Title: Exam 3
Course: NUR 1521C Psychiatric/Mental Health Nursing > Section: Module 7

Q: When making a distinction as to whether an elderly patient has confusion related to delirium or another problem, what information would be of particular value?
- Evidence of spasticity or flaccidity
- The patient's level of motor activity
- Medications the patient has taken recently
- Level of preoccupation with somatic symptoms
A: Medications the patient has taken recently

Q: During morning care, the nursing assistant asks a patient with dementia, "How was your night?" The patient replies, "It was lovely. My husband and I went out to dinner and to a movie." This information is incorrect and the nurse who overhears this should make the assessment that the patient is:
- demonstrating a sense of humor.
- using confabulation.
- perseverating.
- delirious.
A: using confabulation.

Q: A widow, aged 72 years, lives alone and is visited weekly by her son. She takes digoxin, hydrochlorothiazide, and an antihypertensive drug. She also has a prescription for diazepam (Valium) as needed for moderate to severe anxiety. When the son visited today, he found his mother confused. Her speech was thick and slurred and she had an unsteady gait. She was taken to the emergency department, and hospital admission followed. The nurse assessed the patient as having several cognitive problems, including memory and attention deficits and fluctuating levels of orientation. The nurse confirms that the patient's symptoms developed over a 2-day period. The patient's symptoms are most characteristic of:
- delirium.
- dementia.
- amnestic syndrome.
- Alzheimer's disease.
A: delirium.

Q: What environmental conditions should the nurse arrange for a patient with delirium and altered perceptions of her environment?
- Provide a quiet, well-lit room without glare or shadows.
- Have the patient sit by the nurse's desk while awake.
- Reduce room lighting to minimize overstimulation.
- Keep a radio on continuously to reduce isolation.
A: Provide a quiet, well-lit room without glare or shadows.

Q: Which symptom would suggest that the patient is experiencing delirium instead of dementia?
- Altered level of consciousness
- Disorientation to place and time
- Wandering of attention
- Stable autonomic functioning
A: Altered level of consciousness

Q: An elderly male develops bradycardia and has a pacemaker surgically implanted. Although he was lucid preoperatively and has no history of dementia, at 10:00 PM on the night of his surgery, he becomes disoriented to place and time and insists on going home. When placed in soft restraints, he becomes hostile and is later caught trying to burn his way out of the restraints with a cigarette lighter. Which nursing diagnosis should be the priority diagnosis?
- Disturbed thought processes
- Sleep deprivation
- Risk for injury
- Ineffective coping
A: Risk for injury

Q: The patient need that assumes priority when planning care for a patient with late-stage dementia is:
- meaningful verbal communication.
- promotion of self-care activities.
- maintenance of nutrition and hydration.
- preventing the patient from wandering.
A: maintenance of nutrition and hydration.

Q: What should the priority nursing diagnosis be for a patient with fluctuating levels of consciousness, disorientation, and visual and tactile hallucinations?
- Self-care deficit
- Risk for injury
- Disturbed thought processes
- Fear
A: Risk for injury

Q: A patient diagnosed with delirium is restrained in order to prevent the removal of a Foley catheter and the intravenous line. Which response should the nurse expect after the patient is restrained?
- The patient rests better at night.
- The patient becomes visibly agitate
- The patient requires less pain medication.
- The patient experiences a decrease in blood pressure.
A: The patient becomes visibly agitate

Q: 70-year-old woman is beginning to notice mild memory impairment. She fears she is developing Alzheimer's disease and asks her granddaughter, a nurse, if this is the case. What factors would the nurse and her grandmother use to distinguish normal age-related memory impairment from a developing dementia?
- Only dementias interfere with the ability to solve new problems.
- Difficulty finding words occurs in dementia but not normal aging.
- Normal changes of aging do not interfere with day-to-day functioning.
- Dementia progresses much more rapidly than the changes of normal aging.
A: Normal changes of aging do not interfere with day-to-day functioning.

Q: Which intervention would best address the nursing diagnosis of Imbalanced nutrition for elderly patients in stages 2 to 3 of Alzheimer's disease?
- Monitor the frequency and characteristics of bowel movements.
- Offer finger foods the patient can take away from the table.
- Monitor intake and output, and take patient weights each day.
- Provide protein-dense foods to provide for neurological regrowth
A: Offer finger foods the patient can take away from the table.

Q: A nurse is assessing a patient recently admitted into a psychiatric unit for observation. Which patient behavior is indicative of impaired cognition?
- Mumbling
- Asking repeatedly, "How did I get here?"
- Spending hours staring out the window.
- Discussing the 'voices" with another patient.
A: Asking repeatedly, "How did I get here?"

Q: A nurse is caring for a patient who states, "Lately, I'm getting forgetful about things. I am so afraid that I'm getting Alzheimer's disease." Which response by the nurse is most therapeutic?
- "Now, I don't think we really need to discuss this. I'm sure this is just normal aging."
- "I'm forgetful too. I have to make lists to remember everything."
- "Although it's not unusual to experience some lapses of memory, let's discuss your concerns."
- "Oh, what you are describing isn't Alzheimer's disease. It's much more complicated than that."
A: "Although it's not unusual to experience some lapses of memory, let's discuss your concerns."

Q: A family states that the father, who has moderate-stage dementia, is incontinent related to forgetting where the bathroom is locate
d. An intervention the nurse should suggest to the family is to:
- label the bathroom door with a picture of a toilet.
- have someone take him to the bathroom hourly.
- place the patient in disposable adult diapers.
- restrict the patient's fluid intake to reduce voiding.
A: label the bathroom door with a picture of a toilet.

Q: A cognitively impaired nursing home resident is beginning to show physical signs of agitation. Which activity would be most therapeutic to de-escalate the patient's agitation?
- laying bingo with other residents.
- Spending time alone in the patient's room
- Taking a walk outside with the nurse.
- Watching television in the presence of staff.
A: Taking a walk outside with the nurse.

Q: A patient is displaying behaviors consistent with stage 2 Alzheimer's disease. The patient can no longer recognize family members and requires assistance with personal hygiene. The patient is frequently incontinent of feces and urine with displays of violent outbursts during these times. Which nursing diagnoses should the nurse give highest priority to when developing the patient's care plan?
- Violence: directed at self or others.
- Incontinence: both bowel and bladder
- Self-care deficit: hygiene, dressing, toileting
- Altered thought processes with impaired memory
A: Violence: directed at self or others.

Q: A 35-year-old married woman who works full time has recently been absent for 3-day periods on several occasions. Each time she returned to work wearing dark glasses. Facial and body bruises were apparent. Her supervisor became suspicious that she was a victim of battering and referred her to the occupational health nurse. What is the priority question for the nurse to ask when assessing the patient?
- "How did this happen to you?"
- "Do you drink excessively?"
- "Did your husband beat you?"
- "What did you do to deserve this?"
A: "How did this happen to you?"

Q: A victim of a violent rape was treated in the emergency department. As discharge preparation begins, the victim says softly, "I will never be the same again. I can't face my friends. There is no reason to go on." What is the nurse's most appropriate response?
- "Are you thinking of harming yourself?"
- "It will take time, but you will feel the same."
- "Your friends will understand when you explain it was not your fault."
- "You will be able to find meaning in this experience as time goes on."
A: "Are you thinking of harming yourself?"

Q: A child, aged 11 years, stays home from school to care for his siblings while his mother works, because the family cannot afford a babysitter. The home is cluttered and dirty when the community mental health nurse visits to investigate the child's school absences. The nurse's legal responsibility if child abuse or neglect is suspected is to:
- consult with the child's teacher, principal, and school psychologist.
- document the observations and impressions in the family health record.
- report her suspicions of abuse or neglect according to state regulations.
- wait until she has proof of abuse or neglect, then report it to authorities.
A: report her suspicions of abuse or neglect according to state regulations.

Q: The outcome that should be established for an elderly patient with delirium caused by fever and dehydration is that the patient will:
- return to a premorbid level of functioning.
- demonstrate motor responses to noxious stimuli.
- identify stressors negatively affecting self.
- exert control over responses to perceptual distortions.
A: return to a premorbid level of functioning.

Q: A rape victim tells the emergency room nurse "I feel so dirty. Please let me take a shower before the doctor examines me. I just cannot stand being so filthy." What should the nurse do?
- Arrange for the patient to shower.
- Give the patient a basin of hot water and towels.
- Explain that washing would destroy evidence.
- Explain that bathing facilities are not available in the emergency department.
A: Explain that washing would destroy evidence.

Q: What intervention will increase compliance when providing discharge teaching to a victim of violence and sexual assault?
- give referral information verbally and in writing.
- notify the patient's family of the problem so they can offer support.
- offer to stay with the patient until she regains stability.
- advise the patient to try not to think about the assault.
A: give referral information verbally and in writing.

Q: A woman who is a victim of severe emotional violence tells the nurse that her husband abuses her most often when he is intoxicate
d. She states he is always apologetic and brings her gifts after an incident. During which stage in the cycle of violence is gift giving likely to occur?
- tension-building stage.
- acute battering stage.
*
- honeymoon stage.
- recovery stage.
A: honeymoon stage.

Q: A patient is ordered 20 milligrams of haloperidol (Haldol) decanoate by intramuscular injection. 50 milligrams in 1 milliliter of liquid for IM Injection is available. How many milliliters will you administer?
- 0.4 mls
- 4 mls
- 20 mls
- 2 mls
A: 0.4 mls

Q: A patient is ordered 300 milligrams of Thioridazine (Mellaril). 100 milligram tablets are available. How many tablets will you give?
- 1 tablet
- 3 tablets
- 0.50 tablets
- 1 tablet every 4 hours
A: 3 tablets

Q: Calculate the drip rate for 100 mls of IV Fluids to be given over a half hour via a giving set which delivers 10 drops/ml.
- 33 mls
- 33 drops per minute
- 10 drops per minute
- 60 drops per minute
A: 33 drops per minute

Q: A patient tells the nurse, "I'm told that I should reduce the stress in my life, but I have no idea where to start." Which would be the best initial response?
- "Why not start by learning to meditate? That technique will cover everything."
- "In cases like yours, physical exercise works to elevate mood and reduce anxiety."
- "Reading about stress and how to manage it might be a good place to start."
- "Let's talk about what is going on in your life and then look at possible options."
A: "Let's talk about what is going on in your life and then look at possible options."

Q: A patient is noted to have a high level of non-goal-directed motor activity, running from chair to chair in the solarium. He is wide eyed and seems terror stricken. He cries, "They're coming! They're coming!" He neither follows staff direction nor responds to verbal efforts to calm him. Which nursing response should be the highest priority?
- Reduce his fearfulness and running
- Increase environmental stimuli
- Respect the patient's personal space
- Encourage clarification of feelings
A: Reduce his fearfulness and running

Q: Which assessment data most suggests that the patient is experiencing a fugue state?
- After being caught in an affair, a man disappeared only to reappear months later without memory of what had occurred while he was missing.
- A woman reports that when she feels tired or stressed, it seems like her body isn't real and is somehow growing smaller, which seems "crazy" to her.
- A man is extremely anxious about his problems and sometimes "zones out," finding that several minutes have passed without conscious awareness of them.
- A woman finds unfamiliar clothes in her closet, is recognized when she walks into restaurants she's never been to, and complains of "blackouts" despite not drinking.
A: After being caught in an affair, a man disappeared only to reappear months later without memory of what had occurred while he was missing.

Q: The medical-surgical nurse working with patients who has a somatoform disorder will find planning is facilitated by the understanding that the patients will probably:
- be resistant to seeking psychiatric help.
- be interested in seeing the consulting psychiatrist.
- attend psychotherapy sessions without encouragement.
- discover the true reasons for their physical symptoms.
A: be resistant to seeking psychiatric help.

Q: A medical inpatient that is being counseled for somatoform pain disorder states he believes his pain is the result of an undiagnosed injury. He adds that he is unable to adhere to his plan for care, which involves performing his own activities of daily living, walking 20 minutes daily, and using pain medication only at bedtime. Which behavior, as charted by staff, would most suggest that he is responding to interventions?
- "Patient bathed himself and did not seek analgesics this shift."
- "Up ad lib, complains of minor pain but 'trying to do without' pain meds."
- "Patient agrees to try acetaminophen (Tylenol) in place of narcotics."
- "Patient states he is feeling better and is ready to leave the hospital."
A: "Up ad lib, complains of minor pain but 'trying to do without' pain meds."

Q: The nurse who is counseling a patient with dissociative identity disorder should understand that the assessment of highest priority is:
- risk for self-harm.
- cognitive functioning.
- memory impairment.
- treatment motivation
A: risk for self-harm.

Q: The nurse develops a nursing diagnosis of self-care deficit for an older patient with dementia. Which of the following is an appropriate goal for this patient?
- The patient will function at the highest level of independence possible.
- The patient will complete all activities of daily living independently within a 1-hour time frame.
- The patient will be admitted to a long-term care facility to have activities of daily living needs met.
- The nursing staff will attend to all the patient's activities of daily living needs during the hospital stay.
A: The patient will complete all activities of daily living independently within a 1-hour time frame.

Q: The patient with dementia is receiving the following medication. Which medication may help with mental functioning and slowing the progression of the dementia by increasing acetylcholine in the nerve synapses?
- Fluoxetine (Prozac)
- Trazodone (Desyrel)
- Haloperidol (Haldol)
- Donepezil (Aricept)
A: Donepezil (Aricept)

Q: Which assessment question would be highly appropriate to ask a patient with possible generalized anxiety disorder?
- "Have you been a victim of a crime or seen someone badly injured or killed?"
- "How do you feel when others are watching, such as at dances or giving speeches?"
- "Do you do certain things over and over again, things you feel you must do?"
*
- "Do you find yourself worrying so much that it causes problems for you?"
A: "Do you find yourself worrying so much that it causes problems for you?"

Q: The nurse caring for a patient who has been diagnosed as having generalized anxiety disorder tells a preceptor, "I find myself feeling uncomfortable and anxious around the patient. When he starts trembling and perspiring and pacing, I find myself with cold, clammy hands, and my pulse races. I start worrying whether I will be able to help him stay in control." In such an interaction, the patient will most likely experience which of the following?
- claustrophobia.
- acute stress disorder.
- increased anxiety.
- impaired self-esteem.
A: increased anxiety.

Q: A patient tells the nurse that she wants her physician to prescribe diazepam (Valium) for anxiety reduction. The physician has prescribed buspirone (BuSpar). The nurse's reply should be based on the knowledge that buspirone:
- can be administered as a PRN medication.
- does not increase the risk of blood dyscrasias.
- is not habituating or likely to be abuse
- is faster acting than benzodiazepine drugs.
A: is not habituating or likely to be abuse

Q: A soldier serving in the Middle East was in a convoy when a bomb killed three fellow soldiers in the vehicle in front of hers. Five weeks later, loud sounds began to trigger an involuntary re-experiencing of the explosion. Three months later, she reported continuing sleep impairment, nightmares, social withdrawal, disrupted relationships, and flashbacks. What is the soldier most likely experiencing?
- acute stress disorder.
- pathological grief reaction.
- posttraumatic stress disorder.
- panic disorder with agoraphobia.
A: posttraumatic stress disorder.

Q: A Hispanic woman is recovering from surgery on an inpatient unit when she receives word that her mother has passed away unexpectedly. She begins to shout unintelligibly and then complains of palpitations and a sense of heat in her chest and head. Which of the following would be the most appropriate nursing response?
- Provide reassurance and emotional support while continuing to assess the patient.
- Seek an order for supplemental oxygen to treat a suspected pulmonary embolism.
- Report to the physician that the patient appears to be exhibiting a medication reaction.
- Encourage the patient to calm down and to try to avoid reacting hysterically to her loss.
A: Provide reassurance and emotional support while continuing to assess the patient.

Q: The nursing assistant remarks to the nurse, "The patient with amnesia looks together, but when I talk to her, she seems rather vague. What should I be doing for her?" The best reply would be:
- "Provide more info about her past to reduce the unknowns that cause her anxiety."
*
- "Use short, simple sentences and keep her environment calm and protective."
- "Spend as much time with her as you can, and ask questions about her recent life."
- "Structure her time with lots of activities to keep her busy and stimulated."
A: "Use short, simple sentences and keep her environment calm and protective."

Q: I have thoroughly read the course description, requirements, assignments/due dates, and calendar information on this site. Further, I have reviewed the procedures for using the discussion, assignments dropbox, and e-mail features of the site. I understand what is required to complete this course successfully and how to use the online tools to do so.
- Yes, I do
- No, I don't
A: Yes, I do
If right: Great, then begin work on Module 1.
If wrong: Uh oh! Then go back and re-read the syllabus materials completely. If you still cannot answer, Yes, I do, contact the instructor immediately.

Q: A patient has been diagnosed as having blindness related to conversion disorder. She displays indifference regarding the conversion symptom. The nurse states, "I can't understand why the patient doesn't seem more anxious about her symptom." Which explanation from the Clinical Nurse Specialist would enable the nurse to understand the patient's behavior?
- The patient is suppressing her true feelings. She is upset but is not showing it.
- The blindness is actually helping the patient by reducing her anxiety.
- Her needs are met during hospitalization, so she has no need to be anxious.
- She is controlling her own anxiety through partial denial of the blindness.
A: The blindness is actually helping the patient by reducing her anxiety.

Q: When working with a patient with posttraumatic stress disorder who has frequent flashbacks as well as persistent symptoms of arousal, effective nursing interventions would include which of the following?
- encouraging repression of memories associated with the traumatic event.
- explaining that physical symptoms are related to the psychological state.
- triggering flashbacks as a way to help the patient learn to cope with them.
- supporting "numbing" as a temporary way to manage intolerable feelings.
A: explaining that physical symptoms are related to the psychological state.

Q: The nurse wishes to teach an alternative coping strategy to a patient who is currently experiencing severe anxiety. What will the nurse need to do first?
- use measures designed to lower the patient's anxiety.
- determine the mode of learning preferred by the patient.
- devise outcomes and construct a teaching plan.
- determine if the patient has an anxiety disorder.
A: use measures designed to lower the patient's anxiety.

Q: A patient, aged 82 years, has Alzheimer's disease. She lives with her daughter's family and goes to a day care facility on weekdays. The family cares for her during the evening and at night. Noting the patient had several bruises, the nurse discussed her observations with the daughter, who became defensive and said that her mother was very difficult to manage because she is confused and wanders all night. She says the bruises resulted from a fall down stairs. The daughter states, "I have lost my mother, and I cannot bear it anymore. It is wrecking my family." The nursing intervention that should take priority is:
- teaching the daughter more about the effects of Alzheimer's disease.
*
- identifying two options for caregiver respite and care assistance at night.
- supporting the daughter to grieve the loss of her mother's ability to function.
- teaching the family how to give physical care more effectively and efficiently.
A: identifying two options for caregiver respite and care assistance at night.

Q: A patient has just been laid off from his job of 15 years. He is pacing and trembling. His behavior is disorganized. He states that he would like to get some medication to calm him down so he can "think straight." Which of the following is a therapeutic rationale for the use of antianxiety medication as his initial treatment?
- The client believes it would be beneficial to him.
- It would calm the client and allow his discharge.
- It would not be as addictive as antidepressant drugs.
- It would better enable him to participate in treatment.
A: It would better enable him to participate in treatment.

Q: A man checks that his doors are locked two or more times each time he leaves home. The door is always found to be locked. Which of the following initial interventions would most likely be useful to this patient?
- Explaining that his habit is irrational, leads to lateness, and should be discarded.
- Discussing what the patient was thinking and feeling before checking the door.
- Requiring the patient to force himself to leave without checking the doors at all.
- Having him check the doors ten times until he sees the needlessness of checking.
A: Discussing what the patient was thinking and feeling before checking the door.

Q: A famous general sometimes slowed down his entire army because he felt he must count all the windows in each of the buildings he passed. A patient feels that he must repeat washing his hands three times each time he washes. The nurse recognizes that such behaviors serve the purpose of reducing:
- sexual conflicts.
- anxiety.
- guilt.
- uncertainty.
A: anxiety.

Q: A patient accompanied her boyfriend to the emergency department after the two had been in a motorcycle accident. The boyfriend was badly hurt, but the client had only minor bruises. She told the nurse that since she was driving, she should have been the one to be injure
d. A day later, while visiting her boyfriend, she reported that she was unable to move from her chair and unable to walk. Diagnostic workup revealed no physical reason for the problem. The anxiety relief behavior the client is demonstrating is which of the following?
- projection.
- conversion.
- sublimation.
- reframing.
A: conversion.

Q: For the patient whose nursing diagnosis is Powerlessness related to an inability to control compulsive cleaning, the nurse must understand that the patient uses the cleaning to do which of the following?
- enhance her self-esteem.
- reduce spread of illnesses.
- exert control over her anxiety.
- distract herself from her anxiety.
A: exert control over her anxiety.