EXAM 4

Question 1

personality disorders are

Answer 1

maladaptive and inflexible - enduring patterns of behavior that deviates from the norm

Question 2

paranoid disorder nursing intervention 3

Answer 2

Serious, straightforward approach;

teach client to validate ideas before taking action;

involve client in treatment planning

Question 3

shizoid symptoms 3 and intervention 2

Answer 3

Detached from social relationships;
restricted affect; involved with
things more than people

Improve client’s functioning in the community

Question 4

schizotypical symptoms 3 and interventions 3

Answer 4

Acute discomfort in relationships;
eccentric behavior

Develop self-care skills;
social skills training

Question 5

antisocial intervention

Answer 5

Limit setting;

Question 6

BPD intervention

Answer 6

Promote safety!

Question 7

narcissic intevrention

Answer 7

Matter-of-fact approach

Question 8

aviodant intervention

Answer 8

support self esteem

Question 9

dependent disorder inteventions 3

Answer 9

Foster client’s self-reliance and autonomy; teach
problem-solving and decision-making skills;

Question 10

OCPD intevrentions 3

Answer 10

change perspective
cog restructure
risk taking

Question 11

3 steps to limit setting

Answer 11

• State the limit.
• Identify the consequences of exceeding the limit.
• Identify the expected or acceptable behavior.

Question 12

intoxication

Answer 12

use of a substance that results in maladaptive behavior

Question 13

withdrawal syndrome

Answer 13

the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases.

Question 14

substance abuse vs dependence

Answer 14

Substance abuse: using a drug in a way that is inconsistent with medical or social norms, and despite negative consequences (problems in social, vocational, or legal areas of a person’s life.

Substance dependence: problems associated with addiction (e.g., tolerance, withdrawal, and unsuccessful attempts to stop using the substance.

Question 15

10 long term effects of substances

Answer 15

• Cardiac myopathy
• Wernicke encephalopathy
• Korsakoff psychosis
• Pancreatitis
• Esophagitis
• Hepatitis
• Cirrhosis
• Leukopenia
• Thrombocytopenia
• Ascites

Question 16

4 classes of cns depressants

Answer 16

CNS depressants:
Benzodiazepines, barbiturates, nonbarbiturate hypnotics, anxiolytics

Question 17

alcohol intoxication

Answer 17

Slurred speech, unsteady gait, ↓coordination, ↓attention and concentration, impaired judgment, blackouts

Question 18

cns depressant intoxication

Answer 18

Drowsiness, ↓anxiety, slurred speech, ↓coordination, unsteady gait, labile mood, impaired attention or memory, lethargy, confusion, stupor, coma (similar to alcohol)

Question 19

bath salt intoxication

Answer 19

↑energy and agitation; cardiac symptoms (such as racing heart, high blood pressure, and chest pains) and psychiatric symptoms including paranoia, hallucinations, and panic attacks, dehydration, breakdown of skeletal muscle tissue, and kidney failure

Question 20

opioid intoxication

Answer 20

Initial euphoric feelings, then apathy, lethargy, listlessness, impaired judgment, psychomotor retardation or agitation, constricted pupils, drowsiness, slurred speech, impaired attention and memory

Question 21

PCP intoxication

Answer 21

belligerence, aggression, impulsivity, unpredictable behavior.

Question 22

inhalants intoxication

Answer 22

Dizziness, nystagmus, lack of coordination, slurred speech

Question 23

alcohol withdrawal symptoms

Answer 23

(usually begin 4-12 hrs. after last drink; peak 24-48 hrs.)
Tremors, sweating, ↑pulse and BP, insomnia, anxiety, N&V, agitation, perceptual disturbances, headache, ↓orientation, clouding of sensorium, seizure, death

Question 24

stimulant withdrawal

Answer 24

Dysphoria, fatigue, vivid and unpleasant dreams, insomnia or hypersomnia,

Question 25

OPIOID WITHDRAWL

Answer 25

Nausea, vomiting, dysphoria, lacrimation, rhinorrhea, sweating, diarrhea, yawning, fever, insomnia, anxiety, insomnia, dysphoria, anhedonia and drug cravings.

Question 26

5 tx meds for alc withdrawal

Answer 26

Benzodiazepines (lorazepam) for detox on tapering dosing or symptom-triggered dosing

Disulfiram (antabuse): can be used as a deterrent (makes one sick if alcohol taken)

Naltrexone: reduces alcohol cravings

Thiamine: prevents or treats Wernicke-Korsakoff syndrome

chlordiapoxide

Question 27

stimulant withdrawal tx

Answer 27

PRN chlorpromazine

Question 28

inhalant withdrawal tx

Answer 28

Supporting respiratory and cardiac functioning

Question 29

marijuana facts

Answer 29

Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant.
The plant contains the mind-altering chemical THC and other related compounds.
People use marijuana by smoking, eating, drinking, or inhaling it.
Smoking and vaping THC-rich extracts from the marijuana plant (a practice called dabbing) is on the rise.
THC overactivates certain brain cell receptors, resulting in effects such as:
altered senses
changes in mood
impaired body movement
difficulty with thinking and problem-solving
impaired memory and learning
Marijuana use can have a wide range of health effects, including:
hallucinations and paranoia
breathing problems
possible harm to a fetus’s brain in pregnant women
The amount of THC in marijuana has been increasing steadily in recent decades, creating more harmful effects in some people.
It’s unlikely that a person will fail a drug test or get high from passive exposure by inhaling secondhand marijuana smoke.
There aren’t any reports of teens and adults dying from using marijuana alone, but marijuana use can cause some very uncomfortable side effects, such as anxiety and paranoia and, in rare cases, extreme psychotic reactions.
Marijuana use can lead to a substance use disorder, which can develop into an addiction in severe cases.
No medications are currently available to treat marijuana use disorder, but behavioral support can be effective.

Question 30

what is Wernicke-Korsakoff syndrome and how to prevent

Answer 30

braindamage from lack of B1, give thaimine

Question 31

methadone (dolophine) use

Answer 31

heroin withdrawl

Question 32

acamprosate use

Answer 32

decrease alco craving

Question 33

dual diagnosis

Answer 33

tx both at the same time

Question 34

3 features of somatic symptpm illness

Answer 34

Physical complaints suggest major medical illness
but have no demonstrable organic basis

Psychological factors and conflicts seem important in initiating, exacerbating, maintaining symptoms

Symptoms or magnified health concerns are not under patient’s conscious control

Question 35

conversion disorder

Answer 35

unexplained sensory or motor deficits associated with psychological factors; typically involves significant functional impairment; “la belle indifference”

Question 36

malingering vs facticious vs somatic

Answer 36

somatic = non wilful control

Malingering: intentional false or grossly exaggerated symptoms; external incentives as motivation

Factitious disorder: intentional symptoms to gain attention (Munchausen’s syndrome = imposed upon self)
Munchausen’s syndrome by proxy = imposed upon others

Malingering and factitious disorders: willful control of symptoms

Question 37

focus of tx for somatic

Answer 37

relieving symtpoms and improving quality of life - build rapport

Question 38

2 reasons its hard to dx children

Answer 38

Lack of abstract cognitive abilities and verbal skills
Constantly changing and developing

Question 39

ASD

Answer 39

pervasive and usually severe impairment of
Reciprocal social interaction skills (ability to engage in social reciprocity)
Communication problems, and
Restricted stereotypical behavioral patterns.

Question 40

10 common aSD behaviors

Answer 40

• Doesn’t show interest by pointing to objects or people by 14 months
  of age
• Doesn’t play pretend games by 18 months of age
• Avoids eye contact
• Prefers to be alone
• Delayed speech and language skills
• Obsessive interests (e.g., gets stuck on an idea)
• Upset by minor changes in routine
• Repeats words or phrases over and over
• Flaps hands, or rocks or spins in a circle; answers are unrelated to
  questions
• Unusual reactions to sounds, smells, or other sensory experiences

Question 41

methylphenidate ritalin monitor

Answer 41

monitor apetite supression

Question 42

disruptive behavior characterized by

Answer 42

Anger
Hostility
Aggression

Question 43

Key features of, and differences between
Oppositional defiant disorder
Intermittent explosive disorder
Conduct disorder

Answer 43

Children with ODD have limited abilities to make associations between their behavior and the consequences of that behavior both negative and positive.

Enduring pattern of
uncooperative, defiant, disobedient, hostile behavior

toward authority figures

no major antisocial violations- no breaking laws

**conduct = Persistent behavior that violates social norms, rules, laws, and rights of others

-IED = episodes of outbursts

Question 44

4 conduct disorder interventions

Answer 44

• Decreasing violence and increasing compliance with treatment
• Protect others from client’s aggression and manipulation.
• Set limits for unacceptable behavior.
• Providing client and family education

Question 45

3 common causes of delirium

Answer 45

physioligcal
infection
drugs

Question 46

delirium interventions

Answer 46

Promoting patient safety
Managing patient’s confusion:
orienting cues
speaking in low
clear voice
avoiding sensory overload
Promoting sleep, proper nutrition

Question 47

delirum vs dementia

Answer 47

Question 48

A patient with dementia experiences changes in his or her level of consciousness.

Answer 48

false

Question 49

The nurse is providing care for a client who has been diagnosed with antisocial personality disorder. Which outcome should the nurse prioritize when planning this client’s care?

Question 1Select one:

a.
The client will to express anger in an adaptive, nonviolent manner

b.
The client will be free from self-inflicted harm.

c.
The client will use the support system without becoming overly dependent on it.

d.
The client will establish an adequate balance of rest, sleep, and activity.

Answer 49

a

Question 50

A group of nurses are working with clients with personality disorders. Which technique would be most important for the group to use to effectively provide care? Select all that apply.

a.
Solve the problems of the client.

b.
Employ ongoing communication with team members to remain firm and consistent about expectations for clients.

c.
Understand that behavior changes in clients with personality disorders can occur quickly.

d.
Discuss feelings of anger or frustration with colleagues to help them recognize and cope with their own feelings.

e.
Consider the client to be a personal friend.

Answer 50

d, b,

Question 51

Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by what?

Answer 51

anxious/fearful behavior

Question 52

A nurse is assessing a client diagnosed with avoidant personality disorder. Which would the nurse expect to find? Select all that apply.

a.
Detail oriented

b.
Feelings of superiority

c.
Shyness

d.
Perfectionism

e.
Feelings of inadequacy

Answer 52

ce

Question 53

The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client?

Question 9Select one:

a.
“I and other members of the health care team would like you to attend group therapy each day.”

b.
“You’ll be expected to attend group therapy each day.”

c.
“You’ll find your condition will improve much faster if you attend group therapy each day.”

d.
“Please try to attend group therapy each day.”

Answer 53

b

Question 54

A nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse identify as a priority?

a.
Risk for self-directed violence

b.
Risk for other-directed violence

c.
Risk for suicide

d.
Risk for self-injury

Answer 54

b

Question 55

Which personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy?

Answer 55

narcissic

Question 56

Which client is most likely to be at risk for drug dependence and difficulties with withdrawal?

Question 1Select one:

a.
A client who has recently begun treatment with propranolol for the treatment of social phobia

b.
A client with generalized anxiety disorder who has responded well since beginning treatment with fluoxetine earlier in the year

c.
A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident

d.
A man whose obsessive–compulsive disorder is being treated long term with paroxetine

Answer 56

b

Question 57

Which statement about clients with a dual diagnosis is accurate?

Question 3Select one:

a.
Traditional methods of treatment have not been very successful for these clients.

b.
These clients represent a small percentage of hospitalized clients.

c.
Chances for recovery for clients with a dual diagnosis are better than average.

d.
Addictions and mental disorders should be treated separately.

Answer 57

a

Question 58

Which are effects of alcohol withdrawal syndrome? Select all that apply.

Question 4Select one or more:

a.
Increased pulse

b.
Seizures

c.
Decreased blood pressure

d.
Delirium tremens

e.
Hand tremors

Answer 58

abde

Question 59

A client admitted for acute alcohol intoxication begins to experience mild sweating, tachycardia, fever, and nausea and vomiting. Which of the following would be the drug treatment of choice?

Answer 59

chlordiazepoxide

Question 60

A group of nursing students is reviewing information about nutritional supplementation used during alcohol detoxification. The students demonstrate the need for additional review when they identify which of the following as being used?

Answer 60

acamprosate

Question 61

ciwa use

Answer 61

identify severity of alc symptoms

Question 62

Which medication is used to prevent dangerous alcohol withdrawal symptoms?

Answer 62

lorzepam

Question 63

A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind?

Answer 63

The drug helps to satisfy the craving for the opioid

Question 64

Which term describes a situation that occurs when very small amounts of alcohol intoxicates the person after continued heavy drinking?

Answer 64

tolerance break

Question 65

A client reports drinking one to two drinks when drinking behavior first began. Now the client reports drinking at least six drinks with every episode in order to “have a good time.” Which term would best describe this phenomenon?

Answer 65

tolerance

Question 66

The client asks the nurse, “What will happen if I drink while taking disulfiram?” What should be the nurse’s reply?

Question 23Select one:

a.
“You will experience a severe reaction, including a throbbing headache and vomiting.”

b.
“Disulfiram will reverse the effects of alcohol.”

c.
“You will not get any effect from the alcohol you drink.”

d.
“You will not want to drink while taking disulfiram. It reduces the cravings.”

Answer 66

a

Question 67

The nurse is assessing a client with bulimia nervosa. Which symptoms would the nurse expect to find? Select all that apply.

Question 1Select one or more:

a.
Hypotension

b.
Metabolic alkalosis

c.
Normal weight for height

d.
Dental erosion

e.
Cold intolerance

Answer 67

bcd

Question 68

Which technique is a type of cognitive behavioral therapy implemented for bulimic clients?

Answer 68

self monitoring

Question 69

Which are appropriate long-term treatment outcomes for clients who have somatic symptom illness? Select all that apply.

Question 1Select one or more:

a.
The client will verbally express emotional feelings.

b.
The client will identify the relationship between stress and physical symptoms.

c.
The client will assume responsibility for self-care activities.

d.
The client will learn to vary his or her schedule.

e.
The client will demonstrate alternative ways to deal with stress, anxiety, and other feelings.

Answer 69

cbae

Question 70

When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include?

Question 3Select one:

a.
In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.

b.
In factitious disorders, clients are unaware that their symptoms are not real.

c.
In somatic symptom disorder, clients consciously seek attention.

d.
Factitious disorders respond much more readily to psychopharmacologic treatment than does somatic symptom disorder.

Answer 70

a

Question 71

The client presented to the emergency department with a report of chest pain. The nurse performs a thorough physical examination for this client, who has a history of a somatic symptom illness. Which is the best rationale for the physical exam?

Question 6Select one:

a.
Physical exams are reimbursed by third-party payers.

b.
Physical disorders underlie somatic disorders.

c.
Underlying pathology should be ruled out.

d.
Ease the client’s mind that the nurse is looking for physical illness.

Answer 71

c

Question 72

A nurse is assessing a child with attention deficit hyperactivity disorder. Which assessment finding is the nurse likely to see in this child? Select all that apply.

Question 8Select one or more:

a.
Impulsiveness

b.
Attentiveness

c.
Overactivity

d.
Stereotypical movements

e.
Stuttering

Answer 72

ac

Question 73

A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply.

Question 9Select one or more:

a.
The child does not relate to parents.

b.
The child becomes upset with minor changes in routine.

c.
The child is extremely playful.

d.
The child becomes frightened when left alone.

e.
The child avoids eye contact.

Answer 73

abe

Question 74

Which nursing intervention should take priority for a child with attention deficit hyperactivity disorder (ADHD)?

Question 10Select one:

a.
Ensuring the child’s safety and that of others

b.
Simplifying instructions and directions

c.
Structured daily routine

d.
Improved role performance

Answer 74

a

Question 75

Which interventions should a nurse teach the parents of a child with conduct disorder? Select all that apply.

Question 13Select one or more:

a.
Explore whether they feel authentic love for the child.

b.
Advise them to avoid rescuing their child.

c.
Reassure them that the child will become normal with time.

d.
Encourage them to seek proper treatment for their own problems.

e.
Explain about age-appropriate activities and expectations.

Answer 75

bde

Question 76

The parents of a 15-year-old adolescent report that their child is behaving abnormally. After obtaining the history of the client, the nurse responds by telling the parents that their child’s behavior is normal for his age. What would the parents have told the nurse regarding their child? Select all that apply.

Question 14Select one or more:

a.
“Our child spends more time playing than studying.”

b.
“Our child has no friends at school.”

c.
“Our child has difficulty learning and understanding concepts.”

d.
“Our child is an extreme pessimist and tends to stay away from everybody.”

e.
“Our child doesn’t listen to us, preferring to listen to friends.”

Answer 76

ae

Question 77

A nurse is assessing an adolescent with oppositional defiant disorder (ODD). Other than disruptive behavior, what other findings might the nurse expect to see during the assessment? Select all that apply.

Question 15Select one or more:

a.
Impaired decision making

b.
Impaired attention

c.
Impaired physical ability

d.
Impaired sense of direction

e.
Impaired problem-solving abilities

Answer 77

abe

Question 78

Which is true of the time-out strategy that may be used for persons with conduct disorder?

Question 18Select one:

a.
It is a punishment.

b.
It is retreat to a neutral place, so clients can regain self-control.

c.
It should only be used as a last resort.

d.
It is not a permanent solution; eventually, the goal is for the client to avoid time-out.

Answer 78

b

Question 79

Which is the primary treatment for delirium?

Question 24Select one:

a.
Provide adequate nutritional food and fluid intake

b.
Maintain intravenous fluid administration

c.
Identify and treat any causal or contributing medical conditions

d.
Apply physical restraints

Answer 79

c

Question 80

donepezil nursing

Answer 80

for dementia - test stool for GI bleed

Question 81

rivastigmine

Answer 81

for demetia - monitor for loss of apetite

Question 82

galantamine

Answer 82

for dementia - monitor for syncope

Question 83

memantine

Answer 83

for dementia - monitor for HTN, fatigue