Nursing Guide for Mental Health Disorders and Substance Abuse, Exams of Nursing

Download Nursing Guide for Mental Health Disorders and Substance Abuse and more Exams Nursing in PDF only on Docsity! MENTAL HEALTH EXAM 2 SPRING 2019 EXAM WTH ERIFIED ANSWERS 2024 UPDATE GRADED A On the first day of a client’s alcohol detoxification, know which nursing intervention is the priority. Page: 446 (Psychopharmacology for Substance Intoxication and Substance Withdrawal) On the first day of a client's alcohol detoxification, which nursing intervention should take priority? A. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days. B. Educate the client about the biopsychosocial consequences of alcohol abuse. C. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. D. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome. Know which term the nurse should use to describe the administration of a CNS depressant during alcohol withdrawal. Page: 446 Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during the substance induced disorder of alcohol withdrawal? 1. Antagonist therapy 2. Deterrent therapy 3. Codependency therapy 4. Substitution therapy A client with a history of heavy alcohol use has not had nothing to drink in the last 24 hours. Know which client symptom the nurse should immediately report to the MD. Page: 407 A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. Which client symptom should the nurse immediate report to the ED physician? A. Tactile hallucinations B. Blood pressure of 180/100 mm Hg C. Mood rating of 2/10 on numeric scale D. Dehydration The nurse holds the hand of a client who is withdrawing from alcohol. Know what the nurse’s rationale is for this intervention is. Page: 405 A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? 1. To assess for emotional strength 2. To assess for Wernicke-Korsakoff syndrome 3. To assess for tachycardia 4. To assess for fine tremors Know which medication orders should the nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines. (Page 410, Heading: Sedative, Hypnotic, or Anxiolytic Use Disorder) Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? A. Haloperidol (Haldol) and fluoxetine (Prozac) B. Carbamazepine (Tegretol) and donepezil (Aricept) Know which is the most appropriate response by the nurse. (Page: 599 Complicated Grieving) A patient being treated for symptoms of PTSD following a shooting incident at a local elementary school reports, "I feel like there's no reason to go on living when so many others died." Which of these is the most appropriate response by the nurse at this juncture? "You've got lots of reasons to go on living." "There must be something that gives you hope." "You're just experiencing survivor guilt." "Are you having thoughts of hurting or killing yourself?" A client with a Dx. of adjustment disorder becomes angry and starts shouting and crying regarding their parents and states “I wish they would both die!” Know what is the most appropriate nursing response. Page: 599 Brandy is an 18-year-old being treated in the Community Mental Health Clinic for an adjustment disorder after receiving news of her parents' impending divorce. While talking about her feelings she becomes angry and starts shouting and crying. She screams, "I wish they would both die!" Which of these is the most appropriate response by the nurse at this point? Contact the parents and the police to report that Brandy is expressing homicidal ideation. Encourage Brandy to talk more about her anger. Instruct Brandy that it's okay to cry but that it is not acceptable to talk that way about her parents. Assess Brandy for suicidal ideation. Family dynamics are thought to be a major influence in the development of anorexia nervosa. Know which information related to a client’s home environment should the nurse associate with the development of this disorder. (Page: 679 Heading: Predisposing Factors and Theories of Etiology Associated With Anorexia Nervosa, Bulimia) Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client's home environment should a nurse associate with the development of this disorder? A. The home environment maintains loose personal boundaries. B. The home environment places an overemphasis on food. C. The home environment is overprotective and demands perfection. D. The home environment condones corporal punishment. The nurse observes dental deterioration when assessing a client diagnosed with Bulimia Nervosa. Know which best explains this assessment finding. (Page: 676 Heading: Background Assessment Data: Bulimia Nervosa) A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this assessment finding? A. The emesis produced during purging is acidic and corrodes the tooth enamel. B. Purging causes the depletion of dietary calcium. C. Food is rapidly ingested without proper mastication. D. Poor dental and oral hygiene leads to dental caries. A morbidly obese client with B.E.D. is prescribed an anorexiant medication. Know what should be the correct medication to teach the patient about. (Page: 690 Heading: Treatment Modalities) A morbidly obese client is prescribed an anorexiant medication. The nurse should prepare to teach the client about which medication? A. Diazepam (Valium) B. Dexfenfluramine (Redux) C. Sibutramine (Meridia) D. Pemoline (Cylert) A client is admitted with a medical diagnosis of Anorexia Nervosa. Know which nursing diagnosis should take priority. (Page: 680–681 Heading: Diagnosis/Outcome) A client who is 5 foot 6 inches tall and weighs 98 pounds is admitted with a medical diagnosis of anorexia nervosa. Which nursing diagnosis would take priority at this time? A. Ineffective coping R/T food obsession B. Altered nutrition: less than body requirements R/T inadequate food intake C. Risk for injury R/T suicidal tendencies D. Altered body image R/T perceived obesity The nurse is seeing a client for treatment of anorexia nervosa. Know which is the most appropriate correctly written, short-term outcome for this client. Page: 684 A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client? A. The client will use stress-reducing techniques to avoid purging. B. The client will discuss chaos in personal life and be able to verbalize a link to purging. A client diagnosed with Paranoid Personality Disorder becomes violent on a unit. Know which nursing intervention is most appropriate. (Page: 719 Heading: Planning/Implementation) A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate? A. Provide objective evidence that violence is unwarranted. B. Initially restrain the client to maintain safety. C. Use clear, calm statements and a confident physical stance. D. Empathize with the client's paranoid perceptions. A highly emotional female client is wearing flamboyant attire, spiked heels, and theatrical makeup. Know which personality disorder the nurse should associate with these assessment data. Page: 703 A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this assessment data? A. Compulsive personality disorder B. Schizotypal personality disorder C. Histrionic personality disorder D. Manic personality disorder A client diagnosed with Borderline Personality Disorder (BPD) brings up a conflict with the staff with unreasonably demand modification of unit rules. Know which approach is best for the nursing staff to implement. Page: 714, 708 A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? A. Allow the clients to apply the democratic process when developing unit rules. B. Maintain consistency of care by open communication to avoid staff manipulation. C. Allow the client spokesperson to verbalize concerns during a unit staff meeting. D. Maintain unit order by the application of autocratic leadership. Know which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with BPD. Page: 720 Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder? A. Being firm, consistent, and empathetic, while addressing specific client behaviors B. Promoting client self-expression by implementing laissez-faire leadership C. Using authoritative leadership to help clients learn to conform to societal norms D. Overlooking inappropriate behaviors to avoid promoting secondary gains Know which adult client the nurse should recognize as exhibiting the characteristics of a dependent personality disorder. Page: 705–706 Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? A. A physically healthy client who is dependent on meeting social needs by contact with 15 cats B. A physically healthy client who has a history of depending on intense relationships to meet basic needs C. A physically healthy client who lives with parents and relies on public transportation D. A physically healthy client who is serious, inflexible, perfectionistic, and depends on rules to provide security Be able to explain the difference between schizoid and avoidant personality disorders. (Page: 701, 705 Heading: Schizoid Personality Disorder) Family members of a client ask a nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing reply? A. "Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone." B. "Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, whereas clients diagnosed with avoidant personality disorder do not." C. "Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant." D. "Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, whereas clients diagnosed with avoidant personality disorder remain based in reality." Know which client statement indicates to the nurse that a potential diagnosis of Schizotypal Personality Disorder should be considered. Page: 702 "The night nurse is evil. You have to stay." B. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." C. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me." A school nurse notices bruises and burns on the child’s face and arms. Know which other symptom should indicate to the nurse that the child might have been physically abused. Page: 813 A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child may have been physically abused? 1. The child shrinks at the approach of adults. 2. The child begs or steals food or money. 3. The child is frequently absent from school. 4. The child is delayed in physical and emotional development. A client describes a history of physical and emotional abuse in intimate relationships. Know which additional factor the nurse should suspect. Page: 815 A woman presents with a history of physical and emotional abuse in her intimate relationships. What should this information lead a nurse to suspect? 1. The woman may be exhibiting a controlled response pattern. 2. The woman may have a history of childhood neglect. 3. The woman may be exhibiting codependent characteristics. 4. The woman may be a victim of incest. Know which statement by an ER nurse indicates accurate knowledge of domestic violence. Page: 810 Which statement made by an emergency department nurse indicates accurate knowledge of domestic violence? A. "Power and control are central to the dynamic of domestic violence." B. "Poor communication and social isolation are central to the dynamic of domestic violence." C. "Erratic relationships and vulnerability are central to the dynamic of domestic violence." D. "Emotional injury and learned helplessness are central to the dynamic of domestic violence." A client is brought to an ER after being violently raped. Know which nursing action is most appropriate. Page: 819–820 A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? A. Discourage the client from discussing the event as this may lead to further emotional trauma. B. Remain nonjudgmental and actively listen to the client's description of the event. C. Meet the client's self-care needs by assisting with showering and perineal care. D. Provide cues, based on police information, to encourage further description of the event. A domestic violence client fears for her life. A staff nurse asks, “Why doesn’t she just leave him?” Know what is the most appropriate reply by the nurse supervisor. Page: 812 A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisor's most appropriate reply? A. "These clients don't know life any other way, and change is not an option until they have improved insight." B. "These clients have limited KEY: Cognitive skills and few vocational abilities to be able to make it on their own." C. "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation." D. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness." A domestic violence victim states, “The beatings have been getting worse, and I’m afraid that next time he might kill me.” Know which is the most appropriate nursing reply. Page: 822–823 A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, "The beatings have been getting worse, and I'm afraid that next time he might kill me." Which is the appropriate nursing reply? "Let's talk about your options so that you don't have to go home." A. The child is often absent from school and seems apathetic and tired. B. The child is very insecure and has poor self-esteem. C. The child has multiple bruises on various body parts. D. The child has sophisticated knowledge of sexual behaviors. An anorexic client states to the nurse, she has experienced insomnia, nightmares, and panic attacks that occur nightly. She has never married or dated, and lives alone. Know what the nurse should suspect. (Page: 814 Heading: Indicators of Sexual Abuse) An anorexic client states to a nurse, "My father has recently moved back to town." Since that time the client has experienced insomnia, nightmares, and panic attacks that occur nightly. She has never married or dated and lives alone. What should the nurse suspect? A. Possible major depressive disorder B. Possible history of childhood incest C. Possible histrionic personality disorder D. Possible history of childhood physical abuse Know which medications has a direct use in treating symptoms that are common in PTSD. Select all. Page: 608 A patient admitted to the hospital with PTSD is ordered the following medications. Which of these medications has a direct use in treating symptoms that are common in PTSD? Select all that apply. A. Alprazolam B. Propanolol C. Colace D. Dulcolax The nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions. Select all Page: 691 A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) A. Binge eating with obesity B. Bingeing and purging with a diagnosis of bulimia nervosa C. Weight loss with a diagnosis of anorexia nervosa D. Amenorrhea with a diagnosis of anorexia nervosa E. Emaciation with a diagnosis of bulimia nervosa