Mental-Health Nursing

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Author:
plbernal
ID:
151441
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Mental-Health Nursing
Updated:
2012-05-01 15:19:01
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Chapter review questions
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Description:
cognitive, personality disorders adolescents and children
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  1. A 73-year old woman with pneumonia becomes agitated after being admitted to the intensive care unit through the emergency department. She is placed in soft restraints when she continues to try to leave her bed despite being too weak to walk. Her vital signs are erratic, and her thinking seems disorganized. During her first 24 hours in ICU, the patient varies from somnolent to agitated, and from laughing to angry. Her daughter reports that the patient "was never like this at home". What is the most likely explanation for the situation?
    A. Pneumonia has worsened the patient's early-stage dementia
    B. The patient is sundowning due to the decreased stimulation of the intensive care unit
    C. The patient does not want to be in the hospital and is angry that the staff will not let her leave
    D. The patient is experiencing delirium secondary to the pneumonia
    D. The patient is experiencing delirium secondary to the pneumonia
    (this multiple choice question has been scrambled)
  2. The intervention(s) appropriate for a hospitalized patient experiencing delirium include which of the following? Select all that apply.
    A. Immediately placing the patient in restraints if she begins to hallucinate or act irrationally or unsafely
    B. Assuring that a clock and a sign indicating the day and date is displayed where the patient can see it easily
    C. Being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care
    D. Preventing sensory deprivation by placing the patient near the nurses' station and leaving the television and multiple lights turned on 24 hours per day
    E. Speaking with the patient frequently for short periods for reassurance, assisting the patient in remaining oriented, and ensuring the patient's safety
    F. Anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering
    G. Promoting normalized sleep patterns by encouraging the patient to remain awake during the day and facilitating rest at night
    • B. Assuring that a clock and a sign indicating the day and date is displayed where the patient can see it easily
    • C. Being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care
    • E. Speaking with the patient frequently for short periods for reassurance, assisting the patient in remaining oriented, and ensuring the patient's safety
    • F. Anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering
    • G. Promoting normalized sleep patterns by encouraging the patient to remain awake during the day and facilitating rest at night
  3. Which statement about dementia is accurate?
    A. Majority of people over age 85 are affected by dementia
    B. Disorientation is the dominant and most disruptive symptom of dementia
    C. People with dementia tend to be distressed by it and complain about its symptoms
    D. Hypertension, diminished activity levels, and head injury increases the risk of dementia
    D. Hypertension, diminished activity levels, and head injury increases the risk of dementia
    (this multiple choice question has been scrambled)
  4. Mrs. Smith does at the age of 82. In the 2 months following her death, her husband, aged 84 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate?
    A. Meet with family and support persons to help them accept, anticipate, and prepare for the progression on his stage II dementia
    B. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression
    C. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him.
    D. Avoid touch and proximity; these are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented
    B. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression
    (this multiple choice question has been scrambled)
  5. Which of the following intervention(s) would be beneficial for those caring for a loved one with Alzheimer's disease? Select all that apply.
    A. Guide the family to restrict the patient's driving as soon as signs of the forgetfulness are exhibited
    B. Recommend switching to hospital-type gowns to facilitate bathing, dressing, and other physical care of the patient
    C. Discourage wandering by installing complex locks or locks placed at the tops of the doors where the patient cannot readily reach them.
    D. For situations in which the patient becomes upset, teach loved ones to listen briefly, provide support, and then change the topic
    E. Encourage caregivers to care for themselves, as well as the patient, via use of support resources such as adult day care or respite care
    F. If the patient is prone to wander away, encourage family to notify police and neighbors of the patient's condition, wandering behavior, and description
    • D. For situations in which the patient becomes upset, teach loved ones to listen briefly, provide support, and then change the topic
    • E. Encourage caregivers to care for themselves, as well as the patient, via use of support resources such as adult day care or respite care
    • F. If the patient is prone to wander away, encourage family to notify police and neighbors of the patient's condition, wandering behavior, and description
  6. A patient complains that most staff do not like her or care what happens to her, but you are special and she can tell that you are a caring person. She talks with you about being unsure of what she wants to do with her life and her "mixed-up feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it "makes the numbness stop". Given this presentation, you would deduce that this patient most likely has which personality disorder?
    A. Histrionic
    B. Borderline
    C. Dependent
    D. Schiotypal
    B. Borderline
    (this multiple choice question has been scrambled)
  7. Which statement about persons with personality disorders is accurate?
    A. They, unlike those with mood or psychotic disorders, are at very low risk of suicide
    B. They tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them
    C. Their symptoms are not as disabling as most other mental disorders; therefore, their care tends to be less challenging and complicated for staff
    D. They are believed to be purely psychological disorders that is, disorders arising form psychological abnormalities
    B. They tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them
    (this multiple choice question has been scrambled)
  8. A patient shows the nurse multiple fresh, serious (but non-life-threatening) self-inflicted cuts on her forearm. Which response would be most therapeutic?
    A. Recognizing that the injury is, at its heart, a maladaptive attempt to obtain attention, extinguish the behavior by minimizing the attention paid to it
    B. Convey empathy and explore issues that led to the self injury as you administer first-aid to the wounds
    C. Care for the wounds, then search the patient for sharp objects, and place the patient on one-to-one observation or in seclusion for her own safety
    D. Maintain a neutral demeanor while dressing the wounds, and then assign the patient to write a list of circumstances that led to the injury before discussing it further
    D. Maintain a neutral demeanor while dressing the wounds, and then assign the patient to write a list of circumstances that led to the injury before discussing it further
    (this multiple choice question has been scrambled)
  9. A patient is flirting with a peer and is overheard asking him to intercede with staff so that she will be given privileges to leave the inpatient mental health unit. Later she offers a backrub to a nurse if that nurse will give her the prn sedation at 9:00pm that is not ordered until 10:00pm. Which response(s) to such behaviors would be most therapeutic? Select all that apply.
    A. Label the behavior as undesirable, and explore with the patient more effective ways to meet her needs
    B. By role playing, demonstrate other approaches the patient could use to meet her needs
    C. Advise the other patients that this patient is being manipulative and that they should ignore the patient when she behaves this way
    D. Bargain with the patient to determine a reasonable compromise regarding how much of such behavior is acceptable before the patient crosses the line
    E. Explain that such behavior is unacceptable, and give the patient specific examples of consequences that will be enacted if the behavior continues
    F. Ignore the behavior for the time being so the patient will find it unrewarding and in turn seek other, and hopefully more adaptive, ways to meet her needs
    • A. Label the behavior as undesirable, and explore with the patient more effective ways to meet her needs
    • B. By role playing, demonstrate other approaches the patient could use to meet her needs
    • E. Explain that such behavior is unacceptable, and give the patient specific examples of consequences that will be enacted if the behavior continues
  10. A patient becomes angry and frustrated when trying to get his MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which intervention(s) would be the most therapeutic? Select all that apply.
    A. Place the patient on seclusion for 1 hour to allow them to De-escalate
    B. Tell the patient that any further outbursts will result in a loss of privileges
    C. Offer to help the patient learn how to operate his music player and headset
    D. Explore with the patient how he was feeling as he worked with the music player
    E. Point out the consequences of such behavior, and note that it cannot be tolerated
    F. Limit the patient's exposure to frustrating experiences until he attains improved coping skills
    G. Encourage the patient to recognize signs of mounting tension and seek assistance
    • D. Explore with the patient how he was feeling as he worked with the music player
    • F. Limit the patient's exposure to frustrating experiences until he attains improved coping skills
    • G. Encourage the patient to recognize signs of mounting tension and seek assistance
  11. The nurse is assessing a teenage patient for suicidal risk. Which patient statement would require immediate further nursing assessment?
    A. My mom keeps a bunch of pills in her nightstand
    B. I've never tried to kill myself before
    C. The idea of death really scares me
    D. I only smoked one time in my life
    A. My mom keeps a bunch of pills in her nightstand
    (this multiple choice question has been scrambled)
  12. The nurse is preparing to assess a child who primarily speaks Spanish but is fluent in English. Which is the appropriate method for gathering information?
    A. Begin the assessment in English
    B. Obtain on interpreter who is fluent in Spanish
    C. Ask the child if he understands English
    D. Utilize a Spanish dictionary to ask questions of the child
    C. Ask the child if he understands English
    (this multiple choice question has been scrambled)
  13. A 7-year old male who has met earlier normal expectations in cognitive and language development develops a fascination with the bus schedule in his neighborhood and has difficulty establishing friendships with other school children. Which condition should the nurse anticipate?
    A. Severe autism
    B. Mild autism
    C. Rhett's disorder
    D. Asperger's disorder
    D. Asperger's disorder
    (this multiple choice question has been scrambled)
  14. The nurse is caring for a patient with attention deficet hyperactivity disorder (ADHD). Which medication order should the nurse question?
    A. Lithobid (lithium)
    B. Strattera (atomoxitine)
    C. Concerta (methylphenidate)
    D. Wellbutrin (bupropion)
    A. Lithobid (lithium)
    (this multiple choice question has been scrambled)
  15. The nurse is caring for a 9-year old who will be entering the freedom room. Which activity should the nurse anticipate the child would engage in?
    A. Punching soft objects
    B. Throwing pillows
    C. Sitting in the periphery of the room
    D. Listening to a CD
    D. Listening to a CD
    (this multiple choice question has been scrambled)

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