UNIT I

Question 1

Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)?

a. Voluntary control of symptoms
b. Patient’s style of presentation
c. Results of diagnostic testing
d. The role of secondary gains

Answer 1

ANS: B
Patients with illness anxiety disorder (hypochondriasis) tend to be more anxious about their concerns and display more obsessive attention to detail, whereas the patients with conversion (functional neurological) disorder often exhibit less concern with the symptom they are presenting than would be expected. Neither disorder involves voluntary control of the symptoms. Results of diagnostic testing for both would be negative (i.e., no physiological basis would be found for the symptoms). Secondary gains can occur in both disorders but are not necessary to either. See relationship to audience response question.

Question 2

Which prescription medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder?

a. Narcotic analgesics for use as needed for acute pain
b. Antidepressant medications to treat co-morbid depression
c. Long-term use of benzodiazepines to support coping with anxiety
d. Conventional antipsychotic medications to correct cognitive distortions

Answer 2

ANS: B
Various types of antidepressants may be helpful in somatic disorders not only directly by reducing depressive symptoms and hence somatic responses, but also indirectly by affecting nerve circuits that affect not only mood but also fatigue, pain perception, GI distress, and other somatic symptoms. Patients may benefit from short-term use of antianxiety medication (benzodiazepines) but require careful monitoring because of risks of dependence. Conventional antipsychotic medications would not be used, although selected atypical antipsychotics may be useful. Narcotic analgesics are not indicated.

Question 3

A medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder. Care planning is facilitated by understanding that the patient will probably

a. readily seek psychiatric counseling.
b. be resistant to accepting psychiatric help.
c. attend psychotherapy sessions without encouragement.
d. be eager to discover the true reasons for physical symptoms.

Answer 3

ANS: B
Patients with somatic symptom disorders go from one health care provider to another trying to establish a physical cause for their symptoms. When a psychological basis is suggested and a referral for counseling offered, these patients reject both.

Question 4

A patient has blindness related to conversion (functional neurological) disorder but is unconcerned about this problem. Which understanding should guide the nurse’s planning for this patient?

a. The patient is suppressing accurate feelings regarding the problem.
b. The patient’s anxiety is relieved through the physical symptom.
c. The patient’s optic nerve transmission has been impaired.
d. The patient will not disclose genuine fears.

Answer 4

ANS: B
Psychoanalytical theory suggests conversion reduces anxiety through production of a physical symptom symbolically linked to an underlying conflict. Conversion, not suppression, is the operative defense mechanism in this disorder. While some MRI studies suggest that patients
with conversion disorder have an abnormal pattern of cerebral activation, there is no actual alternation of nerve transmission. The other distracters oversimplify the dynamics, suggesting that only dependency needs are of concern, or suggest conscious motivation (conversion operates unconsciously).

Question 5

A patient has blindness related to conversion (functional neurological) disorder. To help the patient eat, the nurse should
a. establish a “buddy” system with other patients who can feed the patient at each
meal.
b. expect the patient to feed self after explaining arrangement of the food on the tray.
c. direct the patient to locate items on the tray independently and feed self.
d. address needs of other patients in the dining room, then feed this patient.

Answer 5

ANS: B
The patient is expected to maintain some level of independence by feeding self, while the nurse is supportive in a matter-of-fact way. The distracters support dependency or offer little support.

Question 6

A patient with blindness related to conversion (functional neurological) disorder says, “All the doctors and nurses in the hospital stop by often to check on me. Too bad people outside the hospital don’t find me as interesting.” Which nursing diagnosis is most relevant?

a. Social isolation
b. Chronic low self-esteem
c. Interrupted family processes
d. Ineffective health maintenance

Answer 6

ANS: B
The patient mentions that the symptoms make people more interested. This indicates that the patient feels uninteresting and unpopular without the symptoms, thus supporting the nursing diagnosis of chronic low self-esteem. Defining characteristics for the other nursing diagnoses are not present in the scenario.

Question 7

To assist patients diagnosed with somatic symptom disorders, nursing interventions of high priority

a. explain the pathophysiology of symptoms.
b. help these patients suppress feelings of anger.
c. shift focus from somatic symptoms to feelings.
d. investigate each physical symptom as it is reported.

Answer 7

ANS: C
Shifting the focus from somatic symptoms to feelings or to neutral topics conveys interest in the patient as a person rather than as a condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome would be that the patient would express feelings, including anger if it is present. Once physical symptoms are investigated, they do not need to be reinvestigated each time the patient reports them.

Question 8

A patient with fears of serious heart disease was referred to the mental health center by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, “My chest is tight, and my heart misses beats. I’m often absent from work. I don’t go out much because I need to rest.” Which health problem is most likely?

a. Dysthymic disorder
b. Somatic symptom disorder
c. Antisocial personality disorder
d. Illness anxiety disorder (hypochondriasis)

Answer 8

ANS: D
Illness anxiety disorder (hypochondriasis) involves preoccupation with fears of having a serious disease even when evidence to the contrary is available. The preoccupation causes impairment in social or occupational functioning. Somatic symptom disorder involves fewer symptoms. Dysthymic disorder is a disorder of lowered mood. Antisocial disorder applies to a personality disorder in which the individual has little regard for the rights of others. See relationship to audience response question.

Question 9

A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note that the patient

a. sees a relationship between symptoms and interpersonal conflicts.
b. has little difficulty communicating emotional needs to others.
c. rarely derives personal benefit from the symptoms.
d. has altered comfort and activity needs.

Answer 9

ANS: D
The patient frequently has altered comfort and activity needs associated with the symptoms displayed (fatigue, insomnia, weakness, tension, pain, etc.). In addition, hygiene, safety, and security needs may also be compromised. The patient is rarely able to see a relation between symptoms and events in his or her life, which is readily discernible to health professionals. Patients with somatic symptom disorders often derive secondary gain from their symptoms and/or have considerable difficulty identifying feelings and conveying emotional needs to others.

Question 10

To plan effective care for patients diagnosed with somatic symptom disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms

a. are generally chronic.
b. have a physiological basis.
c. can be voluntarily controlled.
d. provide relief from health anxiety.

Answer 10

ANS: D
At the unconscious level, the patient’s primary gain from the symptoms is anxiety relief. Considering that the symptoms actually make the patient more psychologically comfortable and may also provide secondary gain, patients frequently fiercely cling to the symptoms. The symptoms tend to be chronic, but that does not explain why they are difficult to give up. The symptoms are not under voluntary control or physiologically based.

Question 11

A patient with a somatic symptom disorder has the nursing diagnosis Interrupted family processes related to patient’s disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will

a. assume roles and functions of other family members.
b. demonstrate performance of former roles and tasks.
c. focus energy on problems occurring in the family.
d. rely on family members to meet personal needs.

Answer 11

ANS: B
The patient with a somatic symptom disorder has typically adopted a sick role in the family, characterized by dependence. Increasing independence and resumption of former roles are necessary to change this pattern. The distracters are inappropriate outcomes.

Question 12

Which comment by a patient who recently experienced a myocardial infarction indicates use of maladaptive, ineffective coping strategies?
a. “My employer should have paid for a health club membership for me.”
b. “My family will see me through this. It won’t be easy, but I will never be alone.”
c. “My heart attack was no fun, but it showed me up the importance of a good diet and more exercise.”
d. “I accept that I have heart disease. Now I need to decide if I will be able to
continue my work daily.”

Answer 12

ANS: A
Blaming someone else and rationalizing one’s failure to exercise are not adaptive coping strategies. Seeing the glass as half full, using social and religious supports, and confronting one’s situation are seen as more effective strategies. The distracters demonstrate effective coping associated with a serious medical condition.

Question 13

A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient?
a. “Since my father died, I’ve been short of breath and had sharp pains that go down
my left arm, but I think it’s just indigestion.”
b. “I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry,
and I think I’m getting seriously dehydrated.”
c. “Sexual intercourse is painful. I pretend as if I’m asleep so I can avoid it. I think
it’s starting to cause problems with my marriage.”
d. “I get choked very easily and have trouble swallowing when I eat. I think I might
have cancer of the esophagus.”

Answer 13

ANS: A
Patients with conversion (functional neurological) disorder demonstrate a lack of concern regarding the seriousness of symptoms. This lack of concern is termed la belle indifférence. There is also a specific, identifiable cause for the development of the symptoms; in this instance, the death of a parent would precipitate stress. The distracters relate to sexual dysfunction and illness anxiety disorder.

Question 14

A patient who experienced a myocardial infarction was transferred from critical care to a step-down unit. The patient then used the call bell every 15 minutes for minor requests and complaints. Staff nurses reported feeling inadequate and unable to satisfy the patient’s needs. When the nurse manager intervenes directly with this patient, which comment is most therapeutic?

a. “I’m wondering if you are feeling anxious about your illness and being left alone.”
b. “The staff are concerned that you are not satisfied with the care you are receiving.”
c. “Let’s talk about why you use your call light so frequently. It is a problem.”
d. “You frustrate the staff by calling them so often. Why are you doing that?”

Answer 14

ANS: A
This patient is experiencing anxiety associated with a serious medical condition. Verbalization is an effective outlet for anxiety. “I’m wondering if you are anxious …” focuses on the emotions underlying the behavior rather than the behavior itself. This opening conveys the nurse’s willingness to listen to the patient’s feelings and an understanding of the commonly seen concern about not having a nurse always nearby as in the intensive care unit. The other options focus on the behavior or its impact on nursing and do not help the patient with her emotional needs.

Question 15

A patient reports fears of having cervical cancer and says to the nurse, “I’ve had Pap smears by six different doctors. The results were normal, but I’m sure that’s because of errors in the laboratory.” Which disorder would the nurse suspect?

a. Conversion (functional neurological) disorder
b. Illness anxiety disorder (hypochondriasis)
c. Somatic symptom disorder
d. Factitious disorder

Answer 15

ANS: B
Patients with illness anxiety disorder have fears of serious medical problems, such as cancer or heart disease. These fears persist despite medical evaluations and interfere with daily functioning. There are no complaints of pain. There is no evidence of factitious or conversion disorder.

Question 16

A patient diagnosed with a somatic symptom disorder says, “My pain is from an undiagnosed injury. I can’t take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much.” It is important for the nurse to assess

a. mood.
b. cognitive style.
c. secondary gains.
d. identity and memory.

Answer 16

ANS: C
Secondary gains should be assessed. The patient’s dependency needs may be met through care from the family. When secondary gains are prominent, the patient is more resistant to giving up the symptom. The scenario does not allude to a problem of mood. Cognitive style and identity and memory assessment are of lesser concern because the patient’s diagnosis has been established.

Question 17

What is an essential difference between somatic symptom disorders and factitious disorders?
a. Somatic symptom disorders are under voluntary control, whereas factitious
disorders are unconscious and automatic.
b. Factitious disorders are precipitated by psychological factors, whereas somatic
symptom disorders are related to stress.
c. Factitious disorders are individually determined and related to childhood sexual
abuse, whereas somatic symptom disorders are culture bound.
d. Factitious disorders are under voluntary control, whereas somatic symptom
disorders involve expression of psychological stress through somatization.

Answer 17

ANS: D
The key is the only fully accurate statement. Somatic symptom disorders involve expression of stress through bodily symptoms and are not under voluntary control or culture bound. Factitious disorders are under voluntary control. See relationship to audience response question.

Question 18

A patient says, “I know I have a brain tumor despite the results of the MRI. The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day.” Which response by the nurse fosters cognitive reframing?
a. “You do not have a brain tumor. The more you talk about it, the more it reinforces
your belief.”
b. “Let’s see if there are any other possible explanations for your vomiting.”
c. “You seem so worried. Let’s talk about how you’re feeling.”
d. “We need to talk about something else.”

Answer 18

ANS: B
Questioning the evidence is a cognitive reframing technique. Identifying causes other than the feared disease can be helpful in changing distorted perceptions. Distraction by changing the subject will not be effective.

Question 19

Which treatment modality should a nurse recommend to help a patient diagnosed with a somatic symptom disorder to cope more effectively?

a. Flooding
b. Response prevention
c. Relaxation techniques
d. Systematic desensitization

Answer 19

ANS: C
Somatic symptom disorders are commonly associated with complicated reactions to stress. These reactions are accompanied by muscle tension and pain. Relaxation can diminish the patient’s perceptions of pain and reduce muscle tension. The distracters are modalities useful in treating selected anxiety disorders.

Question 20

Which assessment question could a nurse ask to help identify secondary gains associated with a somatic symptom disorder?

a. “What are you unable to do now but were previously able to do?”
b. “How many doctors have you seen in the last year?”
c. “Who do you talk to when you’re upset?”
d. “Did you experience abuse as a child?”

Answer 20

ANS: A
Secondary gains should be assessed. Secondary gains reinforce maladaptive behavior. The patient’s dependency needs may be evident through losses of abilities. When secondary gains are prominent, the patient is more resistant to giving up the symptom. There may be a history of abuse or doctor shopping, but the question does not assess the associated gains.

Question 21

A patient diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The patient says, “Although I’m still having pain, I notice it less and am able to perform more activities.” The nurse should evaluate the treatment plan as

a. marginally successful.
b. minimally successful.
c. partially successful.
d. totally achieved.

Answer 21

ANS: C
Decreased preoccupation with symptoms and increased ability to perform activities of daily living suggest partial success of the treatment plan. Total success is rare because of patient resistance.

Question 22

A child has a history of multiple hospitalizations for recurrent systemic infections. The child is not improving in the hospital, despite aggressive treatment. Factitious disorder imposed on another is suspected. Which nursing interventions are appropriate? (Select all that apply.)

a. Increase private visiting time for the parents to improve bonding.
b. Keep careful, detailed records of visitation and untoward events.
c. Place mittens on the child to reduce access to ports and incisions.
d. Encourage family members to visit in groups of two or three.
e. Interact with the patient frequently during visiting hours.

Answer 22

ANS: B, D, E
Factitious disorder imposed on another is a condition wherein a person intentionally causes or perpetuates the illness of a loved one (e.g., by periodically contaminating IV solutions with fecal material). When this disorder is suspected, the child’s life could be at risk. Depending on the evidence supporting this suspicion, interventions could range from minimizing unsupervised visitation to blocking visitation altogether. Frequently checking on the child during visitation and minimizing unobserved access to the child (by encouraging small group visits) reduces the opportunity to tNaUkeRShIaNrGmTfBul.CaOcMtion and increases the collection of data that can help determine whether this disorder is at the root of the child’s illness. Detailed tracking of visitation and untoward events helps identify any patterns there might be between select visitors and the course of the child’s illness. Increasing private visitation provides more opportunity for harm. Educating visitors about aseptic techniques would not be of help if the infections are intentional, and preventing inadvertent contamination by the child himself would not affect factitious disorder by proxy.

Question 23

Which assessment findings suggest the possibility of a factitious disorder, imposed on self-type? (Select all that apply.)

a. History of multiple hospitalizations without findings of physical illness
b. History of multiple medical procedures or exploratory surgeries
c. Going from one doctor to another seeking the desired response
d. Claims illness to obtain financial benefit or other incentive
e. Difficulty describing symptoms

Answer 23

ANS: A, B
Persons with factitious disorders, imposed on self-type, typically have a history of multiple hospitalizations and medical workups, with negative findings from workups. Sometimes they have even had multiple surgeries seeking the origin of the physical complaints. If they do not receive the desired response from a hospitalization, they may elope or accuse staff of incompetence. Such persons usually seek treatment through a consistent health care provider rather than doctor shopping, are not motivated by financial gain or other external incentives, and present symptoms in a very detailed, plausible manner indicating considerable understanding of the disorder or presentation they are mimicking. See relationship to audience response question.

Question 24

A patient diagnosed with a somatic symptom disorder says, “Why has God chosen me to be sick all the time and unable to provide for my family? The burden on my family is worse than the pain I bear.” Which nursing diagnoses apply to this patient? (Select all that apply.)

a. Spiritual distress
b. Decisional conflict
c. Adult failure to thrive
d. Impaired social interaction
e. Ineffective role performance

Answer 24

ANS: A, E
The patient’s verbalization is consistent with spiritual distress. The patient’s description of
being unable to provide for and burdening the family indicates ineffective role performance. No data support diagnoses of adult failure to thrive, impaired social interaction, or decisional
conflict.

Question 25

A nurse assesses a patient suspected of having somatic symptom disorder. Which assessment findings regarding this patient support the suspected diagnosis? (Select all that apply.)

a. Female
b. Reports frequent syncope
c. Rates pain as “1” on a scale of “10”
d. First diagnosed with psoriasis at age 12
e. Reports insomnia often results from back pain

Answer 25

ANS: A, B, E
There is no chronic disease to explain the symptoms for patients with somatic symptom disorder. Patients report multiple symptoms; gastrointestinal and pseudoneurological symptoms are common. This disorder is more common in women than in men. Patients with conversion disorder would have a tendency to underrate pain.

Question 26

A nurse’s neighbor says, “I saw a news story about a man without any known illness who died suddenly after his ex-wife committed suicide. Was that a coincidence, or can emotional shock be fatal?” The nurse should respond by noting that some serious medical conditions may be complicated by emotional stress, including (Select all that apply)

a. cancer.
b. hip fractures.
c. hypertension.
d. immune disorders.
e. cardiovascular disease.

Answer 26

ANS: A, C, D, E
A number of diseases can be worsened or brought to awareness by intense emotional stress. Immune disorders can be complicated associated with detrimental effects of stress on the immune system. Others can be brought about indirectly, such as cardiovascular disease due to acute or chronic hypertension. Hip fractures are not in this group.

Question 27

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?

a. Binge eating
b. Bulimia nervosa
c. Anorexia nervosa
d. Eating disorder not otherwise specified

Answer 27

ANS: C
Overly controlled eating behaviors, extreme weight loss, preoccupation with food, and wearing several layers of loose clothing to appear larger are part of the clinical picture of an individual with anorexia nervosa. The individual with bulimia usually is near normal weight. The binge eater is often overweight. The patient with eating disorder not otherwise specified may be obese.

Question 28

Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating

disorder. Which outcome indicator is most appropriate to monitor?
a. Weight, muscle, and fat congruence with height, frame, age, and sex
b. Calorie intake is within required parameters of treatment plan
c. Weight reaches established normal range for the patient
d. Patient expresses satisfaction with body appearance

Answer 28

ANS: D
Body image disturbances are considered improved or resolved when the patient is consistently satisfied with his or her own appearance and body function. This is a subjective consideration. The other indicators are more objective but less related to the nursing diagnosis.

Question 29

A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient:

a. “Do you often feel fat?”
b. “Who plans the family meals?”
c. “What do you eat in a typical day?”
d. “What do you think about your present weight?”

Answer 29

ANS: C
Although all the questions might be appropriate to ask, only “What do you eat in a typical day?” focuses on the eating patterns. Asking if the patient often feels fat focuses on distortions in body image. Questions about family meal planning are unrelated to eating patterns. Asking for the patient’s thoughts on present weight explores the patient’s feelings about weight.

Question 30

A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and lost 25% of body weight. A nurse asks, “Describe what you think about your present weight and how you look.” Which response by the patient is most consistent with the diagnosis?

a. “I am fat and ugly.”
b. “What I think about myself is my business.”
c. “I’m grossly underweight, but that’s what I want.”
d. “I’m a few pounds’ overweight, but I can live with it.”

Answer 30

ANS: A
Untreated patients with anorexia nervosa do not recognize their thinness. They perceive themselves to be overweight and unattractive. The patient with anorexia will usually tell people perceptions of self. The patient with anorexia does not recognize his or her thinness and will persist in trying to lose more weight.

Question 31

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies?
a. Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte
imbalances and weight loss
b. Disturbed energy field related to physical exertion in excess of energy produced
through caloric intake as evidenced by weight loss and hyperkalemia
c. Ineffective health maintenance related to self-induced vomiting as evidenced by
swollen parotid glands and hyperkalemia
d. Imbalanced nutrition: less than body requirements related to reduced oral intake as
evidenced by loss of 25% of body weight and hypokalemia

Answer 31

ANS: D
The patient’s history and lab result support the nursing diagnosis Imbalanced nutrition: less than body requirements. Data are not present that the patient uses laxatives, induces vomiting, or exercises excessively. The patient has hypokalemia rather than hyperkalemia.

Question 32

Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired outcome related to the nursing diagnosis Imbalanced nutrition: less than body requirements. Within 1 week, the patient will

a. weigh self accurately using balanced scales.
b. limit exercise to less than 2 hours daily.
c. select clothing that fits properly.
d. gain 1 to 2 pounds.

Answer 32

ANS: D
Only the outcome of a gain of 1 to 2 pounds can be accomplished within 1 week when the patient is an outpatient. The focus of an outcome would not be on the patient weighing self. Limiting exercise and selecting proper clothing are important, but weight gain takes priority.

Question 33

Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to gain weight?

a. Assess for depression and anxiety.
b. Observe for adverse effects of refeeding.
c. Communicate empathy for the patient’s feelings.
d. Help the patient balance energy expenditures with caloric intake.

Answer 33

ANS: B
The nursing intervention of observing for adverse effects of refeeding most directly relates to weight gain and is a priority. AsseNsUsiRnSgINfoGrTdBe.pCrOeMssion and anxiety, as well as communicating empathy, relates to coping. Helping the patient achieve balance between energy expenditure and caloric intake is an inappropriate intervention.

Question 34

A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain?
a. Because severe anxiety concerning eating is expected, objective and subjective
data may be unreliable.
b. Patient involvement in decision making increases sense of control and promotes
adherence to the plan of care.
c. Because of increased risk of physical problems with refeeding, the patient’s
permission is needed.
d. A team approach to planning the diet ensures that physical and emotional needs
will be met.

Answer 34

ANS: B
A sense of control for the patient is vital to the success of therapy. A diet that controls weight gain can allay patient fears of too-rapid weight gain. Data collection is not the reason for contracting. A team approach is wise but is not a guarantee that needs will be met. Permission for treatment is a separate issue. The contract for weight gain is an additional aspect of treatment.

Question 35

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention “monitor for complications of refeeding.” Which system should a nurse closely monitor for dysfunction?

a. Renal
b. Endocrine
c. Integumentary
d. Cardiovascular

Answer 35

ANS: D
Refeeding resulting in too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse. Focused assessment is a necessity to ensure the patient’s physiological integrity. The other body systems are not initially involved in the refeeding syndrome.

Question 36

A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy?

a. “What are your feelings about not eating foods that you prepare?”
b. “You seem to feel much better about yourself when you eat something.”
c. “It must be difficult to talk about private matters to someone you just met.”
d. “Being thin doesn’t seem to solve your problems. You are thin now but still
unhappy. ”

Answer 36

ANS: D

The correct response is the only strategy that questions the patient’s distorted thinking.

Question 37

An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient

a. to eat a small meal after purging.
b. not to skip meals or restrict food.
c. to increase oral intake after 4 PM daily.
d. the value of reading journal entries aloud to others.

Answer 37

ANS: B
One goal of health teaching is normalization of eating habits. Food restriction and skipping meals lead to rebound bingeing. Teaching the patient to eat a small meal after purging will probably perpetuate the need to induce vomiting. Teaching the patient to eat a large breakfast but no lunch and increase intake after 4 PM will lead to late-day bingeing. Journal entries are private.

Question 38

A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed?

a. The nurse interacts with the patient in a protective fashion.
b. The nurse’s comments to the patient are compassionate and nonjudgmental.
c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene.
d. The nurse refers the patient to a self-help group for individuals with eating disorders.

Answer 38

ANS: A
In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assumption of a parental role. Protective behaviors are part of the parent’s role. The helpful nurse uses a problem-solving approach and focuses on the patient’s feelings of shame and low self-esteem. Referring a patient to a self-help group is an appropriate intervention.

Question 39

A nursing diagnosis for a patient diagnosed with bulimia nervosa is Ineffective coping related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is that within 2 weeks the patient will

a. appropriately express angry feelings.
b. verbalize two positive things about self.
c. verbalize the importance of eating a balanced diet.
d. identify two alternative methods of coping with loneliness.

Answer 39

ANS: D
The outcome of identifying alternative coping strategies is most directly related to the diagnosis of Ineffective coping. Verbalizing positive characteristics of self and verbalizing the importance of eating a balanced diet are outcomes that might be used for other nursing diagnoses. Appropriately expressing angry feelings is not measurable.

Question 40

Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa?

a. Assist the patient to identify triggers to binge eating.
b. Provide corrective consequences for weight loss.
c. Assess for signs of impulsive eating.
d. Explore needs for health teaching.

Answer 40

ANS: A
For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. Often the triggers are anxiety-producing situations. Identification of triggers makes it possible to break the binge–purge cycle. Because binge eating and purging directly affect physical status, the need to promote physical safety assumes highest priority.

Question 41

One bed is available on the inpatient eating-disorder unit. Which patient should be admitted to this bed? The patient whose weight decreased from
150 to 100 pounds over a 4-month period. Vital signs are temperature, 35.9 C;
a.
pulse, 38 beats/min; blood pressure 60/40 mm Hg
b. 120 to 90 pounds over a 3-month period. Vital signs are temperature, 36 C; pulse, 50 beats/min; blood pressure 70/50 mm Hg
110 to 70 pounds over a 4-month period. Vital signs are temperature 36.5 C;
d. 90 to 78 pounds over a 5-month period. Vital signs are temperature, 36.7 C; pulse,
c.
pulse, 60 beats/min; blood pressure 80/66 mm Hg
62 beats/min; blood pressure 74/48 mm Hg

Answer 41

ANS: A
Physical criteria for hospitalization include weight loss of more than 30% of body weight within 6 months, temperature below 36 C (hypothermia), heart rate less than 40 beats/min, and systolic blood pressure less than 70 mm Hg.

Question 42

A nurse provides health teaching for a patient diagnosed with bulimia nervosa. Priority information the nurse should provide relates to

a. self-monitoring of daily food and fluid intake.
b. establishing the desired daily weight gain.
c. how to recognize hypokalemia.
d. self-esteem maintenance.

Answer 42

ANS: C
Hypokalemia results from potassium loss associated with vomiting. Physiological integrity can be maintained if the patient can self-diagnose potassium deficiency and adjust the diet or seek medical assistance. Self-monitoring of daily food and fluid intake is not useful if the patient purges. Daily weight gain may not be desirable for a patient with bulimia nervosa. Self-esteem is an identifiable problem but is of lesser priority than the dangers associated with hypokalemia.

Question 43

As a patient admitted to the eating-disorder unit undresses, a nurse observes that the patient’s body is covered by fine, downy hair. The patient weighs 70 pounds and is 5’4” tall. Which term should be documented?

a. Amenorrhea
b. Alopecia
c. Lanugo
d. Stupor

Answer 43

ANS: C
The fine, downy hair noted by the nurse is called lanugo. It is frequently seen in patients with anorexia nervosa. None of the other conditions can be supported by the data the nurse has gathered.

Question 44

A patient being admitted to the eating-disorder unit has a yellow cast to the skin and fine, downy hair over the trunk. The patient weighs 70 pounds; height is 5’4”. The patient says, “I won’t eat until I look thin.” Select the priority initial nursing diagnosis.

a. Anxiety related to fear of weight gain
b. Disturbed body image related to weight loss
c. Ineffective coping related to lack of conflict resolution skills
d. Imbalanced nutrition: less than body requirements related to self-starvation

Answer 44

ANS: D
The physical assessment shows cachexia, which indicates imbalanced nutrition. Addressing the patient’s self-starvation is the priority.

Question 45

A nurse conducting group therapy on the eating-disorder unit schedules the sessions immediately after meals for the primary purpose of

a. maintaining patients’ concentration and attention.
b. shifting the patients’ focus from food to psychotherapy.
c. promoting processing of anxiety associated with eating.
d. focusing on weight control mechanisms and food preparation.

Answer 45

ANS: C
Eating produces high anxiety for patients with eating disorders. Anxiety levels must be lowered if the patient is to be successful in attaining therapeutic goals. Shifting the patients’ focus from food to psychotherapy and focusing on weight control mechanisms and food preparation are not desirable. Maintaining patients’ concentration and attention is important, but not the primary purpose of the schedule.

Question 46

Physical assessment of a patient diagnosed with bulimia often reveals

a. prominent parotid glands.
b. peripheral edema.
c. thin, brittle hair.
d. 25% underweight.

Answer 46

ANS: A
Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa and not usually seen in bulimia.

Question 47

Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa?

a. Carefree flexibility
b. Rigidity, perfectionism
c. Open displays of emotion
d. High spirits and optimism

Answer 47

ANS: B
Rigid thinking, inability to demonstrate flexibility, and difficulty changing cognitions are characteristic of patients with eating disorders. The incorrect options are rare in a patient with an eating disorder. Inflexibility, coNnUtRroSlIlNedGTeBm.CotOioMns, and pessimism are more the rule.

Question 48

Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization?

a. Urine output 40 mL/hour
b. Pulse rate 58 beats/min
c. Serum potassium 3.4 mEq/L
d. Systolic blood pressure 62 mm Hg

Answer 48

ANS: D
Systolic blood pressure less than 70 mm Hg is an indicator for inpatient care. Many people without eating disorders have bradycardia (pulse less than 60 beats/min). Urine output should be more than 30 mL/hour. A potassium level of 3.4 mEq/L is within the normal range.

Question 49

A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Which response by the nurse is appropriate?
a. “You and I will have to sit down and discuss this problem.”
b. “It bothers me to see you exercising. I am afraid you will lose more weight.”
c. “Let’s discuss the relationship between exercise, weight loss, and the effects on
your body.”
d. “According to our agreement, no exercising is permitted until you have gained a
specific amount of weight.”

Answer 49

ANS: D
A matter-of-fact statement that the nurse’s perceptions are different will help to avoid a power struggle. Treatment plans have specific goals for weight restoration. Exercise is limited to promote weight gain. Patients must be held accountable for required behaviors.

Question 50

Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges?

a. Powerlessness
b. Ineffective coping
c. Disturbed body image
d. Imbalanced nutrition: less than body requirements

Answer 50

ANS: D
The patient with bulimia nervosa usually maintains a close to normal weight, whereas the patient with anorexia nervosa may approach starvation. The incorrect options may be appropriate for patients with either anorexia nervosa or bulimia nervosa.

Question 51

An outpatient diagnosed with anorexia nervosa has begun refeeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should

a. assess lung sounds and extremities.
b. suggest use of an aerobic exercise program.
c. positively reinforce the patient for the weight gain.
d. establish a higher goal for weight gain the next week.

Answer 51

ANS: A
Weight gain of more than 2 to 5 pounds weekly may overwhelm the heart’s capacity to pump, leading to cardiac failure. The nurse must assess for signs of pulmonary edema and congestive heart failure. The incorrect options are undesirable because they increase the risk for cardiac complications.

Question 52

The treatment team discusses adding a new prescription for lisdexamfetamine dimesylate to the plan of care for a patient diagnosed with binge eating disorder. Which finding from the nursing assessment is most important for the nurse to share with the team?

a. The patient’s history of poly-substance abuse
b. The patient’s preference for homeopathic remedies
c. The patient’s family history of autoimmune disorders
d. The patient’s comorbid diagnosis of a learning disability

Answer 52

ANS: A
Lisdexamfetamine dimesylate is designed to suppress the appetite and presents a risk for abuse. The patient with a history of substance abuse is at risk to abuse this medication as well. The patient’s preference for homeopathic remedies is a consideration, but the history of substance abuse has a higher priority. Lisdexamfetamine dimesylate is commonly used to treat attention deficit hyperactivity disorder rather than learning disabilities. A history of autoimmune disorders in the family is irrelevant.

Question 53

A 7-year-old child was diagnosed with pica. Which assessment finding would the nurse expect associated with this diagnosis?

a. The child frequently eats newspapers and magazines.
b. The child refuses to eat peanut butter and jelly sandwiches.
c. The child often rechews and reswallows foods at mealtimes.
d. The parents feed the child clay because of concerns about anemia.

Answer 53

ANS: A
Pica refers to eating nonfood items after maturing past toddlerhood. Some cultures practice eating nonfood items; however, this factor is a cultural preference rather than a disorder. Refusing to eat peanut butter and jelly sandwiches is an example of a simple food preference in a child. Rumination refers to regurgitation with rechewing, reswallowing, or spitting.

Question 54

A patient referred to the eating disorders clinic has lost 35 pounds in 3 months. For which physical manifestations of anorexia nervosa should a nurse assess? (Select all that apply.)

a. Peripheral edema
b. Parotid swelling
c. Constipation
d. Hypotension
e. Dental caries
f. Lanugo

Answer 54

ANS: A, C, D, F
Peripheral edema is often present because of hypoalbuminemia. Constipation related to starvation is often present. Hypotension is often present because of dehydration. Lanugo is often present and is related to starvation. Parotid swelling is associated with bulimia. Dental caries are associated with bulimia.

Question 55

A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? (Select all that apply.)

a. Flexible mealtimes
b. Unscheduled weight checks
c. Adherence to a selected menu
d. Observation during and after meals
e. Monitoring during bathroom trips
f. Privileges correlated with emotional expression

Answer 55

ANS: C, D, E
Priority milieu interventions support restoration of weight and normalization of eating patterns. This requires close supervision of the patient’s eating and prevention of exercise, purging, and other activities. There is strict adherence to menus. Observe patients during and after meals to prevent throwing away food or purging. Monitor all trips to the bathroom. Mealtimes are structured, not flexible. Weighing is performed on a regular schedule. Privileges are correlated with weight gain and treatment plan compliance.

Question 56

A nurse cares for these four patients. Which patient has the highest risk for problems with sleep physiology?

a. Retiree who volunteers twice a week at Habitat for Humanity
b. Corporate accountant who travels frequently
c. Parent with three teenagers
d. Lawn care worker

Answer 56

ANS: B
The corporate accountant is likely to work long hours and have significant stress associated with work demands. Compounded by travel, these factors are likely to precipitate unstable sleep patterns and inadequate sleep time. The retiree and lawn care worker engage in physical activity during the day, which will promote natural fatigue and sleep. The parent’s sleep is unlikely to be disturbed; teenagers sleep through the night.

Question 57

Which comment is most likely from a patient with chronic sleep deprivation?
a. “I turn on the television every night to get to sleep. I set the timer so it goes off in
30 minutes.”
b. “I have diarrhea frequently and not much energy, so I stay at home most of the
time.”
c. “I only sleep about 7 hours a night, but I know I should sleep 8 or 9 hours.”
d. “When my alarm clock goes off every morning, it seems like I am dreaming.”

Answer 57

ANS: B
A discrepancy between hours of sleep obtained and hours required leads to sleep deprivation. Adults with less than 6 hours of sleep per night often suffer from chronic sleep deprivation. Common complaints include poor general health, physical and mental distress, limitations in ADLs, depressive or anxious symptoms, and pain. One distracter indicates a problem with sleep hygiene (television). The remaining distracters do not indicate a problem.

Question 58

The nurse provides health education for an adult experiencing sleep deprivation. Which instruction has the highest priority?
a. “It’s important to limit your driving to short periods. Sleep deprivation increases
your risks for serious accidents.”
b. “Sleep deprivation is usually self-limiting. See your health care provider if it lasts
more than a year.”
c. “Turn the radio on with a soft volume as you prepare for bed each evening. It willhelp you relax.”
d. “Three glasses of wine each evening helps many patients who suffer from sleep
deprivation.”

Answer 58

ANS: A
Safety is the highest priority for this patient. Sleep deprivation causes psychomotor deficits. Driver drowsiness and fatigue lead to many automobile injuries and fatalities. Alcohol compounds problems associated with sleep deprivation. Sleep deprivation should be evaluated and treated; a 1-year delay is too long.

Question 59

A nurse provides health education for an adult with sleep deprivation. It is most important for the nurse to encourage caution when the patient engages in

a. using a vacuum cleaner.
b. cooking a meal.
c. driving a car.
d. bathing.

Answer 59

ANS: C
Safety is the highest priority for this patient. Sleep deprivation causes psychomotor deficits. Driver drowsiness and fatigue lead to many automobile injuries and fatalities. The distracters are less likely to be associated with serious injury.

Question 60

A patient needs diagnostic evaluation of sleep problems. Which test will evaluate the patient for possible sleep-related problems?

a. Skull x-rays
b. Electroencephalogram (EEG)
c. Positron emission tomography (PET)
d. Single photon emission computed tomography (SPECT)

Answer 60

ANS: B
EEG measures nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. The distracters represent ways to diagnose structural and metabolic problems.

Question 61

A patient says, “It takes me about 15 minutes to go to sleep each night.” This comment describes

a. delta sleep.
b. parasomnia.
c. sleep latency.
d. REM sleep.

Answer 61

ANS: C
Sleep latency refers to the amount of time it takes a person to fall asleep. The distracters represent other phases of the sleep cycle.

Question 62

A person says, “I often feel like I have been dreaming just before I awake in the morning.” Which rationale correctly explains the comment?
a. Sleep architecture changes during the sleep period, resulting in increased
slow-wave sleep at the end of the cycle.
b. Cycles of REM sleep increase in the second half of sleep and occupy longer
periods.
c. Dreams occur more frequently when a person is experiencing unresolved conflicts
or depression.
d. Dream content relates directly to developmental tasks. The person is likely feeling autonomous.

Answer 62

ANS: B
Cycles of REM sleep increase in the second half of sleep and occupy longer periods, up to 1 hour. Dreaming occurs during REM sleep. The question relates to sleep architecture rather than dream content.

Question 63

Which person would be most likely to experience sleep fragmentation?

a. An obese adult
b. A toddler who attends day care
c. A person diagnosed with mild osteoarthritis
d. An adolescent diagnosed with anorexia nervosa

Answer 63

ANS: A
Obese adults experience more disruption of sleep stages, resulting in fragmentation. Obesity is the leading factor for obstructive sleep apnea, which causes sleep fragmentation. These changes are also associated with illness and some medications. The changes are evident on a hypnogram. An adolescent with anorexia nervosa would have a low body weight and therefore decreased risk for sleep fragmentation. Persons with arthritis have pain that may sometimes interrupt sleep, but it would not have as high risk as would obesity. Toddlers do not generally experience sleep fragmentation.

Question 64

A person is prescribed lorazepam 2 mg PO bid as needed for anxiety. When the person takes this medication, which change in sleep is anticipated? The patient will

a. have fewer dreams.
b. have less slow-wave sleep.
c. experience extended sleep latency.
d. enter sleep through REM sleep.

Answer 64

ANS: B
Lorazepam is a benzodiazepine, which reduces slow-wave sleep. REM sleep would likely increase. Persons with narcolepsy often enter sleep through REM.

Question 65

A person is prescribed sertraline 100 mg PO daily. Which change in sleep is likely secondary to this medication? The patient will have

a. more dreams.
b. excessive sleepiness.
c. less slow-wave sleep.
d. less REM sleep.

Answer 65

ANS: D
Sertraline (Zoloft) is an SSRI antidepressant medication, which suppresses REM sleep. Dreams would decrease because they occur during REM. Benzodiazepines reduce slow-wave sleep. SSRIs have a side effect of insomnia.

Question 66

Which season would be most associated with increased periods of wakefulness in the general
population? 
a. Summer 
b. Winter 
c. Spring 
d. Fall

Answer 66

ANS: A
Circadian drive is associated with physiology. Light is the main exogenous factor that drives wakefulness. Days are longest in summer.

Question 67

Normally, most people sleep at night. What is the physiological rationale?

a. The master biological clock responds to darkness with sleep.
b. Darkness stimulates histamine release, which promotes sleep.
c. Cooler environmental temperatures stimulate retinal messages.
d. Stimulation of the sympathetic nervous system promotes sleep.

Answer 67

ANS: A
The master biological clock in the suprachiasmatic nucleus (SCN) of the hypothalamus regulates sleep as well as other physiological processes. Darkness cues the clock for sleep. Light cues it for wakefulness. Light stimulates retinal messages. Histamine release is associated with wakefulness. Stimulation of the sympathetic nervous system promotes alertness.

Question 68

A nurse counsels a patient on ways to determine the person’s total sleep requirement. Which instruction would produce the most accurate results?
a. “For 1 full week, record what you remember about your dream content and related
feelings as soon as you wake up. Bring the record to your next appointment.”
b. “While off work for 1 week, go to bed at your usual time and wake up without an
alarm. Record how many hours you sleep and then average the findings.”
c. “For 2 full weeks, record how much time you sleep each night and rate your
daytime alertness on a scale of 1 to 10. Calculate your average alertness score.”
d. “All adults need 7 or 8 hours of sleep to function properly. Let’s design ways to
help you reach that goal.”

Answer 68

ANS: B
Sleep requirements are most accurately determined by going to bed at the usual time and waking up without an alarm for several nights, ideally on vacation. The average of these findings indicates the estimated requirements. Two distracters relate to dream content and daytime alertness. Some adults are long sleepers or short sleepers with different requirements
for sleep from the general population.

Question 69

A home care nurse assesses a very demanding patient with chronic obstructive pulmonary disease (COPD). Afterward, the nurse talks with the spouse who has provided this patient’s care for 6 years. The spouse says, “I don’t need much sleep anymore. I might need to help him during the night.” Select the nurse’s most therapeutic response.
a. “It sounds like you are very devoted to your spouse.”
b. “I noticed you fell asleep while I was assessing your spouse. I’m concerned about
you.”
c. “Your spouse is lucky to have you to provide care rather than being placed in a
nursing home.”
d. “If you keep going like this, your health will be impaired also. Then who will take
care of both of you?”

Answer 69

ANS: B
Sleep deprivation can cause accidents. The correct answer makes an observation, gives important information about safety, and communicates care and compassion for the spouse. The distracters do not invite further dialogue with the spouse.

Question 70

A patient with rheumatoid arthritis reports, “For the past month I’ve had trouble falling asleep. When I finally get to sleep, I wake up several times during the night.” Which information should the nurse seek initially?

a. “What have you done to try to improve your sleep?”
b. “What would be a good sleep pattern for you?”
c. “How much exercise are you getting?”
d. “Do you have pain at night?”

Answer 70

ANS: D
Patients with diseases such as arthritis may have sleep disturbance related to nightly pain. Because the pain is chronic, the patient may fail to realize it is the reason for the inability to sleep. The other options do not follow the patient’s lead or begin problem solving without an adequate baseline.

Question 71

A 76-year-old man tells the nurse at the sleep disorder clinic, “I awaken almost nightly in the midst of violent dreams in which I am defending myself against multiple attackers. Then I realize I have been hitting and kicking my wife. She has bruises.” Which health problem is most likely?

a. Sleep paralysis
b. Night terror disorder
c. Sleep-related bruxism
d. REM Sleep Behavior Disorder

Answer 71

ANS: D
The scenario describes REM sleep behavior disorder in which the patient engages in violent and complex behaviors during REM sleep as though acting out his dreams. Older men have a higher incidence of this problem. Sleep paralysis refers to the sudden inability to perform voluntary movement at either sleep onset or awakening from sleep. Bruxism refers to grinding teeth during stage 2 sleep. Night terror disorder occurs as arousal in the first third of the night during NREM sleep, accompanied by feelings of panic.

Question 72

A patient reports, “Nearly every night I awaken feeling frightened after a bad dream. The dream usually involves being hunted by people trying to hurt me. It usually happens between 4 and 5 AM.” The nurse assesses this disorder as most consistent with criteria for which problem?

a. Sleep deprivation
b. Nightmare disorder
c. Night terror disorder
d. REM sleep behavior disorder

Answer 72

ANS: B
Nightmares are long, frightening dreams from which people awaken in a frightened state. They occur during REM sleep late in the night. Night terror disorder occurs as arousal in the first third of the night during NREM sleep and is accompanied by feelings of panic. REM sleep behavior disorder involves acting out a violent dream during REM sleep. Nightmare disorder may lead to sleep deprivation.

Question 73

A nurse who works night shift says, “I am exhausted most of the time. I sleep through my alarm. Sometimes my brain does not seem to work right. I am worried that I might make a practice error.” Which question should the nursing supervisor ask first?

a. “What stress are you experiencing in your life?”
b. “How much sleep do you get in a 24-hour period?”
c. “Would it help if you do some exercises just before going to bed?”
d. “Have you considered using a hypnotic medication to help you sleep?”

Answer 73

ANS: B
Total sleep hours should be ascertained before seeking to correct a sleep disorder. In this case, the patient describes sleep deprivation symptoms rather than a sleep disorder. The correct response is the only option that addresses total sleep hours.

Question 74

A patient reports, “The medicine prescribed to help me get to sleep worked well for about a month, but I don’t have any more of those pills. Now my insomnia is worse than ever. I had nightmares the last 2 nights.” Which type of medication did the health care provider most likely prescribe?

a. Benzodiazepine
b. Tricyclic antidepressant
c. Conventional antipsychotic
d. Central nervous system (CNS) stimulant

Answer 74

ANS: A
Benzodiazepines, members of the hypnotic’s family of medications, can worsen existing sleep disturbances when they are discontinued. This class of medications produces tolerance. Once the drug is discontinued, the individual may have rebound insomnia and nightmares. CNS stimulants worsen insomnia while they are in use. Tricyclic antidepressants and atypical antipsychotics may help insomnia but would not be used for initial therapy.

Question 75

A patient experiencing primary insomnia asks the nurse, “I take a nap during the day. Doesn’t that make up for a lost night’s sleep?” Select the nurse’s best reply.
a. “Circadian drives give daytime naps a structure different from nighttime sleep.”
b. “The body clock operates on a 24-hour cycle, making nap effectivenessunpredictable.”
c. “It is a matter of habit and expectation. We expect to be more refreshed from a
night’s sleep.”
d. “Sleep restores homeostasis but works more efficiently when aided by melatonin
secreted at night.”

Answer 75

ANS: A
Regular sleep cycles occur with nighttime sleep, with progression through two distinct physiological states: four stages of NREM and a period of REM sleep. Naps often contain different amounts of REM sleep, thus changing the physiology of sleep as well as the psychological and behavioral effects of sleep.

Question 76

A patient tells the nurse, “Everyone says we should sleep 8 hours a night. I can only sleep 6 hours, no matter how hard I try. Am I doing harm to my body?” Select the nurse’s best response.
a. “Tell me about strategies you have tried to increase your total sleep hours.”
b. “Lack of sleep acts as a stressor on the body and can cause physical changes.”
c. “If you have really tried to sleep more, maybe you should consult your health care
provider.”
d. “If you function well with 6 hours of sleep, you are a short sleeper. That’s normal
for some people.”

Answer 76

ANS: D
Some individuals require less sleep than others do. Those who need less are called “short sleepers,” compared with “long sleepers,” who require more than 8 hours. The distracters do not provide information the patient is seeking or are untrue.

Question 77

A patient says, “I have trouble falling asleep at night and might lie awake until 3 or 4 AM before falling sleep.” Which medication would the nurse expect a health care provider to prescribe for this patient?

a. zolpidem
b. flurazepam
c. risperidone
d. methylphenidate

Answer 77

ANS: A
Zolpidem is a short-acting hypnotic that will help the patient initiate sleep and awaken without untoward symptoms of drowsiness. Methylphenidate is a CNS stimulant. Flurazepam is a long-acting hypnotic that will produce hangover drowsiness during the next day. Risperidone is an antipsychotic and not likely to be useful in this scenario. See relationship to audience response question.

Question 78

A young adult says to the nurse, “I go to sleep without any problem, but I often wake up during the night because it feels like there are rubber bands in my legs.” Which assessment question should the nurse ask to assess for restless legs syndrome (RLS)?

a. “What type of birth control do you use?”
b. “How much caffeine do you use every day?”
c. “How much exercise do you get in a typical day?”
d. “Does anyone else in your family have this problem?”

Answer 78

ANS: D
RLS is a sensory and movement disorder characterized by an unpleasant, uncomfortable sensation in the legs accompanied by an urge to move. Symptoms begin or worsen during periods of inactivity, such as sleep. Symptoms can have a significant impact on the individual’s ability to fall asleep and stay asleep. There is likely to be a strong genetic component, especially when seen in individuals less than 40 years old.

Question 79

Which neurotransmitters are most responsible for wakefulness? (Select all that apply.)

a. -aminobutyric acid (GABA)
b. Norepinephrine
c. Acetylcholine
d. Dopamine
e. Galanin

Answer 79

ANS: B, C, D
The neurotransmitters responsible for wakefulness are dopamine, norepinephrine, serotonin, acetylcholine, histamine, glutamate, and hypocretin. GABA and galanin are sleep-promoting neurotransmitters.

Question 80

A night shift worker reports, “I’m having trouble getting to sleep after a night’s work. I have a hearty breakfast with coffee, read the paper, do my exercises, and then go to bed. However, I just lie awake until it is nearly time to get up to be with my family for dinner.” What changes should the nurse suggest? (Select all that apply.)

a. Drink juice with breakfast rather than coffee.
b. Exercise after awakening rather than before.
c. Turn on the television when going to bed.
d. Do not read the paper.
e. Eat a light breakfast.

Answer 80

ANS: A, B, E
Sleep can be disrupted by caffeine, a CNS stimulant, exercise performed just before trying to sleep, and eating a heavy meal before retiring. Reading the newspaper is not likely to be so stimulating that it disrupts the patient’s ability to sleep. Television will be disruptive to sleep.

Question 81

A new patient at the sleep disorders clinic tells the nurse, “I have not slept well in a year, so I never feel good. I do not expect things will ever improve or be any different.” Interventions the nurse should consider include (Select all that apply)

a. suggesting use of alcohol as a sedative.
b. providing instruction in relaxation techniques.
c. counseling the patient to address cognitive distortions.
d. health teaching regarding factors that influence sleep.
e. teaching fatigue-producing activities to become overtired.
f. encouraging long daytime naps to compensate for sleep deprivation.

Answer 81

ANS: B, C, D
Interventions that could be helpful include teaching relaxation techniques, such as meditation or progressive relaxation, to relieve the tension that sometimes prevents initiation of sleep. Reviewing factors that influence sleep can assist the patient to diagnose and remove barriers to sleep. Cognitive therapy could be helpful in combating the hopelessness verbalized by the patient. Alcohol consumption actually disrupts sleep. Becoming overtired may be a barrier to nighttime sleep. Naps may help replace lost sleep, but lengthy daytime sleep will prevent the patient from sleeping well at night.

Question 82

A new staff nurse tells the clinical nurse specialist, “I am unsure about my role when patients bring up sexual problems.” The clinical nurse specialist should give clarification by saying, “All nurses
a. qualify as sexual counselors. Nurses have knowledge about the biopsychosocial
aspects of sexuality throughout the life cycle.”
b. should be able to screen for sexual dysfunction and give basic information about
sexual feelings, behaviors, and myths.”
c. should defer questions about sex to other health care professionals because of their
limited knowledge of sexuality.”
d. who are interested in sexual dysfunction can provide sex therapy for individuals
and couples.”

Answer 82

ANS: B
The basic education of nurses provides information sufficient to qualify the generalist to assess for sexual dysfunction and perform health teaching. Taking a detailed sexual history and providing sex therapy requires additional training in sex education and counseling. Nurses with basic education are not qualified to be sexual counselors. Additional education is necessary. A registered nurse may provide basic information about sexual function, but complex questions may require referral.

Question 83

A nurse is performing an assessment for a 59-year-old man with a long history of hypertension. What is the rationale for including questions about prescribed medications and their effects on sexual function in the assessment?
a. Sexual dysfunction may result from use of prescription medications for
management of hypertension.
b. Such questions are an indirect way of learning about the patient’s medication
adherence.
c. These questions ease the transition to questions about sexual practices in general.
d. Sexual dysfunction can cause stress and contribute to increased blood pressure.

Answer 83

ANS: A
Some of the drugs used to treat hypertension can interfere with normal sexual functioning and lead to sexual disorders. Hypertension itself can lead to acquired erectile dysfunction. It would not be appropriate or necessary to use such inquiries as a lead-in to other sexual health topics. Sexual dysfunction, while stressful, does not cause hypertension.

Question 84

An adult experienced a myocardial infarction six months ago. At a follow-up visit, this adult says, “I haven’t had much interest in sex since my heart attack. I finished my rehabilitation program, but having sex strains my heart. I don’t know if my heart is strong enough.” Which nursing diagnosis applies?

a. Deficient knowledge related to faulty perception of health status
b. Disturbed self-concept related to required lifestyle changes
c. Disturbed body image related to treatment side effects
d. Sexual dysfunction related to self-esteem disturbance

Answer 84

ANS: A
Patients who have had a myocardial infarction often believe sexual intercourse will cause another heart attack. The patient has completed the rehabilitation, but education is needed regarding sexual activity. These patients should receive information about when sexual activity may begin, positions that conserve energy, and so forth. The scenario does not suggest self-concept or body image disturbance.

Question 85

Which nursing action should occur first regarding a patient who has a problem of sexual dysfunction or sexual disorder? The nurse should

a. develop an understanding of human sexual response.
b. assess the patient’s sexual functioning and needs.
c. acquire knowledge of the patient’s sexual roles.
d. clarify own personal values about sexuality.

Answer 85

ANS: D
Before one can be helpful to patients with sexual dysfunctions or disorders, the nurse must be aware of his or her own feelings and values about sex and sexuality. Nurses must keep their personal beliefs separate from their patient care in order to remain objective, professional, and effective. Nurses must be comfortable with the idea that patients have a right to their own values and must avoid criticism and censure. The other options are indicated as well, but self-awareness must precede them to provide the best care.

Question 86

A patient tells the nurse that his sexual functioning is normal when his wife wears short, red camisole-style nightgowns. He states, “Without the red teddies, I am not interested in sex.” The nurse can assess this as consistent with

a. exhibitionism.
b. voyeurism.
c. frotteurism.
d. fetishism.

Answer 86

ANS: D
To be sexually satisfied, a person with a sexual fetish finds it necessary to have some external object present, in fantasy or in reality. Frotteurism involves deriving sexual pleasure from rubbing against others surreptitiously. Exhibitionism is the intentional display of the genitalia in a public place. Voyeurism refers to viewing others in intimate situations.

Question 87

While performing an assessment, the nurse says to a patient, “While growing up, most of us heard some half-truths about sexual matters that continue to puzzle us as adults. Do any come to your mind now?” The purpose of this question is to

a. identify areas of sexual dysfunction for treatment.
b. determine possible homosexual urges.
c. introduce the topic of masturbation.
d. identify sexual misinformation.

Answer 87

ANS: D
Misinformation about normal sex and sexuality is common. Lack of knowledge may affect an individual’s sexual adjustment. Once myths have been identified, the nurse can give information to dispel the myth.

Question 88

A woman tells the nurse, “My partner is frustrated with me. I don’t have any natural
lubrication when we have sex.” What type of sexual disorder is evident?
a. Genito-pelvic pain/penetration disorder
b. Female sexual interest/arousal disorder
c. Hypoactive sexual desire disorder
d. Female orgasmic disorder

Answer 88

ANS: B
One feature of female sexual interest/arousal disorder relates to inability to maintain physiological requirements for intercourse. For women, this includes problems with lubrication and swelling. The patient’s description does not meet criteria for diagnoses in the distracters.

Question 89

The male manager of a health club placed a hidden video camera in the women’s locker room and recorded several women as they showered and dressed. The disorder most likely represented by this behavior is

a. homosexuality.
b. exhibitionism.
c. pedophilia.
d. voyeurism.

Answer 89

ANS: D
Voyeurism is achieving sexual pleasure through the viewing of others in intimate situations, such as undressing, bathing, or having sexual relations. A homosexual individual would be interested in watching members of the same sex, and homosexuality is not typically associated with voyeurism. Exhibitionists are interested in exposing their genitals to others. Pedophiles seek sexual contact with children.

Question 90

A woman consults the nurse practitioner because she has not achieved orgasm for 2 years, despite having been sexually active. This is an example of

a. Paraphilic disorder.
b. Female orgasmic disorder.
c. Genito-pelvic pain/penetration disorder.
d. Female sexual interest/arousal disorder.

Answer 90

ANS: B
The persistent inhibition of orgasm is a form of sexual dysfunction called female orgasmic disorder. Genito-pelvic pain/penetration disorder applies to painful intercourse. The patient has not indicated that her interest in sexual activity is diminished, so female sexual interest/arousal disorder does not apply. Paraphilic disorder is not applicable.

Question 91

An adult consulted a nurse practitioner because of an inability to achieve orgasm for 2 years, despite having been sexually active. This adult was frustrated and expressed concerns about the relationship with the sexual partner. Which nursing diagnosis is most appropriate for this scenario?

a. Defensive coping
b. Sexual dysfunction
c. Ineffective sexuality pattern
d. Disturbed sensory perception, tactile

Answer 91

ANS: B
Sexual dysfunction is the most appropriate nursing diagnosis for a patient who is experiencing a problem affecting one or more phases of arousal. This is the primary problem reported by this patient. Ineffective sexuality pattern, since it is due to sexual dysfunction, is secondary to the absence of orgasms. The patient has not indicated she does not become aroused, just that she cannot achieve orgasm. Disturbed sensory perception may be part of the etiology, but the problem is sexual dysfunction. There is no evidence of defensive coping.

Question 92

An adult consulted a nurse practitioner because of an inability to achieve orgasm for 2 years, despite having been sexually active. This adult was frustrated and expressed concerns about the relationship with the sexual partner. Which documentation best indicates the treatment was successful?

a. “No complaints related to sexual function; to return next week.”
b. “Patient reports achieving orgasm last week; seems very happy.”
c. “Reports satisfaction with sexual encounters; feels partner is supportive.”
d. “Reports achieving orgasm occasionally; relationship with partner is adequate.”

Answer 92

ANS: C
Human sexuality, sexual expression, and expectations related to sexuality vary tremendously from person to person and across cultures. Therefore, the best indication of satisfactory treatment is that the patient is satisfied with what has been achieved. In this instance, “Patient reports satisfaction with sexual encounters; feels partner is supportive” best indicates that the patient is satisfied, and both presenting issues are progressing in a positive manner. Achieving orgasm once or occasionally may or may not represent satisfactory progress to the patient. “No complaints” does not necessarily mean that satisfaction exists.

Question 93

Which characteristic fits the usual profile of an individual diagnosed with pedophilic disorder?

a. Homosexual
b. Ritualistic behaviors
c. Seeks access to children
d. Self-confident professional

Answer 93

ANS: C
Persons with pedophilic disorder usually place themselves in jobs, activities, or relationships that provide easy access to children. They often become trusted by both parents and children. The other characteristics have no particular relationship to pedophilic disorder.

Question 94

A nurse is anxious about assessing the sexual history of a patient who is considerably older than the nurse is. Which statement would be most appropriate for obtaining information about the patient’s sexual practices?
a. “Some people are not sexually active, others have a partner, and some have several
partners. What has been your pattern?”
b. “Sexual health can reflect a number of medical problems, so I’d like to ask if you
have any sexual problems you think we should know about.”
c. “It’s your own business, of course, but it might be helpful for us to have some
information about your sexual history. Could you tell me about that, please?”
d. “I would appreciate it if you could share your sexual history with me so I can share
it with your health care provider. It might be helpful in planning your treatment.”

Answer 94

ANS: A
Explaining that sexual practices vary helps reduce patient anxiety about the topic by normalizing the full range of sexual practices so that whatever his situation, the patient can feel comfortable sharing it. “It’s your business of course …” implies the nurse does not have a valid reason to seek the information and in effect suggests that the patient perhaps should not answer the question. “It might be helpful …” makes the information seem less valid or important for the nurse to pursue and, again, could discourage the patient from responding fully. Asking if the patient has any sexual problems that staff should know about is not unprofessional, but it is a very broad question that may increase a patient’s uncertainty about what the nurse wants to hear, thus increasing his anxiety. Defining or giving an example of “sexual problem” would make this inquiry more effective.

Question 95

A man says, “I enjoy watching women when I am out in public. I like to go to places where I can observe women crossing their legs in hopes of seeing something good.” Which statement about this behavior is most accurate?
a. It is a sexual disorder. The behavior is socially atypical. It could disrupt
relationships and could be insulting to others.
b. It is not a sexual disorder. These events occur in public, where those he observes
do not have a reasonable expectation of privacy.
c. It is not a sexual disorder. Because it occurs in public areas, this behavior does not
hurt others or involve intrusion into the personal space of those observed.
d. An action is or is not a sexual disorder depending on applicable local laws, so
whether this meets the definition of a sexual disorder depends on the location.

Answer 95

ANS: A
A sexual disorder is defined as an activity that is socially atypical, has the potential to disrupt significant relationships, and may result in insult or injury to others. The behavior described constitutes a sexual disorder (voyeurism). Although laws vary, an act does not have to be illegal to constitute a sexual disorder. The fact that the behavior occurs in a public setting could have a bearing on whether it is illegal, but not on whether it is considered to be a sexual disorder.

Question 96

A parent who is very concerned about a 3-year-old son says, “He likes to play with girls’ toys. Do you think he is homosexual or mentally ill?” Which response by the nurse most professionally describes the current understanding of gender identity?
a. “A child’s interest in the activities of the opposite gender is not unusual or related
to sexuality. Most children do not carry cross-gender interests into adulthood.”
b. “It’s difficult to say for sure because the research is incomplete so far, but chances
are that he will grow up to be a normal adult.”
c. “The research is incomplete, but many boys play with girls’ toys and turn out
normal as adults.”
d. “I am sure that whatever happens, he will be a loving son, and you will be a proud
parent.”

Answer 96

ANS: A
The parent’s inquiry is representing two questions: (1) whether the child’s behavior suggests an increased risk of developing mental illness and (2) what the child’s future sexual preference will be. The psychiatric disorder that most directly addresses gender preferences and cross-gender activities is gender identity disorder. Pointing out that cross-gender activities are not necessarily related to gender identity and not likely to be carried into adulthood is supported by current research. Saying the child will grow up to be “normal” implies that to be homosexual is to be abnormal, which reflects a cultural perspective that most professionals would believe to be inappropriate to share in a professional setting. Research provides information about the relationship between cross-gender interests in childhood and adulthood, so a comment that “research is incomplete” is not entirely accurate. Stating that the child is a wonderful boy the father will be proud of, whatever happens, evades the parent’s question and suggests that parental bonds should not be affected by gender issues. The nurse has a professional obligation to maintain an objective, therapeutic relationship.

Question 97

Which statement about paraphilic disorders is accurate?
a. Paraphilic behavior is controllable by willpower, but most persons with these
disorders fail to do so.
b. Persons with paraphilic disorders rarely experience shame and are not distressed
by their acts.
c. Persons with paraphilic disorders prey primarily on female children between the
ages of 12 and 15 years.
d. Acts of paraphilia are common with the disorders commit the acts
repeatedly, but paraphilic disorders are uncommon.

Answer 97

ANS: D
Paraphilic disorders are uncommon; however, because persons with these disorders repeatedly enact behaviors associated with their disorders, paraphilic acts are relatively common. The majority of victims of pedophiles are males in early adolescence; those pedophiles who prefer females usually prefer prepubescent children. Some persons with paraphilic disorders experience shame and are at higher risk for suicide due to the stigma, shame, and embarrassment. Biological and psychological drives underlying paraphilic behavior can be very strong and often are not controllable by willpower alone. Persons with paraphilic disorders have difficulty controlling their behavior, even when very motivated to do so.

Question 98

A respected school coach was arrested after a student reported the coach attempted to have sexual contact. Which nursing action has priority in the period immediately following the coach’s arrest?

a. Determine the nature and extent of the coach’s sexual disorder.
b. Assess the coach’s potential for suicide or other self-harm.
c. Assess the coach’s self-perception of problem and needs.
d. Determine whether other children were harmed.

Answer 98

ANS: B
Pedophiles and other persons with paraphilic disorders can be at increased risk of self-harm associated with the guilt, shame, and anger they feel about their behavior and its effect on their families, victims, and victims’ families. They also face considerable losses, such as the end of their careers or the loss of freedom to imprisonment. Thus, safety is the priority issue for assessment. Determining the nature and extent of the patient’s disorder and related patient perceptions would be appropriate but not the highest priority for assessment. Investigating whether other victims exist is a matter for law enforcement rather than health care personnel. See relationship to audience response question.

Question 99

An adult seeks treatment for urges involving sexual contact with children. The adult has not acted on these urges but feels shame. Which finding best indicates that this adult is making progress in treatment? The adult

a. consistently avoids schools and shops at malls only during school hours.
b. indicates sexual drive and enjoyment from sex have decreased.
c. reports an active and satisfying sex life with an adult partner.
d. volunteers to become a scout troop leader.

Answer 99

ANS: A
One strategy for avoiding acting on inappropriate urges is to avoid environments and circumstances that evoke those urges; for a pedophile this would include avoiding all situations that would likely result in contact with children. Pedophilic disorder is persistent; elimination of fantasies about children would be unrealistic. A person who volunteers to lead a scout troop is placing himself/herself around children. A diminished sex drive or a healthy sex life with an appropriate partner does not necessarily reduce the desire for sexual contact with children.

Question 100

A patient’s medical record documents sexual masochism. This patient derives sexual pleasure

a. from inanimate objects.
b. by inflicting pain on a partner.
c. when sexually humiliated by a partner.
d. from touching a nonconsenting person.

Answer 100

ANS: C
Sexual masochism is sexual pleasure derived from being humiliated, beaten, or otherwise made to suffer. The distracters refer to fetishism, sexual sadism, and frotteurism.

Question 101

A man with hypospadias tells the nurse, “Intercourse with my new bride is painful.” Which term applies to the patient’s complaint?

a. Delayed ejaculation
b. Erectile dysfunction
c. Premature ejaculation
d. Genito-pelvic pain/penetration disorder

Answer 101

ANS: D
This sexual pain is genito-pelvic pain/penetration disorder and may occur in men or women. The individual feels pain in the genitals during intercourse. Erectile or ejaculation problems are not evident. See relationship to audience response question.

Question 102

A man who regularly experiences premature ejaculation tells the nurse, “I feel like such a failure. It’s so awful for both me and my partner.” Select the nurse’s most therapeutic response.

a. “I sense you are feeling frustrated and upset.”
b. “Tell me more about feeling like a failure.”
c. “You are too hard on yourself.”
d. “What do you mean by awful?”

Answer 102

ANS: A
Using reflection and empathy promotes trust and conveys concern to the patient. The distracters do not offer empathy, probe, and offer premature reassurance.

Question 103

A man who reports frequently experiencing premature ejaculation tells the nurse, “I feel like such a failure. It’s so awful for both me and my partner. Can you help me?” Select the nurse’s best response.

a. “Have you discussed this problem with your partner?”
b. “I can refer you to a practitioner who can help you with this problem.”
c. “Have you asked your health care provider for prescription medication?”
d. “There are several techniques described in this pamphlet that might be helpful.”

Answer 103

ANS: B
The primary role of the nurse is to perform basic assessment and make appropriate referrals. The other options do not clarify the nurse’s role.

Question 104

A 10-year-old boy is diagnosed with gender dysphoria. Which assessment finding would the nurse expect?

a. Having tea parties with dolls
b. A compromised sexual response cycle
c. Identifying with boys who are athletic
d. Intense urges to watch his parents have sex

Answer 104

ANS: A
An individual with gender dysphoria feels at odds with the roles associated with that gender. A child with this diagnosis is likely to engage in play associated with the opposite gender. The other options are not age appropriate or characteristically seen in children with gender dysphoria.

Question 105

A patient approaches the nurse in the clinic waiting room and says, “I want to talk to you about a sexual matter.” The nurse can best facilitate the discussion by

a. saying, “Let’s go my office.”
b. responding, “I want to help. Go ahead; I’m listening.”
c. telling the patient, “Let’s schedule another appointment.”
d. offering to sit in a corner of the waiting room with the patient.

Answer 105

ANS: A
A discussion of sexual concerns requires privacy. Suggesting use of office space is preferable to using the waiting room, where others cannot help but overhear sensitive material. The distracters block communication.

Question 106

A nurse assesses a patient diagnosed with a paraphilic disorder. Which findings are most likely? (Select all that apply.)

a. Childhood history of attention deficit hyperactivity disorder (ADHD)
b. A poorly managed endocrine disorder
c. History of brain injury
d. Cognitive distortions
e. Grandiosity

Answer 106

ANS: A, C, D
ADHD in childhood, substance abuse, phobic disorders, and major depressive disorder/dysthymia are strongly associated with paraphilic disorders. Errors in thought make it seem acceptable for deviant and destructive sexual behaviors to occur. Patients who have experienced head trauma with damage to the frontal lobe of the brain may display symptoms of promiscuity, poor judgment, inability to recognize triggers that set off sexual desires, and poor impulse control. Endocrine problems are not associated with pedophilic disorder. Self-confidence is lacking; therefore, grandiosity would not be expected.

Question 107

A woman is taking a combination oral contraceptive and asks the nurse why progestin is necessary. The nurse will explain that progestin helps prevent pregnancy by which method?

a. Altering the quantity and viscosity of cervical mucus
b. Inhibiting proliferative and secretory changes in the endometrium
c. Increasing motility of muscles and cilia in the fallopian tubes
d. Stimulating a surge in luteinizing hormone (LH)

Answer 107

ANS: A
Progestin alters the quantity and viscosity of cervical mucus, making it thick and hostile to sperm penetration. Estrogen inhibits proliferative and secretory changes in the endometrium. Progestin decreases muscle and ciliary motility and decreases the LH surge.

Question 108

A woman will begin taking a combination oral contraceptive (COC) that has a higher estrogenic activity than her previous COC. When teaching this woman about the new product, the nurse will explain that she may experience which effect(s)?

a. Cyclic breast changes and chloasma
b. Decreased dysmenorrhea and menorrhagia
c. Decreased libido
d. Weight gain and fatigue

Answer 108

ANS: A
Increased estrogenic activity may include side effects such as cyclic breast changes and chloasma as well as increased dysmenorrhea and menorrhagia. Increased progestin causes decreased libido, weight gain, and fatigue.

Question 109

A woman who has recently begun taking a combination oral contraceptive calls the clinic to report breakthrough bleeding. The nurse will:

a. advise her to use a back-up method of contraception.
b. counsel her to continue taking the contraceptive as prescribed.
c. recommend discussing an alternative contraceptive with her provider.
d. suggest that she perform a home pregnancy test to rule out pregnancy.

Answer 109

ANS: B
Breakthrough bleeding is more common at the start of COC use, and there is no evidence that an episode of bleeding is associated with a decrease in the COC’s effectiveness as long as the patient continues to take the pill as prescribed. She does not need to use back-up contraception. Unless the bleeding continues and is problematic, there is no need to change products. A pregnancy test is not indicated.

Question 110

A young woman who is taking Ortho-Tri-Cyclen for contraception tells the nurse that her provider has told her it will help to treat her acne. The nurse explains that this is because this product is:

a. high in progestin.
b. low in androgenic activity.
c. low in estrogen.
d. triphasic.

Answer 110

ANS: B

Products with low androgenic activity help to reduce acne.

Question 111

A woman who is taking a combined oral contraceptive (COC) that contains 21 days of active pills and 7 days of inert pills reports having headaches accompanying withdrawal bleeding every month. The nurse will:
a. counsel her to take ibuprofen to counter these side effects.
b. tell her to stop her oral contraceptive immediately.
c. recommend she use an alternative form of contraception.
d. suggest she ask her provider about changing to a product that allows for
continuous oral administration of active contraceptive pills.

Answer 111

ANS: D
Withdrawal bleeding can be eliminated altogether by continuous oral administration of active pills. The patient may discuss this approach with her provider to see if this will help with her headaches.

Question 112

A woman who is using a NuvaRing transvaginal contraceptive product calls to report that the ring has slipped out while sleeping. The patient is not sure how long the product was dislodged. The nurse will instruct the patient to rinse the ring with lukewarm water, reinsert the ring, and:

a. abstain from sexual intercourse for 24 h.
b. replace it with a new ring as soon as possible.
c. take an oral contraceptive product for 2 weeks.
d. use a back-up method of contraception for 7 days.

Answer 112

ANS: D
If the NuvaRing slips out, it should be rinsed off and reinserted. If it has been out longer than 3 h, the woman should be counseled to use a back-up method of contraception.

Question 113

A 35-year-old woman asks the nurse about oral contraceptives. The nurse learns that the patient smokes and has a family history of venous thromboembolism (VTE). The nurse will suggest that the patient:

a. discuss a progestin-only oral contraceptive with her provider.
b. may want to consider having a tubal ligation.
c. use a transdermal contraceptive product.
d. will not be a candidate for oral contraceptive products.

Answer 113

ANS: A
Patients who smoke or who have an increased risk of VTE may be candidates for progestin-only products. A 35-year-old woman may still want children in the future, so recommending a tubal ligation is not indicated. Transdermal products contain estrogen and carry the same risks as COCs.

Question 114

A woman comes to the clinic for a Depo-Provera injection. The nurse reviews her medical record and notes that it has been 100 days since her last injection. What action will the nurse
perform?
a. Administer Depo-Provera 150 mg IM
b. Give Depo-Provera 300 mg IM
c. Perform a pregnancy test
d. Suggest she wait until she has had a period.

Answer 114

ANS: C
Women should receive depot medroxyprogesterone (Depo-Provera) injections every 13 weeks. Patients who are late for injections (13 weeks plus 1 day) will need to rule out pregnancy before receiving the next injection. Patients who are eligible receive 150 mg IM. It is not correct to give a higher dose.

Question 115

A 45-year-old woman reports cessation of menses for the past 6 months and asks the nurse if she needs to continue using contraception. The nurse will tell her:

a. that she may discontinue using contraception.
b. that she most likely has premature ovarian failure.
c. to begin hormone therapy to prevent menopausal symptoms.
d. to continue using contraception for at least 6 more months.

Answer 115

ANS: D
Women should use contraception until menstruation has ceased for 1 year if they do not wish to become pregnant. Premature ovarian failure occurs when menstruation stops before age 40 years. It is not necessary to treat menopausal symptoms until they occur.

Question 116

A 45-year-old woman who has not had a period for 15 months reports severe hot flashes and poor sleep. The nurse reviews information about hormone replacement therapy and tells this woman that hormone therapy:

a. is very safe and may be used freely to treat menopausal symptoms.
b. may be used indefinitely to treat menopausal symptoms.
c. should be used at the lowest dose possible for less than 5 years.
d. will be necessary to prevent osteoporosis caused by estrogen depletion.

Answer 116

ANS: C
Women should use hormone therapy at the lowest dose possible for a period of less than 5 years. It carries risks for breast cancer and cardiovascular disease and cannot be used indefinitely. Hormone therapy can help slow osteoporosis, but it does not prevent osteoporosis and is not recommended for this use.

Question 117

The parent of a 16-year-old female tells the nurse that the child has not had a menstrual period
in spite of having breast and pubic hair development. The nurse recognizes this as characteristic of which condition?
a. Dysmenorrhea
b. Hypothyroidism
c. Primary amenorrhea
d. Secondary amenorrhea

Answer 117

ANS: C
Females who have never had a period have primary amenorrhea, which is defined as no menses by age 14 without secondary sex characteristics, or no menses by age 16 with secondary sex characteristics. Dysmenorrhea refers to painful cramping with periods. Hypothyroidism can contribute to secondary amenorrhea, which is characterized by cessation of periods for at least 6 months once menses have begun.

Question 118

A young woman reports not having a period for 7 months. Which test will the provider likely order first to evaluate the cause of amenorrhea in this patient?

a. Pelvic ultrasound
b. Pregnancy test
c. Progestational challenge test
d. Serum insulin levels

Answer 118

ANS: B
When secondary amenorrhea occurs, pregnancy must be ruled out prior to performing other tests. A progestational challenge test will be performed if the patient is not pregnant. If polycystic ovarian syndrome is suspected, serum insulin levels and possibly a pelvic ultrasound will be performed.

Question 119

A woman is diagnosed with polycystic ovarian disease (PCOS) after being unable to conceive. Her provider has ordered metformin (Glucophage) and clomiphene citrate (Clomid). The nurse will explain that metformin is given for which purpose?

a. To increase androgen levels
b. To induce ovulation
c. To promote a dominant follicle
d. To regulate menstrual periods

Answer 119

ANS: D
Metformin decreases androgen levels, which helps to regulate periods and promote ovulation. It does not induce ovulation per se, but increases the possibility of ovulation by its antiandrogenic effects. Metformin should not be used specifically for ovulation induction. Clomiphene citrate promotes a dominant follicle.

Question 120

A 30-year-old woman describes having periods every 30 days, lasting 8 days, with heavy bleeding. The nurse understands that these are signs of which condition?

a. Menometrorrhagia
b. Menorrhagia
c. Menorrhea
d. Metrorrhagia

Answer 120

ANS: B
Menorrhagia is defined as regular uterine bleeding lasting more than 7 days with heavy bleeding. Metrorrhagia is irregular uterine bleeding lasting more than 7 days with heavy bleeding. Menorrhea is normal uterine bleeding. Menometrorrhagia is a combination of menorrhagia and metrorrhagia.

Question 121

A woman who has menorrhagia is prescribed ibuprofen, and she asks the nurse how a pain medication can decrease uterine bleeding. The nurse will explain that this is most likely explained by ibuprofen’s effects on:

a. estrogen levels.
b. platelet aggregation.
c. prostaglandin production.
d. uterine endometrium.

Answer 121

ANS: C
Ibuprofen blocks prostaglandin production, which decreases uterine bleeding and cramps. Ibuprofen does not affect estrogen levels. Its effects on platelet aggregation can impair clotting. It does not have effects on the uterine endometrium.

Question 122

A woman who is infertile has taken 50 mg of clomiphene citrate (Clomid) from days 5 through 9 of a cycle and has not ovulated. The nurse will anticipate that the provider will perform which action?

a. Begin recombinant follicle-stimulating hormone therapy.
b. Increase the dose to 100 mg on days 5 through 9 of her next cycle.
c. Order clomiphene citrate to be given throughout her next cycle.
d. Repeat the 50 mg of clomiphene citrate for 2 more cycles.

Answer 122

ANS: B
If clomiphene is unsuccessful, the provider may increase the dose by 50 mg increments for 2 cycles up to 250 mg until ovulation occurs. Recombinant FSH may be used if this fails. It is not correct to administer the drug throughout the cycle or to continue with the initial dose.

Question 123

The nurse performs a history on a woman who will begin taking clomiphene citrate (Clomid) to induce ovulation. Which aspect of this patient’s history is of concern?

a. Anovulation
b. Dysmenorrhea
c. Sexually transmitted infection
d. Uterine fibroids

Answer 123

ANS: D
Patients with a history of uterine fibroids should not take clomiphene. Anovulation is the indication for clomiphene. Dysmenorrhea and sexually transmitted infections are not contraindications.

Question 124

A 50-year-old male patient reports having decreased libido and testicular atrophy. The nurse will anticipate that the provider may order which medication to treat these symptoms?

a. Testosterone (Androderm)
b. Finasteride (Proscar)
c. Gonadotropin-releasing hormone (Gn-RH)
d. Sildenafil (Viagra)

Answer 124

ANS: A
Testosterone is given patients who have low testosterone, evidenced by decreased libido and testicular atrophy in adult men. Finasteride is given to treat benign prostatic hypertrophy. Gn-RH is used to inhibit testosterone production. Sildenafil is used to treat erectile dysfunction.

Question 125

The nurse is teaching the parents of a boy who has inadequate pituitary function and delayed puberty about testosterone cypionate injections. Which statement by the parents indicates a
need for further teaching?
a. “He will need radiographs (x-rays) of his hands every 6 months.”
b. “Injections will be given deep into his gluteal muscles.”
c. “Sexual development will occur in 3–4 months.”
d. “His serum testosterone levels will need to be monitored.”

Answer 125

ANS: C
It takes 3–4 years for sexual development to occur with androgen therapy for hypogonadism, so parents should be reminded of this. X-rays are needed every 6 months to assess bone effects. Injections are given deep intramuscularly into gluteal muscles. Serum testosterone levels will need to be monitored to maintain normal levels and direct changes in testosterone dosing.

Question 126

The nurse is instructing a patient about the buccal muco-adhesive testosterone system (Striant) to treat low testosterone. What information will the nurse include when teaching this patient about this drug?
a. “If the product slides out of position more than 4 h before the next dose, replace it
with a new system.”
b. “Place the flattened surface against the gum and hold it firmly in place for 30
seconds.”
c. “The product may be swallowed after it has been in place for at least 4 h.”
d. “To remove the product, slide it upwards away from the tooth until it releases.”

Answer 126

ANS: A
If the product falls off within the 12-h dosing interval or falls out of position within 4 h of the next dose, it should be discarded and a new product applied. The rounded surface should be placed against the gum. The product should not be swallowed. The product should be removed by sliding downwards toward the tooth.

Question 127

The nurse provides teaching to a man who will begin using an Androderm testosterone patch. Which statement by the patient indicates understanding of the teaching?

a. “I may stop using Androderm when my serum testosterone is normal.”
b. “I should apply this to any skin other than the scrotum or bony areas.”
c. “I will apply two skin patches every morning after a shower.”
d. “My serum testosterone will continue to rise with each day of use.”

Answer 127

ANS: B
Androderm should be applied to any intact skin other than the scrotum or over a bony area. When the medication is withdrawn, testosterone levels will drop. The patient should apply one to two patches every day at 10 PM. The first day of use results in serum testosterone levels in the normal range, and serum levels do not accumulate with continued use.

Question 128

A man who has been using androgen therapy tells the nurse that he and his wife wish to conceive a pregnancy. The nurse will tell this patient that:

a. androgen therapy will not harm the fetus.
b. he will need to increase his dose of testosterone to increase his sperm count.
c. it may take 3 months after cessation of androgen therapy to conceive.
d. there should be no problems conceiving while using androgen therapy.

Answer 128

ANS: C
Androgens cause decreased sperm counts and usually takes 3 months after cessation of therapy to return sperm counts to normal. During pregnancy, androgens can cross the placenta and cause masculinization of the fetus. Virilization can occur in those secondarily exposed to testosterone gel and may cause teratogenic effects in fetuses. Increasing the testosterone will not increase the sperm count.

Question 129

The nurse is teaching an adult male patient about the use of testosterone gel. Which statement by the patient indicates understanding of the teaching?

a. “A decreased urinary stream is an expected side effect.”
b. “I should apply the gel to my forearms every day.”
c. “I will have hand and wrist x-rays every 6 months.”
d. “I will need regular evaluation of serum lipid levels.”

Answer 129

ANS: D
Testosterone can increase lipid levels so these should be monitored regularly. A decreased urinary stream can indicate prostatic hypertrophy and should be reported. Patients should apply the gel where it is least likely to come in contact with other people. Only prepubertal males require bone evaluation by x-ray.

Question 130

The oral antiandrogen drug flutamide (Eulexin) is used to treat which condition?

a. Benign prostatic hypertrophy (BPH)
b. Breast cancer
c. Male-pattern baldness
d. Metastatic prostate cancer

Answer 130

ANS: D
This antiandrogen drug is used to treat metastatic prostate cancer. It is not effective to treat other hormonally dependent diseases such as breast cancer, male-pattern baldness, or BPH.

Question 131

A patient will begin taking finasteride (Propecia) to treat benign prostatic hypertrophy (BPH) and asks the nurse how long the medication will be necessary. The nurse will tell the patient
that he will need to take this medication for how long?
a. 6 months
b. 12 months
c. Indefinitely
d. Until symptoms resolve

Answer 131

ANS: C
Continued treatment with finasteride is recommended in order to sustain results since reversal of effect usually occurs within 1 year after cessation of the drug.

Question 132

A 14-year-old male is being evaluated for delayed puberty. Which finding would indicate delayed puberty in this child?

a. Androgen deficiency
b. Growth hormone deficiency
c. Height of 2.5 standard deviations below the mean
d. Lack of epiphyseal closure

Answer 132

ANS: A
Low androgen levels indicate delayed puberty. Patients who are short and who have not developed secondary sexual characteristics may have growth hormone deficiency, normal variations in development, or delayed puberty. Growth hormone deficiency may cause short stature.

Question 133

A male patient wants to begin taking tadalafil (Cialis) to treat erectile dysfunction. Which aspect of this patient’s history would be of particular concern?

a. Angina pectoris
b. Asthma
c. Benign prostatic hypertrophy (BPH)
d. Color blindness

Answer 133

ANS: A
Patient with angina are often treated with nitrates; phosphodiesterase inhibitors such as tadalafil are contraindicated in patients taking nitrates.

Question 134

A patient will begin using sildenafil citrate (Viagra) to treat erectile dysfunction. The nurse will instruct the patient to take the medication:

a. daily in the morning.
b. just prior to sexual activity.N
c. 30 min-4 h before sexual activity.
d. twice daily.

Answer 134

ANS: C
Sildenafil should be taken at least 30 min and less than 4 h prior to sexual activity. It is not taken daily or twice daily. If taken just prior to sexual activity, it does not have time to take effect.

Question 135

A woman is diagnosed with bacterial vaginosis and will begin taking metronidazole (Flagyl). What will the nurse teach the patient about this medication?
a. “Abstain from sexual intercourse while taking this medication.”
b. “Do not consume alcohol while taking this drug and for 48 hours after finishing
the prescription.”
c. “Take this medication on an empty stomach to increase absorption.”
d. “Topical preparations are ineffective for treating bacterial vaginosis.”

Answer 135

ANS: B
Metronidazole can cause a disulfiram-like reaction when taken with alcohol, so patients should be cautioned against using foods or drug products that contain alcohol. There is no need to abstain from sexual intercourse. Metronidazole should be taken with food. The topical preparation is effective against bacterial vaginosis.

Question 136

The nurse is speaking with the parent of an 11-year-old girl that is considering vaccination for human papillomavirus (HPV). Which of the following statements is NOT correct?

a. “HPV infections cause most cervical, vaginal and oropharyngeal cancers.”
b. “Pap tests can detect cervical dysplasia, which can be a precursor to cervical cancer if left untreated.”
c. “There are several HPV vaccines available in the US.”
d. “HPV infection is uncommon.”

Answer 136

ANS: B

HPV infection is common, with most sexually active persons becoming infected at some point in their lifetime.

Question 137

A patient is taking azithromycin to treat a chancroid infection. Which of the following would be important counseling to the patient?
a. Apply a bacteriostatic ointment to the lesions twice daily.
b. Avoid washing the lesions to prevent spread of the infection.
c. Cover the lesions with gauze at all times to minimize discomfort.
d. Any sexual partners within the 10 days preceding the onset of symptoms should be
examined and treated.

Answer 137

ANS: D
Sex partners of patients who have chancroid should be examined and treated if they had sexual contact with the patient during the 10 days preceding the patient’s onset of symptoms. It is not necessary to apply bacteriostatic ointment or to cover the lesions with gauze. Washing the lesions is recommended.

Question 138

A nursing student encounters a patient newly diagnosed with gonorrhea. The students’ preceptor asks what the recommended treatment would be for this patient. Which statement by the nursing student is correct?

a. “Ceftriaxone IM is prescribed.”
b. “Erythromycin ointment is prescribed.”
c. “IM ceftriaxone and oral azithromycin are prescribed.”
d. “Oral doxycycline is prescribed.”

Answer 138

ANS: C
A single dose of IM ceftriaxone and a single dose of azithromycin are prescribed for gonorrhea. The use of two drugs improves treatment efficacy and slows the development of drug resistance. Erythromycin ophthalmic ointment is used on the neonate.

Question 139

Which of the following is considered the most common STI in young adults in the United
States?
a. HIV
b. Gonorrhea
c. Chlamydia
d. Genital herpes

Answer 139

ANS: C
Chlamydia trachomatis is the most common STI in the United States in young adults. This infection is most often asymptomatic.

Question 140

A woman is diagnosed with herpes simplex virus (genital herpes). Which statement by the patient indicates understanding of the medication regime?
a. “Antiviral drugs can help with my outbreaks and symptoms, but will not cure my
genital herpes.”
b. “I take my medication as prescribed I will not have any more outbreaks.”
c. “If I stay on my medication after my current outbreak resolves I won’t have any
more episodes.”
d. “I can use the medications once a month to treat symptoms.”

Answer 140

ANS: A
Suppressive therapy reduces the frequency of genital herpes recurrences by 70% in those who have frequent recurrences. Systemic antiviral drugs can control some of the signs and symptoms of genital herpes, but these do not cure herpes. Outbreaks occur even while on antiviral medication, and transmission can occur when patients are asymptomatic. Episodic treatment, to be effective, should begin within 1 day of lesion onset or during the prodrome period, not a given week each month.

Question 141

A woman with complaints of abnormal vaginal discharge, vaginal soreness, pruritus, and dysuria is diagnosed with vulvovaginal candidiasis (VVC). Which statement will the nurse include in teaching?

a. “Treatment with prescription medication is lifelong.”
b. “Alcohol should be avoided during treatment.”
c. “Candida albicans can be readily passed between sex partners.”
d. “Over the counter cream can be used to treat the condition.”

Answer 141

ANS: D
Over the counter or prescribed medications can be used to treat the condition; treatment is episodic. The medications do not interact with alcohol. Uncomplicated VVC is not usually acquired through sexual intercourse, thus treatment of sexual partners is not necessary.