End of Chapter Questions Exam 2 420

Which statement made by the primary caregiver of a person with dementia demonstrates an accurate understanding of providing the person with a safe environment?

"We've installed locks on all the outside doors."

Which statement made by a family member tends to support a diagnosis of delirium rather than dementia?

"She was fine last night but this morning she was confused."

In terms of the pathophysiology responsible for both delirium and dementia, which intervention would be appropriate for delirium specifically?

Monitoring neurological status on an ongoing basis

What side effects should the nurse monitor for while caring for a patient taking donepezil (Aricept)? Select all that apply.

Insomnia, Bradycardia, Signs of Dizziness, Reports of Headache

What is the rationale for providing a patient diagnosed with dementia easily accessible finger foods thorough the day?

It increases input throughout the day

Ophelia, a 69-year-old retired nurse, attends a reunion of her former coworkers. Ophelia is concerned because she usually knows everyone, and she cannot recognize faces today. A registered nurse colleague recognizes Ophelias distress and "introduces" Ophelia to those attending. The nurse practitioner understands that Ophelia seems to have a deficit in her

Social cognition ability

After talking with her 85-year-old mother, Nancy became concerned enough to drive to her home and check on her. Her mother's appearance was disheveled, her words were nonsensical, she smelled strongly of urine, and there was a stain on her dressing gown. Because she is a nurse, Nancy recognizes that her mother's condition is likely due to

A urinary tract infection

Lucia, 70 years old, recently underwent a major orthopedic surgical procedure. On postoperative day 3, she responds to the nurse who has been caring for her with affection. At other times, however, she tells the nurse to leave because she does not recognize her and asks to have another nurse care for her, specifically naming the nurse as the "nice” one. The most likely reason for Lucias behavior is that she is

Experiencing an acute delirium

Since his wife's death 2 months earlier, Aaron, 90 years of age and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating, disrupted sleep, and lacks energy.

His family has to remind and -encourage him to shower, take his medications, and eat, all of which he then does. Which of the following responses would be most appropriate?

Arrange for an appointment with a mental health professional for the evaluation and treatment of suspected major depressive disorder.

Nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels. Specialized skills training and continuing education are helpful to diffuse stress, as well as which of the following? Select all that apply.

Expressing emotions by journaling

Engaging in exercise and relaxation activities

Having realistic patient expectations

Which statement made by the psychiatric nurse demonstrates an accurate understanding of the factors that affect an individual's personality?

"T'll need to learn more about this patient's cultural beliefs"

When assessing a patient diagnosed with a borderline personality disorder, which statement by the patient warrants immediate attention?

"Id really like to hurt her for hurting me."

What is the current accepted professional view of the effect of culture on the development of a personality disorder?

There are not enough studies to confirm the role that ethnicity and race have on the prevalence of personality disorders.

Which personality disorders are generally associated with behaviors described as "odd or eccentric"? Select all that apply.

Paranoid, Schizoid

Which behaviors are examples of defense mechanisms often relied upon by those diagnosed with a personality disorder?

Select all that apply.

Regularly attempts to split the staff

Lashes out verbally when confronted with criticism

Destroys another person's belongings when angry

Personality disorders often co-occur with mood and eating disorders. A young woman is undergoing treatment at an eating disorders clinic and her nurse suspects that she may also have a histrionic personality disorder because of her

Dramatic response to frustration

Larry is from a small town and began displaying aggressive and manipulative traits while still a teenager. Now 40 years old, Larry is serving a life sentence for the murders of his wife and her brother. John, the prison psychiatric nurse practitioner, recognizes that Larry's treatment will most likely

Manifest as small incremental changes

Connor is a 28-year-old student, referred by his university for a psychiatric evaluation. He reports that he has no friends at the university and that people call him a loner.

Connor has recently been "giving lectures" to pigeons at the university fountains. He is diagnosed as schizotypal, which differs from schizophrenia in that persons diagnosed as schizotypal

Can be made aware of their delusions

Garret's wife of 8 years is divorcing him because their marriage never developed a warm or loving atmosphere. Garrett states in therapy, "I have always been a loner, and says that he was never concerned about what others think. The nurse practitioner suggests that Garrett try a trial of an antidepressant to

Improve his flat emotions

Josie, a 27-year-old patient, complains that most of the staff do not like her. She says she can tell whether you are a caring person. Josie is unsure of what she wants to do with her life and her "mixed-up feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. two hours later, she is found using a curling iron to burn her arm and explains that it "makes the numbness stop." Given this presentation, which personality disorder would you suspect?

Borderline

Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?

“I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."

Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.

"What do you do to manage anxiety?"

"Do you have a history of disordered eating?"

"Do you think that you drink too much?"

Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?

Conducting routine suicide screenings at a senior center.

Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply.

7 years old

Temper tantrums occur at home and in school

Comorbid autism diagnosis

Which chronic medical condition is a common trigger for major depressive disorder?

Pain

Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider?

Fluoxetine (Prozac)

Cabot has multiple symptoms of depression, including mood reactivity, social phobia, anxiety, and overeating.

With a history of mild hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication?

Monoamine oxidase inhibitor

When a nurse uses therapeutic communication with a withdrawn patient who has major depressive disorder, an effective method of managing the silence is to:

Use the technique of making observations

The biological approach to treating depression with electrodes surgically implanted into specific areas of the brain to stimulate the regions identified to be under active in depression is:

Deep brain stimulation

Two months ago, Natasha's husband died suddenly and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement?

"Depression often begins after a major lost. Losing dad was a major loss"

Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar disorder and her support system? Select all that apply.

"Remember that alcohol and caffeine can trigger a relapse of your symptoms."

"It's critical to let your healthcare provider know immediately if you aren't sleeping well!"

"It will be helpful for your family to understand the management of this disorder"

"Acute episodes of mania and depression tend to come and go, so you need to be able to recognize the early symptoms."

Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply.

I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day."

"I discussed the diuretic my cardiologist prescribed with my psychiatric care provider."

"I've already made arrangements for outpatient lithium level monitoring."

The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply.

Nausea and vomiting for no apparent reason

Shaky hands that make holding a cup difficult

A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEą/L. Which nursing intervention will the nurse implement initially?

Instruct the patient to hold the next dose and contact the prescriber.

Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply.

Monitor the patient's vital signs frequently.

Provide freguent milkshakes and protein drinks.

Reduce the volume on the television and dim bright lights in the environment.

Use a firm but calm voice to give specific, concise directions to the patient.

Substance use disorders are often comorbid with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications.

The nurse caring for this patient recognizes that:

Alcohol ingestion is a form of self-medication.

Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I disorder 8 years ago. Ted has a history of IV drug use, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm.

To reduce Ted's mania, the psychiatric nurse practitioner recommends:

Electroconvulsive therapy (ECT)

A 33-year-old female diagnosed with bipolar 1 disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states,

"You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing ____.

a lower dosage

Tatiana is being treated for bipolar I with lithium. She is seen in the emergency department potential lithium toxicity. What assessment findings would support this diagnosis?

Ataxia, severe hypotension, large volume of dilute urine

Luc's family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting?

Energy drink containers

Which characteristics suggest a man is experiencing the prodromal phase of schizophrenia? Select all that apply.

Displays unusual interest in numbers and specific topics.

Has increasingly unusual thoughts and uses words oddly.

Demonstrates increasing difficulty with concentration.

Which nursing interventions are particularly well chosen for addressing a population at high risk for developing schizophrenia? Select all that apply.

Screening 15- to 25-year-olds for early symptoms.

Teaching ways to cope and build resiliency.

Educating about the risk of psychosis with marijuana use.

To provide effective care for the patient who is taking a second-generation antipsychotic, the nurse should frequently assess for

Metabolic syndrome.

A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic. What information should the nurse provide to the patient regarding her signs and symptoms?

She should experience a reduction in hallucinations.

Which characteristic presents the greatest risk for injury to others by a patient diagnosed with schizophrenia?

Paranoia

Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is hallucinations? Select all that apply.

"I know you say you hear voices, but I cannot hear them."

"Tell me more about what you hear."

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that

They are not actually ill.

Kyle, a patient with schizophrenia, began taking the first-generation antipsychotic haloperidol (Haldol) a week ago.

You find him sitting stiffly and not moving. He is diaphoretic, and when you ask if he is okay, he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.

Hold his medication and contact his prescriber stat.

Wipe him with a washcloth that has been wetted with cold water or alcohol.

Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self medicating with excessive alcohol is common in this disorder and can be an effort to: Select all that apply.

Self-medicate for social discomfort.

Cope with anxiety

Enhance mood.

A patient reports that "the voices are really bad today?" Helpful nursing responses would include

Encouraging the patient to use competing auditory stimuli, such as humming or listening to music.