Chapter 12 & Review 22
Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student’s crisis?
A. The time of year in which the event occurred
B. The presence of support systems
C. A lack of adequate coping mechanisms
D. The individual’s family birth order
What is A lack of adequate coping mechanisms?
Correct Answer: C
Adequate coping mechanisms can influence the development of a crisis.
If a person can draw on past successful coping strategies, a crisis may be diverted.
The second student had a lack of adequate coping mechanisms.
Which is a misconception about suicide?
A. Eight out of 10 individuals who commit suicide give warnings about their intentions.
B. Most suicidal individuals are ambivalent about their feelings regarding suicide.
C. Most individuals commit suicide by taking an overdose of drugs.
D. Initial mood improvement can precipitate suicide.
What is Most individuals commit suicide by taking an overdose of drugs?
Correct Answer: C
§It is a misconception that individuals usually commit suicide by taking an overdose of drugs.
§Gunshot wounds are the leading cause of death among suicide victims.
An individual experienced the death of a parent 2 years ago. This individual has not been able to work since the death, cannot look at any of the parent’s belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately describes this individual’s problem?
A. Post-trauma syndrome related to parent’s death
B. Anxiety (severe) related to parent’s death
C. Coping, ineffective related to parent’s death
D. Grieving, complicated related to parent’s death
What is Grieving, complicated related to parent’s death?
Correct Answer: D
§The excessive reactions the individual continues to exhibit, such as daily crying, inability to return to work, and inability to look at parent’s belongings after a 2-year period, are indicative of dysfunctional or complicated grieving.
§This individual’s grieving response has arrested in the anger stage, is being turned inward on the self, and is manifested by symptoms of depression.
A client diagnosed with obsessive-compulsive disorder (OCD) reports to the nurse that he can’t stop thinking about all the potentially life-threatening germs in the environment. Which is the most accurate way for the nurse to document this symptom?
A. Client is expressing an obsession with germs.
B. Client is manifesting compulsive thinking.
C. Client is expressing delusional thinking about germs.
D. Client is manifesting arachnophobia of germs.
What is Client is expressing an obsession with germs?
Correct Answer: A
A. This is correct. The client is expressing an obsession with germs. Obsessions are unwanted, intrusive, repetitive thoughts.
B. This is incorrect. Compulsions are unwanted, repetitive behavior patterns in response to obsessive thoughts that are efforts to reduce anxiety.
C. This is incorrect. Delusions are false, fixed beliefs.
D. This is incorrect. Arachnophobia is a fear of spiders.
A client has experienced the death of a close family member and at the same time becomes unemployed. The client’s 6-month score on the Recent Life Changes Questionnaire is 110. The nurse:
A. Understands the client is at risk for significant stress-related illness.
B. Determines the client is not at risk for significant stress-related illness.
C. Needs further assessment of the client’s coping skills to determine susceptibility to stress-related illness.
D. Recognizes the client may view the losses as challenges and perceive them as opportunities.
What is Needs further assessment of the client’s coping skills to determine susceptibility to stress-related illness?
Correct Answer: C
A. This is incorrect. Assessment is the first step of the nursing process. The nurse should assess the client’s coping skills and available support before determining susceptibility to stress-related physical and psychological illnesses. The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more or a year-score total of 500 or more indicates high stress in a client’s life and susceptibility to stress-related illnesses.
B. This is incorrect. Assessment is the first step in the nursing process. The nurse should assess the client’s coping skills and available support before determining the client’s perception of the current stresses. A 6-month score of 300 or more or a year-score total of 500 or more on the Recent Life Changes Questionnaire indicates high stress in a client’s life and susceptibility to stress-related physical and psychological illnesses.
C. This is correct. Assessment is the first step in the nursing process. The nurse should assess the client’s coping skills and available support before determining susceptibility to stress-related physical and psychological illnesses. A 6-month score of 300 or more or a year-score of 500 or more indicates high stress in a client’s life and risk for significant stress-related physical and psychological illness.
D. This is incorrect. Assessment is the first step in the nursing process. The nurse should assess the client’s coping skills and available support before determining susceptibility to stress-related illness. A 6-month score of 300 or more or a year-score of 500 or more on the Recent Life Changes Questionnaire indicates high stress in a client’s life is susceptible to significant stress-related physical and psychological illness.
For the past 3 days, a student has skipped classes, cried constantly, experienced panic attacks, and is now exhibiting difficulty with short-term memory. In her assessment of this student, what crucial information should the nurse initially obtain prior to planning interventions?
A. The student’s description of the precipitating stressor
B. The student’s usual ability to cope with stress
C. The student’s available support system
D. The student’s access to community resources
What is The student’s description of the precipitating stressor?
Correct Answer: A
It is important to assess the precipitating stressor that led to the student’s behavioral symptoms.
This data will be crucial when planning client care.
The nurse is caring for an actively suicidal client on the psychiatric unit. What is the nurse’s priority intervention?
A. Discuss strategies for the management of anxiety, anger, and frustration.
B. Provide opportunities for increasing the client’s self-worth, morale, and control.
C. Place client on suicide precautions with one-to-one observation.
D. Explore experiences that affirm self-worth and self-efficacy.
What is Place client on suicide precautions with one-to-one observation?
Correct Answer: C
§Placing the client on suicide precautions with one-to-one observation provides a safe environment for an actively suicidal client.
§Maintaining client safety should always be a priority nursing intervention.
When teaching about the tricyclic group of
antidepressant medications, which information should the nurse include?
A. Strong or aged cheese should not be eaten while taking this group of medications.
B. The full therapeutic potential of tricyclics may not be reached for 4 weeks.
C. Long-term use may result in physical dependence.
D. Tricyclics should not be given with anti-anxiety agents.
What is The full therapeutic potential of tricyclics may not be reached for 4 weeks?
Correct Answer: B
A patient needs to be advised that it may take several weeks for tricyclic medications to reach their full therapeutic effect and for relief of symptoms to be noted.
The client is an older adult who suffers from dementia. The nurse visits with the client and listens as she flips through a photo album and recounts stories from her past. The client is engaged in ____________________ therapy.
What is reminiscence?
Reminiscence therapy is the use of life histories—written or oral or both—to improve psychological well-being. This type of therapy is beneficial for older adults suffering from dementia and other cognitive deficits.
A client has recently been placed in a long-term care facility because of marked confusion and inability to perform most activities of daily living. Which nursing intervention is most appropriate to maintain the client’s self-esteem?
A. Leave the client alone in the bathroom.
B. Assign a variety of caregivers.
C. Allow the client to choose between two different outfits.
D. Modify the daily schedule often to maintain variety.
What is Allow the client to choose between two different outfits?
Correct Answer: C
A. This is incorrect. The nurse should provide appropriate supervision to keep the client safe.
B. This is incorrect. The nurse should maintain consistency of caregivers.
C. This is correct. The most appropriate nursing intervention to maintain this client’s self-esteem is to allow the client to choose between two different outfits when dressing for the day.
D. This is incorrect. The nurse should maintain a structured daily routine to minimize confusion.
Which student statement indicates that learning has occurred regarding risk factors for the development of delirium in older adults?
A. “Taking multiple medications may lead to adverse interactions or toxicity.”
B. “Age-related cognitive changes may lead to alterations in mental status.”
C. “Lack of rigorous exercise may lead to decreased cerebral blood flow.”
D. “Decreased social interaction may lead to profound isolation and psychosis.”
What is “Taking multiple medications may lead to adverse interactions or toxicity.”?
Correct Answer: A
A. This is correct. Taking multiple medications may lead to adverse reactions or toxicity and put an older adult at risk for the development of delirium. Symptoms of delirium include difficulty sustaining and shifting attention, impaired memory, and confusion (disorientation to time and place).
B. This is incorrect. Age-related cognitive changes do not lead to delirium.
C. This is incorrect. Lack of rigorous exercise does not lead to a decrease in cerebral blood flow.
D. This is incorrect. Decreased social isolation does not lead to profound isolation and psychosis; an increase in isolation does this.
A client with a history of a suicide attempt has been discharged and is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client?
A. Provide the client with a safe and structured environment.
B. Isolate the client from all stressful situations that may precipitate a suicide attempt.
C. Observe the client continuously to prevent self-harm.
D. Assist the client to develop more effective coping mechanisms.
What is Assist the client to develop more effective coping mechanisms?
Correct Answer: D
Assisting the client to develop more effective coping mechanisms is a nursing intervention that can and should be implemented in outpatient settings as ongoing follow-up.
A patient has been diagnosed with major depression. The psychiatrist prescribes Paroxetine (Paxil). Which of the following medication information should the nurse include in discharge teaching?
A. Do not eat chocolate while taking this medication.
B. The medication may cause priapism.
C. The medication should not be discontinued abruptly.
D. The medication may cause photosensitivity
What is The medication should not be discontinued abruptly?
Correct Answer: C
§Antidepressants, such as paroxetine, must be tapered and not stopped abruptly.
§All classifications of antidepressants have varying potentials to cause discontinuation syndromes.
§Abrupt withdrawal from SSRIs, such as paroxetine, may result in dizziness, lethargy, headache, and nausea.
Studies have suggested that reexperiencing a traumatic event can become an addiction of sorts. The evidence suggests that the reason for this is which of the following?
A. Those with addictive personalities tend to experience PTSD more often.
B. Perpetuating the traumatic experience yields secondary gains.
C. The reexperiencing of trauma enhances production of endogenous opioid peptides.
D. Concurrent substance abuse issues are symptoms of PTSD.
What is The reexperiencing of trauma enhances production of endogenous opioid peptides?
Correct Answer: C
A. This is incorrect. There are no data that correlate with this statement.
B. This is incorrect. There are no data that state secondary gains, or the advantage that occurs secondary to the illness, occurs with perpetuating the trauma.
C. This is correct. There is a biological aspect to reexperiencing a traumatic event.
D. This is incorrect. This is too general of a statement, as there are no data that corroborate this statement. (PTSD can occur without substance abuse and vice versa.)
A cab driver stuck in traffic is suddenly lightheaded, tremulous, and diaphoretic and experiences tachycardia and dyspnea. An extensive work-up in an emergency department reveals no pathology. Which medical diagnosis is suspected, and which nursing diagnosis is the priority?
A. Generalized anxiety disorder (GAD) and a nursing diagnosis of fear
B. Altered sensory perception and a nursing diagnosis of panic disorder
C. Pain disorder and a nursing diagnosis of altered role performance
D. Panic disorder and a nursing diagnosis of panic anxiety
What is Panic disorder and a nursing diagnosis of panic anxiety?
Correct Answer: D
A. This is incorrect. The client exhibited signs and symptoms of a panic disorder rather than GAD. The priority nursing diagnosis is not fear.
B. This is incorrect. The client exhibited signs and symptoms of a panic disorder rather than altered sensory perception. The priority nursing diagnosis is panic anxiety, not panic disorder.
C. This is incorrect. The client exhibited signs and symptoms of a panic disorder rather than a pain disorder. The priority nursing diagnosis is not altered role performance but panic anxiety.
D. This is correct. The client exhibited signs and symptoms of a panic disorder. The priority nursing diagnosis is panic anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror.
A client is experiencing progressive changes in memory that have interfered with personal, social, and occupational functioning. The client exhibits poor judgment and has a short attention span. The nurse recognizes these as classic signs of which condition?
A. Mania
B. Delirium
C. NCD
D. Parkinsonism
What is NCD?
Correct Answer: C
A. This is incorrect. The client is not exhibiting symptoms of mania.
B. This is incorrect. These are not symptoms consistent with delirium.
C. This is correct. The client is exhibiting signs of an NCD, which is characterized by impairment in abstract thinking, judgment, and impulse control. Behavior may be uninhibited and inappropriate.
D. This is incorrect. These are not symptoms consistent with Parkinson’s disease.
A nurse discovers a client’s suicide note that details the time, place, and means to commit suicide. What is the priority nursing intervention and accompanying rationale for this action?
A. Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note
B. Establishing room restrictions, because the client’s threat is an attempt to manipulate the staff
C. Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide
D. Calling an emergency treatment team meeting, because the client’s threat must be addressed
What is Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide?
Correct Answer: C
A. This is incorrect. Administering Ativan does not address the client’s situation, and there is no indication the client is upset about the note being discovered.
B. This is incorrect. Room restrictions are not appropriate for the suicidal client and there is no indication of manipulation.
C. This is correct. The priority nursing action is to place the client on one-to-one suicide precautions. A client with a specific plan is at very high risk of attempting suicide. The appropriate nursing diagnosis for this client is “risk for suicide.”
D. This is incorrect. An emergency team meeting is unnecessary; the client’s safety needs can be addressed with one-to-one precautions.
A client is diagnosed with persistent depressive disorder (PDD) (dysthymia). Which should the nurse classify as an affective symptom of this disorder?
A. Social isolation with a focus on self
B. Low energy level
C. Difficulty concentrating
D. Gloomy and pessimistic outlook on life
What is a Gloomy and pessimistic outlook on life?
Correct Answer: D
A. This is incorrect. Social isolation is a behavioral symptom.
B. This is incorrect. This is a physiological symptom of depression.
C. This is incorrect. Difficulty concentrating is a cognitive symptom.
D. This is correct. Symptoms of depression can be described as alterations in four areas of human functions: affective, behavioral, cognitive, and physiological. A gloomy and pessimistic outlook on life is an affective symptom of dysthymia. Affective symptoms are those that relate to the mood.
Which concepts are included in Hobfoll’s Conservation of Resources theory? Select all that apply.
A. Availability of resources
B. Disequilibrium
C. Genetics
D. Past experiences
E. Resilience
What are A, C, D?
Correct Answers: A, C & D
A. This is correct. Hobfoll’s Conservation of Resources theory asserts a variety of elements influence an individual’s perception and response to a stressful event. Available resources affect an individual’s perception of adaptive capabilities.
B. This is incorrect. Disequilibrium is not included as part of Hobfoll’s theory.
C. This is correct. Hobfoll’s Conservation of Resources theory asserts that a variety of elements influence an individual’s perception and response to a stressful event. Predisposing factors strongly influence whether the response is adaptive or maladaptive. These include genetic influences, past experiences, and existing conditions.
D. This is correct. Hobfoll’s Conservation of Resources theory asserts that a variety of elements influence an individual’s perception and response to a stressful event. These include genetic influences, past experiences, and existing conditions. An individual who experiences stress in the present becomes more vulnerable to future stress when there is a loss or lack of resources.
E. This is incorrect. Resilience is not included as part of Hobfoll’s theory.
A 56-year-old is brought to the emergency department by the police because she was found wandering confusedly in a busy shopping center several miles from her home. The nurse assesses the client and finds that she has been the victim of domestic violence for 32 years and has recently been beaten by her spouse. Her recollection of current events is hazy and she is not able to give the nurse a detailed account of the abuse. Which of the client’s symptoms cause the nurse to suspect that she is suffering from dissociative fugue? Select all that apply.
A. Her trip to a shopping center several miles from her home
B. The client’s confused wandering
C. Her ability to stay with an abuser all these years
D. The client’s inability to offer details about the domestic abuse
E. Her inability to focus on the questioning
What are A, B & D?
Correct answers: A, B & D
A. This is correct. Dissociative fugue can cause the client to travel suddenly and unexpectedly away from customary places.
B. This is correct. Clients who exhibit dissociative fugue may engage in confused or bewildered wandering.
C. This is incorrect. The client’s ability to sustain abuse is not associated with dissociative fugue.
D. This is correct. Clients with dissociative fugue are often unable to recall some or all of their past. These clients may not be able to recall personal identity and sometimes assume a new identity.
E. This is incorrect. Clients who experience dissociative fugue are able to focus on tasks, but they may not have the memory to offer details about their past.
A nursing instructor is teaching about donepezil. A student asks, “How does this work? Will this cure Alzheimer’s disease?” Which reply by the instructor is appropriate?
A. “Donepezil delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease.”
B. “Donepezil encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease.”
C. “Donepezil delays the destruction of dopamine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease.”
D. “Donepezil encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease.”
What is “Donepezil delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease.”?
Correct Answer: A
A. This is correct. Donepezil slows the progression of Alzheimer’s disease by inhibiting acetylcholinesterase, which delays the destruction of the neurotransmitter acetylcholine, which is necessary for memory processes.
B. This is incorrect. Donepezil does not encourage production of acetylcholinesterase; rather, it inhibits the production.
C. This is incorrect. Donepezil does not delay the destruction of dopamine.
D. This is incorrect. Donepezil does not encourage the production of dopamine, but inhibits acetylcholinesterase.
According to the Three-Step Theory, when strong, active suicide ideation is present:
A. An attempt occurs usually within 3 to 6 months of the initial ideation.
B. Pain management usually prevents escalation to an attempt.
C. It leads to an attempt only if the individual has the capacity to make an attempt.
D. Connectedness to family typically resolves any attempt.
What is It leads to an attempt only if the individual has the capacity to make an attempt?
Correct Answer: C
A. This is incorrect. The Three-Step Theory makes no mention of any timeline associated with ideation and attempt.
B. This is incorrect. Pain is found in the first step of the Three-Step Theory. Pain when combined with hopelessness significantly increases suicide ideation. The question states that a strong, active suicide ideation is already present.
C. This is correct. The Three-Step Theory mentions that when a strong, active ideation is present, it leads to an attempt if the capacity to make the attempt is present.
D. This is incorrect. This is the second step of the Three-Step Theory. Connectedness prevents suicide ideation from escalating in those at risk, but when pain and hopelessness exceed one’s sense of connectedness to others, suicide ideation becomes active.
The psychiatric-mental health nurse is creating a plan of care for a child diagnosed with a depressive disorder. The parents report the child does not seem to know how to make friends and does not seem to be doing as well in school as a family member who is in the same grade. Recently, their child started picking fights while waiting for the bus. The nurse recognizes that the child’s depressive symptoms occur among which age group?
A. 3 to 5 years
B. 6 to 8 years
C. 9 to 12 years
D. 11 to 14 years
What is 6 to 8 years?
Correct Answer: B
A. This is incorrect. Symptoms among children age 3 to 5 years may include accident proneness, phobias, aggressiveness, and excessive self-reproach for minor infractions. Mood congruent auditory hallucinations may also occur.
B. This is correct. Children ages 6 to 8 years may express vague physical complaints and display aggressive behavior. They often cling to parents, avoid new people and challenges, and lag behind their classmates in social skills and academic competence. MDD in children and adolescents can be identified using criteria similar to those used for adults. It is not uncommon, however, for the symptoms of depression to be manifested differently during different ages in childhood.
C. This is incorrect. Symptoms among children age 9 to 12 years include morbid thoughts, excessive worrying, poor self-esteem, and lack of interest in playing with friends.
D. This is incorrect. MDD in children and adolescents can be identified using criteria similar to those used for adults. It is not uncommon, however, for the symptoms of depression to be manifested differently during different ages in childhood.
Which student statement indicates an understanding regarding dissociative identity disorder (DID)?
A. “I suspect my client inherited this disease from his parent.”
B. “It is unlikely my client had a diagnosis of schizophrenia before DID, since the two do not go hand in hand.”
C. “My client experiences periods of blackouts, or lost time where he doesn’t know what happened during that time frame.”
D. “I assume my client has other personalities because he doesn’t want to deal with real life.”
What is “My client experiences periods of blackouts, or lost time where he doesn’t know what happened during that time frame.”?
Correct Answer: C
A. This is incorrect. The student does not understand the teaching if they think DID is genetic.
B. This is incorrect. The student does not understand the teaching if they think schizophrenia is not typically a prior diagnosis preceding DID.
C. This is correct. A client with DID typically has gaps in time, or blackouts, where they may wake up and not know what happened when they have personality splits. The student understands the teaching when they make this statement.
D. This is incorrect. This statement requires further teaching; a client develops DID to deal with past trauma.
An adolescent client who recently lost both parents in a tragic automobile accident has been diagnosed with an adjustment disorder after striking a friend who told the client that they needed to “get their feelings out.” The stage of grieving that this client is struggling with is ____________________.
What is anger?
The stages of grieving include denial, anger, bargaining, depression, and resolution.
The client is expressing anger but in a way that is impairing his relationships with others.