exam 4

Question 1

Which individuals are most at risk for displaying aggressive behavior? Select all that apply.
a. An adolescent embarrassed in front of friends.
b. A young male who feels rejected by the social group.
c. A young adult depressed after the death of a friend.
d. A middle-aged adult who feels that concerns are going unheard.

Answer 1

ABDE

Question 2

A newly admitted male patient has a long history of aggressive behavior toward staff. Which statement by the nurse demonstrates the need for more information about the use of restraint?
a.If his behavior warrants restraints, someone will stay with him the entire time he’s restrained.”
b. “I’ll call the primary provider and get an as-needed (PRN)
seclusion/restraint order.”
c. “If he is restrained, be sure he is offered food and fluids regularly.”
d. “Remember that physical restraints are our last resort.”

Answer 2

B

Question 3

Which intervention(s) should the nurse implement when helping a patient who expresses anger in an inappropriate manner? Select all that apply.
a. Approach the patient in a calm, reassuring manner.
b. Provide suggestions regarding acceptable ways of communicating anger.
c. Warn the patient that being angry is not a healthy emotional state.
d. Set limits on the angry behavior that will be tolerated.
e. Allow any expression of anger as long as no one is hurt.

Answer 3

ABD

Question 4

Which guidelines should direct nursing care when deescalating an angry patient? Select all that apply.
a. Intervene as quickly as possible.
b. Identify the trigger for the anger.
c. Behave calmly and respectfully.
d. Recognize the patient’s need for increased personal space.
e. Demands are agreed to as long as they will not result in harm to anyone.

Answer 4

ABC

Question 5

Which comorbid condition would result in cautious use of an SSRI for a patient with chronic aggression?
a. Asthma
b. Anxiety disorder
c. Glaucoma
d. Bipolar disorder

Answer 5

D

Question 6

Patrick is a widower with four daughters. He enjoyed a healthy relationship with each of them until they reached puberty. As the girls began to mature physically, he acted in an aggressive manner, often beating them without provocation. Patrick is most likely acting on:
a. Self- protective measures
b. Stress of raising four daughters
c. Frustration of unhealthy desire
d. Motivating his daughters to be chaste

Answer 6

C

Question 7

A nurse named Darryl has been hired to work in a psychiatric intensive care unit. He has undergone training on recognizing escalating anger. Which statement indicates that he understands danger signs in regard to aggression?
a. “I need to be aware of patients who are withdrawn and sitting alone.”
b. “An obvious change in behavior is a risk factor for aggression.”
c. “Patients who seek constant attention are more likely to be violent.”
d. “Patients who talk to themselves are the most dangerous.”

Answer 7

B

Question 8

An effective method of preventing escalation in an environment with violent offenders is to develop a level of trust through:
a. A casual authoritative demeanor
b. Keeping patients busy
c. Brief, frequent, nonthreatening encounters
d. Threats of seclusion or punishment

Answer 8

C

Question 9

A 24-hour observation is a good choice for restraint in which of the following patients?
a. An inmate with suicidal ideation on hospice care
b. A sex offender in the psychiatric intensive care unit
c. An aggressive female with antisocial personality disorder
d. An inmate diagnosed with paranoid schizophrenia

Answer 9

A

Question 10

Chronic obstructive pulmonary disease, spinal injury, seizure disorder, and pregnancy are conditions that:
a. Frequently result in out of control behavior.
b. Respond well to therapeutic holding.
c. Necessitate the use of only two- point restraint.
d. Contraindicate restraint and seclusion.

Answer 10

D

Question 11

Which statement made by a new mother should be explored further by the nurse?
a. “I have three children, that’s enough.”
b. “I think the baby cries just to make me angry.”
c. “I wish my husband could help more with the baby.”
d. “Babies are a blessing, but they are a lot of work.”

Answer 11

B

Question 12

Which problem is observed in children who regularly witness acts of violence in their family? Select all that apply.
What safety- related responsibility does the nurse have in any situation of suspected abuse?
a. Protect the patient from future abuse by the abuser.
b. Inform the suspected abuser that the authorities have been notified.
c. Arrange for counseling for all involved parties, but espe cially the patient.
d. Report suspected abuse to the proper authorities.

Answer 12

ABCE

Question 13

What safety- related responsibility does the nurse have in any situation of suspected abuse?
a. Protect the patient from future abuse by the abuser.
b. Inform the suspected abuser that the authorities have been notified.
c. Arrange for counseling for all involved parties, but espe cially the patient.
d. Report suspected abuse to the proper authorities.

Question 14

The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the patient? Select all that apply.
a. The police department
b. An abuse hotline
c. A responsible friend or family member
d. A domestic violence shelter
e. The hospital emergency department

Answer 14

D

Question 15

Secondary effects of abuse often manifest as arrested development in children due to the fact that:
a. Coping is easier than emotional growth
b. Energy for development is diverted to coping
c. Children cannot differentiate love from abuse
d. Abuse fosters a sense of belonging, even if dysfunctional

Answer 15

ABCD

Question 16

The use of a patient- centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and:
a. Establish trust and rapport
b. Ask lots of questions
c. Interrupt the patients’ story to allow for decompression
d. Utilize closed- ended questions

Answer 16

B

Question 17

8. The abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and older adults due to:
   a. The love they have for parents or children.
   b. Their limited options.
   c. The need to feel safe at home.
   d. Other relatives do not want them.

Answer 17

A

Question 18

The abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and older adults due to:
a. The love they have for parents or children.
b. Their limited options.
c. The need to feel safe at home.
d. Other relatives do not want them.

Answer 18

B

Question 19

An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be:
a. A decrease in family interaction so there are fewer opportunities for abuse to occur.
b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses.
c. The perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy.
d. A triad of treatment modalities, including medication, counseling, and role- playing opportunities.

Answer 19

B

Question 20

Perpetrators of domestic violence tend to: Select all that apply.
a. Have relatively poor social skills and have grown up with poor role models.
b. Believe they, if male, should be dominant and in charge in relationships.
c. Force their mates to work and expect them to handle the financial decisions.
d. Be controlling and willing to use force to maintain their power in relationships.
e. Prevent their mates from having relationships and activities outside the family

Answer 20

ABDE

Question 21

Which statement made by a sexually assaulted patient strongly suggests the drug gamma-hydroxybutyric acid (GHB) was involved in the attack?
a. “I remember everything that happened but felt too tired to fight back.”
b. “The drink I was given had a salty taste to it.”
c. “They tell me I was unconscious for 24 hours.”
d. “I heard that I was fighting the nursing staff and saying that they were trying to kill me.”

Answer 21

B

Question 22

Considering the guilt that women feel after being sexually assaulted, which nursing assessment question has priority?
a. “Do you want the police to be called?”
b. “Did you recognize the person who assaulted you?”
c. “Do you have someone you trust that can stay with you?”
d. “Do you have any thoughts about harming yourself?”

Answer 22

D

Question 23

Which statement is an accurate depiction of sexual assault?
a. Rape is a sexual act.
b. Most rapes occur in the home.
c. Rape is usually an impulsive act.
d. Women are usually raped by strangers

Answer 23

B

Question 23

Which racial identification places a woman at the greatest risk of being sexually assaulted in her lifetime?
a. Multiracial
b. American Indian
c. Black non- Hispanic
d. White

Answer 23

A

Question 24

Which signs and symptoms are associated with rapetrauma and rape-trauma response? Select all that apply.
a. Outbursts of anger
b. Major depressive disorder
c. Auditory hallucinations
d. Flashbacks
e. Amnesia for the event

Answer 24

ABDE

Question 25

The stress of being raped often results in suffering similar to people who have witnessed a murder or had a physiological reaction to trauma, resulting in which of the following?
a. Posttraumatic stress disorder
b. Anxiety
c. Depression
d. All of the above

Answer 25

D

Question 26

A young woman named Carly was raped after closing shift behind the restaurant where she works. Six months have passed and Carly has not been able to return to work, refuses to go out to eat, and feels that she has less value as a woman now that she has been raped. Carly’s clinical presentation suggests:
a. Reexperiencing
b. Hyperalertness
c. Avoidance
d. Physical effects

Answer 26

C

Question 27

8. Ron is a victim of assault and has revealed to his family and friends the fact that he was raped. The family reacts with horror and disgust, and the nurse caring for Ron recognizes that
   a. Ron’s family is being judgmental.
   b. Ron’s family should leave the hospital.
   c. Ron’s family will also need support.
   d. Ron’s family’s dynamics are dysfunctional

Answer 27

C

Question 28

9. Perpetrators of sexual assault are often incarcerated but frequently do not undergo therapy. Samuel, convicted of rape and sentenced to 15 years in prison, has asked to see a therapist. The psychiatric nurse practitioner is surprised to learn of the request, as many perpetrators
   a. Boast of their assault history.
   b. Feel regret and remorse.
   c. Do not acknowledge the need for change.
   d. Are unable to recognize rape as a crime.

Answer 28

C

Question 29

10. You are working at a telephone hotline center when Abby, a rape victim, calls. Abby states she is afraid to go to the hospital. What is your best response?
    a. “I’m here to listen, and we can talk about your feelings.”
    b. “You don’t need to go to the hospital if you don’t want to.”
    c. “If you don’t go to the hospital, we can’t collect evidence to help convict your rapist.”
    d. “Why are you afraid to seek medical attention?”

Answer 29

A

Question 30

The nurse is planning the care of patients on her unit, which includes a dual- diagnosis group. Which patient would be appropriate for this group? The patient with
a. Major depression disorder and a history of recurrent suicidal ideation
b. Generalized anxiety disorder and frequent migraine headaches
c. Bipolar disorder and anorexia nervosa
d. Schizophrenia and alcohol use disorder

Answer 30

D

Question 31

A patient continues to dominate the group conversation despite having been asked to allow others to speak. What is the group leader’s most appropriate response?
a. “You are monopolizing the conversation.”
b. “When you talk constantly, it makes everyone feel angry.”
c. “You are supposed to allow others to speak also.”
d. “When you speak out of turn, I am concerned that others will not be able to participate equally.”

Answer 31

D

Question 32

8. Group members are having difficulty deciding what topic to cover in today’s session. Which nurse leader response reflects autocratic leadership?
   a. “We are talking about fear of rejection today.”
   b. “Let’s go around the room and make suggestions for today’s topic.”
   c. “I will let you come to a conclusion together about what to talk about.”
   d. “I’ll work with you to find a suitable topic for today.”

Answer 32

A

Question 33

The advanced practice nurse is assigned a group of patients. Which patient would not be appropriate to consider for inpatient group therapy? (Select all that apply.) The patient who
a. Has limited financial and social resources
b. Is experiencing acute mania
c. Has few friends on the unit
d. Is preparing for discharge tomorrow
e. Does not speak up often yet listens to others

Answer 33

B

Question 34

Group dynamics can vary widely, and sometimes members disrupt the group process. Which of the following participant traits may indicate a need for additional support for a new nurse facilitator? Select all that apply.
a. A member with paranoid delusions
b. A quietly tearful participant expressing suicidal thoughts
c. An angry woman who raises her voice
d. A calm but ineffective communicator

Answer 34

A

Question 35

The nurse describes the purpose of psycho-educational groups as providing group members with the knowledge and skills necessary to manage psychiatric symptoms. Which phase of group development is represented?
a. Planning (formation) phase
b. Orientation phase
c. Working phase
d. Termination phase

Answer 35

B

Question 36

What group would benefit most from a laissez- faire leader?
a. Art group
b. Grief group
c. Social skills group
d. Anger management group

Answer 36

A

Question 37

What advantages does group therapy have over individual therapy? Select all that apply.
a. Groups are less expensive than one- on-one therapy.
b. Groups provide an opportunity to learn from others.
c. Groups are homogeneous in composition.
d. Feedback is available from the group leader and group members.
e. Interpersonal skills can be practiced in a safe environment.

Answer 37

ABDE

Question 38

What question by the nurse leader is helpful in managing a monopolizing member of a group?
a. “You seem angry. Is there something you want to discuss with the group?”
b. “Would it be helpful if you had time to think about the question?”
c. “Would you tell us about experiences that have frightened you?”
d. “Who else would like to share feelings about this issue?”

Answer 38

D

Question 39

Which outcome would be appropriate for a group session on medication education? Select all that apply.
a. Patient will identify three side effects of prescribed medication.
b. Patient will verbalize the purpose of taking the medication.
c. Patient will acknowledge and accept the financial cost of prescribed medications.
d. Patient will correctly identify time of day and dose for each prescribed medication.
e. Patient will list two potential drug–drug and drug–food interactions for prescribed medications.

Answer 39

ABD

Question 40

Which characteristics suggest a man is experiencing the prodromal phase of schizophrenia? Select all that apply.
a. Always afraid that others will steal his belongings.
b. Displays unusual interest in numbers and specific topics.
c. Has increasingly unusual thoughts and uses words oddly.
d. Demonstrates increasing difficulty with concentration.

Answer 40

. a, b, c, d

Question 41

Which nursing interventions are particularly well chosen for addressing a population at high risk for developing schizophrenia? Select all that apply.
a. Screening 15- to 25- year- olds for early symptoms.
b. Forming a support group for females aged 25 to 35 who are diagnosed with substance use disorders.
c. Teaching ways to cope and build resiliency.
d. Educating about the risk of psychosis with marijuana use

Answer 41

a, c, d;

Question 42

To provide effective care for the patient who is taking a second- generation antipsychotic, the nurse should frequently assess for
a. Alcohol use disorder
b. Major depressive disorder
c. Stomach cancer
d. Polydipsia
e. Metabolic syndrome

Answer 42

e

Question 43

A female patient diagnosed with schizophrenia has been prescribed a first- generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?
a. Her memory problems will likely decrease.
b. Depressive episodes should be less severe.
c. She will probably enjoy social interactions more.
d. She should experience a reduction in hallucinations.

Answer 43

d

Question 44

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?
a. Depersonalization
b. Pressured speech
c. Negative symptoms
d. Paranoia

Answer 44

d

Question 45

Which therapeutic communication statement might a psychiatric–mental health registered nurse use when a patient’s nursing diagnosis is hallucinations? Select all that apply.
a. “I know you say you hear voices, but I cannot hear them.”
b. “Stop listening to the voices, they are NOT real.”
c. “Tell me more about what you hear.”
d. “Please tell the voices to leave you alone for now.”

Answer 45

a C

Question 46

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that
a. The medications provided are ineffective.
b. Nurses are trying to control their minds.
c. The medications will make them sick.
d. They are not actually ill

Answer 46

d; 8. a, b; 9. a, b, c; 10. d

Question 47

Kyle, a patient with schizophrenia, began to take 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.
a. Hold his medication and contact his prescriber stat.
b. Wipe him with a washcloth that has been wetted with cold water or alcohol.
c. Administer an “as needed” medication such as benztropine intramuscularly to correct his dystonic reaction.
d. Reassure him that no treatment is needed and that this reaction will pass.
e. Hold his medication for now and consult his prescriber when he comes to the unit later today.

Answer 47

a, b

Question 48

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.
a. Self- medicate for social discomfort.
b. Cope with anxiety.
c. Enhance mood.
d. Enable Tomas to better express himself.

Answer 48

a, b, c

Question 49

A patient reports that “the voices are really bad today.”
Helpful nursing responses would include
a. Giving an additional “as needed” dosage of his antipsychotic medication.
b. Telling him that the voices are not real and that he should ignore them.
c. Directing him to return to his room and try not to think about the voices.
d. Encouraging the patient to use competing auditory stimuli, such as humming or listening to music.

Answer 49

. d

Question 50

1. Which statement demonstrates a well-structured attempt at limit setting?
   a. “Hitting me when you are angry is unacceptable.”
   b. “I expect you to behave yourself during dinner.”
   c. “Come here, right now!”
   d. “Good boys don’t bite.”

Answer 50

A

Question 51

2. Which activity is most appropriate for a child with ADHD?
   a. Reading an adventure novel
   b. Monopoly
   c. Checkers
   d. Tennis

Answer 51

D

Question 52

3. Cognitive- behavioral therapy is going well when a 12- year- old patient in therapy reports to the nurse practitioner:
   a. “I was so mad I wanted to hit my mother.”
   b. “I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named
   Todd.”
   c. “I forgot that you told me to breathe when I become angry.”
   d. “I scream as loud as I can when the train goes by the house.”

Answer 52

B

Question 53

4. What assessment question should the nurse ask when attempting to determine a teenager’s mental health resilience? Select all that apply.
   a. “How did you cope when your father deployed with the
   Army for a year in Iraq?”
   b. “Who did you go to for advice while your father was away for a year in Iraq?”
   c. “How do you feel about talking to a mental health counselor?”
   d. “Where do you see yourself in 10 years?”
   e. “Do you like the school you go to?”

Question 54

5. Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.
   a. Limited language skills
   b. Level of cognitive development
   c. Level of emotional development
   d. Parental denial that a problem exists
   e. Severity of the typical mental illnesses observed in young children

Answer 54

ABC

Question 55

6. Pam, the nurse educator, is teaching a new nurse about seclusion and restraint. Order the following interventions from least (1) to most (5) restrictive:
   a. With the patient, identify the behaviors that are unacceptable and consequences associated with harmful behaviors
   b. Placing the patient in physical restraints
   c. Allowing the patient to take a time- out and sit in his or her room
   d. Offering a PRN medication by mouth
   e. Placing the patient in a locked seclusion room

Answer 55

a-1, b-5, c-3, d-2, e-4

Question 56

In pediatric mental health, there is a lack of sufficient numbers of community- based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply.
a. Children of color and poor economic conditions being underserved
b. Increased stress in the family unit
c. Markedly increased funding
d. Premature termination of services

Answer 56

ABD

Question 57

8. Child protective services have removed 10-year- old Christopher from his parents’ home due to neglect. Christopher reveals to the nurse that he considers the woman next door his “nice” mom, that he loves school, and gets above average grades. The strongest explanation of this response is:
   a. Temperament
   b. Genetic factors
   c. Resilience
   d. Paradoxical effects of neglectC

Answer 57

C

Question 58

April, a 10- year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self- control in the day room. Time- out does not appear to be an effective tool for April to engage in self- reflection. April’s mother admits to putting her in time- out up to 20 times a day. The nurse recognizes that:
a. Time- out is an important part of April’s baseline discipline.
b. Time- out is no longer an effective therapeutic measure.
c. April enjoys time- out and acts out to get some alone time.
d. Time- out will need to be replaced with seclusion and restraint.

Answer 58

B

Question 59

Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:
a. Limited executive function
b. Cerebellum maturation
c. Cerebral stasis and hormonal changes
d. A slight reduction in brain volume

Answer 59

B

Question 60

Which statement made by the psychiatric nurse demonstrates an accurate understanding of the factors that affect an individual’s personality?
a. “Therapy will help her identify that her problems are personality related.”
b. “I’ll need to learn more about this patient’s cultural beliefs.”
c. “It’s encouraging to know that personality disorders respond well to treatment.”
d. “A person’s personality is fluid and adjusts to current social situations.”

Answer 60

b

Question 61

When assessing a patient diagnosed with a borderline personality disorder, which statement by the patient warrants immediate attention?
a. “My mother died ten years ago.”
b. “I haven’t needed medication in weeks.”
c. “My dad never loved me.”
d. “I’d really like to hurt her for hurting me.”

Answer 61

d;

Question 62

What is the current accepted professional view of the effect of culture on the development of a personality disorder?
a. There are not enough studies to confirm the role that ethnicity and race have on the prevalence of personality disorders.
b. The North American and Australian cultures produce higher incidences of personality disorders within their populations.
c. Neither culture nor ethnic background is generally considered in the development of personality disorders.
d. Personality disorders have been found to be primarily the products of genetic factors, not cultural factors.

Answer 62

a

Question 63

Which personality disorders are generally associated with behaviors described as “odd or eccentric”? Select all that apply.
a. Paranoid
b. Schizoid
c. Histrionic
d. Obsessive- compulsive
e. Avoidant

Answer 63

a, b, c

Question 64

Which behaviors are examples of a primitive defense mechanism often relied upon by those diagnosed with a personality disorder? Select all that apply.
a. Regularly attempts to split the staff
b. Attempts to undo feelings of anger by offering to do favors
c. Regresses to rocking and humming to sooth self when fearful
d. Lashes out verbally when confronted with criticism
e. Destroys another person’s belongings when angry

Answer 64

b

Question 65

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 cluster B personality disorder because of her
a. Desire to avoid eating
b. Dramatic response to frustration
c. Excessive exercise routine
d. Morose personality traits

Answer 65

d

Question 66

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
a. Can be made aware of their delusions
b. Are far more delusional than schizophrenics
c. Have a greater need for socialization
d. Do not usually respond to antipsychotic medications

Answer 66

a

Question 67

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 bupropion (Wellbutrin) to
a. Improve his flat emotions
b. Help him to get a good night’s sleep
c. Increase the pleasure of living
d. Prepare Garrett for group therapy

Answer 67

c

Question 68

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 underarms and explains that it “makes the numbness stop.” Given this presentation, which personality disorder would you suspect?
a. Obsessive- compulsive
b. Borderline
c. Antisocial
d. Schizotypal

Answer 68

b

Question 69

Which statement made by the primary caregiver of a person with dementia demonstrates an accurate understanding of providing the person with a safe environment?
a. “The local police know that he has wandered off before.”
b. “I keep the noise level low in the house.”
c. “We’ve installed locks on all the outside doors.”
d. “Our telephone number is always attached to the inside of his shirt pocket.”

Answer 69

C

Question 70

Which statement made by a family member tends to support a diagnosis of delirium rather than dementia?
a. “She was fine last night but this morning she was confused.”
b. “Dad doesn’t seem to recognize us anymore.”
c. “She’s convinced that snakes come into her room at night.”
d. “He can’t remember when to take his pills or whether he’s bathed.”

Answer 70

A

Question 71

In terms of the pathophysiology responsible for both delirium and dementia, which intervention would be appropriate for delirium specifically?
a. Assisting with needs related to nutrition, elimination, hydration, and personal hygiene
b. Monitoring neurological status on an ongoing basis
c. Placing an identification bracelet on patient
d. Giving one simple direction at a time in a respectful tone of voice

Answer 71

B

Question 72

What side effects should the nurse monitor for while caring for a patient taking donepezil (Aricept)? Select all that apply.
a. Insomnia
b. Constipation
c. Bradycardia
d. Signs of dizziness
e. Reports of headache

Answer 72

ACDE

Question 73

What is the rationale for providing a patient diagnosed with dementia easily accessible finger foods thorough the day?
a. It increases input throughout the day
b. The person may be anorexic
c. It helps with the monitoring of food intake
d. It helps to prevent constipation

Answer 73

A

Question 74

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. Early- onset dementia
b. A mild cognitive disorder
c. A urinary tract infection
d. Having skipped breakfast

Answer 74

.c

Question 75

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 Lucia’s behavior is that she is
a. Attention- seeking and manipulative
b. Showing signs of early dementia
c. Experiencing an acute delirium
d. Playing one staff member off against another

Answer 75

c

Question 76

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?
a. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him.
b. Meet with the family and support them to accept, anticipate, and prepare for the progression of his stage 2 dementia.
c. Avoid touch and proximity. These are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented.
d. Arrange for an appointment with a mental health pro fessional for the evaluation and treatment of suspected major depressive disorder.

Answer 76

. d

Question 77

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.
a. Expressing emotions by journaling
b. Describing stressful events on Facebook
c. Engaging in exercise and relaxation activities
d. Having realistic patient expectations
e. Participating in a happy hour after work to blow off steam

Answer 77

a, c,

Question 78

Which statement made by a nurse requires immediate correction by the supervisor?
a. “Many older patients are depressed.”
b. “Retirement is a difficult time for older patients.”
c. “Cognitive decline is normal in patients who are 65 and older.”
d. “Sleep- related problems are often reported by older adults.”

Answer 78

C

Question 79

3. Considering psychosocial role theory, which patient demonstrates healthy adjustment to aging?
   a. The 70- year- old who is training for a 5- mile running race
   b. The older adult who controls diabetes with diet and exercise
   c. The retiree who volunteers 3 days a week at the local library
   d. The 80- year- old who is upbeat and hopeful during chemotherapy for lung cancer

Answer 79

C

Question 80

The older patient is discussing chronic pain and asks the primary care provider for a prescription. Which medication should the nurse anticipate being ordered rather than an opioid?
a. Gabapentin
b. Acetaminophen
c. Morphine
d. Fentanyl

Answer 80

A

Question 81

Which statement by an older patient with a mild neurocognitive disorder demonstrates a safe response to beginning a new medication?
a. “I read the information the pharmacist gave me when I got the prescription filled.”
b. “My daughter comes with me to appointments so that we get all the information we need.”
c. “I know I can call my doctor if I think of any questions later.”
d. “I always follow the instructions on the medication bot

Answer 81

D

Question 82

6. Anxiety problems in older adults can manifest as a fear of falling, greatly influencing an older adult’s personal freedom. A home health nurse checking on a patient with mild dementia and anxiety related to falling should question which new order?
   a. Yoga and tai- chi
   b. Xanax
   c. Relaxation techniques
   d. Electric wheelchair

Answer 82

B

Question 83

7. Fred is an older adult with spinal stenosis and who is being treated with a short-term prescription of opioids for an acute episode of back pain. His nurse recognizes additional teaching is necessary when Fred states:
   a. “Sitting up straight seems to reduce the pain.”
   b. “Sometimes I use a heating pad on my back.”
   c. “Once I get moving for the day my pain gets better.”
   d. “My wife and I share my Norco for our aches and pains.”

Answer 83

D

Question 84

Ling works as a registered nurse in an Alzheimer’s care home. Ling has a specialized rapport- building technique she uses called reminiscence. She uses this technique by:
a. Telling the residents stories about her grandparents’ lives.
b. Playing music from the residents’ formative years.
c. Reviewing movies that the residents enjoy.
d. Encouraging the residents to talk about pleasurable past events.

Answer 84

D

Question 85

Marco, age 83, has dementia and difficulty feeding himself despite the fact that there is nothing wrong with his motor functions. Which term should the nurse use to document this finding?
a. Aphasia
b. Apraxia
c. Agnosia
d. Anergia

Answer 85

B

Question 86

Programs recommended for ambulatory patients who do not need 24-hour nursing care with structured activities along with nursing and medical supervision, intervention, and treatment are called:
a. Respite programs
b. Inpatient care units
c. Hospice
d. Partial hospitalization programs

Answer 86

D

Question 87

During an interview with a patient, which question asked of an older adult is associated with the Patient Self- Determination Act?
a. “Who besides yourself may have access to your medical information?”
b. “Have you discussed your end-of- life choices with your family or designated surrogate?”
c. “Do you have the information you need to make an informed decision about your treatment?”
d. “How can I help you feel comfortable about this interview and any decisions you need to make?”

Answer 87

B