Psychiatric Mental Health Nursing Concepts of Care in Evidence Based Practice 8th Edition by Mary C. Townsend – Test Bank

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Psychiatric Mental Health Nursing Concepts of Care in Evidence Based Practice 8th Edition by Mary C. Townsend – Test Bank

chapter 4

Page 1
1. Which of the following factors is primarily responsible for the changes in inpatient
hospital treatment between the 1980s and the present?
A) Progress in treatment options for mentally ill persons
B) The growth of managed care
C) Less stigma associated with mental illness
D) The current use of milieu therapy
Ans: B
Feedback:
Managed care exerts cost-control measures such as recertification of admissions,
utilization review, and case managementóall of which have altered inpatient treatment
significantly. There has been some progress in treatment options for mentally ill
persons, but that is not the primary factor that has changed mental health inpatient
hospital care. There is lesser stigma associated with mental illness, but that is not the
primary factor that has changed mental health inpatient hospital care. In the 1980s, a
typical psychiatric unit emphasized milieu therapy, which required long lengths of stay
because clients with more stable conditions helped to provide structure and support for
newly admitted clients with more acute conditions.
2. The factor having the most influence on the current trend in treatment settings is the fact
in recent years,
A) funding for community programs has been inadequate.
B) laws have enabled more people to be committed to treatment.
C) state hospitals have expanded to meet the demand.
D) community programs have been fully developed to meet treatment needs.
Ans: A
Feedback:
Adequate funding has not kept pace with the need for community programs and
treatment. Commitment laws have led to deinstitutionalization. Large state hospitals
emptied as a result. Treatment in the community was intended to replace much of state
hospital inpatient care, but funding has been inadequate.
Page 2
3. A patient who has continuously experienced severe symptoms of schizoaffective
disorder for the past 17 years is experiencing an acute psychotic episode. Which level of
care is most appropriate for this patient at this time?
A) Partial hospitalization
B) Residential treatment
C) Inpatient hospital treatment
D) Clubhouse
Ans: C
Feedback:
Long-stay clients in an inpatient setting are people with severe and persistent mental
illness who continue to require acute care services despite the current emphasis on
decreased hospital stays. This population includes clients who were hospitalized before
deinstitutionalization and remain hospitalized despite efforts at community placement. It
also includes clients who have been hospitalized consistently for long periods despite
efforts to minimize their hospital stays. Partial hospitalization is designed for patients
transitioning to independent living. Residential treatment and clubhouse model provide
supervised independent living.
4. A patient with depression is admitted to an inpatient hospital unit for treatment. The
type of therapy most likely provided in this setting includes
A) leisure skills.
B) self-monitoring of treatment.
C) skills for daily living.
D) talk therapy.
Ans: D
Feedback:
A typical psychiatric unit emphasizes talk therapy, or one-on-one interactions between
residents and staff, and milieu therapy, meaning the total environment and its effect on
the client’s treatment. Partial hospitalization programs teach skills for daily living.
Clubhouse models provide patients opportunities for leisure activities and selfmonitoring
of treatment.
5. Which of the following is the highest priority for admission to inpatient care?
A) Confusion or disorientation
B) Need for medication changes
C) Safety of self or others
D) Withdrawal from alcohol or other drugs
Ans: C
Feedback:
Safety is a priority; the inpatient setting provides for the safety of the client and/or
others. Confusion or disorientation, need for medication changes, and withdrawal from
alcohol or other drugs may also require inpatient care but the priority is safety.
Page 3
6. The priority of inpatient care for people with severe mental illness is
A) family issues.
B) insight into illness.
C) social skills.
D) symptom management.
Ans: D
Feedback:
Rapid assessment, stabilization of symptoms, and discharge planning are the focus of
inpatient care today. Family issues, insight into illness, and social skills would not be
priorities of care for clients with severe mental illness.
7. Discharge planning from inpatient care for people with severe mental illness must
address which of the following to be effective? Select all that apply.
A) Finding housing for the client
B) Finding a job for the client
C) Finding transportation for the client
D) Improving family support
E) Identifying ideal recreational activities
Ans: A, C
Feedback:
Clinicians help clients recognize symptoms, identify coping skills, and choose discharge
supports in the inpatient setting. People are able to remain in the community for longer
periods of time when discharge planning addresses environmental supports, housing,
transportation, and access to community support services. Finding a job for the client
may be helpful if appropriate but may not be appropriate for the individual at the time of
discharge from inpatient care. Improving family support and identifying ideal
recreational activities are desirable but not essential for successful reintegration with the
community.
Page 4
8. Which type of community residential treatment setting is most likely to be permanent in
any state?
A) Halfway house
B) Respite housing
C) Independent living programs
D) Evolving consumer household
Ans: D
Feedback:
Because the evolving consumer household is a permanent living arrangement, it
eliminates the problem of relocation. Halfway houses usually serve as temporary
placements that provide support as the clients prepare for independence. Clients who are
served by respite housing are those who live in group homes or independently most of
the time but have a need for ìrespiteî from their usual residences when the client
experiences a crisis, feels overwhelmed, or cannot cope with problems or emotions.
Independent living programs are available in many states, but may vary a great deal in
regard to services provided with some agencies providing a broad range of services or
shelter but few services.
9. A patient is being transferred from a group home to an evolving consumer household.
The goal of this transition is for the patient to eventually
A) meet with a therapist on a weekly basis.
B) resolve crises within a shorter time period.
C) fulfill daily responsibilities without supervision.
D) use the increased emotional support of paid staff.
Ans: C
Feedback:
The evolving consumer household is a group-living situation in which the residents
make the transition from a traditional group home to a residence where they fulfill their
own responsibilities and function without onsite supervision from paid staff.
Page 5
10. What is an important role of the nurse with regard to residents opposing plans to
establish a group home or residential facility in their neighborhood?
A) To provide information to correct misinformation related to stereotypes of persons
with mental illnesses
B) To persuade neighborhood residents that mentally ill people need safe, affordable,
and desirable housing
C) To provide for the safety and security of the neighborhood
D) To ensure the security of persons in the group home
Ans: A
Feedback:
Frequently, residents oppose plans to establish a group home or residential facility in
their neighborhood. They argue that having a group home will decrease their property
values, and they may believe that people with mental illness are violent, will act
bizarrely in public, or will be a menace to their children. These people have strongly
ingrained stereotypes and a great deal of misinformation. Local residents must be given
the facts, and nurses are in a position to advocate for clients by educating members of
the community. The neighborhood residents who object to the establishment of a group
home or residential setting may not be motivated to understand the needs of mentally ill
people. It is not the responsibility for the nurse to provide for the safety and security of
the neighborhood or protect the safety and security of persons in the group home.
11. What are the two essential components of transitional care discharge model that is used
in Canada and Scotland?
A) Peer support and bridging staff
B) Collaboration and funding
C) Relapse and hospitalization
D) Poverty and entitlements
Ans: A
Feedback:
Two essential components of the transitional care discharge model are peer support and
bridging staff. Peer support is provided by a consumer now living successfully in the
community. Bridging staff refers to an overlap between hospital and community
careóhospital staff do not terminate their therapeutic relationship with the client until a
therapeutic relationship has been established with the community care provider. This
model requires collaboration, administrative support, and adequate funding to
effectively promote the patient’s health and well-being and prevent relapse and
rehospitalization. Poverty among people with mental illness is a significant barrier to
maintaining housing. Mentally ill persons often rely on government entitlements for
their income which forces people to have to choose continuation of the entitlement and
dependence versus working inconsistently in unskilled, part-time, and low-paying jobs
with no health insurance.
Page 6
12. Some residential treatment settings are transitional. This means that clients are
eventually expected to
A) become self-sufficient.
B) find employment.
C) no longer need medication.
D) relocate to another setting.
Ans: D
Feedback:
Transitional housing is temporary; clients are expected to move to another residential
setting. Clients using transitional treatment settings are not expected to become totally
self-sufficient, find employment, or not be in need of medication.
13. The primary advantage of an evolving consumer household is that clients
A) are provided with adequate income to combat poverty.
B) do not have to relocate as they become more independent.
C) have on-site staff supervision 24 hours a day.
D) receive on-site medical care.
Ans: B
Feedback:
An evolving consumer household is a permanent living situation, eliminating the need
to change residential settings as clients gain independence. Many clients in evolving
consumer households rely on Social Security Insurance or Social Security Disability
Insurance. Clients function without onsite supervision.
14. The primary goal of a psychiatric rehabilitation program is to promote
A) return to prior level of functioning.
B) medication compliance.
C) complete recovery from mental illness.
D) stabilization and management of symptoms.
Ans: C
Feedback:
Psychiatric rehabilitation goes beyond management of symptoms and medication
management to include personal growth, reintegration into the community,
empowerment, increased independence, and improved quality of life. It is not a goal of
psychiatric rehabilitation to return to the prior level of functioning that may have been
dysfunctional. It may not be realistic for the client to completely recover from mental
illness, but rehabilitation can improve the quality of life for the client.
Page 7
15. What is required for a transitional care model to be most effective in promoting the
client’s health and well-being and prevent relapse and rehospitalization? Select all that
apply.
A) Collaboration
B) Administrative support
C) Adequate funding
D) Family support
E) Completely different providers
F) Isolation from peers who successfully live in the community
Ans: A, B, C
Feedback:
Two essential components of transitional care model are peer support and bridging staff.
Peer support is provided by a consumer now living successfully in the community.
Bridging staff refers to an overlap between hospital and community careóhospital staff
do not terminate their therapeutic relationship with the client until a therapeutic
relationship has been established with the community care provider. This model requires
collaboration, administrative support, and adequate funding to effectively promote the
patient’s health and well-being and prevent relapse and rehospitalization.
16. A patient has just begun daily participation in a community-based partial hospitalization
program. The patient can expect the staff to assist with which of the following treatment
goals? Select all that apply.
A) Stabilizing psychiatric symptoms
B) Finding a better job
C) Improving activities of daily living
D) Learning to structure time
E) Improved family support
F) Developing social skills
Ans: A, C, D, F
Feedback:
Partial hospitalization programs are designed to help clients make a gradual transition
from being inpatients to living independently and to prevent repeat admissions. In day
treatment programs, clients return to home at night; evening programs are just the
reverse. Partial hospitalization programs provide assistance with stabilizing psychiatric
symptoms, monitoring drug effectiveness, stabilizing living environment, improving
activities of daily living, learning to structure time, developing social skills, obtaining
meaningful work, paid employment, or a volunteer position, and providing follow-up of
any health concerns. Finding a better job and improving family support are not goals of
partial hospitalization programs.
Page 8
17. A patient has just been referred to a psychosocial rehabilitation program. The nurse
explains that the benefits of being involved in such a program include: Select all that
apply.
A) continuous monitoring of symptoms.
B) increased independence.
C) increased involvement in treatment decisions.
D) recovery from mental illness.
E) increased community integration.
F) greater opportunities for personal growth.
Ans: B, D, E
Feedback:
Goals of psychosocial rehabilitation programs include recovery from mental illness,
personal growth, quality of life, community reintegration, empowerment, increased
independence, decreased hospital admissions, improved social functioning, improved
vocational functioning, continuous treatment, increased involvement in treatment
decisions, improved physical health, and a recovered sense of self. Monitoring of
symptoms and medication education are major foci of partial hospitalization programs
18. Which type of psychiatric rehabilitation relies on intentional communities and
rehabilitation alliances?
A) Clubhouse model
B) Assertive community treatment
C) Group homes
D) Respite housing
Ans: A
Feedback:
The clubhouse model of psychiatric rehabilitation relies on intentional communities and
rehabilitation alliances. Assertiveness community treatment (ACT) has a problemsolving
orientation, and staff members who are in the community attend to specific life
issues of the client. Group homes are a residential form of treatment for mental illness
but do not provide complete psychiatric rehabilitation. Respite housing is temporary
housing for mentally ill persons and does not provide complete psychiatric
rehabilitation.
Page 9
19. Which is the orientation of assertive community treatment (ACT)?
A) Setting limits on mundane life issues
B) Making a wide range of referrals
C) Providing services in offices
D) Problem-solving orientation
Ans: D
Feedback:
An ACT program has a problem-solving orientation: Staff members attend to specific
life issues, no matter how mundane. ACT programs provide most services directly
rather than relying on referrals to other programs or agencies, and they implement the
services in the clients’ homes or communities, not in offices.
20. Which of the following are advantages of a crisis resolution team or home treatment
team? Select all that apply.
A) It is a residential treatment setting.
B) It is more likely to help a client to perceive his or her situation more accurately.
C) It is designed to assist clients in dealing with mental health crises without
hospitalization.
D) The client may feel better about asking for help.
E) The client must meet multiple criteria to receive this type of care.
Ans: B, C, D
Feedback:
Crisis resolution or respite care is a type of care for clients who have a perception of
being in crisis and needing a more structured environment. A client having access to
respite services is more likely to perceive his or her situation more accurately, feel better
about asking for help, and avoid hospitalization.
21. A nurse is meeting with the city council to advocate for mentally ill persons and the
establishment of a group home in a neighborhood where the plans have been strongly
opposed by the neighbors. The nurse can effectively educate the public on the realities
of group home by citing research that indicates
A) property values quickly rebound in neighborhoods that have group homes.
B) police surveillance will be increased to avert any violence by residents.
C) most people with mental illness do not represent a significant danger to others.
D) neighborhoods that provide park areas provide children a centralized and safe
place to play.
Ans: C
Feedback:
Frequently, residents oppose plans to establish a group home in their neighborhood,
arguing that having a group home will decrease their property values, and they may
believe that people with mental illness are violent, will act bizarrely in public, or will be
a menace to their children. These people have strongly ingrained stereotypes and a great
deal of misinformation.
Page 10
22. A patient with bipolar disorder has a long history of both hospitalizations and
incarcerations. The patient has no permanent residence and has infrequent contact with
his family. Upon admission to the inpatient psychiatric unit for stabilization, the nurse
documents all of the following in the record. Which of the following data most suggests
a positive outcome for this patient?
A) Reporting meeting with the same case manager monthly for the last 3 years
B) History of residential stays at several local homeless shelters
C) Last contact with siblings 4 years ago
D) Income from day labor for 10 days last month
Ans: A
Feedback:
Results are positive when personal connections with case managers are established. The
most recent report from the ACCESS project found frequent shifts between the street,
programs, and institutions worsen the lives of the homeless. The degree of social
support and employment has direct influence on quality of life.
23. A nurse is orienting to a new position working the infirmary in the state penitentiary.
When working with prisoners who are also mentally ill, the nurse examines her own
attitudes. Which of the following beliefs should the nurse discuss with her supervisor
before caring for incarcerated patients?
A) People with mental illness are inherently violent.
B) The mentally ill can get better treatment in prison than in the community.
C) People with mental illness are more vulnerable to victimization when
incarcerated.
D) Many mentally ill would not be in prison if they were stabilized on medication.
Ans: A
Feedback:
Although it is true that people with major mental illnesses who do not take prescribed
medication are at increased risk for being violent, most people with mental illness do
not represent a significant danger to others. Criminalization of mental illness refers to
the practice of arresting and prosecuting mentally ill offenders, even for misdemeanors,
at a rate four times that of the general population in an effort to contain them in some
type of institution where they might receive needed treatment. People with a mental
illness are more likely to be the victims of violence, both in prisons and in the
community.
Page 11
24. The nurse is part of a group setting up a mobile crisis service in conjunction with the
local police department. Community education on which of the following this team will
focus includes?
A) Teaching police officers counseling skills
B) Crisis counseling services to be provided in the prison system
C) Educating about the dangers of the mentally ill in the community
D) Assisting police officers to recognize mental illness
Ans: D
Feedback:
Mobile crisis services are linked to police departments. These professionals are called to
the scene when police officers believe mental health issues are involved. Frequently, the
mentally ill individual can be diverted to crisis counseling services or to the hospital, if
needed, instead of being arrested and going to jail. Often, these same professionals
provide education to police to help them recognize mental illness and perhaps change
their attitude about mentally ill offenders. They do not provide direct counseling
training to police officers.
25. Which of the following are core skill areas that are needed of any effective team
member of an interdisciplinary team? Select all that apply.
A) Interpersonal skills
B) Teamwork skills
C) Communication skills
D) The ability to work independently
E) Risk assessment and risk management skills
Ans: A, B, C, E
Feedback:
The core skill areas that are needed to function as an effective team member of an
interdisciplinary team include interpersonal skills, such as tolerance, patience, and
understanding; humanity, such as warmth, acceptance, empathy, genuineness, and
nonjudgmental attitude; knowledge base about mental disorders, symptoms, and
behavior; communication skills; personal qualities, such as consistency, assertiveness,
and problem-solving abilities; teamwork skills, such as collaborating, sharing, and
integrating; risk assessment and risk management skills. Members of an
interdisciplinary group must work interdependently, not independently.
Page 12
26. A patient has been started on antidepressants. The interdisciplinary team member most
responsible for monitoring effectiveness and side effects of this new medication is the
A) pharmacist.
B) psychiatrist.
C) psychiatric nurse.
D) psychologist.
Ans: C
Feedback:
The nurse is also an essential team member in evaluating the effectiveness of medical
treatment, particularly medications. The pharmacist has a working knowledge of
medications but has limited contact with the patient. The primary function of the
psychiatrist is diagnosis of mental disorders and prescription of medical treatments. The
clinical psychologist practices therapy.
27. A patient is encouraged to join in daily outdoor games with peers on the unit. The
interdisciplinary team member who will monitor the patient’s involvement will be the
A) occupational therapist.
B) recreation therapist.
C) vocational rehabilitation therapist.
D) psychiatric nurse.
Ans: B
Feedback:
The recreation therapist helps the client to achieve a balance of work and play in his or
her life and provides activities that promote constructive use of leisure or unstructured
time. Occupational therapy focuses on the functional abilities of the client and ways to
improve client functioning. Vocational rehabilitation includes determining clients’
interests and abilities and matching them with vocational choices. The nurse has a solid
foundation in health promotion, illness prevention, and rehabilitation in all areas,
allowing him or her to view the client holistically. The nurse is also an essential team
member in evaluating the effectiveness of medical treatment, particularly medications.
Page 13
28. A patient with bipolar disorder taking lithium returns from a walk outside and reports
feeling shaky and dizzy. The nurse suspects the patient is experiencing a toxic reaction
to the lithium and immediately notifies the
A) psychiatrist.
B) psychologist.
C) nurse manager.
D) recreation therapist.
Ans: A
Feedback:
The primary function of the psychiatrist is diagnosis of mental disorders and
prescription of medical treatments. Psychologists participate in the design of therapy
programs for groups of individuals. The nurse is an essential team member in evaluating
the effectiveness of medical treatment particularly medications. The recreation therapist
helps the client to achieve a balance of work and play.
29. A nurse documents that a patient has successfully acquired a job performing janitorial
services at a local manufacturing company. The goal of which of the following levels of
prevention has been achieved?
A) Primary prevention
B) Secondary prevention
C) Tertiary prevention
D) Community prevention
Ans: C
Feedback:
Nurses work to provide mental health prevention services to reduce risks to the mental
health of persons, families, and communities. Examples include primary prevention,
such as stress management education; secondary prevention, such as early identification
of potential mental health problems; and tertiary prevention, such as monitoring and
coordinating rehabilitation services for the mentally ill.
Page 14
30. A psychiatric nurse is planning an educational program addressing primary prevention
strategies in the community. The nurse explores current research regarding which
health-care need?
A) Influencing schizophrenic patients to adhere to medication regimens
B) Assisting high school students to effectively manage stress
C) Coaching patients with depression to obtain employment
D) Teaching parents the early signs of attention deficit disorder in children
Ans: B
Feedback:
Nurses work to provide mental health prevention services to reduce risks to the mental
health of persons, families, and communities. Examples include primary prevention,
such as stress management education; secondary prevention, such as early identification
of potential mental health problems; and tertiary prevention, such as monitoring and
coordinating rehabilitation services for the mentally ill.
31. A psychiatric nurse is planning activities aimed at secondary prevention of mental
illness. Which activity would be most appropriate to develop?
A) Self-esteem building with a local after-school program
B) Social skills training for chronic schizophrenics
C) Parenthood classes at a local community center
D) Depression screening in an assisted living facility
Ans: D
Feedback:
Nurses work to provide mental health prevention services to reduce risks to the mental
health of persons, families, and communities. Examples include primary prevention,
such as stress management education; secondary prevention, such as early identification
of potential mental health problems; and tertiary prevention, such as monitoring and
coordinating rehabilitation services for the mentally ill.
32. Which element would be present in an assertive community treatment (ACT) program?
A) 24-hour-a-day services
B) Infrequent contact with clients
C) Many clients to each staff member
D) Limited length of service
Ans: A
Feedback:
ACT includes a 24-hour-a-day service, many staff members for each client, in-home or
community services, intense and frequent contact, and unlimited length of service.

 

chapter 14

Page 1
1. The nurse knows that which of the following are stages in Selye’s general adaptation
syndrome? Select all that apply.
A) Alarm reaction stage
B) Resistance stage
C) Coping stage
D) Exhaustion stage
E) Panic stage
Ans: A, B, D
Feedback:
The stages in Selye’s general adaptation syndrome include the alarm reaction stage, the
resistance stage, and the exhaustion stage. Selye did not identify either a coping stage or
a panic stage.
2. The nurse knows that which one of the following statements is true about stress and
anxiety?
A) All people handle stress in the same way.
B) Stress is a person’s reaction to anxiety.
C) Anxiety occurs when a person has trouble dealing with life situations, problems,
and goals.
D) Stress is the wear and tear that life causes on the body.
Ans: D
Feedback:
Stress is the wear and tear that life causes on the body. It occurs when a person has
difficulty dealing with life situations, problems, and goals. Each person handles stress
differently. Anxiety is a vague feeling of dread or apprehension; it is a response to
external or internal stimuli that can have behavioral, emotional, cognitive, and physical
symptoms. Anxiety is a response to stress.
3. The nursing student answers the test item correctly when identifying which one of the
following statements is true?
A) Anxiety and fear are the same.
B) Anxiety is unavoidable.
C) Anxiety is always harmful.
D) Fear is feeling threatened by an unknown entity.
Ans: B
Feedback:
Anxiety is distinguished from fear, which is feeling afraid or threatened by a clearly
identifiable external stimulus that represents danger to the person. Anxiety is
unavoidable in life and can serve many positive functions such as motivating the person
to take action to solve a problem or to resolve a crisis.
Page 2
4. The student nurse correctly identifies that which one of the following statements applies
to the parasympathetic nervous system?
A) It is activated during the alarm reaction stage.
B) It is activated during the resistance stage.
C) It is activated during the exhaustion stage.
D) It is commonly referred to as the fight, flight, or freeze response.
Ans: B
Feedback:
In the alarm reaction stage, stress stimulates the body to send messages to the
hypothalamus to the glands, which stimulates the sympathetic nervous system.
Sympathetic nerve fibers ìcharge upî the vital signs at any hint of danger to prepare the
body’s defensesófight, flight, or freeze. The adrenal glands release adrenaline
(epinephrine), which causes the body to take in more oxygen, dilate the pupils, and
increase arterial pressure and heart rate while constricting the peripheral vessels and
shunting blood from the gastrointestinal and reproductive systems and increasing
glycogenolysis to release free glucose for the heart, muscles, and central nervous
system. When the danger has passed, parasympathetic nerve fibers reverse this process
and return the body to normal operating conditions until the next sign of threat
reactivates the sympathetic nervous system. During the resistance stage of the
generalized anxiety syndrome, if the threat has ended, the parasympathetic nervous
system is stimulated and the body responses relax. If the threat persists, the body will
eventually enter the exhaustion stage when the body stores are depleted as a result of the
continual arousal of the physiologic responses and little reserve capacity.
5. The nurse plans to teach a client about dietary modifications to manage diabetes.
Teaching would be most effective if the client displayed which one of the following
characteristics?
A) Focusing only on immediate task
B) Faster rate of speech
C) Narrowed perceptual field
D) Heightened focus
Ans: D
Feedback:
Mild anxiety is associated with increased learning ability. It involves a sensation that
something is different and warrants special attention. Sensory stimulation increases and
helps the person focus attention to learn, solve problems, think, act, feel, and protect
himself or herself. Mild anxiety often motivates people to make changes or to engage in
goal-directed activity. Focusing only on immediate task, a faster rate of speech, and a
narrowed perceptual field are associated with moderate levels of anxiety.
Page 3
6. A client says to the nurse, ìI just can’t talk in front of the group. I feel like I’m going to
pass out.î The nurse assesses the client’s anxiety to be at which level?
A) Mild
B) Moderate
C) Severe
D) Panic
Ans: C
Feedback:
Physiologic responses to severe anxiety include headache, nausea, vomiting, diarrhea,
trembling, rigid stance, vertigo, pale, tachycardia, and chest pain.
7. A student is preparing to give a class presentation. A few minutes before the
presentation is to begin, the student seems nervous and distracted. The student is
looking at and listening to the peer speaker and occasionally looking at note cards.
When the peer speaker asks a question of the group, the student is able to answer
correctly. The professor understands that the student is likely experiencing which level
of stress?
A) Mild
B) Moderate
C) Severe
D) Panic
Ans: B
Feedback:
Moderate anxiety is the disturbing feeling that something is definitely wrong; the person
becomes nervous or agitated. In moderate anxiety, the person can still process
information, solve problems, and learn new things with assistance from others. He or
she has difficulty concentrating independently but can be redirected to the topic. Mild
anxiety is a sensation that something is different and warrants special attention. Sensory
stimulation increases and helps the person focus attention to learn, solve problems,
think, act, feel, and protect himself or herself. As the person progresses to severe anxiety
and panic, more primitive survival skills take over, defensive responses ensue, and
cognitive skills decrease significantly. A person with severe anxiety has trouble thinking
and reasoning.
Page 4
8. A client who suffers from frequent panic attacks describes the attack as feeling
disconnected from himself. The nurse notes in the client’s chart that the client reports
experiencing
A) hallucinations.
B) depersonalization.
C) derealization.
D) denial.
Ans: B
Feedback:
During a panic attack, the client may describe feelings of being disconnected from
himself or herself (depersonalization) or sensing that things are not real (derealization).
Denial is not admitting reality. Hallucinations involve sensing something that is not
there.
9. Which of the following statements about the use of defense mechanisms in persons with
anxiety disorders are accurate? Select all that apply.
A) Defense mechanisms are a human’s attempt to reduce anxiety.
B) Persons are usually aware when they are using defense mechanisms.
C) Defense mechanisms can be harmful when overused.
D) Defense mechanisms are cognitive distortions.
E) The use of defense mechanisms should be avoided.
F) Defense mechanisms can control the awareness of anxiety.
Ans: A, C, D, F
Feedback:
Freud described defense mechanisms as the human’s attempt to control awareness of
and to reduce anxiety. Defense mechanisms are cognitive distortions that a person uses
unconsciously to maintain a sense of being in control of a situation, to lessen
discomfort, and to deal with stress. Because defense mechanisms arise from the
unconscious, the person is unaware of using them. Some people overuse defense
mechanisms, which stops them from learning a variety of appropriate methods to
resolve anxiety-producing situations. The dependence on one or two defense
mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and
create difficulty with relationships.
Page 5
10. Which one of the following can be a positive outcome of using defense mechanisms?
A) Defense mechanisms can inhibit emotional growth.
B) Defense mechanisms can lead to poor problem-solving skills.
C) Defense mechanisms can create difficulty with relationships.
D) Defense mechanisms can help a person to reduce anxiety.
Ans: D
Feedback:
Defense mechanisms can help a person to reduce anxiety. This is the only positive
outcome of using defense mechanisms. The dependence on defense mechanisms can
inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with
relationships. These are all negative outcomes of using defense mechanisms.
11. Which of the following best explains the etiology of anxiety disorders from an
interpersonal perspective?
A) Anxiety is learned in childhood through interactions with caregivers.
B) Anxiety is learned throughout life as a response to life experiences.
C) Anxiety stems from an unconscious attempt to control awareness.
D) Anxiety results from conforming to the norms of a cultural group.
Ans: A
Feedback:
Interpersonal theory proposes that caregivers can communicate anxiety to infants or
children through inadequate nurturing, agitation when holding or handling the child, and
distorted messages. In adults, anxiety arises from the person’s need to conform to the
norms and values of his or her cultural group. Psychoanalytic theories describe reducing
anxiety through the use of defense mechanisms. Defense mechanisms are cognitive
distortions that a person uses unconsciously to maintain a sense of being in control of a
situation, to lessen discomfort, and to deal with stress.
12. Which of the following theories about anxiety is based upon intrapsychic theories?
A) A person’s innate anxiety is the stimulus for behavior.
B) Anxiety is generated from problems in interpersonal relationships.
C) A nurse can help the client to achieve health by attending to interpersonal and
physiologic needs.
D) Anxiety is learned through experiences.
Ans: A
Feedback:
Theories of anxiety can be classified as intrapsychic/psychoanalytic theories,
interpersonal theories, and behavioral theories. Freud’s intrapsychic theory views a
person’s innate anxiety as the stimulus for behavior. Interpersonal theories include
Sullivan’s theory that anxiety is generated from problems in interpersonal relationships
and Peplau’s belief that humans exist in interpersonal and physiologic realms.
Behavioral theorists view anxiety as being learned through experiences.
Page 6
13. Which of the following are interpersonal theories regarding the etiologies of major
anxiety disorders? Select all that apply.
A) Sigmund Freud’s theory
B) Henry Stack Sullivan’s theory
C) Hildegard Peplau’s theory
D) Pavlov’s theory
Ans: B, C
Feedback:
Theories of anxiety can be classified as intrapsychic/psychoanalytic theories,
interpersonal theories, and behavioral theories. Freud’s intrapsychic theory views a
person’s innate anxiety as the stimulus for behavior. Interpersonal theories include
Sullivan’s theory that anxiety is generated from problems in interpersonal relationships
and Peplau’s belief that humans exist in interpersonal and physiologic realms.
Behavioral theorists view anxiety as being learned through experiences.
14. The student nurse correctly identifies that according to Selye (1956, 1974), which stage
of reaction to stress stimulates the body to send messages from the hypothalamus to the
glands and organs to prepare for potential defense needs?
A) Resistance
B) Exhaustion
C) Alarm reaction
D) Autonomic
Ans: C
Feedback:
In the alarm reaction stage, stress stimulates the body to send messages from the
hypothalamus to the glands and organs to prepare for potential defense needs. In the
resistance stage, the digestive system reduces function to shunt blood to areas needed
for defense. The exhaustion stage occurs when the person has responded negatively to
anxiety and stress. There is no autonomic stage.
15. A nurse is working with a client to develop assertive communication skills. The nurse
documents achievement of treatment outcomes when the client makes a statement such
as,
A) ìI’m sorry. I’m not picking this up very quickly.î
B) ìI feel upset when you interrupt me.î
C) ìYou are pushing me too hard.î
D) ìI’m not going to let people push me around anymore.î
Ans: B
Feedback:
Assertiveness training helps the person take more control over life situations.
Techniques help the person negotiate interpersonal situations and foster self- assurance.
They involve using ìIî statements to identify feelings and to communicate concerns or
needs to others.
Page 7
16. A client experiences panic attacks when confronted with riding in elevators. The
therapist is teaching the client ways to relax while incrementally exposing the client to
getting on an elevator. This technique is called
A) systematic desensitization.
B) flooding.
C) cognitive restructuring.
D) exposure therapy.
Ans: A
Feedback:
One behavioral therapy often used to treat phobias is systematic (serial) desensitization,
in which the therapist progressively exposes the client to the threatening object in a safe
setting until the client’s anxiety decreases. Flooding is a form of rapid desensitization in
which a behavioral therapist confronts the client with the phobic object (either a picture
or the actual object) until it no longer produces anxiety. Cognitive restructuring involves
challenging the client’s irrational beliefs. Exposure therapy is similar to flooding.
17. Which techniques would be most effective for a client who has situational phobias?
Select all that apply.
A) Flooding
B) Reminding the person to calm down
C) Systematic desensitization
D) Assertiveness training
E) Decatastrophizing
Ans: A, C
Feedback:
Systematic desensitization is when the therapist progressively exposes the client to a
threatening object in a safe setting until the client’s anxiety decreases. Flooding is a form
of rapid desensitization in which the behavior therapist confronts the client with the
phobic object until it no longer produces anxiety. Systematic desensitization and
flooding are behavioral therapies used in the treatment of phobias. Assertiveness
training would help the person to take more control over life situations.
Decatastrophizing helps the client to realistically appraise the situation. These are both
used for general anxiety. When a person is exposed to a phobic object, the person is not
likely in control. Reminding a person to calm down is not at all an effective way to
manage anxiety.
Page 8
18. A client is currently experiencing a panic attack. Which of the following is the most
appropriate response by the nurse?
A) ìJust try to relax.î
B) ìThere is nothing here to harm you.î
C) ìYou are safe. Take a deep breath.î
D) ìWhat are you feeling right now?î
Ans: C
Feedback:
Nursing interventions for panic disorder include providing a safe environment and
ensuring the client’s privacy during a panic attack, remaining with the client during a
panic attack, helping the client to focus on deep breathing, talking to the client in a
calm, reassuring voice, teaching the client to use relaxation techniques, helping the
client to use cognitive restructuring techniques, and the engaging client to explore how
to decrease stressors and anxiety-provoking situations.
19. A client states, ìI will just die if I don’t get this job.î The nurse then asks the client,
ìWhat will be the worst that will happen if you don’t get the job?î The nurse is using this
response to
A) appraise his situation more realistically.
B) assist the client to make alternative plans for the future.
C) assess if the client has health problems compounded by stress.
D) clarify the client’s meaning.
Ans: A
Feedback:
Decatastrophizing involves the therapist’s use of questions to more realistically appraise
the situation. The therapist may ask, ìWhat is the worst that could happen? Is that
likely? Could you survive that? Is that as bad as you imagine?î
Page 9
20. Which of the following statements about the assessment of persons with anxiety and
anxiety disorders is most accurate?
A) When an elder person has an onset of anxiety for the first time in his or her life, it
is possible that the anxiety is associated with another condition.
B) Panic attacks are the most common late-life anxiety disorders.
C) An elder person with anxiety may be experiencing ruminative thoughts.
D) Agoraphobia that occurs in late life may be related to trauma experienced or
anticipated.
Ans: A
Feedback:
Anxiety that starts for the first time in late life is frequently associated with another
condition such as depression, dementia, physical illness, or medication toxicity or
withdrawal. Phobias, particularly agoraphobia, and GAD are the most common late-life
anxiety disorders. Most people with late-onset agoraphobia attribute the start of the
disorder to the abrupt onset of a physical illness or as a response to a traumatic event
such as a fall or mugging. Ruminative thoughts are common in late-life depression and
can take the form of obsessions such as contamination fears, pathologic doubt, or fear of
harming others.
21. The nurse enters the client’s room and finds the client anxiously pacing the floor. The
client begins shouting at the nurse, ìGet out of my room!î The best intervention by the
nurse would be to
A) approach the client and ask, ìWhat’s wrong?î
B) call for help and say, ìCalm down.î
C) turn and walk away from the room without saying anything.
D) stand at the doorway and say, ìYou seem upset.î
Ans: D
Feedback:
Staying with the client while allowing personal space is an important and safe
intervention; this therapeutic communication technique is designed to get the client to
communicate feelings. It may not be safe for the nurse to approach the client. Help is
not needed at this time, and saying, ìCalm down,î is not effective. Turning and walking
away from the client may seem like rejection and may worsen the client’s anxiety as
well as damage the nurseñclient relationship.
Page 10
22. Which of the following are cognitiveñbehavioral therapy techniques that may be used
effectively with anxious clients? Select all that apply.
A) Positive reframing
B) Decatastrophizing
C) Assertiveness training
D) Humor
E) Unlearning
Ans: A, B, C, E
Feedback:
Positive reframing means turning negative messages into positive messages.
Decatastrophizing involves the therapist’s use of questions to more realistically appraise
the situation. Assertiveness training helps the person take more control over life
situations. Positive reframing, decatastrophizing, and assertiveness training are
cognitiveñbehavioral therapy techniques. Humor is not a cognitiveñbehavioral therapy
technique. Unlearning is the theory underlying behavioral therapy.
23. The nurse is teaching about postoperative wound care. As the wound is uncovered, the
client begins mumbling, breathing rapidly, and trying to get out of bed, and the client
does not respond when the nurse calls his name. Which of the following should be the
nurse’s first action?
A) Ask the client to describe his feelings.
B) Proceed with wound care quickly.
C) Replace the dressing on the wound.
D) Get the assistance of another nurse.
Ans: C
Feedback:
The client has severe anxiety; the priority is to lower the client’s anxiety level. The first
action should be to replace the dressing on the wound to decrease the client’s level of
anxiety and to prevent contamination of the wound before a new dressing can be
applied. The other choices could be done after replacing the dressing on the wound.
24. The nursing student understands correctly when identifying which objective is
appropriate for all clients with anxiety disorders?
A) The client will experience reduced anxiety and accept the fact that underlying
conflicts cannot be treated.
B) The client will experience reduced anxiety and develop alternative responses to
anxiety-provoking situations.
C) The client will experience reduced anxiety and learn to control primitive impulses.
D) The client will experience reduced anxiety and strive for insight through
psychoanalysis.
Ans: B
Feedback:
A primary client outcome is improved adaptive coping skills.
Page 11
25. When a client is experiencing a panic attack while in the recreation room, what
interventions are the nurse’s first priorities? Select all that apply.
A) Provide a safe environment.
B) Request a prescription for an antianxiety agent.
C) Offer the client therapy to calm down
D) Ensure the client’s privacy.
E) Engage the client in recreational activities.
Ans: A, D
Feedback:
During a panic attack, the nurse’s first concern is to provide a safe environment and to
ensure the client’s privacy. If the environment is overstimulating, the client should move
to a less stimulating place. Decreasing external stimuli will help lower the client’s
anxiety level. The client’s safety is priority. Anxious behavior can be escalated by
external stimuli. In a large area, the client can feel lost and panicked, but a smaller room
can enhance a sense of security. An antianxiety agent may be helpful, but it is not the
priority. It would likely be stimulating to engage the client in recreational activities.
26. A client is learning to cope with anxiety and stress. The expected outcome is that the
client will
A) change reactions to stressors.
B) ignore situations that cause stress.
C) limit major stressors in his or her life.
D) avoid anxiety at all costs.
Ans: A
Feedback:
Stress and anxiety in life are unavoidable; managing the effects of stress is a reasonable
goal for treatment. It is not possible or desirable to avoid anxiety at all costs as anxiety
is a warning that the client is not dealing with stress effectively. Learning to heed this
warning and to make needed changes is a healthy way to deal with the stress of daily
events.
27. A client asks the nurse, ìWhy do I have to go to counseling? Why can’t I just take
medications?î The best response by the nurse would be,
A) ìBoth therapies are effective. You can eventually choose one or the other.î
B) ìYou cannot get the full effect of your medications without cognitive therapy as
well.î
C) ìAs soon as your medications reach therapeutic level, you can omit the therapy.î
D) ìMedications combined with therapy help you change how well you function.î
Ans: D
Feedback:
Treatment for anxiety disorders usually involves medication and therapy. This
combination produces better results than either one alone.
Page 12
28. A client asks how his prescribed alprazolam (Xanax) helps his anxiety disorder. The
nurse explains that antianxiety medications such as alprazolam affect the function of
which neurotransmitter that is believed to be dysfunctional in anxiety disorders?
A) Serotonin
B) Norepinephrine
C) GABA
D) Dopamine
Ans: C
Feedback:
Gamma-aminobutyric acid (GABA) is the amino acid neurotransmitter believed to be
dysfunctional in anxiety disorders. GABA reduces anxiety, and norepinephrine
increases it; researchers believe that a problem with the regulation of these
neurotransmitters occurs in anxiety disorders. Serotonin is usually implicated in
psychosis and mood disorders. Dopamine is indicated in psychosis.
29. The nurse is teaching a client with an anxiety disorder ways to manage anxiety. The
nurse suggests which of the following schedules for practicing stress management
techniques?
A) Practice the techniques each morning and night as part of a daily routine.
B) Use the techniques as needed when experiencing severe anxiety.
C) Practice the techniques when relatively calm.
D) Expect to practice the techniques when meeting with a therapist.
Ans: C
Feedback:
The nurse can teach the client relaxation techniques to use when he or she is
experiencing stress or anxiety, including deep breathing, guided imagery and
progressive relaxation, and cognitive restructuring techniques. For any of these
techniques, it is important for the client to learn and to practice them when he or she is
relatively calm.
Page 13
30. The nurse is educating a client and family about managing panic attacks after discharge
from treatment. The nurse includes which of the following in the discharge teaching?
Select all that apply.
A) Continued development of positive coping skills
B) Weaning off of medications as necessary
C) Lessening the amount of daily responsibilities
D) Continued practice of relaxation techniques
E) Development of a regular exercise program
Ans: A, D, E
Feedback:
Client/family education for panic disorder includes reviewing breathing control and
relaxation techniques, discussing positive coping strategies, encouraging regular
exercise, emphasizing the importance of maintaining prescribed medication regimen and
regular follow-up, describing time management techniques such as creating ìto doî lists
with realistic estimated deadlines for each activity, crossing off completed items for a
sense of accomplishment, saying ìno,î and stressing the importance of maintaining
contact with community and participating in supportive organizations. Medication
should be adhered to as prescribed. Daily responsibilities cannot be avoided, rather
should be successfully accomplished.
31. When teaching a client with generalized anxiety disorder, which is the highest priority
for the nurse to teach the client to avoid?
A) Caffeine
B) High-fat foods
C) Refined sugars
D) Sodium
Ans: A
Feedback:
The effects of caffeine are similar to some anxiety symptoms, and, therefore, caffeine
ingestion will worsen anxiety. The other types of foods are also potentially harmful to
physical as well as psychological health, but the worst offender is caffeine.
Page 14
32. An anxiolytic agent, lorazepam (Ativan), has been prescribed for the client. Which of
the following statements by the client would indicate to the nurse that client education
about this medication has been effective?
A) ìMy anxiety will be eliminated if I take this medication as prescribed.î
B) ìThis medication presents no risk of addiction or dependence.î
C) ìI will probably always need to take this medication for my anxiety.î
D) ìThis medication will relax me, so I can focus on problem solving.î
Ans: D
Feedback:
Anxiolytics are designed for short-term use to relieve anxiety. These drugs are designed
to relieve anxiety so that the person can deal more effectively with whatever crisis or
situation is causing stress. Benzodiazepines have a tendency to cause dependence.
Clients need to know that antianxiety agents are aimed at relieving symptoms such as
anxiety but do not treat the underlying problems that cause the anxiety.
33. Which of the following would be key points for the nurse to remember when working
with persons who are suffering from anxiety disorders?
A) It is important for the nurse to ìfixî the client’s problems.
B) Remember to practice techniques to manage stress and anxiety in your own life.
C) If you have any uncomfortable feelings, do not tell anyone about them.
D) Remember that only people who suffer from anxiety disorders have stress that can
interfere with daily life and work.
Ans: B
Feedback:
It is critical for the nurse to remember to practice techniques to manage stress and
anxiety in his or her own life. Remember that everyone occasionally suffers from stress
and anxiety that can interfere with daily life and work. It is important for the nurse to
avoid falling into the pitfall of trying to ìfixî the client’s problems. It is important that
the nurse should discuss any uncomfortable feelings with a more experienced nurse for
suggestions on how to deal with his or her feelings toward these clients.
Page 15
34. Which of the following are reasons that the nurse must understand why and how anxiety
behaviors work? Select all that apply.
A) To provide better care for the client
B) To help understand the role anxiety plays in performing nursing responsibilities
C) To help the nurse to mask his or her own feelings of anxiety
D) So the nurse can identify that his or her own needs are more important than the
clients
E) To help nurses to function at a high level
Ans: A, B, E
Feedback:
Nurses must understand why and how anxiety behaviors work, not just for client care
but to help understand the role anxiety plays in performing nursing responsibilities.
Nurses are expected to function at a high level and to avoid allowing their own feelings
and needs to hinder the care of their clients, but as emotional beings, nurses are just as
vulnerable to stress and anxiety as others, and they have needs of their own.

 

chapter 24

Page 1
1. During the change of shift report in the intensive care unit, the nurse learns that a client
has developed signs of delirium over the past 8 hours. Which behavior documented in
the nursing notes would be consistent with delirium?
A) Unable to identify a water pitcher
B) Unable to transfer to sitting position
C) Difficulty with verbal expression
D) Disoriented to person
Ans: D
Feedback:
Delirium usually develops over a short period, sometimes a matter of hours, and
fluctuates, or changes, throughout the course of the day. Clients with delirium have
difficulty paying attention, are easily distracted and disoriented, and may have sensory
disturbances such as illusions, misinterpretations, or hallucinations. Dementia symptoms
include aphasia (deterioration of language function), apraxia (impaired ability to execute
motor functions despite intact motor abilities), and agnosia (inability to recognize or
name objects despite intact sensory abilities).
2. A nurse working in an assisted living facility is holding an in-service for the nursing
assistants. The nurse reviews common behaviors associated with cognitive deterioration
associated with dementia. Which would cause the nurse to know that the assistants
correctly understood if it were expressed during a posttest?
A) The clients should be able to ask us for items they need.
B) The clients may not recognize their family when they come to visit.
C) The clients who are ambulatory can still carry out activities of daily living
independently.
D) The clients should know when to come to the dining room for meals.
Ans: B
Feedback:
Dementia is a mental disorder that involves multiple cognitive deficits, primarily
memory impairment, and at least one of the following cognitive disturbances: (1)
aphasia, which is deterioration of language function; (2) apraxia, which is impaired
ability to execute motor functions despite intact motor abilities; (3) agnosia, which is
inability to recognize or name objects despite intact sensory abilities; and (4)
disturbance in executive functioning, which is the ability to think abstractly and to plan,
initiate, sequence, monitor, and stop complex behavior.
Page 2
3. Which is believed to be a risk factor specific to the development of delirium?
A) Increased severity of physical illness
B) Older age
C) Baseline cognitive impairment
D) Gradual decline in functioning
Ans: A
Feedback:
An estimated 10% to 15% of people in the hospital for general medical conditions are
delirious at any given time. Onset is sudden. Delirium is common in older, acutely ill
clients. Risk factors for delirium include increased severity of physical illness, older
age, and baseline cognitive impairment such as that seen in dementia. Children may be
more susceptible to delirium, especially that related to a febrile illness or certain
medications such as anticholinergics. Delirium usually develops over a short period,
sometimes a matter of hours, and fluctuates, or changes, throughout the course of a day.
Prevalence of dementia also rises with age, and progression is gradual.
4. Which patient is most likely suffering from dementia?
A) A 90-year-old male who has experienced progressive mental decline that started
with forgetfulness
B) An 80-year-old female who has been in excellent health until she was admitted
through the emergency department with a severe urinary tract infection and is now
very anxious and is threatening staff
C) A 6-year-old child who has just been administered conscious sedation for a closed
reduction of a fractured wrist and says that her parents have three sets of eyes
D) A 22-year-old male who was involved in a motorcycle crash without wearing a
helmet now unable to remember where he is
Ans: A
Feedback:
Memory impairment is the prominent early sign of dementia. The course of dementia is
usually progressive. A 90-year-old gentleman who has experienced progressive mental
decline that started with forgetfulness is most likely suffering from dementia. An 80-
year-old lady who has been in excellent health until she was admitted through the
emergency department with a severe urinary tract infection is likely experiencing
delirium. Delirium almost always results from an identifiable physiologic, metabolic, or
cerebral disturbance or from drug intoxication or withdrawal. The 6-year-old who has
just been administered conscious sedation is likely delirious. A 22-year-old male who
was involved in a motorcycle crash without wearing a helmet and now cannot remember
where he is likely experiencing an amnestic disorder.
Page 3
5. A client with dementia is unable to recognize ordinary objects, such as a pen or
notebook. Which would this be a symptom of?
A) Agnosia
B) Amnesia
C) Apraxia
D) Aphasia
Ans: A
Feedback:
Agnosia is the inability to recognize familiar objects. Amnesia is failure to remember
past events. Apraxia is impairment in the ability to execute motor functions despite
intact motor abilities. Aphasia is a deterioration of language function.
6. Which client would have an increased risk for delirium?
A) An elderly woman with abdominal pain
B) A 3-year-old child with a temperature of 103.2∞F
C) A middle-aged woman newly diagnosed with multiple sclerosis
D) A young adult male with gastroenteritis and dehydration
Ans: B
Feedback:
Young children with high fever are at risk for delirium. The other choices would not be
the most likely candidates for increased risk for delirium.
7. The nurse is caring for a client with cognitive impairment. To determine whether the
client is suffering from delirium or dementia, the nurse reviews the symptoms and
course of each disorder. Place the letter ìAî beside terms describing delirium and the
letter ìBî beside terms describing dementia.
____ Rapid onset
____ Progressive decline
____ Long-term memory impairment
____ Slurred speech
____ Hallucinations
Ans: A, B, B, A, A
Feedback:
Onset of delirium is rapid, but of dementia is gradual. Duration of delirium is brief, but
of dementia is progressing. Delirium affects only short-term memory. Dementia begins
with short-term memory loss and progresses to long-term memory loss. Slurred speech
is characteristic of delirium. Speech with dementia is unchanged until the client begins
to develop aphasia. Visual and tactile hallucinations are common with delirium, but
rarely experienced with dementia.
Page 4
8. The daughter of a woman with dementia asks the nurse if her mother will ever be able to
live independently again. Which would be the most appropriate response by the nurse?
A) ìYou sound like you aren’t ready for her to be dependent on caregivers.î
B) ìHer confusion is a temporary complication of her physical illness and should
subside when the illness gets better.î
C) ìSymptoms of dementia gradually get worse. Unfortunately she will not be
independent again.î
D) ìWith early treatment, mild dementia can be reversed. It may be possible.î
Ans: C
Feedback:
The prognosis for dementia involves progressive deterioration of physical and mental
abilities until death. Typically, in the later stages, clients have minimal cognitive and
motor function, are totally dependent on caregivers, and are unaware of their
surroundings or people in the environment. They may be totally uncommunicative or
make unintelligible sounds or attempts to verbalize. Delirium secondary to physical
illness will subside with physical recovery.
9. Which statement made by the nurse would be most appropriate to an 89-year-old patient
who is confused but has no history of dementia and is hospitalized for an acute urinary
tract infection?
A) ìYou are likely to become progressively more confused now.î
B) ìThis should be just a temporary situation.î
C) ìDon’t worry about it; everyone is confused when they are in the hospital.î
D) ìI know things are upsetting and confusing right now, but your confusion should
clear as you get better.î
Ans: D
Feedback:
ìI know things are upsetting and confusing right now, but your confusion should clear as
you get better,î would be validating and giving information and would provide realistic
reassurance to the client who has delirium as this is often an acute and temporary
situation in elderly people who are acutely ill and have other risk factors such as
medications and illness and age. ìYou are likely to become progressively more confused
now,î is inaccurate as the person likely has delirium, and this will be an acute and
temporary situation. ìThis should be just a temporary situationî provides some
reassurance but no validation. ìDon’t worry about it; everyone is confused when they are
in the hospitalî is inaccurate.
Page 5
10. Which distinguishes delirium from dementia?
A) Delirium has an acute onset and is progressive in course.
B) Delirium has a gradual onset and can be resolved.
C) Dementia has a gradual onset and is progressive in course.
D) Dementia has an acute onset and can be resolved.
Ans: C
Feedback:
Delirium has a sudden onset, and the underlying cause is treatable; by contrast,
dementia has a gradual onset and is progressive rather than treatable.
11. The nurse is performing a health history with a client exhibiting signs of delirium. The
nurse asks the client and family members about possible causes of the delirious state.
Which would the nurse likely attribute as underlying causes for the client’s delirium?
Select all that apply.
A) Recent alcohol use
B) Dehydration
C) Use of antihistamines
D) Sleep disturbances
E) Use of megadoses of vitamins
F) Exposure to paint or gasoline
Ans: A, B, C, D, F
Feedback:
Because the causes of delirium are often related to medical illness, alcohol, or other
drugs, the nurse obtains a thorough history of these areas. The nurse may need to obtain
information from family members if a client’s ability to provide accurate data is
impaired. Information about drugs should include prescribed medications, alcohol, illicit
drugs, and over-the-counter medications. Physiologic or metabolic causes include
hypoxemia, electrolyte disturbances, renal or hepatic failure, hypoglycemia or
hyperglycemia, dehydration, sleep deprivation, thyroid or glucocorticoid disturbances,
thiamine or vitamin B12 deficiency, vitamin C, niacin, or protein deficiency,
cardiovascular shock, brain tumor, head injury, and exposure to gasoline, paint solvents,
insecticides, and related substances. Infectious processes include sepsis, urinary tract
infection, pneumonia, meningitis, encephalitis, HIV, and syphilis.
Page 6
12. A client voluntarily admitted to the inpatient psychiatric unit is currently experiencing
mild delirium. The client approaches the nurse and states, ìI’m going to take walk
outside. I’ll be back in about 10 minutes.î Which is the most appropriate nursing action?
A) Further assess the client’s motives for wanting to walk.
B) Give the client permission to go on a walk on the grounds.
C) Tell the client the walk is not allowed and restrict him to the unit.
D) Designate a staff member to accompany the client on the walk.
Ans: D
Feedback:
The nurse teaches clients to request assistance for activities such as getting out of bed or
going to the bathroom. If clients cannot request assistance, they require close
supervision to prevent them from attempting activities they cannot perform safely alone.
The nurse responds promptly to calls from clients for assistance and checks clients at
frequent intervals.
13. A client with dementia is starting pharmacotherapy to slow the progression of cognitive
decline. The client has a history of moderate but steady alcohol use over the past 45
years. Which medication should the nurse question as least suitable for this client?
A) Tacrine (Cognex)
B) Memantine (Namenda)
C) Donepezil (Aricept)
D) Rivastigmine (Exelon)
Ans: A
Feedback:
Tacrine (Cognex) is a cholinesterase inhibitor; however, it elevates liver enzymes in
about 50% of clients using it. Lab tests to assess liver function are necessary every 1 to
2 weeks; therefore, tacrine is rarely prescribed. Memantine (Namenda) is an NMDA
receptor antagonist that can slow the progression of Alzheimer’s in the moderate or
severe stages. Donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl)
are cholinesterase inhibitors and have shown modest therapeutic effects and temporarily
slow the progress of dementia.
Page 7
14. The nursing supervisor in an extended care facility is managing the environment to best
help the clients with dementia. Which should the nurse include in planning the living
environment?
A) Plan for the same caregivers to provide care to individuals as much as possible.
B) Open the windows and doors to allow fresh air to circulate through the
environment.
C) Provide a buffet-style menu with many food choices.
D) Assign peer-led exercise activates on a daily basis.
Ans: A
Feedback:
A structured environment and established routines can reassure clients with dementia.
Familiar surroundings and routines help to eliminate some confusion and frustration
from memory loss. Providing the same caregiver establishes familiarity and routine.
Safety considerations involve protecting against injury, meeting physiologic needs, and
managing risks posed by the environment. Open doors pose a safety risk of wandering
away. Buffet-style meals require the client to make too many choices, thus adding to
frustration. The nurse encourages clients to engage in physical activity because they
may not initiate such activities independently; many clients tend to become sedentary as
cognitive abilities diminish. Clients often are quite willing to participate in physical
activities but cannot initiate, plan, or carry out those activities without assistance.
15. The nurse encourages the client with dementia to meet nutritional needs. Which is the
best approach to assist in meeting adequate dietary intake?
A) Sit with the client as long as necessary to complete the meal.
B) Provide entertainment during meals such as television or music.
C) Avoid between-meal snacks to encourage appetite.
D) Serve meals in small, bite-size pieces.
Ans: D
Feedback:
Clients may eat poorly because of limited appetite or distraction at mealtimes. The nurse
addresses this problem by providing foods clients like, sitting with clients at meals to
provide cues to continue eating, having nutritious snacks available whenever clients are
hungry, and minimizing noise and undue distraction at mealtimes. Clients who have
difficulty manipulating utensils may be unable to cut meat or other foods into bite-sized
pieces. The food should be cut up when it is prepared, not in front of clients, to deflect
attention from their inability to do so. Food that can be eaten without utensils, or finger
foods such as sandwiches and fresh fruits, may be best.
Page 8
16. The nurse caring for an elderly woman with dementia has asked the woman’s children to
bring old photo albums when they visit. Which best describes the usefulness of viewing
photos when caring for the dementia client?
A) Viewing photos is a form of reminiscence therapy for the client.
B) Sharing photos will encourage interaction with other clients.
C) This can help the children to correctly identify old photographs.
D) Talking about the photos will encourage the client to live in the past.
Ans: A
Feedback:
Reminiscence therapy (thinking about or relating personally significant past
experiences) is an effective intervention for clients with dementia. Rather than
lamenting that the client is ìliving in the past,î this therapy encourages family and
caregivers also to reminisce with the client. Reminiscing uses the client’s remote
memory, which is not affected as severely or quickly as recent or immediate memory.
Photo albums may be useful in stimulating remote memory, and they provide a focus on
the client’s past.
17. The nurse is encouraging a group of clients with dementia to join in upper body range of
motion exercises using light dumbbells. Which technique will most likely result in the
greatest amount of participation?
A) Show an instructional video just prior to the activity.
B) Describe the exercise immediately before performing it.
C) Demonstrate the exercises while clients simultaneously perform them.
D) Perform the same routine daily to avoid the need for repeated instruction.
Ans: C
Feedback:
The nurse encourages clients to engage in physical activity because they may not initiate
such activities independently; many clients tend to become sedentary as cognitive
abilities diminish. Clients often are quite willing to participate in physical activities but
cannot initiate, plan, or carry out those activities without assistance.
Page 9
18. A client with dementia gets angry and begins to yell at the nurse during mealtime. The
nurse leaves the client’s side for 5 to 10 minutes and then returns. Which of the
following best explains the nurse’s behavior?
A) The nurse was unsure of how to calm the client.
B) The nurse was frustrated and needed to take a ìtime-out.î
C) The nurse gave the client a chance to calm down before resuming the meal.
D) The nurse stepped away to verify the safety of other clients.
Ans: C
Feedback:
Time away involves leaving clients for a short period and then returning to them to
reengage in interaction. For example, the client may get angry and yell at the nurse for
no discernible reason. The nurse can leave the client for about 5 or 10 minutes and then
return without referring to the previous outburst. The client may have little or no
memory of the incident and may be pleased to see the nurse on his or her return.
19. Which is the most effective intervention for clients with delirium?
A) Giving detailed explanations
B) Managing environmental stimuli
C) Promoting rest with PRN medications
D) Providing activities for distraction
Ans: B
Feedback:
Clients with delirium become overstimulated easily; their ability to process
environmental stimuli is impaired.
20. The nurse is assessing a client with early signs of dementia. What is the nurse trying to
determine when the nurse asks the client what he ate for breakfast that morning?
A) Orientation
B) Food preferences
C) Recent memory
D) Remote memory
Ans: C
Feedback:
The initial sign of dementia is memory loss for recent events that exceeds normal
forgetfulness. Asking what the client ate for breakfast is not determining orientation,
food preferences, or remote memory.
Page 10
21. The nurse is working with a client who has hallucinations and delusions. The client tells
the nurse she cannot take a shower because she is waiting for her husband to take her
home. Which response by the nurse is best in this situation?
A) ìIt would be best if you just took your shower now.î
B) ìYou seem anxious and upset.î
C) ìYou have plenty of time to shower before it’s time to go home.î
D) ìWhy are you thinking you’re going home?î
Ans: C
Feedback:
This is an example of going along with, rather than correcting, the client’s misperception
so that she can get on with her daily activities and not focus on being upset about not
going home. The other choices are not the best responses in this situation.
22. The nurse is caring for a client with Alzheimer’s disease. The nurse observes that the
client’s pacing and mumbling to himself increase at mealtime and shift change. Which
intervention should the nurse implement first?
A) Administer an antianxiety drug such as lorazepam (Ativan) at these times.
B) Explain the unit routine and the reasons for increased activity to the client.
C) Keep unit activity to a minimum.
D) Move the client to a quieter area during these times.
Ans: D
Feedback:
The nurse must alter the environment because the client will not learn new coping skills
for frustrating or overly stimulating situations. Administering an antianxiety agent or
explaining the routine of the unit and reasons for increased activity to the client may be
done but would not be the initial intervention. The unit activity does not need to be kept
to a minimum.
23. The nurse is developing interventions to promote socialization in a client with moderate
dementia. Which would provide a safe and secure environment for the client?
A) A card game with other clients
B) An activity with the nurse
C) Decorating a bulletin board with the group
D) Morning stretch group with music
Ans: B
Feedback:
The client has to interact only with the nurse, who will behave in a predictable way and
will focus on the client’s needs, without undue or unexpected disruptions. Group
activities do not provide a safe and secure environment like an activity done with the
nurse does.
Page 11
24. The daughter of a client with dementia has been the primary caregiver for 5 months. The
daughter expresses to the nurse, ìAt times it is so overwhelming! I feel I do not have a
life anymore!î Which is the most helpful response by the nurse?
A) ìAre you saying you don’t want to care for your mother anymore?î
B) ìI know it is really hard. It takes a lot of work and you are doing such a good job.î
C) ìYour mother really appreciates what you do for her. You are the best one to care
for her.î
D) ìHere is the number of a caregivers’ support group. How do you think you would
feel talking with others in the same situation?î
Ans: D
Feedback:
Caregivers need outlets for dealing with their own feelings. Support groups can help
them to express frustration, sadness, anger, guilt, or ambivalence; all these feelings are
common. Attending a support group regularly also means that caregivers have time with
people who understand the many demands of caring for a family member with
dementia. The client’s physician can provide information about support groups, and the
local chapter of the National Alzheimer’s Disease Association is listed in the phone
book. Area hospitals and public health agencies also can help caregivers to locate
community resources. The nurse should understand that the caregiver is asking for help
when expressing frustration. The nurse should not dismiss the caregiver’s feelings or in
any way induce additional guilt.
Page 12
25. Which statement by the nurse would be most appropriate to the family member who is
the primary caregiver to a client with dementia?
A) ìMost people seek help when they really need it.î
B) ìWhat is wrong with your family? Can’t they see you need help?î
C) ìYou should be grateful that you still have your family member around.î
D) ìYes, it is important for you to spend some time relaxing and doing what you like
to do. This will help you to be better prepared to manage the demands of the
caregiver role.î
Ans: D
Feedback:
Caregivers need support to maintain personal lives. They need to continue to socialize
with friends and to engage in leisure activities or hobbies rather than focus solely on the
client’s care. Caregivers who are rested, are happy, and have met their own needs are
better prepared to manage the rigorous demands of the caregiver role. Most caregivers
need to be reminded to take care of themselves; this act is not selfish but really is in the
client’s best long-term interests. Many times caregivers will say they will seek help
when they really need it. However, they must maintain their own well-being and not
wait until they are exhausted before seeking relief. The primary caregiver may believe
other family members should volunteer to help without being asked, but other family
members may believe that the primary caregiver chose to take on the responsibility and
do not feel obligated to help out regularly. It is important for the family to express their
feelings and ideas and to participate in caregiving according to their own expectations.
Many families need assistance to reach this type of compromise. Asking the caregiver
what is wrong with his or her family and pointing out that the caregiver needs help are
not helpful to the caregiver. It would be better for the nurse to encourage family
members to share their feelings and to compromise for the best interests of the client.
Telling the caregiver that he or she should be grateful will only increase the caregiver’s
sense of guilt, which is not productive.
26. A client with moderate Alzheimer’s disease is living with her grown daughter. Which
statement by the daughter would indicate the need for intervention by the nurse?
A) ìIt’s distressing when my mother forgets my name.î
B) ìI wish my sister would come to visit more often.î
C) ìMother won’t let anyone else do anything for her.î
D) ìTaking care of my mother is a big responsibility.î
Ans: C
Feedback:
When the caregiver feels as though no one else can provide care, the risk for role strain
is markedly increased. The other choices do not require intervention by the nurse.
Page 13
27. A nurse is educating a group of elderly community members about cognitive disorders.
Which would the nurse include as a measure most likely to prevent Alzheimer’s disease
and other dementias?
A) Crafts
B) Cooking
C) Watching television
D) Reading
Ans: D
Feedback:
People who regularly participate in brain-stimulating activities such as reading books
and newspapers or doing crossword puzzles are less likely to develop Alzheimer’s
disease than those who do not. Engaging in leisure-time physical activity during midlife
and having a large social network are associated with a decreased risk for Alzheimer’s
disease in later life.
28. The caregiver of a client with Alzheimer’s disease reports to the nurse that often the
client will suddenly become angry during meals and nothing seems to calm him down.
The nurse teaches the caregiver to use distraction techniques. Which response would be
best to teach as an example of this technique?
A) ìLet’s look at what is on television.î
B) ìIf you stop yelling, I will get your dessert.î
C) ìDon’t you want to finish your meal?î
D) ìI don’t understand what you are saying.î
Ans: A
Feedback:
Distraction involves shifting the client’s attention and energy to a more neutral topic.
For example, the client may display a catastrophic reaction to the current situation, such
as jumping up from dinner and saying, ìMy food tastes like poison!î The nurse might
intervene with distraction by saying, ìCan you come to the kitchen with me and find
something you’d like to eat?î or ìYou can leave that food. Can you come and help me
find a good program on television?î (redirection/distraction). Influencing behavior with
a reward is a behavioral technique. Asking a direct question is ineffective. Clarification
is used to try to determine meaning behind the client’s message.
Page 14
29. The adult son of a client with dementia asks the nurse how he should respond when his
mother repeatedly says she has had a busy day at work. The mother has not worked in
over 20 years. Which is the best guidance that the nurse could offer?
A) Ask her to explain what she did at work today that kept her busy.
B) Go along with her thought of it having been a busy day, but do not refer to her
work.
C) Reorient her that she is at home and did not go to work.
D) Give her 5 to 10 minutes of rest, and she will have no memory of the incident.
Ans: B
Feedback:
Going along means providing emotional reassurance to clients without correcting their
misperception or delusion. The nurse does not engage in delusional ideas or reinforce
them, but he or she does not deny or confront their existence. For example, a client is
fretful, repeatedly saying, ìI’m so worried about the children. I hope they’re okayî and
speaking as though his adult children were small and needed protection. The nurse could
reassure the client by saying, ìThere’s no need to worry; the children are just fineî (going
along). Time away is an effective technique for aggression.
30. The grown daughter of a woman with Alzheimer’s disease reports to the nurse that she is
trying to keep her mother’s condition from worsening by asking her questions whenever
they are together. Which will be accomplished by this intervention?
A) Decrease environmental misinterpretation
B) Improve memory retention
C) Increase frustration
D) Slow the progress of the disease
Ans: C
Feedback:
Alzheimer’s disease is progressive; clients do not learn new information, and they
become frustrated when asked to perform tasks they are not capable of doing.
Page 15
31. A new nurse has been working with clients with Alzheimer’s disease for almost 6
months. During a staff meeting, the nurse expresses frustration because the same
instructions have to be given to clients on a daily basis. The nurse states, ìI feel like all
my work doesn’t do them any good.î Which should the nurse’s supervisor encourage the
nurse to do?
A) Cease giving instructions because the clients will not remember them anyway.
B) Try to stay supportive and meet the clients’ needs at the current moment.
C) Seek counseling if personal feelings get in the way of client care.
D) Consider transferring to a different client care specialty area.
Ans: B
Feedback:
Teaching is a fundamental role for nurses, but teaching clients who have dementia can
be especially challenging and frustrating. These clients do not retain explanations or
instructions, so the nurse must repeat the same things continually.
The nurse must be careful not to lose patience and not to give up on these clients.
Discussing these frustrations with others can help the nurse to avoid conveying negative
feelings to clients and families or experiencing professional and personal burnout. The
nurse must remain positive and supportive to clients and family.
Page 16
32. Which are possible sources of frustrations for nurses caring for persons with dementia?
Select all that apply.
A) The clients do not retain explanations or instructions, so the nurse must repeat the
same things continually.
B) The nurse may get little or no positive response or feedback from clients with
dementia.
C) It can be difficult to remain positive and supportive to clients and family because
the outcome is so bleak.
D) It can be helpful for the nurse to talk to colleagues or even a counselor about
personal feelings of depression and grief as the dementia progresses.
E) The clients may seem not to hear or respond to anything the nurse does.
Ans: A, B, C, E
Feedback:
Working with and caring for clients with dementia can be exhausting and frustrating for
both the nurse and caregiver. Teaching is a fundamental role for nurses, but teaching
clients who have dementia can be especially challenging and frustrating. These clients
do not retain explanations or instructions, so the nurse must repeat the same things
continuously. The nurse may begin to feel that repeating instructions or explanations
does not good because clients do not understand or remember them. The nurse may get
little or no positive response or feedback from clients with dementia. It can be difficult
to deal with feelings about caring for people who will never get better and go home. As
dementia progresses, clients may seem not to hear or respond to anything the nurse says
or does. Remaining positive and supportive to clients and family can be difficult when
the outcome is so bleak. The nurse may need to deal with personal feelings of
depression and grief as the dementia progresses; he or she can do so by discussing the
situation with colleagues or even a counselor, but this is an intervention instead of a
source of frustration for the nurse.

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