Exam 2 Flashcards
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?
a. “Do you know what will help you manage your anxiety?”
b. “Do you need help to manage your anxiety?”
c. “Can you identify what was happening when your anxiety began to increase?”
d. “Are you feeling anxious right now?”
C
- Which patient is at increased risk for the development of anxiety and will require frequent assessment by the nurse? Select all that apply.
a. Exacerbation of asthma signs and symptoms
b. History of peanut and strawberry allergies
c. History of chronic obstructive pulmonary disease
d. Current treatment for unstable angina pectoris
e. History of a traumatic brain injury
A, C, D, E
Which medication should the nurse be prepared to educate patients on when they are prescribed a selective serotonin reuptake inhibitor (SSRI) for panic attacks?
a. Alprazolam (Xanax)
b. Fluoxetine (Prozac)
c. Clonazepam (Klonopin)
d. Venlafaxine (Effexor)
B
Which statement or statements made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management? Select all that apply.
a. “Relaxation therapy’s main goal is to prevent exhaustion by removing muscle tension.”
b. “Muscle relaxation promotes the relaxation response.”
c. “Show me how you learned to deep breathe in yesterday’s therapy session.”
d. “You’ve said that going to group makes you nervous, so let’s start relaxing now.”
e. “I’ve given you written descriptions of the various relaxation exercises for you to review.”
B, C, D, E
To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a patient who has recently been prescribed an antianxiety medication?
a. Eating high-protein foods.
b. Using acetaminophen without first discussing it with a healthcare provider
c. Taking medications after eating dinner or while having a bedtime snack
d. Buying a large coffee with sugar and extra cream each morning on the way to work
D
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
a. The inherited shyness trait
b. A lack of affection in the home
c. Severe punishment by the parents
d. Is afraid to say something foolish
A
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:
a. “I would like to try a benzodiazepine for my anxiety.”
b. “If I study harder, my anxiety level will go down.”
c. “Mild anxiety is okay because it helps me to focus.”
d. “I have fear that I will fail at college.”
C
The activity of gamma-aminobutyric acid (GABA) contributes to a slowing of neural activity. Which of the following drugs facilitate the action of GABA?
a. Benzodiazepines
b. Antihistamines
c. Anticonvulsants
d. Noradrenergics
A
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?
a. Electrocardiogram
b. Liver enzymes
c. Glomerular filtration rate
d. Complete blood count
B
A homebound patient diagnosed with agoraphobia has been receiving therapy at home. The nurse recognizes effective teaching when the patient states the following:
a. “I may never leave the house again.”
b. “Having groceries delivered is very convenient.”
c. “My risk for agoraphobia is increased by my family history.”
d. “I will go out again someday, just not today.”
C
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?
a. Showers and dresses in clean clothes daily
b. Calls a friend to talk when feeling lonely
c. Spends more time talking about pain in her abdomen
d. Maintains focus and concentration
B
Which patient is at greatest risk for developing a stress-induced myocardial infarction?
a. A patient who lost a child in an accidental shooting 24 hours ago
b. A woman who has begun experiencing early signs of menopause
c. A patient who has spent years trying to sustain a successful business
d. A patient who was diagnosed with chronic major depressive disorder 10 years ago
D
What precipitating emotional factor has been associated with an increased incidence of cancers? Select all that apply.
a. Anxiety
b. Job-related stress
c. Acute grief
d. Feelings of hopelessness and despair from depression
e. Prolonged, intense stress
D, E
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?
a. Call for a family meeting with Aaron in attendance to confront Aaron regarding his diagnosis.
b. Educate Aaron on alternative therapies to deal with pain.
c. Improve reality testing by telling Aaron that you do not believe that the headaches are real.
d. After a limited discussion of physical concerns, shift focus to feelings and effective coping skills.
D
Living comfortable and materialistic lives in Western societies seems to have altered the original hierarchy proposed by Maslow in that:
a. Once lower-level needs are satisfied, no further growth feels necessary.
b. Self-actualization is easier to achieve with financial stability.
c. Esteem is more highly valued than safety.
d. Focusing on materialism reduces interests in love, belonging, and family.
D
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:
a. Showing concern for Diane’s pain will increase her obsessional thinking.
b. Diane’s symptoms are manipulative and under conscious control.
c. Diane believes there is a physical cause for the pain and will resist a psychological explanation.
d. Diane is trying to make her son feel bad about the argument.
C
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?
a. People with conversion disorder are extremely upset about often dramatic symptoms.
b. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder.
c. An organic cause is usually found in most cases of conversion disorder.
d. Symptoms can be turned off and on depending on the patient’s choice.
B
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:
a. Consciously be trying to maintain her role of a sick patient.
b. Not recognize her unmet needs to be cared for.
c. Protect her child from illness.
d. Recognize physical symptoms as a coping mechanism.
A
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. Organic changes in Yolanda’s brain.
b. A flaw in Yolanda’s personality.
c. A normal response to grief and loss.
d. Denial of the reality of a poor prognosis.
C
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?
a. Development of agoraphobia
b. Treatment nonadherence
c. Frequent hypoglycemic reactions
d. Sleeping rather than checking blood sugar
B
Natalya, a patient with a history of alcohol use disorder, has been prescribed disulfiram (Antabuse). Which physical effects support the suspicion that the patient has relapsed? Select all that apply.
a. Intense nausea
b. Diaphoresis
c. Acute paranoia
d. Confusion
e. Dyspnea
A, B, D, E
Which assessment data confirm the suspicion that a patient is experiencing opioid withdrawal? Select all that apply.
a. Pupils are dilated
b. Pulse rate is 62 beats/min
c. Slow movements
d. Extreme anxiety
e. Sleepy
A, D
The nursing diagnosis denial is especially useful when working with substance use disorders and gambling. Which statements describe this diagnosis? Select all that apply.
a. Reports inability to cope
b. Does not perceive the danger of substance use or gambling
c. Minimizes symptoms
d. Refuses healthcare attention
e. Unable to admit the impact of disease on life pattern
B, C, D, E
What action should you take when a female staff member is demonstrating behaviors associated with a substance use disorder?
a. Accompany the staff member when she is giving patient care.
b. Offer to attend rehabilitation counseling with her.
c. Refer her to a peer assistance program.
d. Confront her about your concerns and/or report your concerns to a supervisor immediately.
D
A patient diagnosed with opioid use disorder has expressed a desire to enter into a rehabilitation program. What initial nursing intervention during the early days after admission will help ensure the patient’s success?
a. Restrict visitors to family members only.
b. Manage the patient’s withdrawal symptoms well.
c. Provide the patient a low-stimulus environment.
d. Advocate for at least 3 months of treatment.
B
Lester and Alene have always enjoyed gambling. Lately, Alene has discovered that their savings account is down by $50,000. Alene insists that Lester undergo therapy for his gambling behavior. The nurse recognizes that Lester is making progress when he states:
a. “I understand that I am a bad person for depleting our savings.”
b. “Gambling activates the reward pathways in my brain.”
c. “Gambling is the only thing that makes me feel alive.”
d. “We have always enjoyed gaming. I do not know why Alene is so upset.”
B
Opioid use disorder is characterized by:
a. Lack of withdrawal symptoms
b. Intoxication symptoms of pupillary dilation, agitation, and insomnia
c. Tolerance
d. Requiring smaller amounts of the drug to achieve a high over time
C
Terry is a young male in a chemical dependency program. Recently, he has become increasingly distracted and disengaged. The nurse concludes that Terry is:
a. Bored
b. Depressed
c. Bipolar
d. Not ready to change
D
Max is a 30-year-old male who arrives at the emergency department stating, “I feel like I am having a stroke.” During the intake assessment, the nurse discovers that Max has been working for 36 hours straight without eating and has consumed 8 double espresso drinks and 12 caffeinated sodas. The nurse suspects:
a. Fluid overload
b. Dehydration and caffeine overdose
c. Benzodiazepine overdose
d. Sleep deprivation syndrome
B
Donald, a 49-year-old male, is admitted for inpatient alcohol detoxification. The rationale for admission into this program is due to:
a. Heavy use of a substance known to cause withdrawal
b. A need for rehabilitation
c. The potential for relapse
d. CNS hypoactivity following cessation of alcohol consumption
A
A male patient reports to the nurse, “I’m told I have memories of childhood abuse stored in my unconscious mind. I want to work on this.” Based on this statement, what information should the nurse provide the patient?
a. To seek the help of a trained therapist to help uncover and deal with the trauma associated with those memories.
b. How to use a defense mechanism such as suppression so that the memories will be less threatening.
c. Psychodynamic therapy will allow the surfacing of those unconscious memories to occur in just a few sessions.
d. Group sessions are valuable to identify underlying themes of the memories being suppressed.
A
Which question should the nurse ask when assessing for what Sullivan’s Interpersonal Theory identifies as the most painful human condition?
a. “Is self-esteem important to you?”
b. “Do you think of yourself as being lonely?”
c. “What do you do to manage your anxiety?”
d. “Have you ever been diagnosed with depression?”
B
When discussing therapy options, the nurse should provide information about interpersonal therapy to which patient? Select all that apply.
a. The teenager who is the focus of bullying at school
b. The older woman who has just lost her life partner to cancer
c. The young adult who has begun demonstrating hoarding tendencies
d. The adolescent demonstrating aggressive verbal and physical tendencies
e. The middle-aged adult who recently discovered her partner has been unfaithful
A, B, E
When considering the suggestions of Hildegard Peplau, which activity should the nurse regularly engage in to ensure that the patient stays the focus of all therapeutic conversations?
a. Assessing the patient for unexpressed concerns and fears
b. Evaluating the possible need for additional training and education
c. Reflecting on personal behaviors and personal needs
d. Avoiding power struggles with the manipulative patient
C
Which action reflects therapeutic practices associated with operant conditioning?
a. Encouraging a parent to read to their children to foster a love for learning
b. Encouraging a patient to make daily journal entries describing their feelings
c. Suggesting to a new mother that she spend time cuddling her newborn often during the day
d. Acknowledging a patient who is often verbally aggressive for complimenting a picture another patient drew
D
A nurse is assessing a patient who graduated at the top of his class but now obsesses about being incompetent in his new job. The nurse recognizes that this patient may benefit from the following type of psychotherapy:
a. Interpersonal
b. Operant conditioning
c. Behavioral
d. Cognitive behavioral
D
According to Maslow’s hierarchy of needs, the most basic needs category for nurses to address is:
a. Physiological
b. Safety
c. Love and belonging
d. Self-actualization
A
In an outpatient psychiatric clinic, a nurse notices that a newly admitted young male patient smiles when he sees her. One day the young man tells the nurse, “You are pretty like my mother.” The nurse recognizes that the male is exhibiting:
a. Transference
b. Id expression
c. Countertransference
d. A cognitive distortion
A
Linda is terrified of spiders and cannot explain why. Because she lives in a wooded area, she would like to overcome this overwhelming fear. Her nurse practitioner suggests which therapy?
a. Behavioral
b. Biofeedback
c. Aversion
d. Exposure and response prevention therapy
D
A patient is telling a tearful story. The nurse listens empathically and responds therapeutically with:
a. “The next time you find yourself in a similar situation, please call me.”
b. “I am sorry this situation made you feel so badly. Would you like some tea?”
c. “Let’s devise a plan on how you will react next time in a similar situation.”
d. “I am sorry that your friend was so thoughtless. You should be treated better.”
C
Mild anxiety
every day problem-solving leverage
grasp information effectively
from being in hospital
learn to manage or grow from it before it gets worse
NO sympathetic nervous system response
moderate anxiety
selective inattention
clear thinking hampered, can make SOME decisions
problem solving not optimal
SNS symptoms begin, seek help in making big decisions
severe anxiety
perceptual field greatly reduced (can’t make eye contact or focus)
difficulty concentrating
confused and automatic behavior
somatic symptoms (stomach upset, digestion and sphincter issues, release of cortisol)
Panic
markedly disturbed behavior (running, shouting, etc)
extremely impulsive
security (code gray or rapid response)
rescue meds (haldol [vit H] or ativan)
1:1
change of location
cohorting
concerns of pt safety
hallucinations
unable to process reality; impulsivity
panic attack or panic disorder (PD)
separation anxiety disorder
Developmentally inappropriate levels of concern over being away from a significant other
Assessing their stages in growth and development
Can develop into true interference with life
panic disorder
recurring panic attacks
agoraphobia
excessive anxiety or fear about being in places or situations where escape may be difficult or embarrassing
may occur in places with closed spaces, some pts may not want to leave their home
missing human-human interaction
not a space issue, more loss of control
generalized anxiety disorder (GAD)
excessive worry for months
gets in the way of responsibilities of activities
social anxiety disorder
severe anxiety or fear provoked by exposure to a social or performance situation that will be evaluated negatively by others
physical effects of anxiety disorders
sweating
chest pain
dizziness, decreased sex drive, irritability
increased muscle tension
rapid breathing and breathlessness
heart palpitations
increased BP
N/D
