4431 Exam 4 (Book Questions)

The nurse is providing care for a patient demonstrating behaviors associated with moderate levels of anxiety. What question should the nurse ask initially in attempting to help the patient de-escalate the anxiety?

“Can you identify what was happening when your anxiety began to increase?”

Which patient is at increased risk for the development of anxiety and will require frequent assessment by the nurse?

Exacerbation of asthma signs and symptoms, History of chronic obstructive pulmonary disease, Current treatment for unstable angina pectoris, and History of a traumatic brain injury

Which medication should the nurse be prepared to educate patients on when they are prescribed a selective serotonin reuptake inhibitor (SSRI) for panic attacks?

Fluoxetine (Prozac)

Which statement or statements made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management?

“Show me how you learned to deep breathe in yesterday’s therapy session.”, “Muscle relaxation promotes the relaxation response.”, “You’ve said that going to group makes you nervous, so let’s start relaxing now.”, and “I’ve given you written descriptions of the various relaxation exercises for you to review.”

To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a patient who has recently been prescribed an antianxiety medication?

Buying a large coffee with sugar and extra cream each morning on the way to work

In a parent-teacher conference, the school nurse meets with the parents of a profoundly shy 8-year-old girl. The parents hold hands, speak softly, respond briefly, and have poor eye contact. The nurse recognizes that the child is most likely exposed to parental modeling and

The inherited shyness trait

Isabel is a straight-A student, yet she suffers from severe test anxiety and seeks medical attention. The nurse interviews Isabel and develops a plan of care. The nurse recognizes effective teaching about mild anxiety when Isabel states the following:

“Mild anxiety is okay because it helps me to focus.”

The activity of gamma-aminobutyric acid (GABA) contributes to a slowing of neural activity. Which of the following drugs facilitate the action of GABA?

Benzodiazepines

Samantha is a new patient at the mental health clinic and is seeking assistance for what she describes as “severe anxiety.” In addition to daily self-medicating with alcohol, Samantha describes long-term use of herbal kava. The nurse practitioner knows that kava is associated with inhibiting P450 and orders which of the following tests?

Liver enzymes

A homebound patient diagnosed with agoraphobia has been receiving therapy at home. The nurse recognizes effective teaching when the patient states the following:

“My risk for agoraphobia is increased by my family history.”

Nick, a construction worker, is on duty when a nearly completed wall suddenly falls, crushing a number of his co-workers. Although badly shaken initially, he seemed to be coping well. About 2 weeks after the tragedy, he begins to experience tremors, nightmares, and periods during which he feels numb or detached from his environment. He finds himself frequently thinking about the tragedy and feeling guilty that he was spared while many others died. Which statement about this situation is most accurate?

Nick has acute stress disorder and will benefit from antianxiety medications.

You are caring for Susannah, a 29-year-old who has been diagnosed with dissociative identity disorder. She was recently hospitalized after coming to the emergency department with deep cuts on her arms with no memory of how this occurred. The priority nursing intervention for Susannah is:

Maintain 1:1 observation.

You are caring for Connor, an 8-year-old boy who has been diagnosed with reactive attachment disorder. Which of the following nursing outcomes would be the most appropriate to achieve?

Writes or draws feelings in a journal.

Ashley is a 21-year-old college student who was sexually assaulted at a party. She was seen in the local emergency department and referred for counseling after being diagnosed by the provider on call as having acute stress disorder. Which of the following treatment modalities would you expect to see used in therapy with Ashley?

Cognitive behavioral therapy

Jamie, age 24, has been diagnosed with a dissociative disorder following a traumatic event. Jamie’s mother asks you, “Does this mean my daughter is now crazy?” Your best response would be:

“Jamie is dealing with the anxiety associated with the trauma by separating herself from it. With treatment, she can get back to her previous level of functioning.”

A young child is found wandering alone at a mall. A male store employee approaches and asks where her parents are. She responds, “I don’t know. Maybe you will take me home with you?” This sort of response in children may be due to:

A lack of bonding as an infant

During a routine health screening, a grieving widow whose husband died 15 months ago reports emptiness, a loss of self, difficulty thinking of the future, and anger at her dead husband. The nurse suggests bereavement counseling. The widow is most likely suffering from:

Adjustment disorder

Maggie, a child in protective custody, is found to have an imaginary friend, Holly. The foster family shares this information with the nurse. The nurse teaches the family members about children who have suffered trauma and knows her teaching was effective when the foster mother states:

“I understand that imaginary friends are a coping mechanism.”

The school nurse has been alerted to the fact that an 8-year-old boy routinely play acts as a police officer, “locking up” other children on the playground to the point where the children get scared. The nurse recognizes that this behavior is most likely an indication of:

A potential symptom of traumatization

A pregnant woman is in a relationship with a male who routinely abuses her. Her unborn child may engage in high-risk behavior as a teen as a result of:

Maternal stress

The care plan of a patient diagnosed with a somatic disorder includes the nursing diagnosis impaired coping. Which patient behavior demonstrates a successful outcome for that nursing diagnosis?

b. Calls a friend to talk when feeling lonely

Which patient is at greatest risk for developing a stress-induced myocardial infarction?

A patient who was diagnosed with chronic major depressive disorder 10 years ago

What precipitating emotional factor has been associated with an increased incidence of cancers?

Feelings of hopelessness and despair from depression & Prolonged, intense stress

You are caring for Aaron, a 38-year-old patient diagnosed with somatic symptom disorder. When interacting with you, Aaron continues to focus on his severe headaches. In planning care for Aaron, which of the following interventions would be appropriate?

After a limited discussion of physical concerns, shift focus to feelings and effective coping skills.

Living comfortable and materialistic lives in Western societies seems to have altered the original hierarchy proposed by Maslow in that:

Focusing on materialism reduces interests in love, belonging, and family.

6. Diane, a 63-year-old mother of three, was brought to the community psychiatric clinic. Diane and her son had a bitter fight over finances. Ever since, Diane has been complaining of “a severe pain in my neck.” She has seen several doctors who cannot find a physical basis for the pain. The nurse knows that:

Diane believes there is a physical cause for the pain and will resist a psychological explanation.

Conversion disorder is described as an absence of a neurological diagnosis that manifests in neurological symptoms. Channeling of emotions, conflicts, and stressors into physical symptoms is thought to be the cause of conversion disorder. Which statement is true?

Abnormal patterns of cerebral activation have been found in individuals with conversion disorder.

Melanie is a 38-year-old female admitted to the hospital to rule out a neurological disorder. The testing was negative, yet she is reluctant to be discharged. Today she has added lower back pain and a stabbing sensation in her abdomen. The nurse suspects a factitious disorder in which Melanie may:

Consciously be trying to maintain her role of a sick patient.

You are caring for Yolanda, a 67-year-old patient who has been receiving hemodialysis for 3 months. Yolanda reports that she feels angry whenever it is time for her dialysis treatment. You attribute this to:

A normal response to grief and loss.

Lucas is a nurse on a medical floor caring for Kelly, a 48-year-old patient with newly diagnosed type 2 diabetes. He realizes that depression is a complicating factor in the patient’s adjustment to her new diagnosis. What problem has the most potential to arise?

Treatment nonadherence

Which patient statement acknowledges the characteristic behavior associated with a diagnosis of pica?

“I’m ashamed of it, but I eat my hair.”

In evaluating an eating disorder, what physical criterion for hospital admission would you consider?

A daytime heart rate of less than 50 beats per minute

In considering the need for monitoring, which intervention should the nurse implement for a patient with anorexia nervosa?

Provide scheduled portion-controlled meals and snacks;

Limit time spent in the bathroom during periods when the patient is not under direct supervision; &

Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.

Which intervention will promote independence in a patient being treated for bulimia nervosa?

Allow the patient to make limited choices about eating and exercise as weight gain progresses.

Which patient statement supports the diagnosis of anorexia nervosa?

“I’m terrified of gaining weight.”

Obesity can be the end result of a binge-eating disorder. The nurse understands that the best treatment option in persons with a binge-eating disorder is

Coping strategies

Taylor, a psychiatric registered nurse, orients Regina, a patient with anorexia nervosa, to the room where she will be assigned during her stay. After getting Regina settled, the nurse informs Regina of the following:

“I need to go through the belongings you have brought with you.”

Safety measures are of concern in treating eating disorders. Patients with anorexia nervosa are supervised closely to monitor the following:

Foods that are eaten; Attempts at self-induced vomiting; & Weight

Malika has been overweight all her life. Now an adult, she has health problems related to excessive weight. Seeking weight-loss assistance at a primary care facility, Malika is surprised when the nurse practitioner suggests the following:

A trial of SSRI antidepressant therapy

Malika agrees to try losing weight according to the nurse practitioner’s outlined plan. Additional teaching is warranted when Malika states that

“I prefer to have a gastric bypass rather than use this plan.”

Which patient statement suggests a concern over one’s ability to perform sexually?

“I’m not the partner I used to be.”

The nurse should plan to educate male patients who are taking selective serotonin reuptake inhibitors (SSRIs) on the possible development of which common side effect?

Decreased libido

Which medications are currently approved for the treatment of male erectile disorder?

Sildenafil (Viagra); Tadalafil (Cialis); Vardenafil (Levitra); & Avanafil (Stendra)

Which statement describes a common sexual side effect of diazepam (Valium)?

“I’m just not interested in sex as much.”

Obtaining a sexual history can be embarrassing for the patient and practitioner. Experience with addressing the topic can help, as can which of the following?

Using a professional tone of voice and a relaxed posture

Which patient has the greatest risk for suicide?

A patient who expresses the inability to stop searching the internet for child pornography.

When Melissa was a small child, she insisted that she was a boy, refused to wear dresses, and wanted to be called Mitch. As Melissa reached puberty, she no longer displayed a desire to be male. This change in identity is considered

Normal

Phillip, a 63-year-old male, has exposed his genitals in public for all of his adult life, but the act has lost some of the former thrill. A rationale for this change in his experience may be

Desire waning with age

A male arrested for inappropriate sexual contact in a subway car denies the allegation. On interviewing the man, the nurse suspects frotteuristic disorder due to his

Lack of relationships

Pedophilic disorder is the most common paraphilic disorder where adults who have a primary or exclusive sexual preference for prepubescent children. A subset of this disorder is termed hebephilia and is defined as attraction to

Pubescent individuals