SUBSTANCE ABUSE
Ellie presents in the emergency department loudly proclaiming with rapid speech, “If I don’t get more pain medication right now, I’m going to call the attorney general and sue the entire health care network.” Which of the following should be included in initial screening and assessment? (Select all that apply.)
a. Substance use
b. Pain
c. Mental Illness
d. Prior history of convictions
e. Availability of an inpatient psychiatric bed
a. Substance use
b. Pain
c. Mental Illness
John, a veteran of the war in Iraq, is diagnosed with PTSD. He says to the nurse, “I can’t figure out why God took my buddy instead of me.” From this statement, the nurse assesses which of the following in John?
a. Repressed anger
b. Survivor’s guilt
c. Intrusive thoughts
d. Spiritual distress
b. Survivor’s guilt
Sharon, a woman with multiple cuts and abrasions, arrives at the emergency department with her three small children. She tells the nurse that her husband inflicted these wounds on her. She says, “I didn’t want to come. I’m really okay. He only does this when he has too much to drink. I just shouldn’t have yelled at him.” Which of the following is the best response by the nurse?
a. “How often does he drink too much?”
b. “It is not your fault. You did the right thing by coming here.”
c. “How many times has he done this to you?”
d. “He is not a good husband. You have to leave him before he kills you.”
b. “It is not your fault. You did the right thing by coming here.”
Which of the following individuals demonstrates the highest number of risk factors for suicide?
a. John, who reports that he is in deep emotional pain, feels hopeless, and says “No one is there for me.”
b. Kelly, who has been seeing a doctor for chronic, intractable pain, verbalizes a deep commitment to her religious faith and is taking pain medication.
c. Jim, an American Indian, who graduated from high school with honors but does not yet have a job.
d. Mike, a physician, who reports feeling “burnt out” and is considering retirement.
a. John, who reports that he is in deep emotional pain, feels hopeless, and says “No one is there for me.”
Which of the following is a correct assumption regarding the concept of crisis?
a. Crises occur only in individuals with psychopathology.
b. The stressful event that precipitates crisis is seldom identifiable.
c. A crisis situation contains the potential for psychological growth or deterioration.
d. Crises are chronic situations that recur many times during an individual’s life.
c. A crisis situation contains the potential for psychological growth or deterioration.
When Shelly enters the emergency department she reports, “My bed is on fire, and my stomach, and we’re all dead.” The nurse’s initial response is to call the psychiatric unit to secure an inpatient bed for this patient. This is an example of:
a. Prompt, appropriate referral
b. Patient-centered care
c. Stigma
d. Collaboration
c. Stigma
John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. Which of the following is the nurse’s most appropriate initial intervention?
a. Administer alprazolam as ordered prn for anxiety.
b. Call the physician and report the incident.
c. Stay with John and reassure him of his safety.
d. Have John listen to a tape of relaxation exercises.
c. Stay with John and reassure him of his safety.
A battered woman presents to the emergency department with multiple cuts and abrasions. Her right eye is swollen shut. She says that her husband did this to her. Which of the following is the priority nursing intervention?
a. Tending to the immediate care of her wounds
b. Providing her with information about a safe place to stay
c. Administering the prn tranquilizer ordered by the physician
d. Explaining how she may go about bringing charges against her husband
a. Tending to the immediate care of her wounds
The nurse in the emergency department encounters a patient, Niko, who is expressing suicide ideation. The nurse recognizes that which of the following considerations are important to good suicide risk assessment? (Select all that apply.)
a. Collaborating with the patient
b. Asking specific questions about leisure activities
c. Establishing trust and open communication with the patient
d. Asking the patient specific questions about the strength of his intention to die
e. Identifying whether the patient has thought about a plan for trying to kill himself
a. Collaborating with the patient
c. Establishing trust and open communication with the patient
d. Asking the patient specific questions about the strength of his intention to die
e. Identifying whether the patient has thought about a plan for trying to kill himself
Crises occur when an individual:
a. Is exposed to a precipitating stressor.
b. Perceives a stressor to be threatening.
c. Has no support systems.
d. Experiences a stressor and perceives coping strategies to be ineffective.
d. Experiences a stressor and perceives coping strategies to be ineffective.
Adam was admitted to the ICU after a single car accident in which he struck a cement wall. He is now responsive and wants to be discharged within the next couple of days. Which of the following are priorities for screening? (Select all that apply.)
a. Traumatic brain injury
b. Chronic pain
c. Sexual dysfunction
d. Depression and risk for suicide
a. Traumatic brain injury
d. Depression and risk for suicide
John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regimens would most appropriately be ordered for John?
a. Paroxetine and group therapy
b. Diazepam and implosion therapy
c. Alprazolam and behavior therapy
d. Carbamazepine and cognitive therapy
a. Paroxetine and group therapy
A woman who has a long history of being battered by her husband is staying at the woman’s shelter. She has received emotional support from staff and peers and has been made aware of the alternatives open to her. Nevertheless, she decides to return to her home and marriage. Which of the following is the best response by the nurse to the woman’s decision?
a. “I just can’t believe you have decided to go back to that horrible man.”
b. “I’m just afraid he will kill you or the children when you go back.”
c. “What makes you think things have changed with him?”
d. “I hope you have made the right decision. Call this number if you need help.”
d. “I hope you have made the right decision. Call this number if you need help.”
Theresa, age 27, was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone (Desyrel). She says to the nurse, “My boyfriend broke up with me. We had been together for 6 years. I love him so much. I know I’ll never get over him.” Which is the best response by the nurse?
a. “You’ll get over him in time, Theresa.”
b. “Forget him. There are other fish in the sea.”
c. “You must be feeling very sad about your loss.”
d. “Why do you think he broke up with you, Theresa?”
c. “You must be feeling very sad about your loss.”
Amanda’s mobile home was destroyed by a tornado. Amanda received only minor injuries but is experiencing disabling anxiety in the aftermath of the event. What is this type of crisis called?
a. Crisis resulting from traumatic stress
b. Maturational or developmental crisis
c. Dispositional crisis
d. Crisis of anticipated life transitions
a. Crisis resulting from traumatic stress
The nurse manager recognizes a need to improve mental health and substance use screening and referral services for their clients in the public health clinic. Which of the following is a priority to begin an effective process for implementation?
a. Provide a list of referral sources that is readily available to staff.
b. Educate staff about the importance of prioritizing these public health concerns.
c. Explore the literature for evidence-based screening tools.
d. Inform the staff that they have been stigmatizing patients and this will not be tolerated.
b. Educate staff about the importance of prioritizing these public health concerns.
Shane, a patient diagnosed with PTSD tells the nurse that his social worker is recommending EMDR and asks the nurse to describe this treatment. Which of these is the most accurate response?
a. EMDR is a therapy designed to help you process thoughts and emotions related to the trauma you’ve experienced.
b. EMDR is a treatment to cure insomnia using hypnosis.
c. EMDR is a treatment that uses electrical stimulation to induce a seizure and is beneficial in relieving depression associated with PTSD.
d. EMDR is an acronym that stands for Emotional Motivation to Decrease Responsiveness and it will help you forget the trauma.
a. EMDR is a therapy designed to help you process thoughts and emotions related to the trauma you’ve experienced.
A school nurse notices bruises and scars on Jana’s body. The nurse suspects that the child is being physically abused. How should the nurse proceed with this information?
a. As a healthcare worker, report the suspicion to child protective services.
b. Check Jana again in a week and see if there are any new bruises.
c. Meet with Jana’s parents and ask them how Jana got the bruises.
d. Initiate paperwork to have Jana placed in foster care.
a. As a healthcare worker, report the suspicion to child protective services.
The nurse identifies the primary nursing diagnosis for Theresa as “Risk for Suicide related to feelings of hopelessness from loss of relationship.” Which is the outcome that would be most appropriate for this diagnosis?
a. The patient has experienced no physical harm to herself.
b. The patient sets realistic goals for herself.
c. The patient expresses some optimism and hope for the future.
d. The patient has reached a stage of acceptance in the loss of the relationship with her boyfriend.
a. The patient has experienced no physical harm to herself.
Which of the following is the desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety?
a. The individual will experience no anxiety.
b. The individual will demonstrate hope for the future.
c. The individual will identify that anxiety is at a manageable level.
d. The individual will verbalize acceptance of self as worthy.
c. The individual will identify that anxiety is at a manageable level.
Mr. Li is a patient on a medical unit and is identified as having suicidal ideation. Which of the following is a priority in managing his immediate care?
a. Screen for depression
b. Provide sedative medication
c. Refer him to another setting
d. Continuous monitoring and observation
d. Continuous monitoring and observation
Nina, who is depressed following the breakup of a very stormy marriage, says to the nurse, “I feel so bad. I thought I would feel better once I left, but I feel worse!” Which is the best response by the nurse?
a. “Cheer up, Nina. You have a lot to be happy about.”
b. “You are grieving the loss of your marriage. It’s natural for you to feel bad.”
c. “Try not to dwell on how you feel. If you don’t think about it, you’ll feel better.”
d. “You did the right thing, Nina. Knowing that should make you feel better.”
b. “You are grieving the loss of your marriage. It’s natural for you to feel bad.”
A young woman who was a recent victim of a sexual assault is brought into the emergency department by a friend. Which of the following is the priority nursing intervention?
a. Help her to bathe and clean herself up.
b. Provide physical and emotional support during evidence collection.
c. Provide her with a written list of community resources for survivors of rape.
d. Discuss the importance of a follow-up visit to evaluate for sexually transmitted diseases.
b. Provide physical and emotional support during evidence collection.
Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Theresa says to the nurse, “When I get out of here, I’m going to try this again, and next time I’ll choose a no-fail method.” Which is the best response by the nurse?
a. “You are safe here. We will make sure nothing happens to you.”
b. “You’re just lucky your roommate came home when she did.”
c. “What exactly do you plan to do?”
d. “I don’t understand. You have so much to live for.”
c. “What exactly do you plan to do?”
Andrew, a firefighter, and his entire unit responded to the aftermath of an earthquake. Working as a team, he and his best friend, Carlo, entered a building together to search for survivors. Carlo was killed when the building collapsed. Andrew was injured but survived. Since that time, Andrew has had frequent nightmares and anxiety attacks. He says to the mental health worker, “I don’t know why Carlo had to die and I didn’t!” This statement by Andrew suggests that he is experiencing:
a. Spiritual distress.
b. Night terrors.
c. Survivor’s guilt.
d. Suicidal ideation.
c. Survivor’s guilt.