Violence/ Abuse
A married female client has been referred to the mental health center because she is depressed. The nurse notices bruises on her upper arms and asks about them. After denying any problems, the client starts to cry and says, "He did not really mean to hurt me, but I hate for the kids to see this. I am so worried about them." What is the most crucial information for the nurse to determine?
1. Type and extend of abuse occurring in the family
2. Potential of immediate danger to the client and children
3. Resources available to the client
4. Whether the client wants to be separated from her husband
2. Safety!
When collaborating with the health care provider to develop the plan of care for a child diagnosed with ADHD, the treatment plan will likely include which treatments?
1. Anti-anxiety medications such as buspirone and home schooling
2. Antidepressant medications such as imipramine and family therapy
3. Anti-convulsant medications such as carbamazepine and monthly blood levels
4. Psycho stimulant medications such as methylphenidate and behavior modification
Psycho-stimulant medications such as methylphenidate and behavior modification
The mother of an adolescent client who is diagnosed with oppositional defiant disorder tells the nurse that she has read extensively on the disorder and does not believe it is correct for her daughter. Which response by the nurse is appropriate?
1. “’It sounds like you’re very interested in your daughter. Let’s focus on what is best for her.”
2. “Tell me what you’ve found in your reading that’s leading you to that conclusion.”
3. “Your health care provider has had many years of education and experience, so you can believe he is right.”
4. “That doesn’t matter now because we just need to help her get better.”
2. “Tell me what you’ve found in your reading that’s leading you to that conclusion.”
An older adult experiences short term memory problems and occasional disorientation a few week's after her husband's death. She also is not sleeping, has urinary frequency and burning, and the woman's health care provider to discuss the client's situation and background, assess, and give recommendations. The nurse concludes that the client most likely has which problem?
1. Onset of Alzheimers
2. Trouble adjusting to living alone without her husband
3. Delayed grieving related to Alzheimers
4. Delirium and a UTI
4. Delirium and a UTI
A nurse calls the unit manager to report that her purse has been stolen from the locked break room. The nurse says she thinks she knows which of the staff stole the purse. Which actions by the nurse manager would be appropriate? Select all that apply.
1. Confront the person the nurse suspects
2. Call hospital security to initiate an investigation
3. Ask the nurse to document all the facts related to the incident
4. Alert nursing admin that a staff's purse has been stolen
5. Ask other staff to report any suspicious activity they may have observed.
2. Call hospital security to initiate an investigation
3. Ask the nurse to document all the facts related to the incident
4. Alert nursing admin that a staff's purse has been stolen
5. Ask other staff to report any suspicious activity they may have observed.
When planning the care for a client who is being abused, which measure is most important to include?
1. Being compassionate and empathetic
2. Teaching the client about abuse and the cycle of violence
3. Explaining to the client about their personal and legal rights
4. Helping the client develop a safety plan
4. Safety! Staying alive is crucial!
The nurse meets with the mother of a child diagnosed with ADHD. The mother states, "I feel so guilty that he has this disease, like I did something wrong. I feel like I need to be with him constantly in order for him to get better. But still sometimes I feel like I'm going to lose control and hurt him." The nurse should suggest which intervention to the mother?
1. Arranging for respite care to watch her child and give herself a regular break
2. Taking a job to allow herself to feel some success because her child will not ever improve
3. Arranging to have coffee with friends daily as a way to begin a support group
4. Considering foster care if she feels that she cannot handle her child's problems
1. Arranging for respite care to watch her child and give herself a regular break
The nurse is leading a group session for parents of children diagnosed with oppositional defiant disorder. The nurse should give which recommendation for discipline?
1. Avoid limiting the child's use of the television and computer for punishment.
2. Be consistent with discipline while assisting with ways for the child to more positively express anger and frustration.
3. Use primarily positive reinforcement for good behavior while ignoring any demonstrated bad behavior.
4. Use time out as the primary means of punishment for the child regardless of what the child has done.
2. Be consistent with discipline while assisting with ways for the child to more positively express anger and frustration.
The nurse observes a client in a group who is reminiscing about his past. Which effect should the nurse expect reminiscing to have on the client's functioning in the hospital?
1. Increase the client's confusion and disorientation
2. Cause the client to become sad
3. Decrease the client's feelings of isolation and loneliness
4. Keep the client from participating in therapeutic activities
3. Decrease the client's feelings of isolation and loneliness
Despite education and role play practice of restraint procedures, a staff member is injured when actually restraining a client. When helping the uninjured staff deal with the incident, the nurse should address which factor?
1. The emotional responses may be similar to those of other crime victims
2. The member is likely to resign after experiencing such an injury
3 Legal action against the client will take time and energy
4. The member must debrief with the assaultive client before returning.
1. The emotional responses may be similar to those of other crime victims
After months of counseling, a client abused by her husband tells the nurse that she has decided to stop treatment. There has been no abuse during this time and she feels better able to cope with the needs of her husband and children. How should the nurse begin the discussion with the client?
1. Tell the client this is a bad decision that she will regret in the future
2. Find out more about the client's rationale for her decision to stop treatment.
3. Warn the client that abuse commonly stops when one partner is in treatment, only to begin again later.
4. Remind the client of her duty to protect her children by continuing treatment.
2- Find out more information.
A parent of a child diagnosed with ADHD is talking to the nurse about her son's condition. The parent states the methylphenidate controls his symptoms but is causing him to loose weight. He is difficult to wake and get ready for school unless he gets the medication as soon as he wakes up. He does not eat breakfast and very little lunch. He eats an average dinner. He has lost 3 lb in 2 weeks. Which action should the nurse suggest first?
1. Eat a breakfast bar, banana, and milk at the bedside every am at the same time he takes his medication
2. Monitor weight closely for a month since he will likely stop loosing weight when school ends in 2 weeks
3. Suggest a change of medication to a non-stimulant drug that will treat without causing appetite decrease
4. Suggest a supplement such as high protein or other food to increase his caloric intake
1. Eat a breakfast bar, banana, and milk at the bedside every am at the same time he takes his medication to ensure intake before symptoms of medication set in
A school age client is diagnosed with conduct disorder. After admission, the nurse identifies his problematic behaviors as cruelty to animals, stealing, truancy, aggression with peers, lying, and explosive angry outbursts resulting in destruction of property. The nurse is now talking with the client about his behavioral contract, which should include which components.
1. taking prescribed medications
2. acceptable methods for expressing anger
3. consequences for unacceptable behaviors
4. rules for interacting with staff and other clients
5. personal possessions allowed on the unit
1. taking prescribed medications
2. acceptable methods for expressing anger
3. consequences for unacceptable behaviors
4. rules for interacting with staff and other clients
An older adult client is admitted and diagnosed with delirium. Later in the day, he tries to get out of the locked unit. He yells, "Unlock the door. I've got to go see my doctor. I just can't miss my monthly Friday appointment." Which of the following responses by the nurse is the most appropriate?
1. "Please come away from the door. I'll show you to your room."
2. "It's 5 o'clock Tuesday and you're in the hospital. I'm Pat, a nurse."
3. "The door is locked to keep you from getting lost."
4. "I want you to come eat your lunch before you go to your appointment."
2. "It's 5 o'clock Tuesday and you're in the hospital. I'm Pat, a nurse."
The nurse is managing the care for a client in a disaster shelter who broke a femur and has lost her family home in a hurricane. What measures should the nurse take? Select all that apply.
1. Supervise the care provided to the client during crisis
2. Obtain a prescription for an anti psychotic medications for the client
3. Act as a client advocate for the client in crisis.
4. Discuss with the interdisciplinary team available community resources for the client
5. Obtain accurate identification including name, age, contact info, and names of relatives
1. Supervise the care provided to the client during crisis
3. Act as a client advocate for the client in crisis.
4. Discuss with the interdisciplinary team available community resources for the client
5. Obtain accurate identification including name, age, contact info, and names of relatives
The parent of a school age child tells the nurse that "For most of the year, my husband was unemployed and I worked a second job. Twice I spanked my son repeatedly when he refused to obey. It hasn't happened again. Our family is back to normal." After assessing the family, the nurse decides the child is still at risk for abuse. Which observation best supports this conclusion?
1. The parents say they are taking away privileges when their son refuses to obey.
2. The child has talked about family activities with the nurse.
3. The parents are less negative toward the nurse.
4. The client wears long-sleeved shirts and long pants, even in warm weather.
4. Avoidance and hiding anything implies there is something to hide
1. excessive climbing and running
2. excessive fidgeting
3. pouting behaviors
4. cannot wait to take turns
5. easily distracted
1. excessive climbing and running
2. excessive fidgeting
4. cannot wait to take turns
5. easily distracted
A client was experiencing marital discord with a spouse of 4 years. When the spouse walked out, the client became angry and began to throw things and break dishes. A friend talked the client into seeking help at the local mental health center. Which of these questions should the nurse ask initially to begin assess this client's immediate problem?
1. "Do you feel in control of yourself at this time?"
2. "What did you do to cause your spouse to leave?"
3. "In hindsight, how might you have manged this situation differently?"
4. "What led you to come in for help today?"
4. "What led you to come in for help today?"
What is a realistic short term goal to be accomplished in 2 to 3 days for a client with delirium?
1. Explain the experience of having delirium
2. Resume a normal sleep wake cycle
3. Regain orientation to time and place
4. Establish normal bowel and bladder function
3. Regain orientation to time and place
The nurse is planning care for a group of clients. Which client should the nurse identify as needing the most assistance in accepting being ill?
1. An 8yo boy who alternatively cries for his mother and is angry with the nurse about being hospitalized after a bike accident
2. A 32yo woman diagnosed with depression related to lupus who discusses her medications adverse effects with the nurse
3. A 45yo man who just suffered a severe MI and talks to the nurse about concerns regarding resuming physical activity
4. A 60yo woman diagnosed with COPD who refuses to wear an oxygen mask even though poor oxygenation makes her confused
4. A 60 yo woman diagnosed with COPD who refuses to wear an oxygen mask even though poor oxygenation makes her confused
Which observation by the nurse should suggest that a 15 month old toddler has been abused?
1. The child appears happy when personnel work with him.
2. The child plays alongside others contentedly.
3. The child is underdeveloped for his age.
4. The child sucks his thumb.
3. The child is underdeveloped for his age.
At the admission interview, the father of a 4yo boy with ADHD says to the nurse, “I know that my wife or I must have caused this disease.” What is the nurse’s best response?
1. “ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder.”
2. “What do you think you might have done that could have led you to causing this disorder to develop in your son?”
3. “Many parents feel this way, but I doubt there’s anything that you did that caused ADHD to develop in your child.”
4. “Let’s not focus on the cause but rather on what needs to be done to help you son get better. I know that you and your wife are very interested in helping him to improve his behavior.”
1. “ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder.”
As an angry client becomes more agitated while talking about problems, the nurse decides to ask the staff assistance in taking control of the situation when the client demonstrates which behavior?
1. swearing about a spouse's behaviors when discussing marital problems
2. picking up a pool cue stick and telling the nurse to get out of the way
3. making a fist and pounding loudly on the table
4. coming out of the room instead of staying in time out
2. picking up a pool cue stick and telling the nurse to get out of the way
When caring for the client diagnosed with delirium, the nurse should investigate which condition as the most important?
1. Cancer of any kind
2. Impaired hearing
3. Prescription drug intoxication
4. Heart Failure
3. Prescription drug intoxication
Based on a client's history of violence toward others and inability to cope with anger, what should the nurse use as the most important indicator of goal achievement before discharge?
1. Acknowledgment of the client's angry feelings
2. Ability to describe situations that provoke angry feelings
3. Development of a list of how anger has been handled in the past
4. Verbalization of feelings in an appropriate manner
4. Verbalization of feelings in an appropriate manner