Chapter 36
A nurse asks an assigned client diagnosed with a tic disorder, "How are you doing today?" The client responds with "doing today, doing today, doing today." Which speech pattern disturbance is this an example of?
Echolalia
Which of the following conditions is characterized by multiple motor tics and one or more vocal tics many times throughout the day for 1 year or more?
Tourette's syndrome
A nurse is assessing a 78-year-old client who lives in a home alone. To assess the client's instrumental activities of daily living, which question would be most appropriate to ask?
“How often do you go to the store to buy groceries?”
Instrumental activities of daily living are part of the functional status assessment of older adults. These activities include shopping, talking on the telephone, and driving or using other transportation. Bathing, showering, dressing, and cooking are examples of activities of daily living.
ADLs (Activities of daily living) versus IADLs (Instrumental Activities of Daily Living)
IADLs: remember SHAFT - Shopping, Housekeeping (or housework), Accounting (or managing money), Food preparation, and Transportation
ADLs: bathe, walk, go to the bathroom, eat and take adequate rest
Cognitive disorders are characterized by what?
Impaired attention, memory, and abstract thinking
Cognitive mental disorders are characterized by a disruption of or deficit in cognitive function, which encompasses orientation, attention, memory, vocabulary, calculation ability, and abstract thinking.
After teaching a group of students about medications used to treat ADHD, the instructor determines that the education was successful when the group identifies atomoxetine as which of the following?
Noradrenergic reuptake inhibitor
Atomoxetine (Strattera), a noradrenergic reuptake inhibitor, is not classified as a stimulant and is effective in the treatment of ADHD. Antipsychotics are rarely used to treat ADHD. Methylphenidate is a stimulant. Alpha agonists include guanfacine and clonidine.
The parents of a child are concerned about their child's behavior now that the child has started school. The nurse assesses and evaluates the child. Which symptoms are characteristic of attention deficit hyperactivity disorder (ADHD)? Select all that apply.
Inattentiveness
Overactivity
Impulsiveness
A nurse is developing a presentation for an adolescent community group on mental health and illness, focusing on mood disorders. Which of the following would the nurse most likely include as a major mental health issue in adolescents?
Depression
The nurse is caring for a client diagnosed with dementia. Based on the nurse's understanding of dementia and the existence of other disorders, the nurse would be alert for signs and symptoms of which disorder?
Anxiety
In dementia, anxiety is very common. The Rating Anxiety in Dementia (RAID) scale was developed as a global scale to assess anxiety in patients with dementia (Shankar et al., 1999). The domains that the RAID scale assesses include worry, apprehension and vigilance, motor tension, autonomic hyperactivity, phobias, and panic attacks.
An 80-year-old client with Alzheimer's disease is prescribed donepezil. Which teaching points should the nurse provide to the client's spouse about the new medication?
"The drug won't cure the client's Alzheimer's, but it has the potential to slow down the progression of the disease."
Cholinesterase inhibitors such as donepezil cannot cure Alzheimer's disease, but they can slow the progression of the disease and can stabilize symptoms. The drug does not directly affect sleep patterns.
A child is diagnosed with attention deficit hyperactivity disorder and is to receive pharmacologic therapy. Which of the following would the nurse expect to be prescribed as a first line agent?
Atomoxetine
A nurse working on a unit for children with mental health issues understands the importance of assessing self-concept, even in young children. Some ways to do this when working with young children are which of the following? Select all that apply.
The parents of a toddler are distraught that he has been diagnosed with autism spectrum disorder. When providing teaching for the child's parents, which of the following would the nurse need to bear in mind about the etiology of this disorder?
The expression of multiple genes involved with neurogenesis seems to play a role.
The client is brought to the clinic with dementia and is unable to recognize ordinary objects, such as a pen or notebook. The family is upset and concerned. The nurse notes that this is a symptom of which condition?
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.
The psychiatric nurse documents that the cognitively impaired client is exhibiting "confabulation" when observed doing what?
Telling other clients that the client "was a dairy farmer" when the client actually ran a small grocery store
Confabulation is the filling in of memory gaps with false but sometimes plausible content to conceal the memory deficit, such as a client telling others that the client "was a dairy farmer" when the client actually ran a small grocery store. Evidence of perseveration is a client telling the staff repeatedly that "my name is George and I'm hungry." Sundown syndrome can be described as a client pacing nervously and resisting the staff's request to "get ready for bed." Concrete thinking is described when the client asks where the cats are when told it's "raining cats and dogs."
Which of the following is accurate with regard to suicide in older adults?
Rates increase with age
A nursing student has learned about attachment and how this emotional bond between infant and parent helps create the groundwork for future relationships. What statement made by this student indicates a need for further clarification from the instructor?
"Mother-child separation for 1 week or more within the first 2 years of life has been related to self-reliance on the child's part in later years."
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 and are formulating a collaborative plan. The child is experiencing signs of which disorder?
Conduct disorder
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. Oppositional defiant disorder 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 is characterized by inattentiveness, overactivity, and impulsiveness.
A family member of an older adult female client who lost her spouse two weeks ago tells the nurse the client has been agitated and not eating well. What should the nurse assess first?
The natural response to death.
Bereavement, a natural response to the death of a loved one, includes crying and sorrow, anxiety and agitation, insomnia, and loss of appetite. Although major depressive disorder and cognitive impairment are also associated with agitation and loss of appetite, there is a very recent death of a spouse in the case of this client. The nurse should first assess further for bereavement. There is no indication that the client is experiencing suicidal thinking, it would be appropriate to assess further for this if the nurse came to know other risk factors for suicide are also present.
A client has been admitted to an inpatient unit for treatment of delirium. Which of the following is the primary treatment for delirium?
Identify and treat any causal or contributing medical conditions
The primary treatment of delirium is to identify and treat any causal or contributing medical conditions.
The nurse is questioning the family of a client brought in with cognitive impairment as the nurse assesses and evaluates the client's condition. Which distinguishes delirium from dementia?
Dementia has a gradual onset and is progressive in course.
Delirium has a sudden onset, and the underlying cause is treatable or self-limiting; by contrast, dementia has a gradual onset and is progressive rather than treatable.
An assessment of a child is different from an assessment of adults. Which are included in the assessment of children and adolescents? Select all that apply.
language
emotional skills
social abilities
Assessment of children and adolescents requires the nurse to consider the child's developmental level, including language, cognitive, social, and emotional skills.
A child with attention deficit hyperactivity disorder is taking methylphenidate (Ritalin) in divided doses. If the child takes the first dose at 8 AM, the school nurse might expect to see which behavior occuring around noontime.
Lack of appetite
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.
A nurse is preparing a survey to help family members of older adults to determine if they are at risk for depression. Which question should the nurse include on the survey? Select all that apply.
"Has your family member retired recently?"
"Does your family member experience chronic pain?"
"Has your family member talked more about finalizing a will?"
Although retirement can symbolize a time to enjoy more personal freedom in later years of life, it can also bring a decreased sense of self-worth and finances. An impaired financial status and change in social roles should be viewed as risk factors for depression in older adults. Chronic pain is considered a risk factor in depression as it can lower the client's ability to cope with life stresses. The act of finalizing a will should be considered a risk factor not only for depression but also suicide for any older adult and warrants further exploration with the client. Older adults are less likely to report feelings of sadness or worthlessness than are younger adults. Normal cognitive changes during aging include the slowing of information processing and memory retrieval. It would not be useful to include asking about the client's memory on a survey seeking to identify risk factors of depression in the older adult.
A group of student nurses are reviewing diagnostic criteria for the clinical diagnosis of Alzheimer disease (AD). Which finding(s) indicates that a client may have AD? Select all that apply.
Unable to identify a pen
Unable to verbally communicate
Inability to use a telephone
Diagnostic criteria for AD is confirmed at autopsy, although there are clinical/behavioral findings such as aphasia, apraxia, agnosia, and/or a disturbance in executive functioning that can indicate clinical symptoms. The inability to identify a pen (agnosia), inability to verbally communicate (aphasia), and the inability to use a telephone (apraxia) supports AD. An abnormal chemistry profile is not directly correlated. Intact remote memory is a normal finding.
A nurse is reviewing a journal article about Huntington's disease and the role of genetics. The nurse demonstrates understanding of the information by identifying which type of genetic transmission as being seen in this condition.
Autosomal dominant
Huntington's disease is a progressive, genetically transmitted autosomal dominant disorder characterized by choreiform movements and mental abnormalities.