NURS 230 Mental Health FINAL 22-24 CH

The nurse is assessing a 2-year-old child during a wellness checkup. Which statement(s) by the parent indicate that the child needs to be screened for autism spectrum disorder? Select all that apply.

A. "My child rarely makes eye contact with me or siblings."

B. "My child loves to have a difference in routines daily."

C. "I notice that my child has very few facial expressions to situations."

D. "There is no spontaneous play at all and will only plays with one object.

E. "Will answer questions when asked with a one-word response."

A. "My child rarely makes eye contact with me or siblings."

C. "I notice that my child has very few facial expressions to situations."

D. "There is no spontaneous play at all and will only plays with one object.

A parent expresses concern to the nurse that the child's regularly scheduled measles, mumps, and rubella (MMR) vaccines may not be safe and cause autism. Which is the most appropriate response by the nurse?

A. "It is recommended that you wait until the child is older to vaccinate."

B. "There are safer alternative immunizations available now."

C. "There has been no research to establish a relationship between vaccines and autism."

D. "The risks do not outweigh the benefits of immunization against childhood diseases."

C. "There has been no research to establish a relationship between vaccines and autism."

A parent informs the nurse that they are concerned that the parent's child might suffer from attention-deficit/hyperactivity disorder (ADHD). The child can sit still, running all over the house, and having difficulty in school. Which is the best response by the nurse?

A. "From what you are describing, ADHD may be a possibility and we will refer you to a specialist for screening."

B. "All children can be like that and it may be a disciplinary issue and not a symptom of ADHD."

C. "Not all children do well in school and parents have a very high expectation of achievement."

D. "You should be sure to talk to the health care provider about prescribing medication for treatment."

A. "From what you are describing, ADHD may be a possibility and we will refer you to a specialist for screening."

The nurse is educating parents of a child with attention-deficit/hyperactivity disorder (ADHD)about the prescription for atomoxetine. Which client statement(s) indicate that the education is effective? Select all that apply.

A. "We will need to bring our child in for routine liver function testing."

B. "Prior to the administration of the medication, a chest x-ray will be done."

C. "If our child reports a dry mouth, we can give sugar free candy or gum."

D. "It is better to give the medication with food."

E. "We need to monitor appetites since the medication may suppress appetite."

A. "We will need to bring our child in for routine liver function testing."

C. "If our child reports a dry mouth, we can give sugar free candy or gum."

D. "It is better to give the medication with food."

E. "We need to monitor appetites since the medication may suppress appetite."

A child with attention-deficit/hyperactivity disorder (ADHD) arrives with a parent for a scheduled checkup. The nurse assesses that the child looks thin and has lost several pounds since the last

visit 6 months ago. Which action will the nurse take to improve the child's nutritional status?

A. Stop all medication for treatment until the child regains the weight.

B. Have the child sit at the table for three large meals a day with the family.

C. Encourage the parents to include finger foods several times a day.

D. Add milk shakes and other foods high in sugar to increase weight gain.

C. Encourage the parents to include finger foods several times a day.

The nurse observe a child with attention-deficit/hyperactivity disorder (ADHD) grab another child in a group session. Which response by the nurse is most effective in stopping the behavior?

A. "If you can't sit still in the group, you will not be allowed to attend again."

B. "It's ok to want to make new friends and show you affection to them."

C. "It's not alright to grab other children. When you want something, ask them."

D. "I am sure that your parents do not allow you to act this way at home, do they?"

C. "It's not alright to grab other children. When you want something, ask them."

The school nurse is talking with the parent of a 7-year-old child who is having difficulty in the classroom due to a diagnosis of attention-deficit/hyperactivity disorder (ADHD). The child is having

difficulty paying attention, listening, and completing tasks. Which suggestion can the nurse give for improvement to the parent?

A. Allow the child to listen to music with headphones while completing class work.

B. Request that the child be seated in front of the teacher in the classroom.

C. Encourage the parent to increase the dosage of medication the child is taking.

D. Have the child do the majority of school work on a computer in the classroom.

B. Request that the child be seated in front of the teacher in the classroom.

A child with attention-deficit/hyperactivity disorder (ADHD) tells the parents that they do not like how the medication makes them feel and the parents ask the nurse what they can do to decrease the side effects. Which is the best response by the nurse?

A. Give the child the medicine at night.

B. Have the child eat breakfast and snacks later in the day and bedtime.

C. Limit the number of calories the child eats each day.

D. Let the child take daytime naps.

B. Have the child eat breakfast and snacks later in the day and bedtime.

The nurse is assisting a child with attention-deficit/hyperactivity disorder (ADHD) to complete the child's activities of daily living. Which is the best approach for nurse to use with this child?

A. Break tasks into small steps.

B. Let the child complete tasks at the child's own pace.

C. Offer rewards when all tasks are completed.

D. Set a time limit to complete all tasks.

A. Break tasks into small steps.

The nurse is preparing to bring a child and their parents into the examination room to see the health care provider. Which are the best way(s) for the nurse to assess the child for attention- deficit/hyperactivity disorder (ADHD)? Select all that apply.

A. Directly observing the child

B. Reviewing the client's record

C. Interviewing the client's parents

D. Interviewing the client's teachers

E. Assessing the client in a group of peers

A. Directly observing the child

C. Interviewing the client's parents

D. Interviewing the client's teachers

E. Assessing the client in a group of peers

The nurse is planning the care for a child with attention-deficit/hyperactivity disorder (ADHD). When discussing interventions with the parent, which nursing intervention will be the highest priority?

A. Provide a structured daily routine.

B. Ensure the child's safety due to impulsiveness.

C. Simplify instructions and directions with only one step at a time.

D. Improve role performance.

B. Ensure the child's safety due to impulsiveness.

An 8-year-old with attention-deficit/hyperactivity disorder is jumping off the bed onto a chair. Which response by the nurse would be most appropriate?

A. "I need to talk to you."

B. "Stop jumping on the bed now."

C. "You are going to hurt yourself."

D. "Why are you jumping off the bed?"

B. "Stop jumping on the bed now."

The parent of a 6-year-old child with autism spectrum disorder (ASD) informs the nurse that the temper tantrums are getting difficult to control and the parent is afraid of what the child will do to themself and other family members. Which option will the nurse discuss with the parent to help manage the behaviors?

A. These behaviors are difficult to manage, but they will get better as the child ages.

B. The use of antipsychotic medications may be helpful with the tantrums and aggression.

C. The parent will need to take a firmer disciplinary approach with the child.

D. The child may require inpatient care since this is not a typical behavior of ASD.

B. The use of antipsychotic medications may be helpful with the tantrums and aggression.

The parents of a child with attention-deficit/hyperactivity disorder (ADHD) express to the nurse, "We get so frustrated when our child never listens to us." Which parenting strategies will the nurse discuss with the parents? Select all that apply.

A. Use appropriate time-out strategies for behavior control.

B. Provide occasional rewards and consequences for behavior.

C. Give verbal reprimands for negative behavior.

D. Resist giving praise until fully compliant with requests.

E. Use a point system for positive and negative behavior.

A. Use appropriate time-out strategies for behavior control.

C. Give verbal reprimands for negative behavior.

E. Use a point system for positive and negative behavior.

A nurse working with children with autism spectrum disorder (ASD) hears an unlicensed assistive personnel (UAP) stating, "I don't know why we put in so much time educating these parents, they

don't seem to care what we say." Which is the best response to the UAP about the importance of educating parents of children with ASD?

A. "I understand how you feel. The parents are too overwhelmed to really hear what we say."

B. "We help parents feel relieved to have specific strategies that can help them and their child be more successful."

C. "The parents are the ones paying for the care that their child is receiving so we are obligated to teach."

D. "Any parent who has a child who receives special school services has to be educated about care ."

B. "We help parents feel relieved to have specific strategies that can help them and their child be more successful."

A nurse is providing education to a group of parents who have children with attention- deficit/hyperactivity disorder (ADHD). Which information will the nurse include in the education? Select all that apply.

A. Placing your child on medication alone will be adequate treatment.

B. Take the time to learn how to rebuild a child's self-esteem.

C. Support groups can provide information and encouragement from others.

D. ADHD is not the fault of the parents or the child.

E. Children with ADHD do not qualify for special school services.

B. Take the time to learn how to rebuild a child's self-esteem.

C. Support groups can provide information and encouragement from others.

D. ADHD is not the fault of the parents or the child.

The nurse is educating parents of a child with attention-deficit/hyperactivity disorder (ADHD). Which statement by the parents would indicate the need for further teaching?

A. "We'll have the child do homework at the kitchen table with the child's siblings."

B. "We'll make sure the child completes one task before going on to another."

C. "We'll set up rules with specific times for eating, sleeping, and playing."

D. "We'll use simple, clear directions and instructions."

A. "We'll have the child do homework at the kitchen table with the child's siblings."

The nurse is talking with a parent of a 12-year-old child with autism spectrum disorder (ASD) about behavior that has deteriorated recently. Which is the best response by the nurse?

A. "It is likely an effect of hormonal changes."

B. "The child may need medication to control these behaviors."

C. "It may be a reaction to the overprotection of parents."

D. "Since this is a progressive illness, behavior will get worse."

A. "It is likely an effect of hormonal changes."

The nurse is working with a school-age child who is being evaluated for a mental health disorder. The parents of the child ask the nurse why the health care staff is having such a difficult time diagnosing the child. Which is the best response by the nurse? Select all that apply.

A. Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening.

B. Children are constantly changing and developing and unable to discriminate unusual symptoms from normal feelings.

C. Behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level.

D. Sometimes, children "outgrow" psychiatric disorders at different stages of life.

E. Children and adolescents experience some of the same mental health problems as adults and are diagnosed using the same criteria.

A. Children usually lack the abstract cognitive abilities and verbal skills to describe what is happening.

B. Children are constantly changing and developing and unable to discriminate unusual symptoms from normal feelings.

C. Behaviors that are appropriate for a child of one developmental level may be inappropriate for a child of a different developmental level.

The nurse has been working with the family of a small child with attention-deficit/hyperactivity disorder (ADHD). The nurse feels very frustrated because the parents refuse to implement the effective parenting skills that the nurse has taught. Which is the best action for the nurse at this time?

A. Review effective disciplinary practices with the parents again.

B. Refer the parents to a family therapist.

C. Praise the parents for doing their best in a difficult situation.

D. Explore alternative living arrangements for the child.

C. Praise the parents for doing their best in a difficult situation.

A client with a tic disorder tells the nurse that they are experiencing more complex motor tics and verbal tics lately but they get better when occupied with a task. Which question will be most appropriate to ask the client to determine the best option for decreasing these symptoms?

A. "Have you been experiencing an increase in stress lately?"

B. "Is there any changes that you have made to your diet?"

C. "Are you taking any new medications?

D. "Have you developed any new allergies?"

A. "Have you been experiencing an increase in stress lately?"

A nurse is teaching a family how to best help their child who has been recently diagnosed with a neurodevelopmental disorder. Which statement indicates to the nurse that teaching has been effective?

A. "We will be able to do more things with our family."

B. "We will be able to enjoy more structure in our home."

C. "We will be able to go to the races every weekend like we used to."

D. "We will be able to go on the bus tour with our church group."

B. "We will be able to enjoy more structure in our home."

The parent of a child with attention-deficit/hyperactivity disorder (ADHD) tells the school nurse that the child's teacher has called a conference. Which statement is true regarding evaluation of treatment for the child with ADHD?

A. The child notices the change in treatment before anyone else.

B. The change is subtle and gets noticed at the follow-up visit.

C. It is the siblings that notice the change in behavior first.

D. The parents or teacher notice positive outcomes of treatment.

D. The parents or teacher notice positive outcomes of treatment.

A parent of a child who is diagnosed with mild-to-moderate intellectual developmental disorder is upset and states, "Am I going to have to put my child in an institution?" Which is the most therapeutic response by the nurse?

A. "It all depends on the behavioral issues that the child experiences."

B. "Your child will be able to receive care at home and in the community."

C. "You may need to consider residential or day care services for your child."

D. "You will need to receive intensive education to be able to care for your child at home."

B. "Your child will be able to receive care at home and in the community."

A young adolescent client arrives in the outpatient clinic and demonstrates various motor and vocal tics. The client is emotional and states that other children avoid them and call them horrible names.

Which prescription by the health care provider will the nurse educate the client and parent about?

A. Risperidone

B. Lithium

C. Methylphenidate

D. Atomoxetine

A. Risperidone

The nursing is caring for a child in the pediatric outpatient clinic being treated with imipramine for the treatment of enuresis. Which report by the parent is of most concern to the nurse?

A. The parent states the child is having a bowel movement every other day.

B. The parent states the child is sleepy for about 2 hours after taking the pill.

C. The child reports nausea after taking the pill relieved with food.

D. The child is having decreased urinary output and difficulty urinating.

D. The child is having decreased urinary output and difficulty urinating.

A child is expelled from school for repeated fighting and vandalizing school property. The school nurse and counselor meet with the parents to explain that the child may benefit from counseling

and are formulating a collaborative plan. The child is experiencing signs of which disorder?

A. Oppositional defiant disorder

B. Asperger syndrome

C. Attention-deficit/hyperactivity disorder

D. Conduct disorder

D. Conduct disorder

An adolescent is displaying behaviors associated with conduct disorder such as stealing, fighting, skipping school, and not adhering to the rules at home. Which factor(s) stated by the client does the nurse correlate with the behaviors exhibited by the adolescent? Select all that apply.

A. "Our family is dysfunctional and no one gets along."

B. "My parents are strict and set firm limits."

C. "My parents are into drugs and alcohol."

D. "If I don't do what my parent says, I get beaten."

E. "We live in a rundown apartment on a bad side of town."

A. "Our family is dysfunctional and no one gets along."

C. "My parents are into drugs and alcohol."

D. "If I don't do what my parent says, I get beaten."

E. "We live in a rundown apartment on a bad side of town."

The nurse is using limit setting with a child diagnosed with conduct disorder. Which statement reflects the most effective way for the nurse to set limits with the child?

A. "That is not allowed here. You will lose a privilege. You need to stop."

B. "Stop what you are doing. Go to your room."

C. "I would appreciate if you would not do that."

D. "Why do you do these things?"

A. "That is not allowed here. You will lose a privilege. You need to stop."

Parents bring their child to the clinic and state to the nurse, "We just don't know what to do anymore. It must be a medical disorder because our child has never been in trouble or acted this way. They are lying, stealing, and destroying property." Which is likely to be the most effective intervention for this adolescent?

A. Placing the child in a "boot camp"

B. Parenteral education about discipline

C. Incarceration into the penal system

D. Prevention and early intervention

D. Prevention and early intervention

A 14-year-old client is being treated for conduct disorder. The client refuses to attend class today and states that "Yesterday, the other nurse told them they didn't have to go to class if they didn't want to." Which is the best response by the nurse?

A. "Fine, but you're confined to your room and not allowed to socialize."

B. "You are obligated to attend class. Missing class is against the rules."

C. "You and I both know that the nurse didn't say that."

D. "Why do you keep fighting the system, just go along with the rules."

B. "You are obligated to attend class. Missing class is against the rules."

The nurse is meeting with the family of a client with conduct disorder. The nurse discusses changes the parents can make to help their child manage problematic behaviors. Which parenting technique will the nurse educate the parents to use?

A. Provide consistent consequences for behaviors.

B. Set earlier curfews than the child's peers adhere to.

C. Release the child from household responsibilities until they are dependable.

D. Avoid discussing feelings and expectations with the child.

A. Provide consistent consequences for behaviors.

The nurse is educating a pregnant client about prenatal care and the potential for decreasing the risk for conduct disorder. The client presently has a child with a conduct disorder and is concerned that this will happen again. Which statement made by the client indicates further education is required?

A. "As long as I only have a beer or two a couple of times a week, my unborn child will be ok."

B. "I should be sure to be adherent to my prescribed prenatal vitamins and folic acid."

C. "Prenatal care is important and I will attend all of my visits routinely.

D. "There are several factors that are involved for a child to develop a conduct disorder."

A. "As long as I only have a beer or two a couple of times a week, my unborn child will be ok."

The nurse is admitting an adolescent client with a conduct disorder to an inpatient facility. Which will the nurse discuss with the client that will be enforced throughout the stay related to limit setting? Select all that apply.

A. State the expected behavior of the client in the facility.

B. Inform the client about the rules or limits.

C. Inform the client they will be incarcerated for nonadherence to the rules.

D. Explain the consequences if clients exceed the limit.

E. Occasionally limit enforcement but allow some freedoms.

A. State the expected behavior of the client in the facility.

B. Inform the client about the rules or limits.

D. Explain the consequences if clients exceed the limit.

An adolescent is exhibiting out-of-control behavior and yelling and threatening another person on the behavioral health unit. Which is the priority action by the nurse and health care team?

A. Inform the adolescent they will be placed isolation.

B. Notify the police that the client is out of control.

C. Place the adolescent in restraints.

D. Institute a time-out.

D. Institute a time-out.

The nurse is talking with the parents of a child with disruptive behavior disorder about ways to help the child manage behaviors. Which action is best for the nurse advocate for the child to have their needs met?

A. Support transferring the child to a healthy living environment.

B. Teach the parents age-appropriate expectations of the child.

C. Reinforce the parents' expectations of the child's behavior.

D. Interpret the child's thoughts and feelings to the parent.

B. Teach the parents age-appropriate expectations of the child.

The nurse is assessing an adolescent client. The parent is in the room and answers most of the questions, even though the questions are directed at the client. Which action(s) from the parents of a child with conduct disorders does the nurse identify may be a contributing factor to the behaviors? Select all that apply.

A. The parents may not behave appropriately because of a lack of knowledge.

B. The parents blame the school when the child causes a disturbance in school.

C. The parents engage in yelling at, hitting, or simply ignoring the behavior of the child.

D. The parents make reasonable curfews that are age appropriate.

E. The parents establish household responsibilities that are age appropriate.

A. The parents may not behave appropriately because of a lack of knowledge.

B. The parents blame the school when the child causes a disturbance in school.

C. The parents engage in yelling at, hitting, or simply ignoring the behavior of the child.

The nurse is presenting information about conduct disorders to a community group. Which recommendation will the nurse provide that is the best setting for care of a client with conduct disorders when parents cannot provide safe, structured environments and adequate supervision?

A. An acute care setting

B. School

C. Residential treatment settings

D. Jail-diversion program

C. Residential treatment settings

Parents of a child who has behavioral problems ask the nurse which is the most effective way to deal with these behaviors and prevent them in their other children. Which is the best response by the nurse?

A. Administering medications

B. Adopting more of a relaxed limit setting strategy

C. Attending group-based parenting classes

D. Being overprotective of the child

C. Attending group-based parenting classes

The adolescent client is exhibiting "bullying behaviors." Which may be concern(s) that a nurse has when caring for clients who have conduct disorders? Select all that apply.

A. Believing that the client should be able to refrain from hostility and aggression through use of will power

B. Having conflicted feelings regarding holding clients accountable for their behaviors without having a punitive attitude

C. Discussing feelings, fears, or frustrations with colleagues

D. Having anxiety and fears for the nurse's personal safety

E. Believing that aggression is the most productive way to deal with anger

A. Believing that the client should be able to refrain from hostility and aggression through use of will power

B. Having conflicted feelings regarding holding clients accountable for their behaviors without having a punitive attitude

D. Having anxiety and fears for the nurse's personal safety

The nurse is working with clients who have disruptive behavior disorders. Which are important point(s) for the nurse to consider when working with these clients and their families? Select all that apply.

A. Most behavior disorders are caused by being raised by parents who had behavior disorders in their own childhoods.

B. Remember to focus on the client's strengths and assets, as well as their problems.

C. Transient conduct disorders are common in all children.

D. Avoid a "blaming" attitude toward clients and/or families.

E. Focus on positive actions to improve situations and/or behaviors.

B. Remember to focus on the client's strengths and assets, as well as their problems.

D. Avoid a "blaming" attitude toward clients and/or families.

E. Focus on positive actions to improve situations and/or behaviors.

The nurse is considering switching to another area of nursing due to feelings of stress prior to going to work. Which is the most important reason for the nurse who cares for children with conduct disorders to discuss feelings, fears, or frustrations with colleagues?

A. To make the nurse feel better about working in the area and avoid burnout

B. To encourage camaraderie between colleagues and to provide the same treatment to the children

C. To keep negative emotions from interfering with the ability to provide care to clients with problems with aggression

D. To ensure that all caregivers have the same attitudes and beliefs about children with conduct disorders

C. To keep negative emotions from interfering with the ability to provide care to clients with problems with aggression

After being arrested for prostitution, an adolescent client has been referred to a mental health clinic by a juvenile officer. The client has a history of truancy and being physically abusive to siblings. From the history gathered during assessment, the nurse identifies that these behaviors correlate with which disorder?

A. Intermittent explosive disorder

B. Oppositional disorder

C. Conduct disorder

D. Childhood depressive disorder

C. Conduct disorder

A client has been referred to a mental health center by a juvenile court after being arrested for vandalism. At the mental health center, the client refuses to participate in scheduled activities and was observed pushing another client. Which action by the nurse is the most therapeutic?

A. Neutrally permitting refusals

B. Coaxing to gain compliance

C. Offering rewards in advance

D. Establishing firm limits

D. Establishing firm limits

A preadolescent client has been considered a neighborhood bully for several years. Peers avoid them, and the parent says, "I cannot believe a thing my child tells me." Recently, the client was observed shooting at several dogs with a pellet gun and setting fire to a vacant lot for the first time. A nurse would assess these behaviors as being most consistent with which disorder?

A. Conduct disorder

B. Oppositional defiant disorder

C. Pyromania

D. Defiance of authority

A. Conduct disorder

When a young client is disruptive, the nurse responds, "You must take a time-out." Which is the priority outcome for intervention with a time-out?

A. The client will have increased socialization.

B. The client will develop adequate coping skills.

C. The client will understand the consequences of poor behavior.

D. The client will identify signs of increasing agitation.

D. The client will identify signs of increasing agitation.

The nurse is working with an aggressive adolescent with behavioral disorder, and the client has been resistant to the treatment plan. Which action can the nurse take to keep the negative emotions from interfering with a positive outcome for the client?

A. Have another nurse care for the client to refrain from showing bias.

B. Discuss feelings, fears, and frustrations with colleagues regarding the client.

C. Inform the client that their behaviors are causing frustration and anger.

D. Consider another area of nursing since this is likely to continue to happen.

D. Consider another area of nursing since this is likely to continue to happen.

The nurse is performing an assessment for a 14-year-old client whose parents are concerned with recent behaviors exhibited by the adolescent. Which statement(s) by the client in the interview portion of the assessment does the nurse identify as typical adolescent behaviors? Select all that apply.

A. Consistent and predictable behaviors

B. Lacks caring about peer approval

C. Inability to postpone gratification

D. Verbally aggressive with parents

E. Critical of self and others

D. Verbally aggressive with parents

E. Critical of self and others

The nurse is talking with an adolescent client who has been externalizing behaviors indicating a conduct disorder. Which client statement(s) indicate that externalizing behaviors are being experienced?

A. "I got caught cheating on an exam. I cheat all of the time, why should I study?"

B. "I set fire to a trash can on school property when I threw my cigarette in it."

C. "When I get dropped off at school, I skip and go drink with my friends."

D. "My stomach hurts and I feel nauseated all of the time."

E. "I'm always tired and sleepy. Just don't feel like going anywhere or doing things."

A. "I got caught cheating on an exam. I cheat all of the time, why should I study?"

B. "I set fire to a trash can on school property when I threw my cigarette in it."

C. "When I get dropped off at school, I skip and go drink with my friends."

The nurse is performing a family assessment to determine why an adolescent is engaging in risky behaviors. The parent states, "I just don't understand why my child would want to drink alcohol when my spouse is an alcoholic and has had several DUI's as well as being abusive to the children and I." Which is the best response by the nurse?

A. "If the spouse doesn't know right from wrong, how can you expect the child to behave any differently?"

B. "Parents that engage in risky behaviors are more likely to have children that engage in these behaviors."

C. "I realize this is unusual behavior because you would think the child would not want to repeat those behaviors."

D. "You never know what type of things children will pick up. You have to be the best parent for you and your spouse."

B. "Parents that engage in risky behaviors are more likely to have children that engage in these behaviors."

The nurse is having a group activity in the day room with adolescent clients with behavioral issues. One of the clients becomes angry and picks up someone else's project and throws it on the floor, breaking it. Which response by the nurse is most appropriate?

A. "If you can't behave when we are trying to have an activity, you won't be able to participate."

B. "I am so frustrated with you and the way you always have to have your way."

C. "Did it make you feel better to hurt your peers' feelings and destroy their hard work?"

D. "Throwing things is unacceptable behavior. Tell me why you are upset and let's talk about it."

D. "Throwing things is unacceptable behavior. Tell me why you are upset and let's talk about it."

During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium?

A) Unable to identify a water pitcher

B) Unable to transfer to sitting position

C) Difficulty with verbal expression

D) Disoriented to person

D) Disoriented to person

A nurse working in an assisted living facility is holding an in-service for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest?

A) The clients should be able to ask us for items they need.

B) The clients may not recognize their family when they come to visit.

C) The clients who are ambulatory can still carry out activities of daily living independently.

D) The clients should know when to come to the dining room for meals.

B) The clients may not recognize their family when they come to visit.

Which is believed to be a risk factor specific to the development of delirium?

A) Increased severity of physical illness

B) Older age

C) Baseline cognitive impairment

D) Gradual decline in functioning

A) Increased severity of physical illness

Which patient is most likely suffering from dementia?

A) A 90-year-old male who has experienced progressive mental decline that started with forgetfulness

B) An 80-year-old female who has been in excellent health until she was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff

C) A 6-year-old child who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that her parents have three sets of eyes

D) A 22-year-old male who was involved in a motorcycle crash without wearing a helmet now unable to remember where he is

A) A 90-year-old male who has experienced progressive mental decline that started with forgetfulness

A client with dementia is unable to recognize ordinary objects, such as a pen or notebook. Which would this be a symptom of?

A) Agnosia

B) Amnesia

C) Apraxia

D) Aphasia

A) Agnosia

Which client would have an increased risk for delirium?

A) An elderly woman with abdominal pain

B) A 3-year-old child with a temperature of 103.2∞F

C) A middle-aged woman newly diagnosed with multiple sclerosis

D) A young adult male with gastroenteritis and dehydration

B) A 3-year-old child with a temperature of 103.2∞F

The nurse is caring for a client with cognitive impairment. To determine whether the client is suffering from delirium or dementia, the nurse reviews the symptoms and course of each disorder. Place the letter A beside terms describing delirium and the letter B beside terms describing dementia.

____ Rapid onset

____ Progressive decline

____ Long-term memory impairment

____ Slurred speech

____ Hallucinations

_A_ Rapid onset

_B_ Progressive decline

_B_ Long-term memory impairment

_A_ Slurred speech

_A_ Hallucinations

The daughter of a woman with dementia asks the nurse if her mother will ever be able to live independently again. Which would be the most appropriate response by the nurse?

A) ìYou sound like you aren't ready for her to be dependent on caregivers.

B) Her confusion is a temporary complication of her physical illness and should subside when the illness gets better.

C) Symptoms of dementia gradually get worse. Unfortunately she will not be independent again.

D) With early treatment, mild dementia can be reversed. It may be possible.

C) Symptoms of dementia gradually get worse. Unfortunately she will not be independent again.

Which statement made by the nurse would be most appropriate to an 89-year-old patient who is confused but has no history of dementia and is hospitalized for an acute urinary tract infection?

A) ìYou are likely to become progressively more confused now.î

B) ìThis should be just a temporary situation.î

C) ìDon't worry about it; everyone is confused when they are in the hospital.î

D) ìI know things are upsetting and confusing right now, but your confusion should clear as you get better.î

D) ìI know things are upsetting and confusing right now, but your confusion should clear as you get better.î

Which distinguishes delirium from dementia?

A) Delirium has an acute onset and is progressive in course.

B) Delirium has a gradual onset and can be resolved.

C) Dementia has a gradual onset and is progressive in course.

D) Dementia has an acute onset and can be resolved.

C) Dementia has a gradual onset and is progressive in course.

The nurse is performing a health history with a client exhibiting signs of delirium. The nurse asks the client and family members about possible causes of the delirious state. Which would the nurse likely attribute as underlying causes for the client's delirium?

Select all that apply.

A) Recent alcohol use

B) Dehydration

C) Use of antihistamines

D) Sleep disturbances

E) Use of megadoses of vitamins

F) Exposure to paint or gasoline

A) Recent alcohol use

B) Dehydration

C) Use of antihistamines

D) Sleep disturbances

F) Exposure to paint or gasoline

A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing mild delirium. The client approaches the nurse and states, ìI'm going to take walk outside. I'll be back in about 10 minutes.î Which is the most appropriate nursing action?

A) Further assess the client's motives for wanting to walk.

B) Give the client permission to go on a walk on the grounds.

C) Tell the client the walk is not allowed and restrict him to the unit.

D) Designate a staff member to accompany the client on the walk.

D) Designate a staff member to accompany the client on the walk.

A client with dementia is starting pharmacotherapy to slow the progression of cognitive decline. The client has a history of moderate but steady alcohol use over the past 45 years. Which medication should the nurse question as least suitable for this client?

A) Tacrine (Cognex)

B) Memantine (Namenda)

C) Donepezil (Aricept)

D) Rivastigmine (Exelon)

A) Tacrine (Cognex)

The nursing supervisor in an extended care facility is managing the environment to best help the clients with dementia. Which should the nurse include in planning the living environment?

A) Plan for the same caregivers to provide care to individuals as much as possible.

B) Open the windows and doors to allow fresh air to circulate through the environment.

C) Provide a buffet-style menu with many food choices.

D) Assign peer-led exercise activates on a daily basis.

A) Plan for the same caregivers to provide care to individuals as much as possible.

The nurse encourages the client with dementia to meet nutritional needs. Which is the best approach to assist in meeting adequate dietary intake?

A) Sit with the client as long as necessary to complete the meal.

B) Provide entertainment during meals such as television or music.

C) Avoid between-meal snacks to encourage appetite.

D) Serve meals in small, bite-size pieces.

D) Serve meals in small, bite-size pieces.

The nurse caring for an elderly woman with dementia has asked the woman's children to bring old photo albums when they visit. Which best describes the usefulness of viewing photos when caring for the dementia client?

A) Viewing photos is a form of reminiscence therapy for the client.

B) Sharing photos will encourage interaction with other clients.

C) This can help the children to correctly identify old photographs.

D) Talking about the photos will encourage the client to live in the past.

A) Viewing photos is a form of reminiscence therapy for the client.

The nurse is encouraging a group of clients with dementia to join in upper body range of motion exercises using light dumbbells. Which technique will most likely result in the greatest amount of participation?

A) Show an instructional video just prior to the activity.

B) Describe the exercise immediately before performing it.

C) Demonstrate the exercises while clients simultaneously perform them.

D) Perform the same routine daily to avoid the need for repeated instruction.

C) Demonstrate the exercises while clients simultaneously perform them.

A client with dementia gets angry and begins to yell at the nurse during mealtime. The nurse leaves the client's side for 5 to 10 minutes and then returns. Which of the following best explains the nurse's behavior?

A) The nurse was unsure of how to calm the client.

B) The nurse was frustrated and needed to take a ìtime-out.î

C) The nurse gave the client a chance to calm down before resuming the meal.

D) The nurse stepped away to verify the safety of other clients.

C) The nurse gave the client a chance to calm down before resuming the meal.

Which is the most effective intervention for clients with delirium?

A) Giving detailed explanations

B) Managing environmental stimuli

C) Promoting rest with PRN medications

D) Providing activities for distraction

B) Managing environmental stimuli

The nurse is assessing a client with early signs of dementia. What is the nurse trying to determine when the nurse asks the client what he ate for breakfast that morning?

A) Orientation

B) Food preferences

C) Recent memory

D) Remote memory

C) Recent memory

The nurse is working with a client who has hallucinations and delusions. The client tells the nurse she cannot take a shower because she is waiting for her husband to take her home. Which response by the nurse is best in this situation?

A) ìIt would be best if you just took your shower now.î

B) ìYou seem anxious and upset.î

C) ìYou have plenty of time to shower before it's time to go home.î

D) ìWhy are you thinking you're going home?î

C) ìYou have plenty of time to shower before it's time to go home.î

The nurse is caring for a client with Alzheimer's disease. The nurse observes that the client's pacing and mumbling to himself increase at mealtime and shift change. Which intervention should the nurse implement first?

A) Administer an antianxiety drug such as lorazepam (Ativan) at these times.

B) Explain the unit routine and the reasons for increased activity to the client.

C) Keep unit activity to a minimum.

D) Move the client to a quieter area during these times.

D) Move the client to a quieter area during these times.

The nurse is developing interventions to promote socialization in a client with moderate dementia. Which would provide a safe and secure environment for the client?

A) A card game with other clients

B) An activity with the nurse

C) Decorating a bulletin board with the group

D) Morning stretch group with music

B) An activity with the nurse

The daughter of a client with dementia has been the primary caregiver for 5 months. The daughter expresses to the nurse, ìAt times it is so overwhelming! I feel I do not have a life anymore!î Which is the most helpful response by the nurse?

A) ìAre you saying you don't want to care for your mother anymore?î

B) ìI know it is really hard. It takes a lot of work and you are doing such a good job.î

C) ìYour mother really appreciates what you do for her. You are the best one to care for her.î

D) ìHere is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?î

D) ìHere is the number of a caregivers' support group. How do you think you would feel talking with others in the same situation?î

Which statement by the nurse would be most appropriate to the family member who is the primary caregiver to a client with dementia?

A) ìMost people seek help when they really need it.î

B) ìWhat is wrong with your family? Can't they see you need help?î

C) ìYou should be grateful that you still have your family member around.î

D) ìYes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role.î

D) ìYes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role.î

A client with moderate Alzheimer's disease is living with her grown daughter. Which statement by the daughter would indicate the need for intervention by the nurse?

A) ìIt's distressing when my mother forgets my name.î

B) ìI wish my sister would come to visit more often.î

C) ìMother won't let anyone else do anything for her.î

D) ìTaking care of my mother is a big responsibility.î

C) ìMother won't let anyone else do anything for her.î

A nurse is educating a group of elderly community members about cognitive disorders. Which would the nurse include as a measure most likely to prevent Alzheimer's disease and other dementias?

A) Crafts

B) Cooking

C) Watching television

D) Reading

D) Reading

The caregiver of a client with Alzheimer's disease reports to the nurse that often the client will suddenly become angry during meals and nothing seems to calm him down. The nurse teaches the caregiver to use distraction techniques. Which response would be

best to teach as an example of this technique?

A) ìLet's look at what is on television.î

B) ìIf you stop yelling, I will get your dessert.î

C) ìDon't you want to finish your meal?î

D) ìI don't understand what you are saying.î

A) ìLet's look at what is on television.î

The adult son of a client with dementia asks the nurse how he should respond when his mother repeatedly says she has had a busy day at work. The mother has not worked in over 20 years. Which is the best guidance that the nurse could offer?

A) Ask her to explain what she did at work today that kept her busy.

B) Go along with her thought of it having been a busy day, but do not refer to her work.

C) Reorient her that she is at home and did not go to work.

D) Give her 5 to 10 minutes of rest, and she will have no memory of the incident.

B) Go along with her thought of it having been a busy day, but do not refer to her work.

The grown daughter of a woman with Alzheimer's disease reports to the nurse that she is trying to keep her mother's condition from worsening by asking her questions whenever they are together. Which will be accomplished by this intervention?

A) Decrease environmental misinterpretation

B) Improve memory retention

C) Increase frustration

D) Slow the progress of the disease

C) Increase frustration

A new nurse has been working with clients with Alzheimer's disease for almost 6 months. During a staff meeting, the nurse expresses frustration because the same instructions have to be given to clients on a daily basis. The nurse states, ìI feel like all my work doesn't do them any good.î Which should the nurse's supervisor encourage the nurse to do?

A) Cease giving instructions because the clients will not remember them anyway.

B) Try to stay supportive and meet the clients' needs at the current moment.

C) Seek counseling if personal feelings get in the way of client care.

D) Consider transferring to a different client care specialty area.

B) Try to stay supportive and meet the clients' needs at the current moment.

Which are possible sources of frustrations for nurses caring for persons with dementia? Select all that apply.

A) The clients do not retain explanations or instructions, so the nurse must repeat the same things continually.

B) The nurse may get little or no positive response or feedback from clients with dementia.

C) It can be difficult to remain positive and supportive to clients and family because the outcome is so bleak.

D) It can be helpful for the nurse to talk to colleagues or even a counselor about personal feelings of depression and grief as the dementia progresses.

E) The clients may seem not to hear or respond to anything the nurse does.

A) The clients do not retain explanations or instructions, so the nurse must repeat the same things continually.

B) The nurse may get little or no positive response or feedback from clients with dementia.

C) It can be difficult to remain positive and supportive to clients and family because the outcome is so bleak.

E) The clients may seem not to hear or respond to anything the nurse does.