abused wives who stay with their husbands. Women often cite personal and financial dependency as a reason why they find leaving an abusive relationship extremely difficult. The victim may suffer from low self-esteem and defines her success as a person by her ability to remain loyal to her marriage and “make it work.” Some women internalize the criticism they receive and mistakenly believe they are to blame. Women also fear their abuser will kill them if they try to leave. An abuser often has feelings of low self-esteem and poor problem-solving and social skills and may interpret any attempts at defense or any behavior of the abused person as abuse of the perpetrator.

Front 72

Which of the following are typical characteristics of the perpetrator of intimate partner abuse? Select all that apply.

A. The perpetrator respects his partner.

B. The perpetrator is intimidated by his partner.

C. The perpetrator often believes that the partner is his own property.

D. The perpetrator is emotionally immature and needy.

E. The perpetrator is often irrationally jealous, even of his own children.

Back 72

C. The perpetrator often believes that the partner is his own property.

D. The perpetrator is emotionally immature and needy.

E. The perpetrator is often irrationally jealous, even of his own children.

Response Feedback: The perpetrator often believes that the partner is his own property. The perpetrator is often irrationally jealous, even of his own children if the partner pays any attention to them. The perpetrator is emotionally immature and needy. The perpetrator does not respect his partner because if he did, he would not believe that the partner is his own property to do with as he wishes. The perpetrator wants to maintain control over his partner and is therefore not intimidated by the partner but by the thought of the partner not being available.

Front 73

Which of the following behaviors would first alert the school nurse or teacher to suspect sexual abuse in a 7-year-old child?

A. The child wears dirty and threadbare clothing.

B. The child has a preference for associating with peers, rather than adults.

C. The child tells sexually explicit stories to peers.

D. The child has learning problems and shyness.

Back 73

C. The child tells sexually explicit stories to peers.

Response Feedback: Children who have sexual knowledge not expected at their age have often been sexually abused. A child who has been sexually abused by an adult may feel more comfortable with peers than with adults. Learning problems, shyness, and wearing dirty and threadbare clothing may be related to many situations other than sexual abuse. "nC

Front 74

Which of the following is the best explanation for why family violence tends to occur over multiple generations of families?

A. All persons who have become victims of family violence will grow up to perpetrate family violence.

B. Family violence may be perpetuated between generations of families by role modeling and social learning.

C. Family violence does not tend to have an intergenerational transmission process.

D. A tendency toward violence is hereditary.

Back 74

B. Family violence may be perpetuated between generations of families by role modeling and social learning.

Response Feedback: The intergenerational transmission process shows that patterns of violence are perpetuated from one generation to the next through role modeling and social learning. Not all persons exposed to family violence, however, become abusive or violent as adults.

Front 75

Which one of the following statements regarding intimate partner violence is true?

A. It is common for abusers to use one type of abuse only.

B. Intimate partner violence can exist with former partners.

C. Psychological abuse is not as harmful as physical abuse.

D. Males are never the victim in intimate partner violence.

Back 75

B. Intimate partner violence can exist with former partners.

Response Feedback: Intimate partner violence is the mistreatment or misuse of one person by another in the context of an emotionally intimate relationship. The relationship may be spousal, between partners, boyfriend, girlfriend, or an estranged relationship. Ninety to ninety-five percent of domestic violence victims are women. By deduction, this means that 5% to 10% of domestic violence victims are men. The abuse can be emotional or psychological, physical, sexual, or a combination (which is common). All abuse is harmful.

Front 76

Which of the following is the best action for the nurse to take when assessing a child who might be abused?

A. Confront the parents with the facts and ask them what happened.

B. Consult with a professional member of the health team about making a report.

C. Ask the child which of his parents caused this injury.

D. Say or do nothing; the nurse has only suspicions, not evidence.

Back 76

B. Consult with a professional member of the health team about making a report.

Front 77

Which of the following is true about domestic violence between same-sex partners?

A. Such violence is less common than that between heterosexual partners.

B. The frequency and intensity of violence are greater than between heterosexual partners.

C. Rates of violence are about the same as between heterosexual partners.

D. None of the above.

Back 77

C. Rates of violence are about the same as between heterosexual partners.

Front 78

Which of the following assessment findings might indicate elder self-neglect?

A. Hesitancy to talk openly with nurse

B. Inability to manage personal finances

C. Missing valuables that are not misplaced

D. Unusual explanations for injuries

Back 78

B. Inability to manage personal finances

Front 79

Which type of child abuse can be most difficult to treat effectively?

A. Emotional

B. Neglect

C. Physical

D. Sexual

Back 79

A. Emotional

Front 80

Women in battering relationships often remain in those relationships as a result of faulty or incorrect beliefs. Which of the following beliefs is valid?

A. If she tried to leave, she would be at increased risk for violence.

B. If she would do a better job of meeting his needs, the violence would stop.

C. No one else would put up with her dependent clinging behavior.

D. She often does things that provoke the violent episodes.

Back 80

A. If she tried to leave, she would be at increased risk for violence.

Front 81

Examples of child maltreatment include (Select all that apply)

A. Calling the child stupid for climbing on a fence and getting injured

B. Giving the child a time-out for misbehaving by hitting a sibling

C. Failing to buy a desired toy for Christmas

D. Spanking an infant who won't stop crying

E. Watching pornographic movies in a child's presence

F. Withholding meals as punishment for disobedience

Back 81

A. Calling the child stupid for climbing on a fence and getting injured

D. Spanking an infant who won't stop crying

E. Watching pornographic movies in a child's presence

F. Withholding meals as punishment for disobedience

Front 82

A female client comes to an urgent care clinic and says, "I've just been raped." What should the nurse do? (Select all that apply)

A. Allow the client to express whatever she wants.

B. Ask the client if staff can call a friend or family member for her.

C. Offer the client coffee, tea, or whatever she likes to drink.

D. Get the examination completed quickly to decrease trauma to the client.

E. Provide the client privacy - let her go to a room to make phone calls.

F. Stay with the client until someone else arrives to be with her.

Back 82

A. Allow the client to express whatever she wants.

B. Ask the client if staff can call a friend or family member for her.

F. Stay with the client until someone else arrives to be with her.

Front 83

A child with ADHD complains to his parents that he does not like the side effects of his medicine, Adderall. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice?

A. Have the child eat a good breakfast and snacks late in the day and at bedtime.

B. Give the child his medicine at night.

C. Let the child take daytime naps.

D. Limit the number of calories the child eats each day.

Back 83

A. Have the child eat a good breakfast and snacks late in the day and at bedtime.

Response Feedback: Giving stimulants during daytime hours usually effectively combats insomnia. Eating a good breakfast with the morning dose and substantial nutritious snacks late in the day and at bedtime helps the child to maintain an adequate dietary intake. Daytime napping for a child with ADHD is unrealistic and not developmentally necessary.

Front 84

A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin) in divided doses. If the child takes the first dose at 8 AM, which behavior might the school nurse expect to see at noon?

A. Social isolation from peers

B. Lack of appetite for lunch

C. Sleepiness or drowsiness

D. Increased impulsivity or hyperactive behavior

Back 84

D. Increased impulsivity or hyperactive behavior

Response Feedback: Ritalin has a short half-life, so doses are needed about every 4 hours during the day to maintain symptom control. Giving stimulants during daytime hours usually effectively combats insomnia.

Front 85

A mother expresses concern to the nurse that the child's regularly scheduled vaccines may not be safe. The mother states that she has heard reports that they cause autism. The most appropriate response by the nurse is,

A. “There are safer alternative immunizations available now.”

B. “It is recommended that you wait until the child is older to vaccinate.”

C. “The risks do not outweigh the benefits of immunization against childhood diseases.”

D. “There has been no research to establish a relationship between vaccines and autism.”

Back 85

D. “There has been no research to establish a relationship between vaccines and autism.”

Response Feedback: The National Institute of Child Health and Human Development, Centers for Disease control (CDC) and the Academy of Pediatrics have all conducted research studies for several years and have concluded that there is no relationship between vaccines and autism and that the MMR vaccine is safe.

Front 86

A nurse asks an assigned client, “How are you doing today?” The client responds with “doing today, doing today, doing today.” Which speech pattern disturbance is this an example of?

A. Stereotypic movement disorder

B. Echolalia

C. Selective mutism

D. Reactive attachment disorder

Back 86

B. Echolalia

Response Feedback: Echolalia is repeating the last heard sound, word, or phrase. Stereotypic movement disorders include waving, rocking, twirling objects, biting fingernails, handing the head, biting or hitting oneself, or picking at the skin or body orifices. Selective mutism is characterized by persistent failure to speak in social situations where speaking is expected.

Front 87

A nurse is providing education to a group of parents who have children with ADHD. Which of the following statements would be accurate and should be included in the education? Select all that apply.

A. Medication alone will adequately treat children with ADHD.

B. ADHD is not the fault of the parents or the child, and that techniques and school programs are available to help.

C. Because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems.

D. Children with ADHD do not qualify for special school services under the Individuals with Disabilities Education Act.

E. It is important for parents of children with ADHD to learn how to rebuild their child's self-esteem.

Back 87

B. ADHD is not the fault of the parents or the child, and that techniques and school programs are available to help.

C. Because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems.

E. It is important for parents of children with ADHD to learn how to rebuild their child's self-esteem.

Response Feedback: Although medication can help reduce hyperactivity and inattention and allow the child to focus during school, it is by no means a cure-all. The child needs strategies and practice to improve social skills and academic performance. Because these children are often not diagnosed until the second or third grade, they may have missed much basic learning for reading and math. Parents should know that it takes time for them to catch up with other children of the same age. Most of these children have low self-esteem because they have been labeled as having behavior problems and have been corrected continually by parents and teachers for not listening, not paying attention, and misbehaving. Parents must understand how to help rebuild their child's self-esteem. Parents should give positive comments as much as possible to encourage the child and acknowledge his or her strengths. One technique to help parents to achieve a good balance is to ask them to count the number of times they praise or criticize their child each day for several days. ADHD is not the fault of the parents or the child, and that techniques and school programs are available to help. Children with ADHD do qualify for special school services under the Individuals with Disabilities Education Act.

Front 88

A parent is concerned that his child might suffer from attention deficit hyperactivity disorder (ADHD). Which of the following behaviors reported by the parent would be consistent with this diagnosis?

A. The child has been hoarding objects.

B. The child has lots of friends.

C. The child interrupts others.

D. The child is excelling academically in school.

Back 88

C. The child interrupts others.

Response Feedback: By the time the child starts school, symptoms of ADHD begin to interfere significantly with behavior and performance. He or she cannot listen to directions or complete tasks. The child interrupts and blurts out answers before questions are completed. Academic performance suffers because the child makes hurried, careless mistakes in schoolwork, often loses or forgets homework assignments, and fails to follow directions. Socially, peers may ostracize or even ridicule the child for his or her behavior. The child often loses necessary things.

Front 89

A parent of a child with autism spectrum disorder asks the nurse if there is anything that can be done to control the child's tantrums. Which option should the nurse inform the parents that may be appropriate?

A. Give the child rewards for resisting tantrums.

B. Explore the use of antipsychotic medications to control tantrums.

C. Place the child in a time-out when tantrums occur.

D. Reason with the child why tantrums are not effective.

Back 89

B. Explore the use of antipsychotic medications to control tantrums.

Response Feedback: Pharmacologic treatment with antipsychotics, such as haloperidol (Haldol) or risperidone (Risperdal), may be effective for specific target symptoms such as temper tantrums, aggressiveness, self-injury, hyperactivity, and stereotyped behaviors. 1

Front 90

An 8-year-old with attention deficit hyperactivity disorder is jumping off the bed onto a chair. Which should be the nurse's first step?

A. “Why are you jumping off the bed?”

B. “I need to talk to you.”

C. “You are going to hurt yourself.”

D. “Stop that right now.”

Back 90

D. “Stop that right now.”

Response Feedback: If the child is engaged in a potentially dangerous activity, the first step is to stop the behavior. Attempting to talk to or reason with a child engaged in a dangerous activity is unlikely to succeed because his or her ability to pay attention and to listen is limited.

Front 91

For which reason is it crucial for nurses to advocate for children and adolescents regarding psychiatric disorders?

A. It is much more difficult to diagnose psychiatric disorders in children and adolescents.

B. It is not necessary because psychiatric disorders do not occur in children and adolescents.

C. Psychiatric disorders in children manifest themselves very quickly.

D. Children and adolescents experience some of the same mental health problems as adults.

Back 91

A. It is much more difficult to diagnose psychiatric disorders in children and adolescents.

Response Feedback: It is much more difficult to diagnose psychiatric disorders in children and adolescents. Many of the same psychiatric disorders that affect adults also occur in children and adolescents, but because psychiatric disorders in children are difficult to diagnose, they do not manifest themselves very quickly.

Front 92

For which reasons is it more difficult to diagnose psychiatric disorders in children than in adults? Select all that apply.

A. Children and adolescents experience some of the same mental health problems as adults and are diagnosed using the same criteria as for adults.

B. Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening.

C. Because they are constantly changing and developing, children are unable to discriminate unusual or unwanted symptoms from normal feelings and sensations.

D. Behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level.

E. Sometimes, children “outgrow” psychiatric disorders.

Back 92

B. Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening.

C. Because they are constantly changing and developing, children are unable to discriminate unusual or unwanted symptoms from normal feelings and sensations.

D. Behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level.

Response Feedback: Psychiatric disorders are not diagnosed as easily in children as they are in adults. Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening. Because they are constantly changing and developing, children have limited sense of a stable, normal self to allow them to discriminate unusual or unwanted symptoms from normal feelings and sensations. Additionally, behaviors that are normal in a child of one age may indicate problems in a child of another age. Sometimes the manifestations of psychiatric disorders in adults are less of a problem than they were for the child at a younger age, but this does not make it more difficult to diagnose psychiatric disorders in children than in adults. Children and adolescents experience some of the same mental health problems as adults and are diagnosed using the same criteria as for adults, but this does not make it more difficult for children to be diagnosed.

Front 93

The mother of a 15-year-old boy tells the nurse that her son is becoming more assertive in conflict situations and wants to get a job. She asks if it is healthy for a 15-year-old to be so independent. Which is valid information for the nurse to offer the mother?

A. It sounds like he is trying to avoid her.

B. She should observe for signs of substance abuse.

C. His behaviors reflect normal growth and development.

D. He is overly independent.

Back 93

C. His behaviors reflect normal growth and development.

Response Feedback: The behaviors described by the mother are typical in terms of growth and development for a 15-year-old. The other choices are not found to give valid information to the mother regarding increased adolescent independence.

Front 94

The mother of a 6-year-old boy with attention deficit hyperactivity disorder asks to speak to the nurse about her son's disruptive behavior. The nurse would be most therapeutic by saying which of the following?

A. “Your son sure is active.”

B. “You need to take a firmer approach with your son.”

C. “It must be difficult to handle your son at home.”

D. “Your son is a cute child, but he needs to calm down.”

Back 94

C. “It must be difficult to handle your son at home.”

Response Feedback: Parents find themselves chronically exhausted mentally and physically. Parents need support and reassurance, and making a statement about the difficulties of handling the child at home validates the mother's feelings. It is not appropriate to say, “Your son is a cute child, but he needs to calm down.” It may make the parents defensive to say, “You need to take a firmer approach with your son.” “Your son sure is active” is not a therapeutic response.

Front 95

The nurse has been working with the family of a small child with a psychiatric disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best action for the nurse at this time?

A. Try to remember that the parents are trying to the best of their ability to carry out the suggestions.

B. Refer the parents to a family therapist.

C. Review effective disciplinary practices with the parents again.

D. Explore alternative living arrangements for the child.

Back 95

A. Try to remember that the parents are trying to the best of their ability to carry out the suggestions.

Response Feedback: The nurse's beliefs and values about raising children affect how he or she deals with children and parents. The nurse must not be overly critical about how parents handle their children's problems until the situation is fully understood: Caring for a child as a nurse is very different from being responsible around the clock. The parents likely have other obstacles to carrying out effective discipline. Teaching again is not likely to effect change. Given their own skills and problems, parents often give their best efforts. Given the opportunity, resources, support, and education, many parents can improve their parenting. It is premature to refer to family therapy or remove the child from the home. Emotional barriers to effective parenting should be explored first.

Front 96

The nurse is assessing a 16-month-old child during a well-baby checkup. Which of the following behaviors would be consistent with autism spectrum disorder?

A. The child displays little eye contact with others.

B. The child makes few facial expressions toward others.

C. The child does not like repetition.

D. The child thrives on changes in routine.

E. The child answers questions verbally.

Back 96

A. The child displays little eye contact with others.

B. The child makes few facial expressions toward others.

C. The child does not like repetition.

Response Feedback: Children with autism display little eye contact with and make few facial expressions toward others; they use limited gestures to communicate. They have limited capacity to relate to peers or parents. They lack spontaneous enjoyment, express no moods or emotional affect, and cannot engage in play or make-believe with toys. There is little intelligible speech. These children engage in stereotyped motor behaviors such as hand flapping, body twisting, or head banging.

Front 97

The nurse is assisting a child with ADHD to complete his ADLs. Which is the best approach for nurse to use with this child?

A. Let the child complete tasks at his own pace.

B. Break tasks into small steps.

C. Offer rewards when all tasks are completed.

D. Set a time limit to complete all tasks.

Back 97

B. Break tasks into small steps.

Response Feedback: Before beginning any task, adults must gain the child's full attention. The adult should tell the child what needs to be done and break the task into smaller steps if necessary. This approach prevents overwhelming the child and provides the opportunity for feedback about each set of problems he or she completes.

Front 98

The nurse understands that when working with a child with a mental health problem, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child?

A. Teach the parents age-appropriate expectations of the child.

B. Interpret the child's thoughts and feelings to the parent.

C. Support transferring the child to a healthy living environment.

D. Reinforce the parents' expectations of the child's behavior.

Back 98

A. Teach the parents age-appropriate expectations of the child.

Response Feedback: Working with parents is a crucial aspect of dealing with children with these disorders. Parents often have the most influence on how these children learn to cope with their disorders. The nurse can teach parents age-appropriate activities and expectations for clients.

Front 99

The parents of a child with ADHD express to the nurse, “We get so frustrated when our son never minds us.” Which parenting strategies should the nurse discuss with the parents? Select all that apply.

A. Use time-out for behavior control.

B. Resist giving praise until fully compliant with requests.

C. Provide occasional rewards and consequences for behavior.

D. Use a point system for positive and negative behavior.

E. Give verbal reprimands for negative behavior.

Back 99

A. Use time-out for behavior control.

D. Use a point system for positive and negative behavior.

E. Give verbal reprimands for negative behavior.

Response Feedback: Educating parents and helping them with parenting strategies are crucial components of effective treatment of ADHD. Effective approaches include providing consistent rewards and consequences for behavior, offering consistent praise, using time-out, and giving verbal reprimands. Additional strategies are issuing daily report cards for behavior and using point systems for positive and negative behavior.

Front 100

The parents of an autistic child ask the nurse, “Will my child ever be normal?” Which would be the most appropriate response by the nurse?

A. “You seem worried about your child's future.”

B. “Your child should outgrow autistic traits by adolescence.”

C. “Autistic children can fully recover with the right treatment and education.”

D. “Your child will probably always have some autistic traits.”

Back 100

D. “Your child will probably always have some autistic traits.”

Response Feedback: Autistic traits persist into adulthood, and most people with autism remain dependent to some degree on others. Manifestations vary from little speech and poor daily living skills throughout life to adequate social skills that allow relatively independent functioning. Social skills rarely improve enough to permit marriage and child rearing.

Front 101

When teaching the parents of a child with attention deficit hyperactivity disorder (ADHD), which statement by the parents would indicate the need for further teaching?

A. “We'll make sure he completes one task before going on to another.”

B. “We'll have him do his homework at the kitchen table with his brothers and sisters.”

C. “We'll set up rules with specific times for eating, sleeping, and playing.”

D. “We'll use simple, clear directions and instructions.”

Back 101

B. “We'll have him do his homework at the kitchen table with his brothers and sisters.”

Response Feedback: The child with ADHD cannot accomplish complex tasks, such as homework, in a noisy or chaotic setting where there are a lot of distractions. The other choices do not indicate the need for further teaching.

Front 102

When the prognosis of improvement in a child with psychiatric disorders is poor, what can the nurse do to positively influence children and adolescents and their parents?

A. Assist the child and the parents to develop coping mechanisms.

B. Focus on their problems instead of their strengths and assets.

C. Continue to remind the child and parents that the prognosis for improvement is very poor.

D. Encourage the parents to believe that the child will recover spontaneously.

Back 102

A. Assist the child and the parents to develop coping mechanisms.

Response Feedback: Working with children and adolescents can be both rewarding and difficult. Many disorders of childhood such as severe developmental disorders severely limit the child's abilities. It may be difficult for the nurse to remain positive with the child and parents when the prognosis for improvement is poor. Even in overwhelming and depressing situations, the nurse has an opportunity to positively influence children and adolescents, who are still in crucial phases of development. The nurse often can help these clients to develop coping mechanisms they will use through adulthood. It is important to remember to focus on the client's and parents' strengths and assets, not just their problems.

Front 103

Which of the following are common coexisting psychiatric disorders for adults with ADHD? Select all that apply.

A. Social phobia

B. Alcohol dependence

C. Major depression

D. Obsessive–compulsive disorder

E. Bipolar disorder

Back 103

A. Social phobia

B. Alcohol dependence

C. Major depression

E. Bipolar disorder

Response Feedback: Approximately 70% to 75% of adults with ADHD have at least one coexisting psychiatric diagnosis, with social phobia, bipolar disorder, major depression, and alcohol dependence being the most common.

Front 104

Which of the following disorders involves problems with forming sounds associated with speech?

A. Mixed receptive–expressive language disorder

B. Phonologic disorder

C. Stuttering

D. Expressive language disorder

Back 104

B. Phonologic disorder

Response Feedback: Phonologic disorder involves problems with articulation. Mixed receptive–expressive language disorder includes problems of expressive language disorder along with difficulty understanding and determining the meaning of words and sentences. Expressive language disorder involves an impaired ability to communicate through verbal and sign language. Stuttering is a disturbance of the normal fluency and time patterning of speech.

Front 105

Which of the following symptoms are characteristic of ADHD? Select all that apply.

A. Impulsiveness

B. Encopresis

C. Inattentiveness

D. Overactivity

E. Enuresis

Back 105

A. Impulsiveness

C. Inattentiveness

D. Overactivity

Response Feedback: ADHD is characterized by inattentiveness, overactivity, and impulsiveness. Encopresis is the repeated passage of feces into inappropriate places such as clothing or the floor by a child who is at least 4 years of age either chronologically or developmentally. Enuresis is the repeated voiding of urine during the day or at night into clothing or bed by a child at least 5 years of age either chronologically or developmentally. Encopresis and enuresis are elimination disorders that are unrelated to ADHD.

Front 106

Which of the following terms describes the repeating of one's own words or sounds?

A. Coprolalia

B. Palilalia

C. Echolalia

D. None of the above

Back 106

B. Palilalia

Response Feedback: Palilalia is the repeating of one's own words or sounds. Coprolalia is the use of socially unacceptable words, which are frequently obscene. Echolalia is the repeating of the last heard sound, word, or phrase.

Front 107

Which of the following would be important circumstances to gather assessment data for a child with ADHD? Select all that apply.

A. Direct observation of the child

B. Reviewing the client's record

C. Interviewing the client's teachers

D. Assessing the client in a group of peers

E. Interviewing the client's parents

Back 107

A. Direct observation of the child

C. Interviewing the client's teachers

D. Assessing the client in a group of peers

E. Interviewing the client's parents

Response Feedback: During assessment, the nurse gathers information through direct observation and from the child's parents, day care providers (if any), and teachers. Assessing the child in a group of peers is likely to yield useful information because the child's behavior may be subdued or different in a focused one-to-one interaction with the nurse. Reviewing the client's record will not yield much assessment data.

Front 108

Which one of the following nursing interventions should take priority for a child with ADHD?

A. Simplifying instructions and directions

B. Structured daily routine

C. Ensuring the child's safety and that of others

D. Improved role performance

Back 108

C. Ensuring the child's safety and that of others

Response Feedback: Safety of the child and others is always a priority. The other nursing interventions are appropriate for a child with ADHD, but the priority is safety.

Front 109

Which one of the following statements about educating parents of a child with ADHD is true?

A. It is important for the nurse to spend the majority of his or her time with parents of children with ADHD in talking to the parents.

B. Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful.

C. It is unimportant to educate the family members about ADHD as they already know the problem too well.

D. If the child receives special school services under the Individuals with Disabilities Education Act, there is no need for further services.

Back 109

B. Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful.

Response Feedback: Parents feel empowered and relieved to have specific strategies that can help them and their child be more successful. Including parents in planning and providing care for the child with ADHD is important. The nurse must listen to the parents' feelings. The education of a child with ADHD is important, but the child is only in school for part of their day. The parents must deal with the child and the other aspects of the child's life at all times.

Front 110

A child is taking pemoline (Cylert) for ADHD. The nurse must be aware of which of the following side effects?

A. Decreased thyroid-stimulating hormone

B. Decreased RBC count

C. Elevated WBC count

D. Elevated liver function tests

Back 110

D. Elevated liver function tests

Front 111

Teaching for methylphenidate (Ritalin) should include which of the following?

A. Give the medication after meals.

B. Give the medication when the child becomes overactive.

C. Increase the child's fluid intake when he or she is taking the medication.

D. Take the child's temperature daily.

Back 111

A. Give the medication after meals.

Front 112

The nurse would expect to see all the following symptoms in a child with ADHD except

A. Easily distracted and forgetful

B. Excessive running, climbing, and fidgeting

C. Moody, sullen, and pouting behavior

D. Interrupts others and can't take turns

Back 112

C. Moody, sullen, and pouting behavior

Front 113

The nurse is teaching a 12-year-old with intellectual disability about medications. Which of the following interventions is essential?

A. Speak slowly and distinctly.

B. Teach the information to the parents only.

C. Use pictures rather than printed words.

D. Validate client understanding of teaching.

Back 113

D. Validate client understanding of teaching.

Front 114

Which of the following is used to treat enuresis?

A. Imipramine (Tofranil)

B. Methylphenidate (Ritalin)

C. Olanzapine (Zyprexa)

D. Risperidone (Risperdal)

Back 114

A. Imipramine (Tofranil)

Front 115

The nurse is assessing an adult client with ADD. The nurse expects which of the following to be present?

A. Difficulty remembering appointments

B. Falling asleep at work

C. Problems getting started on a project

D. Lack of motivation to do tasks

Back 115

A. Difficulty remembering appointments

Front 116

The nurse recognizes which of the following as a common behavioral sign of autism?

A. Clinging behavior toward parents

B. Creative imaginative play with peers

C. Early language development

D. Indifference to being hugged or held

Back 116

D. Indifference to being hugged or held

Front 117

A 7-year-old child with ADHD is taking clonidine (Kapvay). Common side effects include (Select all that apply)

A. Appetite suppression

B. Dizziness

C. Dry mouth

D. Hypotension

E. Insomnia

F. Nausea

Back 117

B. Dizziness

C. Dry mouth

D. Hypotension

Front 118

A teaching plan for the parents of a child with ADHD should include (Select all that apply)

A. Allowing as much time as needed to complete any task.

B. Allowing the child to decide when to do homework.

C. Giving instructions in short simple steps.

D. Keeping track of positive comments the child is given.

E. Providing a reward system for completion of daily tasks.

F. Spending time at the end of the day reviewing the child's behavior.

Back 118

C. Giving instructions in short simple steps.

D. Keeping track of positive comments the child is given.

E. Providing a reward system for completion of daily tasks.

Front 119

A 14-year-old girl is being treated for conduct disorder. She refuses to attend class today, stating that yesterday the other nurse told her she did not have to go to class if she did not want to. Which would be the best response by the nurse?

A. “Missing class is against the rules.”

B. “Fine, but you're confined to your room.”

C. “You and I both know you're lying.”

D. “Why do you keep fighting the system?”

Back 119

A. “Missing class is against the rules.”

Response Feedback: Reinforcing rules avoids a power struggle; the nurse must set limits on the unacceptable behavior of missing class. The nurse can negotiate with a client a behavioral contract outlining expected behaviors, limits, and rewards to increase treatment compliance.

Front 120

A child has been displaying behaviors associated with conduct disorder. The nurse should further assess for which common risk factors seen in children with conduct disorder. Select all that apply.

A. Possible child abuse

B. Poverty conditions

C. Strict disciplinary practices

D. Family history of substance abuse

E. Poor family functioning

Back 120

A. Possible child abuse

B. Poverty conditions

D. Family history of substance abuse

E. Poor family functioning

Response Feedback: Risk factors include poor parenting, low academic achievement, poor peer relationships, low self-esteem, poor family functioning, marital discord, family history of substance abuse and psychiatric problems, child abuse, inconsistent parental responses, exposure to violence in the media, and community socioeconomic disadvantages such as inadequate housing, crowded conditions, and poverty. Protective factors include resilience, family support, positive peer relationships, and good health.

Front 121

A child is expelled from school for repeated fighting and vandalizing school property. The school nurse and counselor meet with the parents to explain that the child may benefit from counseling as the child is experiencing signs of which disorder?

A. Conduct disorder

B. Attention deficit hyperactivity disorder

C. Asperger's syndrome

D. Oppositional defiant disorder

Back 121

A. Conduct disorder

Response Feedback: Conduct disorder is characterized by persistent antisocial behavior in children and adolescents that significantly impairs their ability to function in social, academic, or occupational areas. Behavioral symptoms include physical fights, destruction of property, vandalism, and serious violation of rules among others. ODD consists of an enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures without major antisocial violations. Asperger's disorder is a pervasive developmental disorder characterized by the same impairments of social interaction and restricted stereotyped behaviors seen in autistic disorder, but there are no language or cognitive delays. Attention deficit hyperactivity disorder (ADHD) is characterized by inattentiveness, overactivity, and impulsiveness.

Front 122

A client with conduct disorder starts yelling at another client and calling the client insulting names. Which is the most appropriate response by the nurse?

A. “You're still having problems controlling your anger.”

B. “Yelling at others is unacceptable. You need to let staff know you're upset.”

C. “How would you feel if someone yelled at you like that?”

D. “What's the matter with you? Don't you know any better?”

Back 122

B. “Yelling at others is unacceptable. You need to let staff know you're upset.”

Response Feedback: The nurse must show acceptance of clients as worthwhile persons even if their behavior is unacceptable. This means that the nurse must be matter of fact about setting limits and must not make judgmental statements about clients. He or she must focus only on the behavior.

Front 123

An 11-year-old child talks to the school nurse about a single episode of disruptive behavior in class. The child states, “I had a stomachache and felt like vomiting. I couldn't help it. I was just so mad at my dad.” Which would be the most appropriate response by the nurse?

A. “I can understand your anger, but you can't disrupt the classroom.”

B. “If you can get rid of your anger, perhaps your stomachache will go away.”

C. “I can see that you're angry. Let's look at better ways to express it.”

D. “Perhaps it would be helpful if you let your dad know you're angry.”

Back 123

C. “I can see that you're angry. Let's look at better ways to express it.”

Response Feedback: A child at this age may have difficulty expressing negative or intense emotions verbally; the nurse's response helps teach the child appropriate expressions of anger.

Front 124

The nurse has been working with the family of a small child with oppositional defiant disorder. The nurse is feeling very frustrated because the parents refuse to implement effective parenting skills that the nurse has taught. What is the best nursing action at this time?

A. Explore alternative living arrangements for the child.

B. Refer the parents to a family therapist.

C. Review effective disciplinary practices with the parents again.

D. Try to remember that the parents are trying to the best of their ability to carry out the suggestions.

Back 124

D. Try to remember that the parents are trying to the best of their ability to carry out the suggestions.

Response Feedback: The nurse's beliefs and values about raising children affect how he or she deals with children and parents. The nurse must not be overly critical about how parents handle their children's problems until the situation is fully understood: Caring for a child as a nurse is very different from being responsible around the clock. The parents likely have other obstacles in carrying out effective discipline. Teaching again is not likely to effect change. It is premature to refer to family therapy or remove the child from the home. Emotional barriers to effective parenting should be explored first.

Front 125

The nurse is meeting with a family of a client with conduct disorder. The nurse discusses changes the parents can make to help their child change problematic behaviors. Which parenting technique would the nurse encourage the parents to use?

A. Avoid discussing feelings and expectations with the child.

B. Release the child from household responsibilities until he can demonstrate dependable behavior.

C. Provide consistent consequences for behaviors.

D. Set earlier curfews than the child's peers adhere to.

Back 125

C. Provide consistent consequences for behaviors.

Response Feedback: Parents need to replace old patterns such as yelling, hitting, or simply ignoring behavior with more effective strategies. The nurse can teach parents age-appropriate activities and expectations for clients such as reasonable curfews, household responsibilities, and acceptable behavior at home. The parents may need to learn effective limit setting with appropriate consequences. Parents often need to learn to communicate their feelings and expectations clearly and directly to these clients. Some parents may need to let clients experience the consequences of their behavior rather than rescuing them.

Front 126

The nurse is using limit setting with a child diagnosed with conduct disorder. Which statement reflects the most effective way for the nurse to set limits with the child?

A. “That is not allowed here. You will lose a privilege. You need to stop.”

B. “Why do you do these things?”

C. “I would appreciate if you would not do that.”

D. “Stop what you are doing. Go to your room.”

Back 126

A. “That is not allowed here. You will lose a privilege. You need to stop.”

Response Feedback: The nurse must set limits on unacceptable behavior at the beginning of treatment. Limit setting involves three steps: (1) informing clients of the rule or limit; (2)explaining the consequences if clients exceed the limit; and (3) stating expected behavior.

Front 127

The nurse understands that when working with a child with a disruptive behavior disorder, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child?

A. Reinforce the parents' expectations of the child's behavior.

B. Support transferring the child to a healthy living environment.

C. Teach the parents age-appropriate expectations of the child.

D. Interpret the child's thoughts and feelings to the parent.

Back 127

C. Teach the parents age-appropriate expectations of the child.

Response Feedback: Working with parents is a crucial aspect of dealing with children with these disorders. Parents often have the most influence on how these children learn to cope with their disorders. The nurse can teach parents age-appropriate activities and expectations for clients.

Front 128

When presenting information about conduct disorders to a community group, the nurse is asked, “which is the best setting for care of a client with conduct disorders when parents cannot provide safe, structured environments and adequate supervision for the client?” Which would be the most appropriate reply by the nurse?

A. Residential treatment settings

B. School

C. The acute care setting

D. Jail-diversion program

Back 128

A. Residential treatment settings

Response Feedback: Group homes, halfway houses, and residential treatment settings are designed to provide safe, structured environments and adequate supervision if that cannot be provided at home. Clients with conduct disorder are seen in acute care settings only when their behavior is severe and only for short periods of stabilization. Clients with legal issues may be placed in detention facilities, jails, or jail-diversion programs.

Front 129

Which are actions of the parents of a child with conduct disorders that may contribute to the problems of the child? Select all that apply.

A. The parents make reasonable curfews that are appropriate for the age of the client.

B. The parents establish household responsibilities that are appropriate for the age of the client.

C. The parents blame the school when the child causes a disturbance in school and receives detention.

D. The parents may not behave appropriately themselves because of a lack of knowledge.

E. The parents engage in yelling at, hitting, or simply ignoring the behavior of their child.

Back 129

C. The parents blame the school when the child causes a disturbance in school and receives detention.

D. The parents may not behave appropriately themselves because of a lack of knowledge.

E. The parents engage in yelling at, hitting, or simply ignoring the behavior of their child.

Response Feedback: Parents may also need help in learning social skills, solving problems, and behaving appropriately. Often, parents have their own problems, and they have had difficulties with the client for a long time before treatment was instituted. Parents need to replace old patterns such as yelling, hitting, or simply ignoring behavior with more effective strategies. The nurse can teach parents age-appropriate activities and expectations for clients such as reasonable curfews, household responsibilities, and acceptable behavior at home. Some parents may need to let clients experience the consequences of their behavior rather than rescuing them.

Front 130

Which are characteristics of intermittent explosive disorder (IED)?

A. It involves repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outbursts.

B. The intensity of the emotional outburst is usually within proportion to the stressor or situation.

C. The episode may occur with seemingly no warning.

D. Afterward, the person with IED will not have any remorse.

E. They usually last less than 30 minutes.

Back 130

A. It involves repeated episodes of impulsive, aggressive, violent behavior, and angry verbal outbursts.

C. The episode may occur with seemingly no warning.

E. They usually last less than 30 minutes.

Response Feedback: Intermittent explosive disorder (IED) involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts, usually lasting less than 30 minutes. During these episodes, there may be physical injury to others, destruction of property, and injury to the individual as well. The intensity of the emotional outburst is grossly out of proportion to the stressor or situation. The episode may occur with seemingly no warning. Afterward, the individual may be embarrassed and feel guilty or remorseful for his or her actions, but that does not prevent future impulsive, aggressive outbursts.

Front 131

Which are important points for the nurse to consider when working with clients with disruptive behavior disorders and their families? Select all that apply.

A. Transient conduct disorders are common in all children.

B. Remember to focus on the client's strengths and assets, as well as their problems.

C. Avoid a “blaming” attitude toward clients and/or families.

D. Most behavior disorders are caused by being raised by parents who had behavior disorders in their own childhoods.

E. Focus on positive actions to improve situations and/or behaviors.

Back 131

B. Remember to focus on the client's strengths and assets, as well as their problems.

C. Avoid a “blaming” attitude toward clients and/or families.

E. Focus on positive actions to improve situations and/or behaviors.

Response Feedback: Points to consider when working with clients with disruptive behavior disorders and their families include the following: • Remember to focus on the client's strengths and assets, as well as their problems. • Avoid a blaming attitude toward clients and/or families; rather focus on positive actions to improve situations and/or behaviors. There is a familial tendency for behavior disorders, but that is not the only cause for behavior disorders. Conduct disorders are not common in all children, but it can be difficult to distinguish normal child behavior from conduct disorders at times.

Front 132

Which are most likely included in the history of a child with conduct disorder? Select all that apply.

A. Disturbed relationships with peers

B. Serious violation of rules

C. Major antisocial violations

D. Aggression toward people or animals

E. Destruction of property

Back 132

A. Disturbed relationships with peers

B. Serious violation of rules

D. Aggression toward people or animals

E. Destruction of property

Response Feedback: Children with conduct disorder have a history of disturbed relationships with peers, aggression toward people or animals, destruction of property, deceitfulness or theft, and serious violation of rules (e.g., truancy, running away from home, and staying out all night without permission). Major antisocial violations would be indicative of antisocial behavior.

Front 133

Which disorder is exemplified by vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity?

A. Moderate conduct disorder

B. Mild conduct disorder

C. Intermittent explosive disorder

D. Oppositional defiance Disorder

Back 133

A. Moderate conduct disorder

Response Feedback: Examples of moderate conduct disorder include vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity. Intermittent explosive disorder (IED) involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts, usually lasting less than 30 minutes. In mild conduct disorder, the child has some conduct problems that cause relatively minor harm to others. Examples include repeated lying, truancy, minor shoplifting, and staying out late without permission. Oppositional defiant disorder (ODD) consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations.

Front 134

Which is an effective way for parents to deal with problem behaviors in children and to prevent later development of conduct disorders?

A. Administering medications

B. Being overprotective of the child

C. Avoiding setting limits

D. Group-based parenting classes

Back 134

D. Group-based parenting classes

Response Feedback: Parental behavior profoundly influences children's behavior. Group-based parenting classes are effective to deal with problem behaviors in children and prevent later development of conduct disorders.

Front 135

Which is likely to be most effective for adolescents with conduct disorder?

A. Focusing on the parenting education

B. Early intervention

C. Involvement with the legal system

D. Incarceration

Back 135

B. Early intervention

Response Feedback: Many treatments have been used for conduct disorder with only modest effectiveness. Early intervention is more effective, and prevention is more effective than treatment. Dramatic interventions, such as “boot camp” or incarceration, have not proved effective and may even worsen the situation. Treatment must be geared toward the client's developmental age. For school-aged children with conduct disorder, the child, family, and school environment are the focus of treatment. Adolescents rely less on their parents and more on peers, so treatment for this age group includes individual therapy. Many adolescent clients have some involvement with the legal system as a result of criminal behavior, but this is a consequence of and not a treatment for conduct disorder.

Front 136

Which is the most commonly used treatment for oppositional defiant disorder?

A. Individual therapy

B. Pharmacologic treatment

C. “Boot camp”

D. Parent training models of behavioral interventions

Back 136

D. Parent training models of behavioral interventions

Response Feedback: Treatment for ODD is based on parent management training models of behavioral interventions. These programs are based on the idea that ODD problem behaviors are learned and inadvertently reinforced in the home and school. Older children may also benefit from individual therapy in addition to the behavioral program. There is little evidence that medications help ODD behaviors; however, successful pharmacologic treatment of comorbid disorders such as ADHD may also decrease the severity of ODD symptoms. Dramatic interventions, such as “boot camp” or incarceration, have not proved effective and may even worsen the situation.

Front 137

Which is the most important reason for the nurse who cares for children with conduct disorders to discuss feelings, fears, or frustrations with colleagues?

A. To keep negative emotions from interfering with the ability to provide care to clients with problems with aggression.

B. To make the nurse feel better and avoid burnout.

C. To encourage camaraderie between colleagues.

D. To ensure that all caregivers have the same attitudes and beliefs about children with conduct disorders.

Back 137

A. To keep negative emotions from interfering with the ability to provide care to clients with problems with aggression.

Response Feedback: It is important for the nurse to discuss feelings, fears, or frustrations with colleagues to keep negative emotions from interfering with the ability to provide care to clients with problems with aggression. It may also make the nurse feel better and avoid burnout, but that is not the most important reason to do so. It may encourage camaraderie between colleagues, but that is not the most important reason for the nurse to do so. It will not be possible to ensure that all caregivers have the same attitudes and beliefs about children with conduct disorders, but they must be consistent with limit setting, irrespective of their own attitudes and beliefs.

Front 138

Which is true of the time-out strategy that may be used for persons with conduct disorder?

A. Time-out is retreat to a neutral place, so clients can regain self-control.

B. Eventually, the goal is for the client to avoid time-out.

C. It should only be used as a last resort.

D. It is a punishment.

Back 138

A. Time-out is retreat to a neutral place, so clients can regain self-control.

Response Feedback: Time-out is retreat to a neutral place, so clients can regain self-control. It is not a punishment. When a client's behavior begins to escalate, such as when he or she yells at or threatens someone, a time-out may prevent aggression or acting out. Staff may need to institute a time-out for clients if they are unwilling or unable to do so. Eventually, the goal for clients is to recognize signs of increasing agitation and take a self-instituted time-out to control emotions and outbursts.

Front 139

Which may be concerns that a nurse has when caring for clients who have conduct disorders? Select all that apply.

A. Thinking that the client should be able to refrain from hostility and aggression through use of will power.

B. Having anxiety and fears for the nurse's personal safety.

C. Discussing feelings, fears, or frustrations with colleagues.

D. Having conflicted feelings regarding holding clients accountable for their behaviors without having a punitive attitude.

E. Believing that aggression is the most productive way to deal with aggression.

Back 139

A. Thinking that the client should be able to refrain from hostility and aggression through use of will power.

B. Having anxiety and fears for the nurse's personal safety.

D. Having conflicted feelings regarding holding clients accountable for their behaviors without having a punitive attitude.

Response Feedback: The nurse's beliefs and values about raising children affect how he or she deals with children and parents. The nurse may also have personal feelings about the disruptive and/or aggressive behaviors, such as thinking the client should be able to refrain from hostility and aggression through use of will power. It can be difficult to reconcile holding clients accountable for their behaviors, but avoiding a purely punitive attitude. Working with aggressive clients of any age may provoke anxiety and fears for personal safety in the nurse. It is important for the nurse to discuss feelings, fears, or frustrations with colleagues to keep negative emotions from interfering with the ability to provide care to clients with problems with aggression.

Front 140

Which steps are involved in limit setting? Select all that apply.

A. Explain the consequences if clients exceed the limit.

B. Inform clients or the rule or limit.

C. Threaten incarceration.

D. Occasionally limit enforcement.

E. State expected behavior.

Back 140

A. Explain the consequences if clients exceed the limit.

B. Inform clients or the rule or limit.

E. State expected behavior.

Response Feedback: Limit setting involves three steps: 1. Inform clients of the rule or limit. 2. Explain the consequences if clients exceed the limit. 3. State expected behavior. Threatening the client with incarceration is not likely effective. Providing consistent limit enforcement with no exceptions by all members of the health-care team, including parents, is essential.

Front 141

A nurse assessing a client with intermittent explosive disorder (IED) would expect which of the following?

A. Blaming others for provoking angry outbursts

B. Difficulty coping with ordinary life stressors

C. Lack of remorse for aggressive behavior

D. Premeditated aggressive outbursts to get what the client wants

Back 141

B. Difficulty coping with ordinary life stressors

Front 142

Parents of a child with oppositional defiant disorder (ODD) are referred to a parent management training program. The parents ask the nurse what to expect from these sessions. The best response by the nurse is

A. "This is a method of parenting that involves negotiation of responsibilities with your child."

B. "This is a support group for parents to discuss the difficulties they are having with their children."

C. "You will have a chance to learn how to manage all of your child's negative behaviors."

D. "You will learn behavior management techniques to use at home with your child."

Back 142

D. "You will learn behavior management techniques to use at home with your child."

Front 143

The nurse has completed teaching sessions for parents about conduct disorder. Which of the following statements indicates a need for further teaching?

A. "Being consistent with rules at home will probably be a real challenge for me and my child."

B. "It helps to know that these problems will get better as my child gets older."

C. "Real progress for our child is likely to take several weeks or even months."

D. "We need to set up a system of rewards and consequences for our child's behavior."

Back 143

B. "It helps to know that these problems will get better as my child gets older."

Front 144

Which of the following is normal adolescent behavior?

A. Being critical of self and others

B. Defiant, negative, and depressed behavior

C. Frequent hypochondriacal complaints

D. Unwillingness to assume greater autonomy

Back 144

A. Being critical of self and others

Front 145

An effective nursing intervention for the impulsive and aggressive behaviors that accompany conduct disorder is

A. Assertiveness training.

B. Consistent limit setting.

C. Negotiation of rules.

D. Open expression of feelings.

Back 145

B. Consistent limit setting.

Front 146

The nurse understands that effective limit setting for children includes (Select all)

A. Allowing the child to participate in defining limits.

B. Consistent enforcement of limit by entire team.

C. Explaining the consequences of exceeding limits.

D. Informing the child of the rule or limit.

E. Negotiation of reasonable requests for change in limits.

F. Providing three or four cues or prompts to follow the established limit.

Back 146

B. Consistent enforcement of limit by entire team.

C. Explaining the consequences of exceeding limits.

D. Informing the child of the rule or limit.

Front 147

A 16-year-old with oppositional defiant disorder (ODD) is most likely to have difficulty in relationships with

A. Family friends.

B. Law enforcement.

C. Parents - mother, father, or both.

D. Peers of the same age group.

E. School superintendent.

F. Store manager at work.

Back 147

B. Law enforcement.

C. Parents - mother, father, or both.

E. School superintendent.

F. Store manager at work.

Front 148

A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client approaches the nurse and states, “I'm going to take walk outside. I'll be back in about 10 minutes.” Which is the most appropriate nursing action?

A. Tell the client the walk is not allowed and restrict him to the unit.

B. Designate a staff member to accompany the client on the walk.

C. Give the client permission to go on a walk on the grounds.

D. Further assess the client's motives for wanting to walk.

Back 148

B. Designate a staff member to accompany the client on the walk.

Response Feedback: The nurse teaches clients to request assistance for activities such as getting out of bed or going to the bathroom. If clients cannot request assistance, they require close supervision to prevent them from attempting activities they cannot perform safely alone. The nurse responds promptly to calls from clients for assistance and checks clients at frequent intervals.

Front 149

A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which of the following best explains the nurse's behavior?

A. The nurse was frustrated and needed to take a “time-out.”

B. The nurse stepped away to verify the safety of other clients.

C. The nurse gave the client a chance to calm down before resuming the meal.

D. The nurse was unsure of how to calm the client.

Back 149

C. The nurse gave the client a chance to calm down before resuming the meal.

Response Feedback: Time away involves leaving clients for a short period and then returning to them to reengage in interaction. For example, the client may get angry and yell at the nurse for no discernible reason. The nurse can leave the client for about 5 or 10 minutes and then return without referring to the previous outburst. The client may have little or no memory of the incident and may be pleased to see the nurse on his or her return.

Front 150

A client with dementia is starting pharmacotherapy to slow the progression of cognitive decline. The client has a history of moderate but steady alcohol use over the past 45 years. Which medication should the nurse question as least suitable for this client?

A. Donepezil (Aricept)

B. Rivastigmine (Exelon)

C. Tacrine (Cognex)

D. Memantine (Namenda)

Back 150

C. Tacrine (Cognex)

Response Feedback: Tacrine (Cognex) is a cholinesterase inhibitor; however, it elevates liver enzymes in about 50% of clients using it. Lab tests to assess liver function are necessary every 1 to 2 weeks; therefore, tacrine is rarely prescribed. Memantine (Namenda) is an NMDA receptor antagonist that can slow the progression of Alzheimer's in the moderate or severe stages. Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl) are cholinesterase inhibitors and have shown modest therapeutic effects and temporarily slow the progress of dementia.

Front 151

A client with dementia is unable to recognize ordinary objects, such as a pen or notebook. Which would this be a symptom of?

A. Apraxia

B. Agnosia

C. Aphasia

D. Amnesia

Back 151

B. Agnosia

Response Feedback: Agnosia is the inability to recognize familiar objects. Amnesia is failure to remember past events. Apraxia is impairment in the ability to execute motor functions despite intact motor abilities. Aphasia is a deterioration of language function.

Front 152

A client with moderate Alzheimer's disease is living with her grown daughter. Which statement by the daughter would indicate the need for intervention by the nurse?

A. “It's distressing when my mother forgets my name.”

B. “Mother won't let anyone else do anything for her.”

C. “I wish my sister would come to visit more often.”

D. “Taking care of my mother is a big responsibility.”

Back 152

B. “Mother won't let anyone else do anything for her.”

Response Feedback: When the caregiver feels as though no one else can provide care, the risk for role strain is markedly increased. The other choices do not require intervention by the nurse.

Front 153

A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, “I feel like all my work doesn't do them any good.” Which should the nurse's supervisor encourage the nurse to do?

A. Cease giving instructions because the clients will not remember them anyway.

B. Seek counseling if personal feelings get in the way of client care.

C. Consider transferring to a different client care specialty area.

D. Try to stay supportive and meet the clients' needs at the current moment.

Back 153

D. Try to stay supportive and meet the clients' needs at the current moment.

Response Feedback: Teaching is a fundamental role for nurses, but teaching clients who have dementia can be especially challenging and frustrating. These clients do not retain explanations or instructions, so the nurse must repeat the same things continually. The nurse must be careful not to lose patience and not to give up on these clients. Discussing these frustrations with others can help the nurse to avoid conveying negative feelings to clients and families or experiencing professional and personal burnout. The nurse must remain positive and supportive to clients and family.

Front 154

A nurse is educating a group of elderly community members about cognitive disorders. Which would the nurse include as a measure most likely to prevent Alzheimer's disease and other dementias?

A. Watching television

B. Reading

C. Cooking

D. Crafts

Back 154

B. Reading

Response Feedback: People who regularly participate in brain-stimulating activities such as reading books and newspapers or doing crossword puzzles are less likely to develop Alzheimer's disease than those who do not. Engaging in leisure-time physical activity during midlife and having a large social network are associated with a decreased risk for Alzheimer's disease in later life.

Front 155

A nurse working in an assisted living facility is holding an in-service for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest?

A. The clients should be able to ask us for items they need.

B. The clients may not recognize their family when they come to visit.

C. The clients should know when to come to the dining room for meals.

D. The clients who are ambulatory can still carry out activities of daily living independently.

Back 155

B. The clients may not recognize their family when they come to visit.

Response Feedback: Dementia is a mental disorder that involves multiple cognitive deficits, primarily memory impairment, and at least one of the following cognitive disturbances: (1) aphasia, which is deterioration of language function; (2) apraxia, which is impaired ability to execute motor functions despite intact motor abilities; (3) agnosia, which is inability to recognize or name objects despite intact sensory abilities; and (4) disturbance in executive functioning, which is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior.

Front 156

During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium?

A. Disoriented to person

B. Difficulty with verbal expression

C. Unable to transfer to sitting position

D. Unable to identify a water pitcher

Back 156

A. Disoriented to person

Response Feedback: Delirium usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of the day. Clients with delirium have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations. Dementia symptoms include aphasia (deterioration of language function), apraxia (impaired ability to execute motor functions despite intact motor abilities), and agnosia (inability to recognize or name objects despite intact sensory abilities).

Front 157

The adult son of a client with dementia asks the nurse how he should respond when his mother repeatedly says she has had a busy day at work. The mother has not worked in over 20 years. Which is the best guidance that the nurse could offer?

A. Go along with her thought of it having been a busy day, but do not refer to her work.

B. Reorient her that she is at home and did not go to work.

C. Give her 5 to 10 minutes of rest, and she will have no memory of the incident.

D. Ask her to explain what she did at work today that kept her busy.

Back 157

A. Go along with her thought of it having been a busy day, but do not refer to her work.

Response Feedback: Going along means providing emotional reassurance to clients without correcting their misperception or delusion. The nurse does not engage in delusional ideas or reinforce them, but he or she does not deny or confront their existence. For example, a client is fretful, repeatedly saying, “I'm so worried about the children. I hope they're okay” and speaking as though his adult children were small and needed protection. The nurse could reassure the client by saying, “There's no need to worry; the children are just fine” (going along). Time away is an effective technique for aggression.

Front 158

The caregiver of a client with Alzheimer's disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm him down. The nurse teaches the caregiver to use distraction techniques. Which response would be best to teach as an example of this technique?

A. “I don't understand what you are saying.”

B. “Don't you want to finish your meal?”

C. “Let's look at what is on television.”

D. “If you stop yelling, I will get your dessert.”

Back 158

C. “Let's look at what is on television.”

Response Feedback: Distraction involves shifting the client's attention and energy to a more neutral topic. For example, the client may display a catastrophic reaction to the current situation, such as jumping up from dinner and saying, “My food tastes like poison!” The nurse might intervene with distraction by saying, “Can you come to the kitchen with me and find something you'd like to eat?” or “You can leave that food. Can you come and help me find a good program on television?” (redirection/distraction). Influencing behavior with a reward is a behavioral technique. Asking a direct question is ineffective. Clarification is used to try to determine meaning behind the client's message.

Front 159

The daughter of a client with dementia has been the primary caregiver for 5 months. The daughter expresses to the nurse, “At times it is so overwhelming! I feel I do not have a life anymore!” Which is the most helpful response by the nurse?

A. “Are you saying you don't want to care for your mother anymore?”

B. “I know it is really hard. It takes a lot of work and you are doing such a good job.”

C. “Your mother really appreciates what you do for her. You are the best one to care for her.”

D. “Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?”

Back 159

D. “Here is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?”

Response Feedback: Caregivers need outlets for dealing with their own feelings. Support groups can help them to express frustration, sadness, anger, guilt, or ambivalence; all these feelings are common. Attending a support group regularly also means that caregivers have time with people who understand the many demands of caring for a family member with dementia. The client's physician can provide information about support groups, and the local chapter of the National Alzheimer's Disease Association is listed in the phone book. Area hospitals and public health agencies also can help caregivers to locate community resources. The nurse should understand that the caregiver is asking for help when expressing frustration. The nurse should not dismiss the caregiver's feelings or in any way induce additional guilt.

Front 160

The daughter of a woman with dementia asks the nurse if her mother will ever be able to live independently again. Which would be the most appropriate response by the nurse?

A. “Her confusion is a temporary complication of her physical illness and should subside when the illness gets better.”

B. “With early treatment, mild dementia can be reversed. It may be possible.”

C. “Symptoms of dementia gradually get worse. Unfortunately she will not be independent again.”

D. “You sound like you aren't ready for her to be dependent on caregivers.”

Back 160

C. “Symptoms of dementia gradually get worse. Unfortunately she will not be independent again.”

Response Feedback: The prognosis for dementia involves progressive deterioration of physical and mental abilities until death. Typically, in the later stages, clients have minimal cognitive and motor function, are totally dependent on caregivers, and are unaware of their surroundings or people in the environment. They may be totally uncommunicative or make unintelligible sounds or attempts to verbalize. Delirium secondary to physical illness will subside with physical recovery.

Front 161

The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. Which will be accomplished by this intervention?

A. Increase frustration

B. Slow the progress of the disease

C. Decrease environmental misinterpretation

D. Improve memory retention

Back 161

A. Increase frustration

Response Feedback: Alzheimer's disease is progressive; clients do not learn new information, and they become frustrated when asked to perform tasks they are not capable of doing.

Front 162

The nurse caring for an elderly woman with dementia has asked the woman's children to bring old photo albums when they visit. Which best describes the usefulness of viewing photos when caring for the dementia client?

A. Viewing photos is a form of reminiscence therapy for the client.

B. Sharing photos will encourage interaction with other clients.

C. Talking about the photos will encourage the client to live in the past.

D. This can help the children to correctly identify old photographs.

Back 162

A. Viewing photos is a form of reminiscence therapy for the client.

Response Feedback: Reminiscence therapy (thinking about or relating personally significant past experiences) is an effective intervention for clients with dementia. Rather than lamenting that the client is “living in the past,” this therapy encourages family and caregivers also to reminisce with the client. Reminiscing uses the client's remote memory, which is not affected as severely or quickly as recent or immediate memory. Photo albums may be useful in stimulating remote memory, and they provide a focus on the client's past.

Front 163

The nurse encourages the client with dementia to meet nutritional needs. Which is the best approach to assist in meeting adequate dietary intake?

A. Sit with the client as long as necessary to complete the meal.

B. Avoid between-meal snacks to encourage appetite.

C. Provide entertainment during meals such as television or music.

D. Serve meals in small, bite-size pieces.

Back 163

D. Serve meals in small, bite-size pieces.

Response Feedback: Clients may eat poorly because of limited appetite or distraction at mealtimes. The nurse addresses this problem by providing foods clients like, sitting with clients at meals to provide cues to continue eating, having nutritious snacks available whenever clients are hungry, and minimizing noise and undue distraction at mealtimes. Clients who have difficulty manipulating utensils may be unable to cut meat or other foods into bite-sized pieces. The food should be cut up when it is prepared, not in front of clients, to deflect attention from their inability to do so. Food that can be eaten without utensils, or finger foods such as sandwiches and fresh fruits, may be best.

Front 164

The nurse is assessing a client with early signs of dementia. What is the nurse trying to determine when the nurse asks the client what he ate for breakfast that morning?

A. Orientation

B. Remote memory

C. Food preferences

D. Recent memory

Back 164

D. Recent memory

Response Feedback: The initial sign of dementia is memory loss for recent events that exceeds normal forgetfulness. Asking what the client ate for breakfast is not determining orientation, food preferences, or remote memory.

Front 165

The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which intervention should the nurse implement first?

A. Explain the unit routine and the reasons for increased activity to the client.

B. Move the client to a quieter area during these times.

C. Administer an antianxiety drug such as lorazepam (Ativan) at these times.

D. Keep unit activity to a minimum.

Back 165

B. Move the client to a quieter area during these times.

Response Feedback: The nurse must alter the environment because the client will not learn new coping skills for frustrating or overly stimulating situations. Administering an antianxiety agent or explaining the routine of the unit and reasons for increased activity to the client may be done but would not be the initial intervention. The unit activity does not need to be kept to a minimum.

Front 166

The nurse is caring for a client with cognitiveimpairment. To determine whether the client is suffering from delirium ordementia, the nurse reviews the symptoms and course of each disorder. Place theletter “A” beside terms describing delirium and the letter “B” beside termsdescribing dementia.

____ Rapid onset

____ Progressive decline

____ Long-term memory impairment

____ Slurred speech

____ Hallucinations

Back 166

__A__ Rapid onset

__B__ Progressive decline

__B__ Long-term memory impairment

__A__ Slurred speech

__A__ Hallucinations

Response Feedback: Onset of delirium is rapid, but of dementia is gradual. Duration of delirium is brief, but of dementia is progressing. Delirium affects only short-term memory. Dementia begins with short-term memory loss and progresses to long-term memory loss. Slurred speech is characteristic of delirium. Speech with dementia is unchanged until the client begins to develop aphasia. Visual and tactile hallucinations are common with delirium, but rarely experienced with dementia.

Front 167

The nurse is developing interventions to promote socialization in a client with moderate dementia. Which would provide a safe and secure environment for the client?

A. An activity with the nurse

B. A card game with other clients

C. Morning stretch group with music

D. Decorating a bulletin board with the group

Back 167

A. An activity with the nurse

Response Feedback: The client has to interact only with the nurse, who will behave in a predictable way and will focus on the client's needs, without undue or unexpected disruptions. Group activities do not provide a safe and secure environment like an activity done with the nurse does.

Front 168

The nurse is encouraging a group of clients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation?

A. Show an instructional video just prior to the activity.

B. Demonstrate the exercises while clients simultaneously perform them.

C. Perform the same routine daily to avoid the need for repeated instruction.

D. Describe the exercise immediately before performing it.

Back 168

B. Demonstrate the exercises while clients simultaneously perform them.

Response Feedback: The nurse encourages clients to engage in physical activity because they may not initiate such activities independently; many clients tend to become sedentary as cognitive abilities diminish. Clients often are quite willing to participate in physical activities but cannot initiate, plan, or carry out those activities without assistance.

Front 169

The nurse is performing a health history with a client exhibiting signs of delirium. The nurse asks the client and family members about possible causes of the delirious state. Which would the nurse likely attribute as underlying causes for the client's delirium? Select all that apply.

A. Exposure to paint or gasoline

B. Sleep disturbances

C. Dehydration

D. Recent alcohol use

E. Use of antihistamines

F. Use of megadoses of vitamins

Back 169

A. Exposure to paint or gasoline

B. Sleep disturbances

C. Dehydration

D. Recent alcohol use

E. Use of antihistamines

Response Feedback: Because the causes of delirium are often related to medical illness, alcohol, or other drugs, the nurse obtains a thorough history of these areas. The nurse may need to obtain information from family members if a client's ability to provide accurate data is impaired. Information about drugs should include prescribed medications, alcohol, illicit drugs, and over-the-counter medications. Physiologic or metabolic causes include hypoxemia, electrolyte disturbances, renal or hepatic failure, hypoglycemia or hyperglycemia, dehydration, sleep deprivation, thyroid or glucocorticoid disturbances, thiamine or vitamin B12 deficiency, vitamin C, niacin, or protein deficiency, cardiovascular shock, brain tumor, head injury, and exposure to gasoline, paint solvents, insecticides, and related substances. Infectious processes include sepsis, urinary tract infection, pneumonia, meningitis, encephalitis, HIV, and syphilis.

Front 170

The nurse is working with a client who has hallucinations and delusions. The client tells the nurse she cannot take a shower because she is waiting for her husband to take her home. Which response by the nurse is best in this situation?

A. “It would be best if you just took your shower now.”

B. “You seem anxious and upset.”

C. “Why are you thinking you're going home?”

D. “You have plenty of time to shower before it's time to go home.”

Back 170

D. “You have plenty of time to shower before it's time to go home.”

Response Feedback: This is an example of going along with, rather than correcting, the client's misperception so that she can get on with her daily activities and not focus on being upset about not going home. The other choices are not the best responses in this situation.

Front 171

The nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. Which should the nurse include in planning the living environment?

A. Open the windows and doors to allow fresh air to circulate through the environment.

B. Plan for the same caregivers to provide care to individuals as much as possible.

C. Provide a buffet-style menu with many food choices.

D. Assign peer-led exercise activates on a daily basis.

Back 171

B. Plan for the same caregivers to provide care to individuals as much as possible.

Response Feedback: A structured environment and established routines can reassure clients with dementia. Familiar surroundings and routines help to eliminate some confusion and frustration from memory loss. Providing the same caregiver establishes familiarity and routine. Safety considerations involve protecting against injury, meeting physiologic needs, and managing risks posed by the environment. Open doors pose a safety risk of wandering away. Buffet-style meals require the client to make too many choices, thus adding to frustration. The nurse encourages clients to engage in physical activity because they may not initiate such activities independently; many clients tend to become sedentary as cognitive abilities diminish. Clients often are quite willing to participate in physical activities but cannot initiate, plan, or carry out those activities without assistance.

Front 172

Which are possible sources of frustrations for nurses caring for persons with dementia? Select all that apply.

A. The nurse may get little or no positive response or feedback from clients with dementia.

B. It can be difficult to remain positive and supportive to clients and family because the outcome is so bleak.

C. It can be helpful for the nurse to talk to colleagues or even a counselor about personal feelings of depression and grief as the dementia progresses.

D. The clients do not retain explanations or instructions, so the nurse must repeat the same things continually.

E. The clients may seem not to hear or respond to anything the nurse does.

Back 172

A. The nurse may get little or no positive response or feedback from clients with dementia.

B. It can be difficult to remain positive and supportive to clients and family because the outcome is so bleak.

D. The clients do not retain explanations or instructions, so the nurse must repeat the same things continually.

E. The clients may seem not to hear or respond to anything the nurse does.

Response Feedback: Working with and caring for clients with dementia can be exhausting and frustrating for both the nurse and caregiver. Teaching is a fundamental role for nurses, but teaching clients who have dementia can be especially challenging and frustrating. These clients do not retain explanations or instructions, so the nurse must repeat the same things continuously. The nurse may begin to feel that repeating instructions or explanations does not good because clients do not understand or remember them. The nurse may get little or no positive response or feedback from clients with dementia. It can be difficult to deal with feelings about caring for people who will never get better and go home. As dementia progresses, clients may seem not to hear or respond to anything the nurse says or does. Remaining positive and supportive to clients and family can be difficult when the outcome is so bleak. The nurse may need to deal with personal feelings of depression and grief as the dementia progresses; he or she can do so by discussing the situation with colleagues or even a counselor, but this is an intervention instead of a source of frustration for the nurse.

Front 173

Which client would have an increased risk for delirium?

A. A middle-aged woman newly diagnosed with multiple sclerosis

B. An elderly woman with abdominal pain

C. A 3-year-old child with a temperature of 103.2°F

D. A young adult male with gastroenteritis and dehydration

Back 173

C. A 3-year-old child with a temperature of 103.2°F

Response Feedback: Young children with high fever are at risk for delirium. The other choices would not be the most likely candidates for increased risk for delirium.

Front 174

Which distinguishes delirium from dementia?

A. Dementia has an acute onset and can be resolved.

B. Delirium has a gradual onset and can be resolved.

C. Delirium has an acute onset and is progressive in course.

D. Dementia has a gradual onset and is progressive in course.

Back 174

D. Dementia has a gradual onset and is progressive in course.

Response Feedback: Delirium has a sudden onset, and the underlying cause is treatable; by contrast, dementia has a gradual onset and is progressive rather than treatable.

Front 175

Which is believed to be a risk factor specific to the development of delirium?

A. Increased severity of physical illness

B. Older age

C. Gradual decline in functioning

D. Baseline cognitive impairment

Back 175

A. Increased severity of physical illness

Response Feedback: An estimated 10% to 15% of people in the hospital for general medical conditions are delirious at any given time. Onset is sudden. Delirium is common in older, acutely ill clients. Risk factors for delirium include increased severity of physical illness, older age, and baseline cognitive impairment such as that seen in dementia. Children may be more susceptible to delirium, especially that related to a febrile illness or certain medications such as anticholinergics. Delirium usually develops over a short period, sometimes a matter of hours, and fluctuates, or changes, throughout the course of a day. Prevalence of dementia also rises with age, and progression is gradual.

Front 176

Which is the most effective intervention for clients with delirium?

A. Giving detailed explanations

B. Managing environmental stimuli

C. Providing activities for distraction

D. Promoting rest with PRN medications

Back 176

B. Managing environmental stimuli

Response Feedback: Clients with delirium become overstimulated easily; their ability to process environmental stimuli is impaired.

Front 177

Which patient is most likely suffering from dementia?

A. An 80-year-old female who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff

B. A 22-year-old male who was involved in a motorcycle crash without wearing a helmet now unable to remember where he is

C. A 6-year-old child who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that her parents have three sets of eyes

D. A 90-year-old male who has experienced progressive mental decline that started with forgetfulness

Back 177

D. A 90-year-old male who has experienced progressive mental decline that started with forgetfulness

Response Feedback: Memory impairment is the prominent early sign of dementia. The course of dementia is usually progressive. A 90-year-old gentleman who has experienced progressive mental decline that started with forgetfulness is most likely suffering from dementia. An 80-year-old lady who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection is likely experiencing delirium. Delirium almost always results from an identifiable physiologic, metabolic, or cerebral disturbance or from drug intoxication or withdrawal. The 6-year-old who has just been administered conscious sedation is likely delirious. A 22-year-old male who was involved in a motorcycle crash without wearing a helmet and now cannot remember where he is likely experiencing an amnestic disorder.

Front 178

Which statement by the nurse would be most appropriate to the family member who is the primary caregiver to a client with dementia?

A. “What is wrong with your family? Can't they see you need help?”

B. “You should be grateful that you still have your family member around.”

C. “Most people seek help when they really need it.”

D. “Yes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role.”

Back 178

D. “Yes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role.”

Response Feedback: Caregivers need support to maintain personal lives. They need to continue to socialize with friends and to engage in leisure activities or hobbies rather than focus solely on the client's care. Caregivers who are rested, are happy, and have met their own needs are better prepared to manage the rigorous demands of the caregiver role. Most caregivers need to be reminded to take care of themselves; this act is not selfish but really is in the client's best long-term interests. Many times caregivers will say they will seek help when they really need it. However, they must maintain their own well-being and not wait until they are exhausted before seeking relief. The primary caregiver may believe other family members should volunteer to help without being asked, but other family members may believe that the primary caregiver chose to take on the responsibility and do not feel obligated to help out regularly. It is important for the family to express their feelings and ideas and to participate in caregiving according to their own expectations. Many families need assistance to reach this type of compromise. Asking the caregiver what is wrong with his or her family and pointing out that the caregiver needs help are not helpful to the caregiver. It would be better for the nurse to encourage family members to share their feelings and to compromise for the best interests of the client. Telling the caregiver that he or she should be grateful will only increase the caregiver's sense of guilt, which is not productive.

Front 179

Which statement made by the nurse would be most appropriate to an 89-year-old patient who is confused but has no history of dementia and is hospitalized for an acute urinary tract infection?

A. “This should be just a temporary situation.”

B. “I know things are upsetting and confusing right now, but your confusion should clear as you get better.”

C. “Don't worry about it; everyone is confused when they are in the hospital.”

D. “You are likely to become progressively more confused now.”

Back 179

B. “I know things are upsetting and confusing right now, but your confusion should clear as you get better.”

Response Feedback: “I know things are upsetting and confusing right now, but your confusion should clear as you get better,” would be validating and giving information and would provide realistic reassurance to the client who has delirium as this is often an acute and temporary situation in elderly people who are acutely ill and have other risk factors such as medications and illness and age. “You are likely to become progressively more confused now,” is inaccurate as the person likely has delirium, and this will be an acute and temporary situation. “This should be just a temporary situation” provides some reassurance but no validation. “Don't worry about it; everyone is confused when they are in the hospital” is inaccurate.

Front 180

The nurse is talking with a woman who is worried that her mother has Alzheimer's disease. The nurse knows that the first sign of dementia is

A. Disorientation to person, place, or time.

B. Memory loss that is more than ordinary forgetfulness.

C. Inability to perform self-care tasks without assistance.

D. Variable with different people.

Back 180

B. Memory loss that is more than ordinary forgetfulness.

Front 181

The nurse has been teaching a caregiver about donepezil (Aricept). The nurse knows that teaching has been effective by which of the following statements?

A. "Let's hope this medication will stop the Alzheimer's disease from progressing any further."

B. "It is important to take this medication on an empty stomach."

C. "I'll be eager to see if this medication makes any improvement in concentration."

D. "This medication will slow the progress of Alzheimer's disease temporarily,"

Back 181

D. "This medication will slow the progress of Alzheimer's disease temporarily,"

Front 182

When teaching a client about memantine (Namenda), the nurse will include which of the following?

A. Lab tests to monitor the client's lifer function are needed.

B. Namenda can cause elevated blood pressure.

C. Taking Namenda will improve the client's cognitive functioning.

D. The most common side effect of Namenda is GI bleeding.

Back 182

B. Namenda can cause elevated blood pressure.

Front 183

Which of the following statements by the caregiver of a client newly diagnosed with dementia requires further intervention by the nurse?

A. "I will remind Mother of things she has forgotten."

B. "I will keep Mother busy with favorite activities as long as she can participate."

C. "I will try to find new and different things to do every day."

D. "I will encourage Mother to talk about her friends and family."

Back 183

C. "I will try to find new and different things to do every day."

Front 184

A client with delirium is attempting to remove the intravenous tubing from his arm, saying to the nurse, "Get off me! Go away!" The client is experiencing which of the following?

A. Delusions

B. Hallucinations

C. Illusions

D. Disorientation

Back 184

B. Hallucinations

Front 185

Which of the following statements indicates the caregiver's accurate knowledge about the needs of a parent at the onset of the moderate stage of dementia?

A. "I need to give my parent a bath at the same time every day."

B. "I need to postpone any vacations for 5 years."

C. "I need to spend time with my parent doing things we both enjoy."

D. "I need to stay with my parent 24 hours a day for supervision."

Back 185

C. "I need to spend time with my parent doing things we both enjoy."

Front 186

Which of the following interventions is most appropriate in helping a client with early-stage dementia complete activities of daily living (ADLs)?

A. Allow enough time for the client to complete ADLs as independently as possible.

B. Provide the client with a written list of all the steps needed to complete ADLs.

C. Plan to provide step-by-step prompting to complete the ADLs.

D. Tell the client to finish ADLs before breakfast or the nursing assistant will do them.

Back 186

A. Allow enough time for the client to complete ADLs as independently as possible.

Front 187

A client with late moderate-stage dementia has been admitted to a long-term care facility. Which of the following nursing interventions will help the client to maintain optimal cognitive function?

A. Discuss pictures of children and grandchildren with the client.

B. Do word games or crossword puzzles with the client.

C. Provide the client with a written list of daily activities.

D. Watch and discuss the evening news with the client.

Back 187

A. Discuss pictures of children and grandchildren with the client.

Front 188

When assessing a client with delirium, the nurse will expect to see (Select all that apply)

A. Aphasia.

B. Confusion.

C. Impaired level of consciousness.

D. Long-term memory impairment.

E. Mood fluctuations.

F. Rapid onset of symptoms.

Back 188

B. Confusion.

C. Impaired level of consciousness.

F. Rapid onset of symptoms.

Front 189

Interventions for clients with dementia that follow the psychosocial model of care include (Select all that apply)

A. Asking the clients about the place where they were born.

B. Correcting the client's misperceptions or delusions.

C. Finding activities that engage the client's attention.

D. Introducing new topics of discussion at dinner.

E. Processing behavioral problems to improve coping skills.

F. Providing unrelated distractions when the client is agitated.

Back 189

A. Asking the clients about the place where they were born.

C. Finding activities that engage the client's attention.

F. Providing unrelated distractions when the client is agitated.

Front 190

The chargenurse notices that when a client with a history of sexual abuse is admitted,one nurse subtly and sometimes overtly verbally attacks the client. She finds out the nurse was sexually abusedas a child. In making assignments thecharge nurse should:

a. assignthe nurse to this client to promote feedback to the client from someone who hasbeen on ‘their side’.

b. assignthe nurse to the client and insist the nurse begin therapy to work onunresolved feelings

c. assign someone elseto the client; the nurse is not ready to cope with this and may be detrimentalto the client

d. assignsomeone else to the client but do not inform the nurse of your rationale fordoing so

Back 190

c. assign someone else to the client; the nurse is not ready to cope with this and may be detrimental to the client

Front 191

A 18 mo. oldis brought into clinic with a URI. Younote some bruising on the arms legs and trunk. Which findings would prompt you to evaluate for suspected child abuse?(select all that apply)

a.superficial scrapes on lower legs

b. deep blue area onbuttocks

c. circular,symmetrical scars on back

d. largebruise on thigh

e. bruises in variousstages healing on trunk

f.parent is hypercritical of child

Back 191

b. deep blue area on buttocks

c. circular, symmetrical scars on back

e. bruises in various stages healing on trunk

f. parent is hypercritical of child

Front 192

What historywould you expect to find in a client with dementia? (select all that apply)

a. slowprogression of symptoms

b. admits to feelingsof sadness

c. actsapathetic and pessimistic

d. changes inpersonality

e. difficulty payingattention

f. familynot sure when symptoms began

Back 192

b. admits to feelings of sadness

d. changes in personality

e. difficulty paying attention

Front 193

A child withADHD has a nursing diagnosis of impaired social interaction. Which would not be an appropriate interventionfor this child?

a. socially isolate the child when interactionswith others are inappropriate

b. set limits with consequences on inappropriatebehaviors

c. provide rewards for appropriate behaviors

Back 193

a. socially isolate the child when interactions with others are inappropriate

Front 194

Which of thefollowing would be appropriate for a child with ADHD?

a.monopoly

b. volleyball

c. pool

d. checkers

Back 194

b. volleyball

Front 195

A womanstaying at a domestic violence shelter participates in group therapy andreceives support from staff and peers. She is aware of the alternatives available to her yet decides to returnhome to her husband. The best response by the nurse upon her leaving is:

a. “I just can’t believe you have decided to goback to that man.”

b. “I’m just afraid he will kill you or thechildren when you go back.”

c. “What makes you think things have changedwith your husband.”

d. “I hope you have made the rightdecision. Call this number if you needhelp.”

Back 195

d. “I hope you have made the right decision. Call this number if you need help.”

Front 196

Familymembers of patients with DAT can help by all of these except:

a. visiting only twicea week

b. helpingthe client with menu selection

c. limitvisitors to 1-2 at a time

d. go withpt. to diagnostic test

Back 196

a. visiting only twice a week

Front 197

Your patientwith delirium awakens during the night and calls for her husband. The bestresponse by the nurse is:

a.“Everything is OK, Mrs. N. Go back to sleep. I’ll take care of you.”

b. “I cansee how restless you are. I’ll get you another sleeping pill to help yousleep.”

c. “He’s nothere, Mrs. N, you’re seeing things again. Try to get some sleep.”

d. “Mrs. N, you are inthe hospital. I’m your nurse and I’ll help you call your husband in themorning.”

Back 197

d. “Mrs. N, you are in the hospital. I’m your nurse and I’ll help you call your husband in the morning.”

Front 198

Mr. D, age69, was admitted with multi-infarct dementia. Characteristics the nurse expects to see include:

a. loss ofintellectual abilities, ataxia, aphasia.

b. intactshort-term memory, impaired long-term memory.

c. intact long-termmemory, impaired short-term memory.

d. cloudedconsciousness, intact abstract thinking.

Back 198

c. intact long-term memory, impaired short-term memory.

Front 199

Nursinginterventions to counteract memory loss characteristic in dementia include:

a.discussing early childhood memories.

b. engagingMr. D in a memory-matching game.

c. placing a clock anda calendar in Mr. D’s room.

d. encouraging good nutritionand administering vitamins.

Back 199

c. placing a clock and a calendar in Mr. D’s room.

Front 200

Mr. S hasexperienced a gradual flattening of affect, confusion, and withdrawal, and hasbeen diagnosed with Alzheimer’s disease. The nurse assesses the followingadditional characteristics of:

a. personality change,wandering, inability to perform purposeful movements.

b.delusions, hallucinations, confusion about date and time.

c. tremors,unsteady gait, transient paresthesias.

d. transientblindness, slurred speech, weakness.

Back 200

a. personality change, wandering, inability to perform purposeful movements.

Front 201

An 8 yearold has ADHD and was referred to the psychiatric clinic by the schoolpsychologist for temper tantrums and restlessness in the classroom. Additionalassessments expected by the nurse include:

a.stereotypic repetitive movements, nail-biting, and stuttering.

b. inattention,distractibility, impulsivity, and fidgeting.

c.oppositional defiant behavior; running away

d. emotionallability, sleep disturbance, and poor appetite.

Back 201

b. inattention, distractibility, impulsivity, and fidgeting.

Front 202

Nursinginterventions for a client with ADHD include:

a. aversivetherapy, neuroleptics

b.role-playing groups

c.supportive therapy, low-dose tranquilizers

d. minimizing environmental stimuli; psychostimulant drugs.

Back 202

d. minimizing environmental stimuli; psychostimulant drugs.

Front 203

Whendiscussing encopresis with the parents of a 6-year-old the nurse is aware thatin the absence of a physical cause, the etiology of encopresis is thought tobe:

a. anxietyrelated to control issues.

b.dehydration and poor fluid intake.

c. disturbedparent–child relationship.

d. siblingrivalry and competition.

Back 203

c. disturbed parent–child relationship.

Front 204

Ground rulesfor nurses to follow when establishing rapport with children include:

a. acceptingthe child and discussing undesirable behavior.

b. tailoringyour speech to fit the child by using childlike language.

c. letting the childknow you are in charge by setting rules quickly.

d. imitatingthe child’s nonverbal behavior to establish rapport.

Back 204

c. letting the child know you are in charge by setting rules quickly.

Front 205

Mrs. J comesto the emergency department after being hit with a belt by her boyfriend. Shehas bruises on her face and a swollen arm. Which responses made by the nurse interviewingMrs. J is most therapeutic?

a. “You needto consider finding a new boyfriend.”

b. “You looklike you’ve been run over by a Mack truck.”

c. “Have you consideredpressing charges as a way of protecting yourself?”

d. “If Iwere you, I’d start carrying a weapon with me.”

Back 205

c. “Have you considered pressing charges as a way of protecting yourself?”

Front 206

Initialnursing interventions for a client who has been physically or sexually abusedinclude:

a. expressingyour own anger and revulsion to validate the client’s feelings.

b. staying with theclient and providing privacy.

c. sharingdetails of the incident with family and visitors.

d.discouraging expression of strong feelings

Back 206

b. staying with the client and providing privacy.

Front 207

Helpfulreality orientation techniques for individuals with cognitive impairmentinclude all except the following:

a. q 15 minute checksfor cognitive ability.

b. using acalendar in the room.

c. usinglarge poster boards with the date, weather, and schedule.

d.reinforcing reality frequently by validation and clarification.e. warnother staff about his advances.

Back 207

a. q 15 minute checks for cognitive ability.

Front 208

Whendocumenting findings of suspected child abuse the nurse should do all of thefollowing except:

a. record suspicionsand judgments

b. usespecific quotes from parents or paraphrase what they say

c. bespecific when describing wounds and their locations.

d. usespecific terminology whenever possible

Back 208

a. record suspicions and judgments

Front 209

When helping15-year-old Josh, who smokes and drinks excessively, find an outlet for histension, anxiety, and frustration with his parents, friends, and teachers, thenurse would suggest which activities?

a. Discussearly childhood memories with his peers.

b. Avoidsituations that have any conflict.

c. Directlyexpress anger to the individual who is making Josh angry.

d.Participate in jogging, swimming, and sports activities.

Back 209

d. Participate in jogging, swimming, and sports activities.

Front 210

Susan ishaving difficulty with activities of daily living. The most effective techniqueto assist her would be to:

a. completeSusan’s daily hygiene activities for her until she can do them independently.

b. askanother client to assist Susan with her daily hygiene.

c. encourageSusan’s children to help her with her daily hygiene.

d. tell Susan in amatter-of-fact manner that it is time to take a shower, and provide thenecessary items.

Back 210

d. tell Susan in a matter-of-fact manner that it is time to take a shower, and provide the necessary items.

Front 211

Which planwould be most useful for the nursing home client with middle stage Alzheimer’sdisease?

a. help client express favorite pastimes andenjoyable activities .

b. orient client to present time and assistclient in being alert when visitors arepresent.

c. direct conversation to reminisce and talkabout important events in past .

d. encourage verbalization of feelings replacement in nursing home.

Back 211

c. direct conversation to reminisce and talk about important events in past .

Front 212

A clientwith DAT refuses to get out of the bed of another client. You say, “Jim, please get up.” When he doesn’t move you should:

a. repeat,“Jim, please get up”

b. say, “JimI asked you to get out of John’s bed, this is not your bed.”

c. pull thecover off of Jim and help him into a sitting position

d. say, “Jim, if youdon’t get up now, you will miss lunch.”

Back 212

d. say, “Jim, if you don’t get up now, you will miss lunch.”

Front 213

Mary walkstoward you shaking her fist and says, “You have been hiding my things. Where did you put my purse?” Your bestresponse is “Mary,…:

a. you knowI would not hide your things.”

b. don’tshake your fist at me. I work here.”

c. I am toobusy to hide your things. I did seeHelen in your room earlier.”

d. you seem upset. Letme help you look for your purse.”

Back 213

d. you seem upset. Let me help you look for your purse.”

Front 214

Millie won’ttake a bath unless she can bring her doll, what should you do?

a. let her bring thedoll

b. have herleave the doll in the bed, reassure her it will be okay.

c. have herroommate ‘babysit’ for Millie, leave the doll with her

d. leave thedoll in the nursing station for ‘safety’

Back 214

a. let her bring the doll

Front 215

A batteredclient tells you, “My husband is very sorry. He said he will never hit me again.” Your best response is:

a. “Being sorry after an episode of violence iscommon. I know you want to believe him,but unless he gets help, this could happen again.”

b. “I’m gladhe realized he handled his emotions poorly. I hope this is the end of it for your family.”

c. “Onceabusers admit their problem, things usually change for the better.”

d. “You arelucky the violence occurred only once in your marriage.”

Back 215

a. “Being sorry after an episode of violence is common. I know you want to believe him, but unless he gets help, this could happen again.”

Front 216

Esther isstanding at the door of the locked Alzheimer’s unit crying “My childrenare waiting for me, I need to go.” Yourbest response is:

a. “Yourchildren are all grown up. This is yourhome.”

b. “Yourchildren live far away, they have children of their own now.”

c. “Tell me about yourchildren.”

d. “You are75 years old, your children are adults themselves.”

Back 216

c. “Tell me about your children.”

Front 217

Which of thefollowing may indicate a child has autism? (Select all)

a. doesn’t like to beheld

b. interactswell with younger brother

c. doesn’tsmile

d. playswith crib toys frequently

e. would rather sleep thanplay

Back 217

a. doesn’t like to be held

c. doesn't smile

Front 218

Which isleast important when orienting a client to reality?

a. tellingthe client what day it is

b. show theclient where the fork is on the table

c. post alarge calendar on the bulletin board

d. ask the client howthey feel?

Back 218

d. ask the client how they feel?

Front 219

Which planwould be most useful for the nursing home client with middle stage Alzheimer’sdisease?

a. help client express favorite pastimes andenjoyable activities

b. orient client to present time and assistclient in being alert when visitors arepresent

c. direct conversation to reminisce and talkabout important events in past

d. encourage verbalization of feelings replacement in nursing home

Back 219

c. direct conversation to reminisce and talk about important events in past

Front 220

One sign of normal aging is:

a.inability to learn new things

b. growing inability to recognize closeacquaintances

c. progressive declining cognitiveabilities

d. a slowing in the learning of new information

Back 220

d. a slowing in the learning of new information

Front 221

Which of these applies to delirium?

a. needs long term care focusing on qualityof life

b. sudden onset of confusion

c. progressive deterioration of cognition

d. attempts to compensate for diminishedcapacity

Back 221

b. sudden onset of confusion

Front 222

Causes of reversible dementia: (select all)

a. Huntington’s chorea

b. Korsakoff’s

c. drug interactions

d. Alzheimer’s

e. depression

f. malnutrition

g. transient ischemic attacks

Back 222

c. drug interactions

e. depression

f. malnutrition

Front 223

Apraxia is:

a. disturbance in basicfunctioning…planning, organizing

b. inability to articulate thoughts

c. unable to recognize objects, or use themproperly

d. inability to carry out motor activities

Back 223

d. inability to carry out motor activities

Front 224

Common side effect of manyacetylcholinesterase inhibitors:

a. hallucinations

b. skin rash

c. liver toxicity

d. photosensitivity

e. nausea and vomiting

Back 224

e. nausea and vomiting

Front 225

Which is not an early sign of dementia?

a. getting lost doing a routine errand b. forgetting the name of someone you metearlier in the day

c. misplacing items

d. deterioration in personal hygiene

Back 225

b. forgetting the name of someone you met earlier in the day

Front 226

Which of these is not used for treatment ofearly DAT?

a. Reminyl

b. Namenda

c. Thiamine

d. Aricept

e. Exelon

Back 226

b. Namenda