NUR 325 Exam 1

Which of the following is NOT an accurate statement regarding stress?

a. Stress can be an internal or external event

b. Stress is experienced by the individual that is perceived and appraised for

c. Stress is objective

d. Stress can be a demand of life

C (Stress is subjective. Not everyone feels stress the same way. One thing that may be stressful to you may not be stressful to someone else.)

Which of the following definitions accurately describes the key term of cognitive appraisal?

a. Describes the body's short-term and long-term reactions to stress

b. Condition in which all competing elements are in balance

c. Individual's perception regarding how stressful an event is or will be

d. Cognitive and behavioral efforts to manage stress

C

Which of the following definitions accurately describes the key term of general adaptation syndrome?

a. Describes the body's short-term and long-term reactions to stress

b. Condition in which all competing elements are in balance

c. Individual's perception regarding how stressful an event is or will be

d. Cognitive and behavioral efforts to manage stress

A

Chronic stress may lead to:

a. Hypoglycemia

b. Loss of homeostasis

c. Positive psychological manifestations

d. Positive social manifestations

B

Which of the following definitions accurately describes the key term of coping?

a. Describes the body's short-term and long-term reactions to stress

b. Condition in which all competing elements are in balance

c. Individual's perception regarding how stressful an event is or will be

d. Cognitive and behavioral efforts to manage stress

D

Which of the following physiologic responses would one expect in an individual that is stressed? (Select all that apply.)

a. Decreased water retention

b. Increased heart rate and blood pressure, and cardiac output

c. Increased bronchial dilation

d. Decreased pupil dilation

e. Increased blood glucose

f. Decreased protein synthesis

B C E

Which of the following definitions accurately describes the key term of equilibrium?

a. Describes the body's short-term and long-term reactions to stress

b. Condition in which all competing elements are in balance

c. Individual's perception regarding how stressful an event is or will be

d. Cognitive and behavioral efforts to manage stress

B

A broken bone would be an example of which source of stress?

a. Psychological

b. Physiological

c. Emotional

d. Episodic

B

A patient being diagnosed with dementia would be an example of which source of stress?

a. Psychological

b. Physiological

c. Emotional

d. Episodic

B

The loss of a loved one would be an example of which source of stress?

a. Psychological

b. Physiological

c. Emotional

d. Episodic

C

A stressful event that doesn't happen often and is unique would be which type of stress?

a. Acute

b. Episodic

c. Chronic

d. Psychological

A

A nursing students' stress levels are elevated because of a test that is coming up in a few days. Which type of stress would this example be?

a. Acute

b. Episodic

c. Chronic

d. Psychological

B

Which of the following populations would have the lowest risk for having stress?

a. Young adults

b. Elderly

c. Children

d. Homeless persons

C

Which of the following qualify as individual factors that would put a someone at risk for developing stress? (Select all that apply.)

a. Dementia

b. Moving to a different state or country

c. Depression

d. Chronic pain

e. Being a caregiver

f. Winning the lottery

A B C D E

Which of the following is an example of a primary preventative measure taken to reduce stress?

a. Taking a screening test to identify stress

b. Taking antidepressants

c. Maintaining positive relationships and overall health

d. Taking muscle relaxants

C

After the loss of a loved one, you decide to go to counseling sessions to reduce the amount of stress in your life. Which level of prevention does this situation represent?

a. Primary

b. Secondary

c. Tertiary

d. Quaternary

A

You decide to schedule an appointment for a screening for stress after your divorce. Which level of prevention does this situation represent?

a. Primary

b. Secondary

c. Tertiary

d. Quaternary

B

After going to counseling because of the loss of a loved one, the therapist decides to prescribe SSRIs (Selective serotonin repute inhibitors) because of your stress levels. Which level of prevention does this situation represent?

a. Primary

b. Secondary

c. Tertiary

d. Quaternary

C

A patient who is having difficulty managing his diabetes mellitus responds to the news that his hemoglobin A1C, a measure of blood sugar control over the past 90 days, has increased by saying, "The hemoglobin A1C is wrong. My blood sugar levels have been excellent for the last 6 months." Which defense mechanism is the patient using?

a. Denial.

b. Conversion.

c. Dissociation.

d. Displacement.

A (Denial is avoiding emotional stress by refusing to consciously acknowledge anything that causes intolerable anxiety. This patient's statements reflect denial about poorly controlled blood sugars.)

A grandfather living in Japan worries about his two young grandsons who disappeared after a tsunami. This is an example of:

a. A situational crisis.

b. A maturational crisis.

c. An adventitious crisis.

d. A developmental crisis.

C (An adventitious crisis is a type of crisis resulting from a natural disaster such as a tsunami.)

The nurse plans care for a 16-year-old male, taking into consideration that stressors experienced most commonly by adolescents include which of the following?

a. Loss of autonomy caused by health problems

b. Physical appearance, family, friends, and school

c. Self-esteem issues, changing family structure

d. Search for identity with peer groups and separation from family

D (Stressors that apply to preadolescents are self-esteem issues and a changing family structure. A loss of autonomy caused by health problems applies to the older adult. Stressors that apply to children are physical appearance, family, friends, and school.)

When assessing an older adult who is showing symptoms of anxiety, insomnia, anorexia, and mild confusion, one of the first assessments includes which of the following?

a. The amount of family support

b. A 3-day diet recall

c. A thorough physical assessment

d. Threats to safety in her home

C (Stress often causes symptoms similar to physical illnesses. Physical causes for problems need to be investigated and treated before treatment for stress-related symptoms can be initiated.)

A 34-year-old single father who is anxious, tearful, and tired from caring for his three young children tells the nurse that he feels depressed and doesn't see how he can go on much longer. Which of the following would be the nurse's best response?

a. "Are you thinking of suicide?"

b. "You've been doing a good job raising your children. You can do it!"

c. "Is there someone who can help you during the evenings and weekends?"

d. "What do you mean when you say you can't go on any longer?"

D (You need to get information about what the gentleman means when he says he can't go on any longer. He might be thinking of turning his children over to a grandparent or seeking other child-care arrangements. Asking about suicide initially might be premature. Asking, "Are you thinking of suicide?" prematurely might shut the patient down entirely. If the patient talks about suicide, for safety reasons it is very important to further discuss his suicidal thoughts and refer to the appropriate health care professional. Asking the open-ended question provides an opportunity to understand what the person is thinking and open lines of communication.)

The nurse is interviewing a patient in the community clinic and gathers the following information about her: she is intermittently homeless, a single parent with two children who have developmental delays, and is suffering from chronic asthma. She does not laugh or smile, does not volunteer any information, and at times appears close to tears. She has no support system and does not work. She is experiencing an allostatic load. As a result, which of the following would be present during complete patient assessment? (Select all that apply.)

a. Posttraumatic stress disorder

b. Rising hormone levels

c. Chronic illness

d. Return of vital signs to normal

e. Depression

C E (An increased allopathic load can result in long-term physiological and psychological problems such as chronic illness and depression. Posttraumatic stress disorder results from a single traumatic event. Hormone levels rise in the alarm stage. Vital signs return to normal in the resistance stage.)

During the assessment interview of an older woman who is recently widowed, the nurse suspects that this woman is experiencing a developmental crisis. Which of the following questions provide information about the impact of this crisis? (Select all that apply.)

a. With whom do you talk on a routine basis?

b. What do you do when you feel lonely?

c. How is having diabetes affecting your life?

d. I know this must be hard for you. Let me tell you what might help.

e. Do you have any changes in lifestyle habits: sleeping, eating, smoking, and drinking?

A B E (A developmental crisis occurs as a person moves through the stages of life, including widowhood. It is important to gather information about how this crisis affects her interactions, coping with loneliness, and any changes in lifestyle habits. Although stress can affect diabetes, there is nothing in this situation that states that the woman has diabetes. Saying, "I know this must be hard for you. Let me tell you what might help" is unacceptable, because the whole purpose of assessment is to gather data and let the patient tell his or her story.)

After a health care provider has informed a patient that he has colon cancer, the nurse enters the room to find the patient gazing out the window in thought. Which of the following are appropriate responses or actions of the nurse? (Select all that apply.)

a. "I know another patient whose colon cancer was cured by surgery."

b. Straighten the patient's bed and room

c. "Have you thought about how you are going to tell your family?"

d. "Would you like for me to sit down with you for a few minutes so you can talk about this?"

e. Sit quietly with the patient

D E (Sitting quietly or asking the patient if he would like you to sit down for a few minutes so he can talk are both effective. This provides the patient some quiet time, knowing that someone is there. Allowing the patient to talk allows the nurse to assess the patient's fears, knowledge, and perception of the situation, which is of utmost importance. The other responses are telling the patient what to do or giving reassurance, and the situation does not call for either of these.)

The nurse is evaluating the coping success of a patient experiencing stress from being newly diagnosed with multiple sclerosis and psychomotor impairment. Which of the following statements indicate that the patient is beginning to cope with the diagnosis? (Select all that apply.)

a. "I'm going to learn to drive a car so I can be more independent."

b. "My sister says she feels better when she goes shopping, so I'll go shopping."

c. "I'm going to let the occupational therapist assess my home to improve efficiency."

d. "I've always felt better when I go for a long walk. I'll do that when I get home."

e. "I'm going to attend a support group to learn more about multiple sclerosis."

C E (Inviting the occupational therapist into the patient's home and attending support groups are early indicators that the patient is recognizing some of the challenges of the disease and participating in positive realistic activities to cope with the stressors related to changes in physical functioning. The other options relate to independence and other coping strategies but do not address coping with the specific challenges of the disease.)

A patient with type 2 diabetes is experiencing a lot of work-related stress and is fearful of losing his job. In addition, his wife is threatening divorce. His blood sugar is elevating, and his doctors want him to attend some stress-management classes. He says, "My blood sugar can't be high because of my work stress." What causes blood glucose to rise during stress? (Select all that apply.)

a. Increases in antidiuretic hormone (ADH)

b. Increases in cortisol

c. Increases in aldosterone

d. Increases in adrenocorticotropic hormone (ACTH)

e. Increases in epinephrine

B D E (An increased allopathic load can result in long-term physiological and psychological problems such as chronic illness and depression. Posttraumatic stress disorder results from a single traumatic event. Hormone levels rise in the alarm stage. Vital signs return to normal in the resistance stage.)

A crisis intervention nurse is working with a mother whose Down syndrome child has been hospitalized with pneumonia and who has lost her child's disability payment while the child is hospitalized. The mother worries that her daughter will fall behind in special-school classes during hospitalization. Which strategies are effective in helping this mother cope with these stressors? (Select all that apply.)

a. Referral to social service process reestablishing the child's disability payment

b. Sending the child home in 72 hours and having the child return to school

c. Coordinating hospital-based and home-based schooling with the child's teacher

d. Teaching the mother signs and symptoms of a respiratory tract infection

e. Telling the mother that the stress will decrease in 6 weeks when everything is back to normal

A C D (The stressors for this parent are her child's illness, missing school, and loss of disability payments. Obtaining resources to resolve these stressors will reduce the mother's stress load and allow her to focus on helping her child improve and preventing another respiratory tract infection. Discharging the child in 72 hours with a return to school may not be best for the child's physical condition and may make the situation worse. Giving the mom a 6-week time frame is unrealistic because everyone's time frame is different. The mom may also need to adjust to a "new normal.")

A staff nurse is talking with the nursing supervisor about the stress that she feels on the job. Which of the following are true about work-related stress? (Select all that apply.)

a. Job-related stress can affect the quality of patient care.

b. Stress can affect nurses' efficiency and decision making.

c. Nurses who talk about feeling stress are unprofessional and should calm down.

d. Nurses frequently experience stress with the rapid changes in health care technology.

e. Nurses cannot resolve job-related stress.

A B D (Nurses frequently experience stress with the rapid changes in health care and when the situation seems out of their personal control. When job stress remains unresolved, patient care and clinical decision making can be affected because the stress is perceived as uncontrolled and all consuming.)

A nurse is assessing a patient's stressor to determine if it is a threat. What type of appraisal is this?

a. Primary

b. Secondary

c. Tertiary

d. Engagement

A

A nurse is evaluating their resources to over, eliminate, or reduce the stressor. What type of appraisal is this?

a. Primary

b. Secondary

c. Tertiary

d. Engagement

B

The nurse should document which physiologic stressor after performing a screening assessment on a patient?

a. Dementia

b. Caregiving of parent

c. Divorce

d. Death of friend

A (Physiologic stressors have physical causes. Dementia is an example of a physiological stressor. Caregiving, divorce, and death of a friend are examples of psychological or emotional stressors.)

A patient has begun smoking again and drinks six alcoholic beverages per day since experiencing the loss of his job. The nurse recognizes that the patient is exhibiting symptoms of which type of stress?

a. Psychological

b. Emotional

c. Physiological

d. Behavioral

D (Signs and symptoms of behavioral stress include smoking, overeating, and substance abuse.)

The nurse is creating the plan of care for a patient who was recently hospitalized for the treatment of anxiety and depression related to a diagnosis of cervical cancer 1 month ago. In planning tertiary prevention strategies for this patient, the nurse knows to add which tertiary interventions to the patient's plan of care:

a. Counseling

b. Screening for stress-related diseases

c. A rehabilitation program focused on stress management

d. A daily exercise program

C (In planning tertiary prevention care for a patient undergoing treatment related to stress, the nurse knows that including recommendations for a rehabilitation program focused on stress management is part of creating tertiary care. The purpose of tertiary care is focused on prevention and rehabilitation of the patient. Option A is incorrect. Counseling is a primary prevention strategy focused on health promotion and protection. Option B is incorrect; screening for stress-related diseases is part of secondary prevention, which focuses on early diagnosis and screening of diseases. Option D is incorrect. Planning a daily exercise program is part of secondary prevention strategies, which focuses on early diagnosis and treatment.)

Which nursing interventions are likely to help the patient to cope by addressing the mediators of stress? (Select all that apply.)

a. "A divorce, while stressful, can be the beginning of a new, better phase of life."

b. "You said you used to jog; getting back to aerobic exercise could be helpful."

c. "Journaling gives one more awareness of how experiences have affected them."

d. "Perhaps a short-term loan from your father will make your layoff less stressful."

e. "Slowing your breathing by counting to three between breaths will calm you."

f. "I have found a support group for newly divorced persons in your neighborhood."

A C D F (Stress mediators are factors that can help persons cope by influencing how they perceive and respond to stressors; they include personality, social support, perceptions, and culture. Suggesting that a divorce may have positive as well as negative aspects helps the patient to alter his perceptions of the stressor. Journaling increases self-awareness regarding how life experiences may have shaped how one perceives and responds to stress (or how one's personality affects how one responds to stressors). A loan could help the patient perceive a layoff differently by reducing the financial pressures that accompany it. Participation in support groups is an excellent way to expand one's support network relative to specific issues. However, neither aerobic exercise nor breathing-control exercises, while helpful in other ways, affect stress mediators.)

A diabetic patient who is hospitalized asks the nurse what factors are associated with increased blood glucose while in the hospital? Which response(s) by the nurse are appropriate? (Select all that apply.)

a. Blood sugar may be higher in the hospital due to the increased bed rest.

b. Stressors such as illness cause the release of hormones that increase blood sugar.

c. Increased blood sugar occurs because the kidneys are not able to metabolize glucose as well during stressful times.

d. A patient's diet is different here in the hospital than at home, and that is the most likely because of the increased glucose level.

e. Medications such as steroids may increase glucose levels.

A B E (The release of cortisol, epinephrine, and norepinephrine increases blood glucose levels. Activity decreases blood glucose; therefore, increase in blood glucose while in the hospital could be related to inactivity. Steroids cause increases in blood glucose levels. The kidneys do not control blood glucose. A diabetic patient who is hospitalized will be on an appropriate diet to help control blood glucose.)

A patient has come to the health clinic for an annual checkup. He reports an increase of stress at work and having to work a lot of mandatory overtime hours. He has not been able to do his usual daily exercise for several weeks. What is the best response by the nurse?

a. "There are other ways you can reduce your stress, such as cutting back on your work hours."

b. "Have you considered a medication to help you sleep at night?"

c. "Including exercise in your schedule will just increase the stress from work."

d. "Regular exercise would be good because it helps the body deal with stress."

D (Exercise is a form of emotion-based coping that increases a feeling of well-being. Cutting back on hours may not be an option in his current work climate, although it might help reduce stress. There are other nonpharmacologic methods that may help with stress, such as music or meditation, which would not involve possible side effects from medications. Exercise will decrease feelings of stress when balanced with the time requirements of the stressor.)

The nurse is assessing a patient's coping abilities related to expected placement in a long-term care facility. Which risk factor is of most concern to the nurse?

a. The patient's family members all live several hours away.

b. The patient is a retired police officer.

c. The patient was recently diagnosed with Alzheimer's disease.

d. The patient will need assistance in moving from his home.

C (Poor cognition is a key risk factor for poor coping because the patient has difficulty assessing a situation and making decisions that allow a sense of control. Limited support is a risk factor, but decreased cognition adds to the patient's inability to understand changes. A retired police officer would typically have experienced stress and have some strengths in managing stress. Needing assistance to move is a short-term need; the inability to understand the need for the move or a new situation because of poor cognitive function is the greater concern.)

The nurse is assessing the coping abilities of a patient recently diagnosed with a degenerative neuromuscular disease with no known cure. Which statement by the patient alerts the nurse that more intervention is needed?

a. "I have decided to take some art lessons at the community center."

b. "I am sleeping much better when I have two drinks and smoke before bed."

c. "I am scheduling a family reunion for the upcoming holiday.'

d. "I have decided to sell my house and move into an apartment with my son."

B (Using alcohol, smoking, or drugs to enhance sleep is not a positive coping mechanism, and it is also a safety hazard; other interventions should be enlisted to help the patient cope with the devastating diagnosis. Taking art lessons and planning a family reunion are positive ways to not focus on the illness and keep the patient from becoming more isolated. Moving in with a family member is a problem-solving strategy that allows the patient to maintain more control over the illness outcome.)

A nurse has begun working in a new unit with high-acuity patients who are scheduled for numerous diagnostic tests before being transferred to the appropriate medical or surgical unit. She also has care responsibilities for her children and her aging parents. The nurse is experiencing signs of being overwhelmed. What counsel might the nurse manager share with the nurse to help her cope with work stress?

a. Take some time off to decide if she really wants to be a nurse.

b. Encourage her to catch up on her documentation responsibilities while taking her lunch break.

c. Enlist the help of other family members in the care of her children so she can focus on work.

d. Request that another nurse help her focus on essential aspects of care rather than optional aspects of care.

D (Learning to prioritize care to what is essential to perform versus what would be nice to perform but could be eliminated on stressful days will help the nurse manage her physical and emotional resources at work. Taking time off does not address the underlying issue of how to handle work stress. Periodic breaks in a work day, such as a meal break, allow the staff to refocus and maintain energy to complete their work. Support from family may help address stressors at home but does not help manage stress at work.)

The nurse working in the pediatric emergency room was working with an infant who passed away despite a lengthy resuscitation effort. Which of the following strategies is a positive coping behavior?

a. Meet with friends after work for a drink and talk about the events from the shift.

b. Discuss the code with colleagues and chalk it up as part of a day's work.

c. Reflect on what could have been done better and vow to be better next time.

d. Debrief with other health care professionals who were involved with the resuscitation and talk about how the nurse feels.

D (Debriefing is an example of a positive coping strategy that will help the nurse process the events and prevent burnout. Having a drink afterward may lead to alcohol abuse and will not serve as a debriefing strategy. Death of a patient is a traumatic event even when death is a common occurrence some health care settings. Reviewing resuscitations can be useful if done to improve overall care; however, the nurse should talk about the events as well.)

The nurse is developing a discharge plan for a patient who was recently diagnosed with diabetes. What information about the patient does the nurse need to determine whether the patient has effective coping strategies in place to carry out the plan of care?

a. Support available for the patient at home

b. The highest grade the patient completed in school

c. The financial resources available

d. The patient's confidence level

D (Effective coping is related to how confident the individual is and does not depend on one's education level. Support at home is important; however, this question is asking about the patient's ability. Support at home will assist the patient in reaching his or her goals. Financial security may help with the cost of care.)

The pediatric operating room nurse is working with a child and his family as the child undergoes surgery to repair a cleft palate. When the nurse enters the family waiting area to inform the parents of how the procedure went, the father yells at the nurse and asks, "What took you so long?" What nursing interventions would be most effective to respond to this situation?

a. Emotion-focused coping strategies

b. Problem-focused coping strategies

c. Cognitive restructuring

d. Develop an action plan

A (The parent is exhibiting misplaced aggression aimed toward the nurse. Emotion-focused coping strategies address the feelings one has as a result of the stressor. This will assist the parent in talking about his fears. Problem-focused coping strategies are most commonly applied when stressors can be modified, changed, or controlled. Cognitive restructuring is when an individual is encouraged to look at the stressor from other perspectives. The nurse can assist the parent with an action plan, which will assist in determining various coping methods in various situations and develop an individualized plan.)

The nurse is completing a care plan for a patient who is exhibiting poor coping after receiving a serious medical diagnosis. Which interventions would the nurse consider? (Select all that apply.)

a. Recommend a glass of wine before dinner each night for relaxation.

b. Compile a list of activities that are of interest to the patient.

c. Review pamphlets about treatment options with the patient.

d. Identify positive aspects of the illness, such as the chance to spend more time with family.

e. Reinforce the fact that the medical team can make treatment decisions, so the patient does not need to worry.

B C D (Interventions that develop an action plan (activities that the patient is still able to do), education about the illness (review of treatment options), and changing how the patient views some aspect of the illness (have more time with family members) are all interventions that help coping skills. Recommending the use of alcohol is not good, because the drinking may get out of control or the alcohol may interact with prescribed medications. Having the medical team make all decisions reinforces the lack of control the patient feels and encourages negative coping mechanisms of denial and avoidance.)

A community health nurse is preparing a course on protecting cognitive function. Which population group should the nurse target for teaching?

a. Older male adults with diabetes

b. Older female adults who are overweight

c. Young adults living in school dormitories

d. Adolescents attending summer camps

A (The primary risk factor for cognitive impairment is advancing age; males with a history of stroke or diabetes are at significant risk. Older females with a history of poor health, insomnia, and lack of social support are at risk for cognitive impairment, not those who are overweight. Risk factors for young adults include substance abuse and high-risk behaviors, not crowded living conditions. Adolescents who attend summer camp are not necessarily at risk for cognitive problems; adolescents who participate in high-risk behaviors would be at risk.)

A 90-year-old patient is admitted to the hospital. Shortly after admission, the family notices that the patient is exhibiting disorientation and agitation. When questioned about the behavior by the family, the nurse states that the patient is at risk for developing which common complication of hospitalization in older adults?

a. Delirium

b. Dementia

c. Alzheimer's disease

d. Sundowner syndrome

A (Delirium, which occurs over hours to a few days, is the most frequent complication of hospitalization in the elderly population. Dementia occurs over a period of months. Alzheimer's disease develops over months to years. Sundowner syndrome is most prominent in dementia and becomes worse in the evenings.)

The nurse is reviewing the needs of a patient with cognitive impairment. What is the priority concern that the nurse should address for this patient?

a. Promoting at least 6 hours of sleep a night

b. Encouraging an oral intake of 1200 calories per day

c. Managing the patient's pain from arthritis

d. Supervising medication administration

D (Safety is the priority concern for the cognitively impaired patient; safely taking medication addresses safety needs for the patient. Sleep, nutrition, and management of pain are important components of the patient's care and can affect overall health, but safety is the highest priority.)

A patient recently admitted to the hospital has been diagnosed with delirium. The family of the patient asks the nurse to explain what delirium is. How should the nurse respond?

a. Delirium is reversible with treatment of the underlying cause.

b. Delirium is progressive and has no known cure.

c. Delirium affects a specific area of cognitive functioning.

d. Delirium indicates the onset of a cerebrovascular accident.

A (Delirium can be reversible with treatment of the precipitating problem and control of predisposing factors. Dementia is progressive and irreversible. Focal cognitive disorders affect a single area of cognitive functioning. Memory and orientation may be affected by a cerebrovascular accident (stroke), but delirium is not a sign of a stroke.)

The nurse is establishing a therapeutic environment for a patient admitted with dementia and influenza. Which intervention would be important for the nurse to implement?

a. Keep a radio on all the time to provide sound for the patient.

b. Decrease patient confusion by limiting verbal interactions.

c. Limit family visits to one person for 30 minutes per day.

d. Provide a quiet environment in a private room.

D (The patient experiencing dementia needs a quiet environment with a minimum of unfamiliar stimulation from a roommate. A patient with dementia does not need extra stimulation from having a radio on continually. The nurse should speak clearly and quietly to the patient before any procedure or assistance to decrease agitation. Family visits would be encouraged because family members are familiar to the patient and their presence increases a sense of security.)

How is the relationship between the concepts of cognition and nutrition best expressed?

a. Unidirectional

b. Time dependent

c. Indirect

d. Reciprocal

D (The relationship between the concepts of cognition and nutrition is best expressed as reciprocal, meaning that cognition affects nutrition and nutrition affects cognition. An example of this reciprocity is the case of a person with impaired cognition who forgets to eat and drink. This leads to alterations in blood sugar and hydration status, which in turn further impair cognitive function.)

According to available research, which is a primary risk factor for cognitive impairment?

a. Advancing age

b. Female gender

c. Caucasian

d. Northern European ancestry

A (Multiple studies have been conducted evaluating characteristics of individuals who developed cognitive impairment compared with those who did not. The results indicate that a primary risk factor for cognitive impairment is advancing age. No differences in impairment have been found across populations based on race, ethnicity, or gender, although correlated risk factors among women and men differ.)

Which of the following is an essential defining difference between delirium and dementia?

a. Occurrence of sundowning syndrome

b.Presence of delusions

c. Incoherent speech

d. Disturbance in consciousness

D (Delirium is a disorder of disturbed consciousness and altered cognition, whereas dementia is characterized by progressive deterioration in cognitive function with little or no disturbance in consciousness or perception. Sundowning, delusions, and incoherent speech occur with both conditions.)

Ideomotor apraxia is classified as a deficit in which cognitive area?

a. Memory

b. Language

c. Thought process

d. Visuospatial

D (Ideomotor apraxia is an abnormality affecting the visuospatial cognitive area. Apraxia is the inability to perform purposeful movements or manipulate objects despite intact sensory and motor abilities. Ideomotor apraxia is a specific type of apraxia in which there is an inability to translate an idea into action.)

Which aspects of cognitive function are tested when a person is asked to start with 100 and count backward, subtracting 7 each time? Mark all that apply.

a. Attention

b. Concentration

c. Thought process

d. Immediate recall

e. Short-term memory

f. Long term memory

A B (Asking the patient to count backward from 100, subtracting 7 each time is an assessment of attention and concentration. Attention and immediate recall are tested by asking the patient to repeat a set of numbers both as stated and backward. Thought process is assessed by evaluating conversation for coherence, relevance, logic, and organization. Short-term memory is assessed by asking the patient to remember three stated items and repeat them back in 5 minutes. Long-term memory is tested by asking for information that has been in memory for at least 24 hours.)

The home care nurse is visiting patients in the community. Which patient is exhibiting an early warning sign of Alzheimer's disease (AD)?

a. A 65-yr-old male patient does not recognize his family members and close friends

b. A 59-yr-old female patient misplaces her purse and jokes about having memory loss

c. A 79-yr-old male patient is incontinent and not able to perform hygiene independently

d. A 72-yr-old female patient is unable to locate the address where she has lived for 10 years

D (An early warning sign of AD is disorientation to time and place such as geographic disorientation. Occasionally misplacing items and joking about memory loss are examples of normal forgetfulness. Impaired ability to recognize family and close friends is a clinical manifestation of middle or moderate dementia (or AD). Incontinence and inability to perform self-care activities are clinical manifestations of severe or late dementia (or AD).)

When caring for a patient with Alzheimer's disease, which task could be delegated to the LPN/LVN on the team?

a. Administer enteral feedings via a gastrostomy tube.

b. Teach patient and caregivers memory enhancement aids.

c. Use bed alarms and frequent monitoring to decrease fall risk.

d. Make referrals for community services such as adult day care.

A (Administering enteral feedings via a gastrostomy tube is within the scope of practice for the LPN/LVN. The RN will be responsible for individualized teaching and patient referrals. The UAP will be able to use bed alarms and frequently monitor the patient.)

The nurse in the long-term care facility cares for a 70-yr-old man with late-stage dementia who is undernourished and has problems chewing and swallowing. What should the nurse include in the plan of care for this patient?

a. Turn on the television to provide a distraction during meals.

b. Provide thickened fluids and moist foods in bite-size pieces.

c. Limit fluid intake during scheduled meals to prevent aspiration.

d. Allow the patient to select favorite foods from the menu choices.

B (If patients with dementia have problems chewing or swallowing, pureed foods, thickened liquids, and nutritional supplements should be provided. Foods that are easy to swallow are moist and should be in bite-size pieces. Distractions at mealtimes, including the television, should be avoided. Fluids should not be limited but offered frequently; fluids should be thickened. Patients with late-stage dementia have difficulty understanding words and would not have the cognitive ability to select menu choices.)

A 78-yr-old woman was transferred to the intensive care unit after emergency abdominal surgery. The nurse notes the patient is disoriented and confused, has incoherent speech, is restless, and agitated. Which action by the nurse is most appropriate?

a. Reorient the patient.

b. Notify the physician.

c. Document the findings.

d. Administer lorazepam (Ativan).

A (The patient is exhibiting clinical manifestations of delirium. Care of the patient with delirium is focused on eliminating precipitating factors and protecting the patient from harm. Give priority to creating a calm and safe environment. The nurse should stay at the bedside and provide reassurance and reorienting information as to place, time, and procedures. The nurse should reduce environmental stimuli, including noise and light levels. Avoid the use of chemical and physical restraints if possible.)

Unlicensed assistive personnel (UAP) working for a home care agency report a change in the alertness and language of an 82-yr-old female patient. The home care nurse plans a visit to evaluate the patient's cognitive function. Which assessment would be most appropriate?

a. Glasgow Coma Scale (GCS)

b. Confusion Assessment Method (CAM)

c. Mini-Mental State Examination (MMSE)

d. National Institutes of Health Stroke Scale (NIHSS)

C (The MMSE is a commonly used tool to assess cognitive function. Cognitive testing is focused on evaluating memory, ability to calculate, language, visual-spatial skills, and degree of alertness. The CAM is used to assess for delirium. The GCS is used to assess the degree of impaired consciousness. The NIHSS is a neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction on the levels of consciousness, language, neglect, visual field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.)

Which nursing intervention is most appropriate when caring for patients with dementia?

a. Avoid direct eye contact.

b. Lovingly call the patient "honey" or "sweetie."

c. Give simple directions, focusing on one thing at a time.

d. Treat the patient according to his or her age-related behavior.

C (When dealing with patients with dementia, tasks should be simplified, giving directions using gestures or pictures and focusing on one thing at a time. It is best to treat these patients as adults, with respect and dignity, even when their behavior is childlike. The nurse should use gentle touch and direct eye contact. Calling the patient "honey" or "sweetie" can be condescending and does not demonstrate respect.)

Which statement by the wife of a patient with Alzheimer's disease (AD) demonstrates an accurate understanding of her husband's medication regimen?

a. "I'm really hoping his medications will slow down his mental losses."

b. "We're both holding out hope that this medication will cure his disease."

c. "I know that this won't cure him, but we learned that it might prevent a bodily decline while he declines mentally."

d. "I learned that if we are vigilant about his medication schedule, he may not experience the physical effects of his disease."

A (There is presently no cure for AD, and drug therapy aims at improving or controlling decline in cognition. Medications do not directly address the physical manifestations of AD.)

Which patient has the greatest risk of developing delirium?

a. A patient with fibromyalgia whose chronic pain has recently worsened

b. A patient with a fracture who has spent the night in the emergency department

c. An older patient whose recent computed tomography shows brain atrophy

d. An older patient who takes multiple medications to treat various health problems

D (Polypharmacy is implicated in many cases of delirium, and this phenomenon is especially common among older adults. Brain atrophy, if associated with cognitive changes, is indicative of dementia. Alterations in sleep and environment, as well as pain, may cause delirium, but this is less of a risk than in an older adult who takes multiple medications.)

Which patient should receive a depression assessment first?

a. A patient in the early stages of Alzheimer's disease

b. A patient who is in the final stages of Alzheimer's disease

c. A patient experiencing delirium secondary to dehydration

d. A patient who has become delirious following an atypical drug response

A (Patients in the early stages of Alzheimer's disease are particularly susceptible to depression because they are acutely aware of their cognitive changes and the expected disease trajectory. Delirium is typically a shorter term health problem that does not typically pose a heightened risk of depression.)

A patient is diagnosed with the mild cognitive impairment stage of Alzheimer's disease. What nursing intervention should the nurse use with the patient?

a. Communicate using a letter or picture board.

b. Treat disruptive behavior with antipsychotic drugs.

c. Use a calendar and family pictures as memory aids.

d. Apply a wander guard mechanism to keep the patient in the area.

C (The patient with mild cognitive impairment will have problems with memory, language, or another essential cognitive function that is severe enough to be noticeable to others but does not interfere with activities of daily living. A calendar and family pictures for memory aids will help this patient. This patient should not yet have disruptive behavior or get lost easily. Using a writing board will not help this patient with communication.)

A 59-yr-old female patient with a frontotemporal lobar dementia has difficulty with verbal expression. While her husband was at work, she walked to the gas station for a soda but did not understand the request for payment. What can the nurse suggest to keep the patient safe?

a. Assisted living

b. Adult day care

c. Advance directives

d. Monitor for behavioral changes

B (To keep the patient safe during the day while the husband is at work, an adult day care facility would be the best choice. This patient would not need assisted living. Advance directives are important but are not related to her safety. Monitoring for behavioral changes will not keep her safe during the day.)

When providing community health care teaching regarding the early warning signs of Alzheimer's disease (AD), which signs should the nurse ask family members to report (select all that apply.)?

a. Misplacing car keys

b. Losing sense of time

c. Difficulty performing familiar tasks

d. Problems with performing basic calculations

e. Momentarily forgets an acquaintance's name

f. Becoming lost in a usually familiar environment

B C D F (Difficulty performing familiar tasks, problems with performing basic calculations, losing sense of time, and becoming lost in a usually familiar environment are all part of the early warning signs of AD. Misplacing car keys and momentarily forgetting a name is a normal frustrating event for many people.)

The patient is having some increased memory and language problems. What diagnostic tests will be done before this patient is diagnosed with Alzheimer's disease (select all that apply.)?

a. Urinalysis

b. Chest x-ray

c. MRI of the head

d. Liver function tests

e. Neuropsychologic testing

f.Blood urea nitrogen and serum creatinine

A C D E F (Because there is no definitive diagnostic test for Alzheimer's disease, and many conditions can cause manifestations of dementia, testing must be done to eliminate any other causes of cognitive impairment. These include urinalysis to eliminate a urinary tract infection, an MRI to eliminate brain tumors, liver function tests to eliminate encephalopathy, BUN and serum creatinine to rule out renal dysfunction, and neuro-psychologic testing to assess cognitive function. A chest x-ray examination is not used to investigate an alternate cause of memory or language problems.)

Which of the following basic functions should the nurse test first in an assessment of mental status?

a. Behavior

b. Consciousness

c. Judgment

d. Language

B (According to the textbook, consciousness is the most fundamental of these particular characteristics; therefore, it would be tested first.)

Which of the following is NOT true regarding people with dementia?

a. Most people can tell they are developing dementia early on

b. They have significantly impaired intellectual function that interferes with normal activities and relationships

c. They lose their ability to solve problems and maintain emotional control

d. They may experience personality changes and behavioral problems

A

A patient with dementia is unable to verbally communicate with you because they are forgetting common words. What is this called in medical terminology?

a. Aphasia

b. Apraxia

c. Agnosia

d. Diminished executive functioning

A (Aphasia is a language disturbance. Apraxia is an impaired ability to carry out motor activities despite intact motor function. Agnosia is the failure to recognize or identify objects. Executive functioning is complex behavior such as planning, organizing and abstracting.)

Your patient has no motor disability, but it unable to pick up their spoon and bring it to their mouth to feed themselves. What is this called in medical terminology?

a. Aphasia

b. Apraxia

c. Agnosia

d. Diminished executive functioning

B (Aphasia is a language disturbance. Apraxia is an impaired ability to carry out motor activities despite intact motor function. Agnosia is the failure to recognize or identify objects. Executive functioning is complex behavior such as planning, organizing and abstracting.)

When assessing your patient for cognitive impairment, you put a key in their palm and ask them to identify what the object is with their eyes closed. They then respond with, "I am not sure what this is, but it feels familiar. I forget the name of it." What is this called in medical terminology?

a. Aphasia

b. Apraxia

c. Agnosia

d. Diminished executive functioning

C (Aphasia is a language disturbance. Apraxia is an impaired ability to carry out motor activities despite intact motor function. Agnosia is the failure to recognize or identify objects. Executive functioning is complex behavior such as planning, organizing and abstracting.)

Upon assessment of your patient that is suspected to have dementia, it is concluded that they are unable to perform complex behaviors like planning, organizing, and abstracting. What is this called in medical terminology?

a. Aphasia

b. Apraxia

c. Agnosia

d. Diminished executive functioning

D (Aphasia is a language disturbance. Apraxia is an impaired ability to carry out motor activities despite intact motor function. Agnosia is the failure to recognize or identify objects. Executive functioning is complex behavior such as planning, organizing and abstracting.)

Which of the following statements is true regarding dementia?

a. It is a part of the normal aging process

b. Early onset is easy to detect

c. It is a slow, progressive disease

d. It is a reversible condition

C

You are assessing a 75-year-old male patient that has been admitted to the clinic you work at because he is suspected of having dementia. His daughter has been his caregiver for around 6 months so you decide to ask her some questions regarding his impaired cognition. To screen for symptoms of dementia, which of the following questions might you ask her? (Select all that apply).

a. Is he unaware of his declining abilities?

b. Does he ever seem anxious to you?

c. Does your father seem to be more irritable than normal?

d. Does he have difficulty performing familiar tasks?

e. Does he have difficulty understanding concepts, or poor insight?

A D E (Anxiety and irritability are symptoms of delirium.)

Which of the following patient's would be least likely to develop dementia?

a. A 45 year old female who's mother had dementia.

b. A 57 year old male who has diabetes.

c. A 20-year-old female who has lead poisoning

d. An 18-year-old male who is postoperative for an appendectomy.

D

A 75-year-old female patient has just been admitted to the clinic you work at. You review their health history and see that they were diagnosed with dementia two years ago. You ask their caregiver some questions about behavioral changes that have occurred with the patient, which they then reveal that she has been hoarding bottle caps in one of the kitchen cabinets for about 6 months and can't seem to convince her to stop doing it. The caregiver also states that the patient tend to wander and is unable to perform ADLs. Which of the following diseases do these symptoms indicate?

a. Alzheimer's

b. Delirium

c. Lewy Body

d. Depression

A

When diagnosing a patient with Alzheimer's, which of the following tests would be unnecessary to do?

a. MMSE

b. Spinal tap for CSF

c. Neurologic exam

d. Physical exam

B

A nurse instructor is teaching a group of nursing students tips for communicating with patients who have dementia. Which of the following statements made by the students indicates further instruction?

a. "I will make sure to give one instruction at a time, and to give it slowly."

b. "I will be at eye level with them when I am communicating."

c. "I will ask them: Do you remember?"

d. "I will speak positives instead of negatives."

C

Which of the following statements are true regarding delirium?

a. It is an acute, confusional state

b. It's onset is slow

c. It is long-lasting

d. It is irreversible

A

A 78-year-old male patient has just been admitted to the your ER with symptoms of confusion, anxiety, and a decrease in memory. The patient's wife tells you that she thinks he has dementia, but you suspect otherwise. To rule out delirium, which of the following tests would you perform on your patient? (Select all that apply).

a. WBC count

b. Fluid and electrolytes

c. ALT, AST, and total bilirubin

d. Chest x-ray

e. MRI

f. BUN, creatinine

A B C F

Which of the following statements regarding delirium is true?

a. Delirium usually lasts a few weeks to a month.

b. A patient with delirium must be monitored until all signs of confusion are clear.

c. Full recovery of delirium is uncommon.

d. Dehydration is not a cause of delirium.

B

Which of the following is NOT true regarding depression?

a. It is a normal part of aging.

b. Emotional experiences of sadness, grief, response to loss, and temporary "blue" moods are normal.

c. Persistent depression significantly interferes with ability to function.

d. It is a mood disorder.

A (Depression is NOT a normal part of aging).

Anhedonia is known as:

a. The difficulty to swallow

b. The difficulty to speak

c. An inability to experience pleasure from normally pleasurable life events

d. Having thoughts of death

C

Your client is experiencing the following symptoms: Change in appetite, low self-esteem, impaired concentration, and insomnia. Which of the following conditions do you suspect your patient of having?

a. Depression

b. Bipolar disorder

c. Dementia

d. Delirium

A

How would you assess a patient in a comatose state for pain?

a. Take their vital signs.

b. Observe the patient for grimacing or shielding.

c. It is unnecessary to assess a patient in a comatose state for pain.

A

Which of the following is NOT an example of chronic pain?

a. Arthritis

b. Fibromyalgia

c. Degenerative disc disease

d. Broken leg

D

Which of the following manifestations would you not see in a patient with acute pain?

a. Increased pulse

b. Increased RR

c. Decreased temperature

d. Increased BP

C

Your patient has cancer and is currently having a pain level of 8 out of 10 despite being on a regular routine of taking pain medication. Which of the following types of pain does your patient most likely have?

a. Acute

b. Chronic

c. Breakthrough

C

Your patient is experiencing a pain level of 8 out of 10 two hours into their dose of Percocet. Which of the following types of pain does this situation represent?

a. Chronic

b. End-of-dose failure

c. Acute

B

How long is it acceptable to leave an ice pack on your patient for?

a. 5-10 minutes

b. 15-20 minutes

c. 30 minutes

d. 60 minutes

B

A 65-year-old woman has fallen while sweeping her driveway, sustaining a tissue injury. She describes her condition as an aching, throbbing back. Which type of pain are these complaints most indicative of?

a. Neuropathic pain

b. Nociceptive pain

c. Chronic pain

d. Mixed pain syndrome

B (Nociceptive pain refers to the normal functioning of physiologic systems that leads to the perception of noxious stimuli (tissue injury) as being painful. Patients describe this type of pain as dull or aching, and it is poorly localized. Neuropathic pain is described as shooting, tingling, burning, or numbness that is constant in the extremities, as in diabetic neuropathy. Chronic pain lasts longer than 30 days and is characterized by a disease affecting brain structure and function, such as chronic headaches or open wounds. Mixed pain syndromes are caused by different pathophysiologic mechanisms such as a combination of neuropathic and nociceptive pain; this occurs in syndromes such as sciatica, spinal cord injuries, and cervical or lumbar spinal stenosis.)

Stephanie is a 70-year-old retired schoolteacher who is interested in nondrug, mind-body therapies, self-management, and alternative strategies to deal with joint discomfort from rheumatoid arthritis. Which of the following options should you suggest for her plan of care, considering her expressed wishes?

a. Using a stationary exercise bicycle and free weights and attending a spinning class

b. Using mind-body therapies such as music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy

c. Drinking chamomile tea and applying icy/hot gel

d. Receiving acupuncture and attending church services

B (Mind-body therapies are designed to enhance the mind's capacity to affect bodily functions and symptoms and include music therapy, distraction techniques, meditation, prayer, hypnosis, guided imagery, relaxation techniques, and pet therapy, among many others. Although getting exercise, drinking chamomile tea and applying gels, and receiving acupuncture and attending church services may be beneficial, they are not classified as mind-body therapies in combination as specified in these answer choices.)

Postoperative surgical patients should be given alternating doses of acetaminophen and which medication throughout the postoperative course, unless contraindicated?

a. Antihistamine

b. Local anesthetic

c. Opioids

d. Nonsteroidal anti-inflammatory drug (NSAID)

D (Unless contraindicated, all surgical patients should routinely be given acetaminophen and an NSAID in scheduled doses throughout the postoperative course. Opioid analgesics are added to the treatment plan to manage moderate-to-severe postoperative pain. A local anesthetic is sometimes administered epidurally or by continuous peripheral nerve block.)

Which of the following is a priority for a nurse to include in a teaching plan for a patient who desires self-management and alternative strategies?

a. Body alignment and superficial heat and cooling

b. Patient-controlled analgesia (PCA) pump

c. Neurostimulation

d. Peripheral nerve blocks

A (Body alignment and thermal management are examples of nonpharmacologic measures to manage pain. They can be used individually or in combination with other nondrug therapies. Proper body alignment achieved through proper positioning can help prevent or relieve pain. Thermal measures such as the application of localized, superficial heat and cooling may relieve pain and provide comfort. PCA, neurostimulation, and peripheral nerve blocks are not totally self-managed or alternative therapies, because they are used under the direction of medical professionals.)

The nurse is caring for a patient who sustained a hip fracture and had an open reduction and internal fixation (ORIF) of a hip fracture. The patient is complaining of pain. Which should the nurse do next?

a. Reposition the patient.

b. Assess the level of pain.

c. Administer of pain medications before getting the patient up.

d. Maintain bed rest.

B (The nurse should first assess the pain level further before determining which intervention is needed. Repositioning the patient is an intervention and should come after assessment. Administering pain medications is an intervention and should come after assessment. Bed rest is not an intervention for pain management.)

The nurse is caring for a patient who will be discharged with a pain management plan following a fracture to the forearm. Which of the following should the nurse instruct the patient to do first when in pain?

a. Try not to take your medications until you pain level is at an 8.

b. Take your pain medications when your pain level is at a 3.

c. Try repositioning your arm and applying ice before taking medications.

d. Keep the hand immobile to prevent pain.

C (Nonpharmacological measures may prevent the need for medications and may be all that is necessary for proper management. A pain level of an 8 is difficult to manage. Patients should consider taking pain medications when their pain level is under 5 to gain better control over the pain. Elevating the shoulder would be uncomfortable for the patient and this position may increase pain.)

The nurse is obtaining a history from a patient in pain. Which question asked by the nurse will give the most information about the patient's pain?

a. How long have you had this pain?

b. Can you describe your pain?

c. How much medication do you take for the pain?

d. How many times a day do you take medication for the pain?

B (Because pain is a subjective experience, asking a question that addresses the patient's experience with the pain will elicit more information than the more specific information asked in the other three responses.)

Following the initiation of a pain management plan, pain should be reassessed and documented on a regular basis as a way to evaluate the effectiveness of treatments. Pain should be re-assessed at which minimum interval? (Select all that apply).

a. With each new report of pain

b. Before and after administration of narcotic analgesics

c. Every 10 minutes

d. Every shift

A B (Following the initiation of a pain management plan, pain should be reassessed and documented on a regular basis as a way to evaluate the effectiveness of treatments. At a minimum, pain should be reassessed with each new report of pain and before and after administration of analgesics.)