Psychiatric Nursing, 7th Edition by Norman L. Keltner – Debbie Steele – Test Bank

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Psychiatric Nursing, 7th Edition by Norman L. Keltner – Debbie Steele – Test Bank

Chapter 02: Historical Issues

 

MULTIPLE CHOICE

 

  1. A person says, “Now that many state hospitals are closed, patients with psychiatric problems are free in our community. It is not safe for me.” The nurse’s reply should be based on knowledge that:
a. depressed patients are nonviolent.
b. state hospitals are no longer needed.
c. major depression is very prevalent.
d. bizarre behavior is viewed as sensational.

 

 

ANS:  C

Four of the top medical disorders causing disability are psychiatric disorders (i.e., major depression, schizophrenia, bipolar disorder, and alcohol abuse). The other options are not true statements.

 

DIF:    Cognitive level: Understanding       REF:   p. 9

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. Select the most accurate characterization of treatment of the mentally ill prior to the Period of Enlightenment.
a. Large asylums provided custodial care.
b. Care for the mentally ill was more compassionate.
c. Care focused on reducing stress and meeting basic human needs.
d. Patients were banished from communities or displayed for public amusement.

 

 

ANS:  D

In the 1700s it was common practice for caretakers to display mentally ill patients for the amusement of the paying public. The creation of large asylums took place during the Period of Enlightenment. Mental illness was first studied during the Period of Scientific Study. Dealing with stress and meeting basic needs are concerns of the modern era.

 

DIF:    Cognitive level: Understanding       REF:   p. 10

TOP:   Nursing process: Assessment          MSC:  NCLEX: Safe, Effective Care Environment

 

  1. What concerns were shared by society during both the Period of Enlightenment and the Period of Community Mental Health?
a. Moving patients out of asylums
b. Studying brain structure and function
c. Meeting basic human needs humanely
d. Providing medication to control symptoms

 

 

ANS:  C

The use of asylums signaled concern for meeting basic needs of the mentally ill, who in earlier times often wandered the countryside. With deinstitutionalization, many patients who were poorly equipped to provide for their own needs were returned to the community. The current system must now concern itself with ensuring that patients have such basic needs as food, shelter, and clothing. Studying brain structure and function is more a concern of modern times, as is the provision of medication.

 

DIF:    Cognitive level: Applying               REF:   pp. 10-11       TOP:   Nursing process: Planning

MSC:  NCLEX: Safe, Effective Care Environment

 

  1. A key factor motivating passage of the Community Mental Health Centers Act in 1963 was that mentally ill individuals had been:
a. hospitalized only if they demonstrated violent behavior.
b. geographically isolated from family and community.
c. discharged before receiving adequate treatment.
d. used as subjects in pharmacologic research.

 

 

ANS:  B

State hospitals were often located a great distance from the patients’ homes, making family visits difficult during hospitalization. The Community Mental Health Centers Act in 1963 served as the impetus for deinstitutionalization, allowing patients and families to receive care close to home. Admission only for behavior that endangers self or others is more consistent with current admission criteria. Early discharge rarely occurred before the community mental health movement. Unethical pharmacologic research was not a major issue leading to community mental health legislation.

 

DIF:    Cognitive level: Understanding       REF:   p. 13              TOP:   Nursing process: Planning

MSC:  NCLEX: Safe, Effective Care Environment

 

  1. Freud’s contribution to psychiatry that most affects current psychiatric nursing is:
a. the challenge to look at humans objectively.
b. recognition of the importance of human sexuality.
c. theories about the importance of sleep and dreams.
d. discoveries about the effectiveness of free association.

 

 

ANS:  A

Freud’s work created a milieu for thinking about mental disorders in terms of the individual human mind. This called for therapists to look objectively at the individual, a principle that is basic to nursing. The correct answer is the most global response. Freud’s theories of psychosexual development are an aspect of holistic nursing practice, but not the entire focus. Free association is not a pivotal issue in nursing practice.

 

DIF:    Cognitive level: Understanding       REF:   p. 12

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. The greatest impact in the care of the mentally ill over the past 50 years has resulted from progress and improvement in which area?
a. Self-help groups
b. Outpatient therapy
c. Psychotropic drugs
d. Patients’ rights awareness

 

 

ANS:  C

The advent of psychotropic drugs allowed patients to normalize thinking and feeling. As psychosis diminished, the individual became accessible for psychotherapeutic interventions. Hospital stays were shortened. Hospital milieus improved. Though important, none of the other choices has had such a significant impact.

 

DIF:    Cognitive level: Understanding       REF:   p. 12              TOP:   Nursing process: Evaluation

MSC:  NCLEX: Physiologic Integrity

 

  1. An adult with schizophrenia is discharged from a state mental hospital after 20 years of institutionalization. When planning care in the community, which premise applies? This patient is likely to:
a. independently find support services to aid transition from hospitalization to community.
b. adjust smoothly to the community if provided with sufficient support services.
c. self-administer antipsychotic medications correctly if provided with education.
d. need crisis or emergency psychiatric interventions from time to time.

 

 

ANS:  D

Patients with serious mental illness are rarely considered cured at the time of hospital discharge. Decompensation is likely from time to time, even when good community support is provided. The emergency room may become a first-line resource in the continuum of care designed to prevent rehospitalization. Unfortunately, transitional services are not always readily available. Adjustment to a community environment after long institutionalization is often a slow process.

 

DIF:    Cognitive level: Understanding       REF:   p. 15              TOP:   Nursing process: Planning

MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patient’s insurance form. Which resource should the nurse use to discern the criteria used to establish this diagnosis?
a. The Diagnostic and Statistical Manual of Mental Disorders (DSM)
b. Nursing Diagnosis Manual
c. A psychiatric nursing textbook
d. A behavioral health reference manual

 

 

ANS:  A

The DSM gives the criteria used to diagnose each mental disorder. The distracters do not contain diagnostic criteria for mental illness.

 

DIF:    Cognitive level: Understanding       REF:   pp. 17-18

TOP:   Nursing process: Assessment          MSC:  NCLEX: Safe, Effective Care Environment

 

  1. A shift in the psychiatric nursing focus during the community mental health period of the 1960s resulted in:
a. disillusionment with the high numbers of people seeking treatment.
b. focusing more attention on complications associated with substance abuse.
c. spending more time providing services to persons with serious mental illness.
d. shifting focus away from the most acutely ill and to persons with a perceived greater potential for improvement.

 

 

ANS:  D

The community mental health movement brought with it a broadening of areas of concern to the psychiatric nurse. It became acceptable, even desirable, for psychiatric nurses to focus on what was called the worried well, as opposed to providing care for acutely ill psychotic individuals. Neither disillusionment with the numbers seeking treatment nor providing more services to those with severe mental illness occurred.

 

DIF:    Cognitive level: Understanding       REF:   p. 16              TOP:   Nursing process: Evaluation

MSC:  NCLEX: Safe, Effective Care Environment

 

  1. An adult with serious mental illness is being admitted to a community behavioral health inpatient unit. Recognizing current trends in hospitalization, this patient is likely to:
a. comply readily with the prescribed treatment.
b. have a clear understanding of the illness.
c. display aggressive behavior.
d. stabilize within 24 hours.

 

 

ANS:  C

Compared with patients of the 1960s and 1970s, today’s patients are likely to display more aggressive behavior. This understanding is critical to making astute assessments that lead to planning for the provision of safety for patients and staff. Treatment compliance, understanding of the illness process, and discharge against medical advice are possible issues with which the nurse might deal, but these are less relevant when admission assessment is performed.

 

DIF:    Cognitive level: Analyzing             REF:   p. 14

TOP:   Nursing process: Assessment          MSC:  NCLEX: Safe, Effective Care Environment

 

  1. When a nurse working in a well-child clinic asks a parent’s address, the parent responds, “My children and I are homeless.” The nurse can assess this response as:
a. a common occurrence, because 1 out of 50 children are homeless.
b. a signal to investigate the possibility that the parent has severe mental illness.
c. evidence of child abuse or neglect that should be reported to social service agencies.
d. unusual because most homeless individuals have severe mental illness or substance abuse problems.

 

 

ANS:  A

The current belief is that the homeless are people (including entire families) who have been displaced by social policies over which they have no control. One out of 50 children is homeless. Although homelessness might be associated with serious mental illness, it might also be the result of having a weak support system and of social policies over which the individual or family has no control. Clinic users come from all socioeconomic backgrounds.

 

DIF:    Cognitive level: Understanding       REF:   p. 16

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. Which individual should the nurse assess as having the highest risk for homelessness?
a. An older adult woman with mild dementia who resides in an assisted-living facility
b. An adult with serious mental illness and no family
c. An adolescent with an eating disorder
d. A married person with alcoholism

 

 

ANS:  B

The adult has both a serious mental illness and a potentially weak support system. Both are risk factors for homelessness. The other individuals have psychiatric disorders but have better established support systems.

 

DIF:    Cognitive level: Applying               REF:   p. 16

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A former pediatric nurse begins working in a clinic housed in a homeless shelter. The nurse asks the clinic director, “What topic should I review to improve my effectiveness as I begin my new job?” Which topic should the clinic director suggest?
a. Care of school-age children
b. Psychiatric and substance abuse assessment
c. Communicable disease prevention strategies
d. Sexually transmitted disease signs and symptoms

 

 

ANS:  B

It is estimated that significant numbers of the homeless population have a serious mental illness and/or suffer from substance abuse or dependence. Although the other conditions may exist, the numbers are not as significant.

 

DIF:    Cognitive level: Applying               REF:   p. 16

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. Which skill is most important to a nurse working as a member of a community mental health team that strives to use a seamless continuum of care?
a. Case management
b. Diagnostic ability
c. Physical assessment skills
d. Patients’ rights advocacy

 

 

ANS:  A

To effectively use a seamless continuum of care, a nurse must have case management skills with which he or she can coordinate care using available and appropriate community resources. Psychosocial assessment and physical assessment are functions that can be fulfilled by another health care worker. Patients’ rights advocacy is one aspect of case management.

 

DIF:    Cognitive level: Analyzing             REF:   p. 16

TOP:   Nursing process: Implementation   MSC:  NCLEX: Safe, Effective Care Environment

 

  1. The broadened scope of psychiatric nursing practice is attributable primarily to:
a. increased use of psychotropic drugs.
b. opening of community mental health centers.
c. legislation that changed nurse practice acts across the country.
d. recidivism of seriously mentally ill patients in public mental hospitals.

 

 

ANS:  B

Community mental health centers were designed and organized to provide services in addition to inpatient hospitalization, thus giving nurses opportunities to practice in a variety of treatment settings (e.g., emergency rooms, partial hospitalization settings, outpatient care) and to have new roles, such as consultant, liaison, and case manager. Increased use of psychotropic drugs is not as important a factor as are community mental health centers. Legislation changing nurse practice acts broadened the scope of practice for nurse practitioners only by allowing prescriptive privileges. Recidivism is not a relevant factor.

 

DIF:    Cognitive level: Applying               REF:   p. 16

TOP:   Nursing process: Implementation   MSC:  NCLEX: Safe, Effective Care Environment

 

  1. A patient with mental illness was initially treated in an outpatient setting and then hospitalized for a week when the disorder became acute. After discharge to a halfway house, this patient’s care was managed by a community mental health nurse. Which inference applies to this community?
a. Additional mental health services should be made available for the severely mentally ill.
b. A seamless continuum of services is in place to serve persons with severe mental illness.
c. Case management services should be expanded to care for acute as well as long-term system consumers.
d. There are insufficient data to make a conclusion.

 

 

ANS:  B

Data are sufficient to suggest that a seamless continuum of service is in place, because the individual is able to move between continuum treatment sources and is given the services of a case manager to coordinate care. Data provided are insufficient to warrant any of the other assessments.

 

DIF:    Cognitive level: Analyzing             REF:   p. 16              TOP:   Nursing process: Evaluation

MSC:  NCLEX: Safe, Effective Care Environment

 

MULTIPLE RESPONSE

 

  1. Which changes in psychiatric nursing practice are directly attributable to events occurring during the Decade of the Brain? Select all that apply.
a. Homeless shelters became practice sites.
b. Nurses upgraded knowledge of psychopharmacology.
c. Nurses provided psychoeducation to patients and families.
d. Nurses viewed psychiatric symptoms as resulting from brain irregularities.
e. Nurses were more likely to advocate for patients’ rights related to involuntary commitment.

 

 

ANS:  B, C, D

Psychobiologic research relating to brain structure and function made it possible for psychiatric nurses to view symptoms as brain irregularities and made it necessary for them to become knowledgeable about psychotropic medications to make appropriate assessments regarding desired outcomes and side and toxic effects of therapy. With hospital stays shortened, it became necessary for nurses to provide psychoeducation to patients and families who would need to monitor outcomes, symptoms of relapse, and side and toxic effects of medication. Homeless shelters became practice sites with the onset of deinstitutionalization. Advocacy for patients’ rights relating to hospitalization and commitment became an ethical issue before the Decade of the Brain.

 

DIF:    Cognitive level: Analyzing             REF:   p. 15

TOP:   Nursing process: Implementation   MSC:  NCLEX: Safe, Effective Care Environment

 

  1. A community mental health nurse works in a mental health services system that is undergoing change to become a seamless system. To promote integrity of the new system, the nurse should focus on (select all that apply)
a. psychopathology.
b. symptom stabilization.
c. medication management.
d. patient and family psychoeducation.
e. patient reintegration into the community.
f. holistic issues relating to patient care.

 

 

ANS:  D, E, F

A seamless system of mental health services will require new conceptualizations. Nurses will need to focus more on recovery and reintegration than on symptom stabilization and more on holistic issues such as finances and housing than on medication management. Consumers and family members will also need to be provided with extensive psychoeducation.

 

DIF:    Cognitive level: Applying               REF:   p. 16

TOP:   Nursing process: Implementation   MSC:  NCLEX: Safe, Effective Care Environment

 

  1. A newcomer to a community support meeting asks a nurse, “Why aren’t people with mental illnesses treated at state institutions anymore?” What would be the nurse’s accurate responses? Select all that apply.
a. “Funding for treatment of mental illness now focuses on community treatment.”
b. “Psychiatric institutions are no longer accepted because of negative stories in the press.”
c. “There are less restrictive settings available now to care for individuals with mental illness.”
d. “Our nation has fewer people with mental illness; therefore, fewer hospital beds are needed.”
e. “Better drugs now make it possible for many persons with mental illness to live in their communities.”

 

 

ANS:  A, C, E

Deinstitutionalization and changes in funding shifted care for persons with mental illness to the community rather than large institutions. Care provided in a community setting, closer to family and significant others, is preferable. Improvements in medications to treat serious mental illness made it possible for more patients to live in their home communities. Prevalence rates for serious mental illness have not decreased. Although the national perspectives on institutional care did become negative, that was not the reason many institutions closed.

 

DIF:    Cognitive level: Applying               REF:   pp. 12-13

TOP:   Nursing process: Implementation   MSC:  NCLEX: Safe, Effective Care Environment

 

  1. Put these services in order from least to most intensive.
a. Day treatment
b. Hospitalization
c. Scheduled visits at a community mental health center

 

 

ANS:  A, B, C

The continuum of care represents treatment services along a range of intensity. Hospitalization is the most intensive, progressing to day treatment, and finally to routine visits at a community mental health center.

 

DIF:    Cognitive level: Analyzing             REF:   17

TOP:   Nursing process: Implementation   MSC:  NCLEX: Safe, Effective Care Environment

 

Chapter 12: Introduction to Psychotropic Drugs

 

MULTIPLE CHOICE

 

  1. A nurse administers a highly protein-bound medication. Which patient would have the most immediate and powerful effect from this drug?
a. A healthy adolescent
b. A 76-year-old patient with malnutrition
c. A woman in the second trimester of pregnancy
d. An adult with a fractured femur from a sporting accident

 

 

ANS:  B

The older malnourished patient would have fewer serum proteins to bind the drug; therefore, higher amounts of free drug would be available to act immediately. The patients described in the distracters would have normal protein levels, so the drug would be bound.

 

DIF:    Cognitive level: Analyzing             REF:   p. 119

TOP:   Nursing process: Assessment          MSC:  NCLEX: Physiologic Integrity

 

  1. A novice nurse asks, “What is the role of psychopharmacology in the psychotherapeutic management model?” A mentor should respond that psychopharmacology makes it possible to:
a. use the least restrictive treatment alternatives.
b. prevent violence against nurses.
c. identify desirable outcomes.
d. determine psychopathology.

 

 

ANS:  A

By effectively treating psychotic symptoms, the incidence of violent behaviors has been reduced. This makes possible the use of the least restrictive treatment alternative, an important facet of psychotherapeutic management. Psychopharmacology does not make the other options possible.

 

DIF:    Cognitive level: Understanding       REF:   p. 128

TOP:   Nursing process: Implementation   MSC:  NCLEX: Safe, Effective Care Environment

 

  1. The parent of a teen diagnosed with schizophrenia asks, “Why does schizophrenia usually appear in adolescence?” The nurse’s reply would be based on which premise?
a. Stimulation of neurotransmitters is unstable.
b. Neuronal system complexity stabilizes.
c. Dendrite branching becomes complete in adolescence.
d. Amino acid production increases.

 

 

ANS:  C

Arborization, or branching of dendrites, is a process that continues into adolescence. Some authorities have suggested that this might account for the appearance of schizophrenia at this period in life. The other options are of no relevance.

 

DIF:    Cognitive level: Understanding       REF:   p. 124

TOP:   Nursing process: Implementation   MSC:  NCLEX: Physiologic Integrity

 

  1. The primary mechanisms of action of certain antidepressants result from neurotransmitter inactivation by enzyme-based metabolism and:
a. electrochemical stimulation.
b. stimulation of natural precursors.
c. extraction of precursors from the bloodstream.
d. reuptake into the presynaptic storage vesicles.

 

 

ANS:  D

Neurotransmitters are inactivated in two ways: (1) they are metabolized by enzymes, and (2) they are taken back into the presynaptic storage vesicles—a process called reuptake. The other options have no physiologic basis in fact.

 

DIF:    Cognitive level: Understanding       REF:   p. 125

TOP:   Nursing process: Implementation   MSC:  NCLEX: Physiologic Integrity

 

  1. When discussing treatment of an aggressive patient with psychosis, a health care provider says, “I plan to prescribe the original antipsychotic drug.” Which medication is relevant to the statement?
a. Paroxetine (Paxil)
b. Clozapine (Clozaril)
c. Imipramine (Tofranil)
d. Chlorpromazine (Thorazine)

 

 

ANS:  D

Only chlorpromazine and clozapine are antipsychotics. Chlorpromazine is a traditional drug, introduced in the early 1950s, whereas clozapine is a newer drug, introduced in the 1990s. Paroxetine and imipramine are antidepressants.

 

DIF:    Cognitive level: Applying               REF:   p. 118            TOP:   Nursing process: Planning

MSC:  NCLEX: Physiologic Integrity

 

  1. A nurse assesses a newly hospitalized patient with a long history of serious and persistent mental illness. The priority assessment information to obtain regarding medication safety is:
a. adverse reactions to drugs taken previously.
b. history of drug compliance and noncompliance.
c. level of support available from significant others.
d. length of time on various psychotropic medications.

 

 

ANS:  A

Information related to safety is the nurse’s priority. Adverse reactions to psychotropic medications can be dangerous, even life-threatening. If a patient has had an adverse reaction to a particular drug, it would be unwise to administer it again. The other options do not address a safety issue.

 

DIF:    Cognitive level: Analyzing             REF:   p. 128

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. Studies about psychiatric patients’ understanding of psychopharmacology suggest that the nursing diagnosis most applicable is:
a. deficient knowledge related to drug therapy.
b. impaired memory related to drug side effects.
c. impaired decision making related to drug dependency.
d. disturbed thought processes related to anticipation of side effects.

 

 

ANS:  A

Research has shown that most patients do not know important facts about the medications prescribed for them. As a result, they are often noncompliant. As knowledge deficits are removed, better compliance can be expected. Data are not present to suggest applicability of the other options.

 

DIF:    Cognitive level: Applying               REF:   pp. 126-127

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A realistic outcome of patient teaching about psychotropic medication is that the patient will:
a. understand physiologic responses to drug therapy.
b. assess effectiveness of prescribed drugs in controlling symptoms.
c. describe onset, peak, and duration of action of each drug prescribed.
d. state the purpose, dose, and significant side effects of each drug prescribed.

 

 

ANS:  D

The correct response identifies basic information that each patient should have. Because the information is basic, the outcome, as stated, is realistic. The other options are less basic and less attainable.

 

DIF:    Cognitive level: Applying               REF:   pp. 127-128

TOP:   Nursing process: Outcome Identification

MSC:  NCLEX: Psychosocial Integrity

 

  1. A week after beginning fluoxetine (Prozac), a patient complains, “I still feel so depressed all the time.” Based on pharmacodynamics, the nurse’s best action is to:
a. administer the medication on an empty stomach.
b. advise the health care provider that the drug is ineffective.
c. reassess the expected outcomes of antidepressant therapy.
d. educate the patient that the drug needs more time to be effective.

 

 

ANS:  D

One week is probably an insufficient time for antidepressants to become effective in reducing patient symptoms. The phenomenon of receptor down-regulation develops in 2 to 4 weeks. The other options are not supported by research studies.

 

DIF:    Cognitive level: Analyzing             REF:   p. 122

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. Bearing in mind the function of the blood–brain barrier, dangers associated with administering large doses of water-soluble drugs relate primarily to the:
a. rapid development of tolerance.
b. high risk of adverse systemic effects.
c. liver’s inability to metabolize water-soluble drugs.
d. rapid passage into the brain increasing the risk of overdose.

 

 

ANS:  B

Water-soluble drugs penetrate the blood–brain barrier slowly and in insignificant amounts. A dose high enough to affect the brain would invariably cause adverse systemic side effects. The other effects are not related.

 

DIF:    Cognitive level: Analyzing             REF:   p. 123            TOP:   Nursing process: Evaluation

MSC:  NCLEX: Physiologic Integrity

 

  1. A nurse administering a selective serotonin reuptake inhibitor (SSRI) antidepressant should carefully observe the patient for symptoms related to:
a. dopamine excess.
b. decreased GABA level.
c. increased serotonin level.
d. decreased acetylcholine level.

 

 

ANS:  C

Depression is thought to be related to decreased amounts of the neurotransmitters norepinephrine and serotonin. SSRIs increase the reuptake of serotonin, increasing the availability of this neurotransmitter at the synapse. If the SSRI is effective, the increased serotonin will result in a decrease in symptoms of depression. The other options would not be related to SSRI administration.

 

DIF:    Cognitive level: Understanding       REF:   p. 125

TOP:   Nursing process: Implementation   MSC:  NCLEX: Physiologic Integrity

 

  1. Bioavailability of orally administered drugs is initially associated with which physiologic phenomenon?
a. Rate of renal excretion
b. First-pass metabolism
c. Synaptic transmission
d. Blood–brain barrier

 

 

ANS:  B

First-pass metabolism in the liver reduces the bioavailability of orally administered drugs. The other options do not occur first.

 

DIF:    Cognitive level: Understanding       REF:   p. 119

TOP:   Nursing process: Implementation   MSC:  NCLEX: Physiologic Integrity

 

  1. A patient taking clozapine (Clozaril) says, “I get plenty of vitamin C by drinking 8 ounces of grapefruit juice each morning.” Select the nurse’s best response.
a. “High doses of Vitamin C support the immune system and general good health.”
b. “Name another juice you would drink, because grapefruit juice can cause a bad reaction while taking clozapine.”
c. “Grapefruit juice lessens the effectiveness of your medication. You might need higher doses.”
d. “New research shows papaya juice is a better source of vitamin C than grapefruit juice.”

 

 

ANS:  B

Only the correct option provides vital information based on the cytochrome P-450 enzyme system’s involvement in drug metabolism. Clozapine metabolism is inhibited by the ingestion of grapefruit juice, making the likelihood of a toxic reaction to the drug more likely, because the drug accumulates in the body.

 

DIF:    Cognitive level: Applying               REF:   p. 120

TOP:   Nursing process: Implementation   MSC:  NCLEX: Physiologic Integrity

 

  1. A patient taking a psychotropic medication reports, “This medicine isn’t working right for me. It’s causing side effects.” Select the nurse’s best comment to further assess the scenario.
a. “Has the drug caused diaphoresis?”
b. “Have you experienced urinary retention?”
c. “Are you experiencing episodes of tachycardia?”
d. “Tell me more about how the medication is affecting you.”

 

 

ANS:  D

Open-ended communication techniques are important strategies for exploring the patient’s concerns. It is also important for the nurse to use culturally familiar terms. Patients are unlikely to know the meaning of terms such as tachycardia, diaphoresis, and urinary retention.

 

DIF:    Cognitive level: Applying               REF:   pp. 126-127

TOP:   Nursing process: Assessment          MSC:  NCLEX: Physiologic Integrity

 

  1. A patient takes a psychotropic medication that affects acetylcholine receptors. The patient complains of dry mouth and constipation. What effect is the drug having on the acetylcholine receptors?
a. Activation
b. Antagonism
c. Stimulation
d. Paradoxical

 

 

ANS:  B

The patient’s complaints indicate suppression of the parasympathetic nervous system, which is associated with antagonism of the action of acetylcholine.

 

DIF:    Cognitive level: Understanding       REF:   p. 126            TOP:   Nursing process: Evaluation

MSC:  NCLEX: Physiologic Integrity

 

  1. A patient takes a psychotropic medication that affects serotonin receptors. The patient complains of anxiety, insomnia, and loss of appetite. What effect is the drug having on the serotonin receptors?
a. Activation
b. Antagonism
c. Paradoxical
d. Inhibition

 

 

ANS:  A

The patient’s complaints indicate activation of serotonin receptors. None of the other options correctly identifies this effect.

 

DIF:    Cognitive level: Understanding       REF:   p. 125            TOP:   Nursing process: Evaluation

MSC:  NCLEX: Physiologic Integrity

 

  1. A patient takes a psychotropic medication that affects norepinephrine receptors. The patient reports, “It feels like my heart is pounding in my chest.” What effect is the drug having on the norepinephrine receptors?
a. Inhibition
b. Activation
c. Paradoxical
d. Antagonism

 

 

ANS:  B

The patient’s complaints indicate activation of norepinephrine receptors. The medication has stimulated the action of b1-receptors. None of the other options correctly identifies this outcome.

 

DIF:    Cognitive level: Understanding       REF:   p. 126            TOP:   Nursing process: Evaluation

MSC:  NCLEX: Physiologic Integrity

 

MULTIPLE RESPONSE

 

  1. What information should the nurse include in patient teaching about psychotropic medication? Select all that apply.
a. Drug pharmacokinetics
b. Common drug interactions
c. Management of common side effects
d. Descriptive list of all possible adverse effects
e. Written copies of information about the drug and its effects

 

 

ANS:  B, C, E

Teaching about how to manage common annoying side effects, such as dry mouth and orthostatic hypotension, can promote medication compliance by the patient. Knowing what side effects to report promotes patient safety. In addition, knowing about common drug–drug interactions, such as the potentiating effects of alcohol on sedating drugs, promotes patient safety. Providing written materials is helpful to patients who can then refer to these resources rather than having to rely on memory. Pharmacokinetics and an extensive list of side effects are major aspects of the nurse’s role but are not expected from patients.

 

DIF:    Cognitive level: Applying               REF:   pp. 126-127

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. An outpatient diagnosed with schizophrenia has been omitting doses of medication. Which questions should the clinic nurse ask to determine the reasons for the problem? Select all that apply.
a. “Are you experiencing any troublesome side effects?”
b. “Is the medicine affecting your sexual performance?”
c. “Does the medicine make you think slower?”
d. “Do you believe your dose is too high?”
e. “Do you believe you have an illness?”

 

 

ANS:  A, B, C, D, E

Each question listed refers to a common reason for patients not taking medication as prescribed.

 

DIF:    Cognitive level: Applying               REF:   pp. 126-127

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. Sequence the following historical events beginning with the evolution of psychotropic medications:
a. SSRI antidepressants were developed.
b. Drugs became available to treat patients diagnosed with Alzheimer’s disease.
c. Clozapine (Clozaril), the first atypical antipsychotic drug, was marketed.
d. Chlorpromazine (Thorazine) was discovered.

 

 

ANS:  A, B, C, D

Evolutionary events in the development of psychotropic drugs changed the care environment for patients with mental illness and had significant effects on the nurse’s role.

 

DIF:    Cognitive level: Understanding       REF:   p. 118

TOP:   Nursing process: Implementation   MSC:  NCLEX: Safe, Effective Care Environment

 

 

Chapter 24: Schizophrenia Spectrum and Other Psychotic Disorders

 

MULTIPLE CHOICE

 

  1. A patient laughs while saying, “My dog died yesterday.” The nurse documents this behavior using what terminology?
a. Autistic
b. Ambivalence
c. Inappropriate affect
d. Associative looseness

 

 

ANS:  C

Speaking of a sad topic while laughing exemplifies inappropriate affect. Autism is characterized by having little concern for external reality. Ambivalence is the simultaneous presence of opposite emotions. Associative looseness is characterized by stringing unrelated topics together.

 

DIF:    Cognitive level: Applying               REF:   p. 252

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. How long must the symptoms of schizophrenia be present before a diagnosis can be made?
a. At least 6 months
b. At least 1 month
c. More than 1 week
d. On at least three occasions in the past year

 

 

ANS:  A

To meet diagnostic criteria, signs of schizophrenia must be continuously present for a minimum of 6 months and not caused by substance abuse or a medical disorder.

 

DIF:    Cognitive level: Understanding       REF:   p. 249

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient displays disorganized speech and behavior as well as a flat affect. The patient prefers to sit alone and often appears to be listening and responding to unseen stimuli. To begin a therapeutic relationship, the nurse should:
a. take the patient to a medication education class.
b. offer a simple activity, and sit with the patient.
c. ask the patient what the voices are saying.
d. quietly watch television with the patient.

 

 

ANS:  B

For withdrawn patients, nurses should begin with undemanding one-to-one interactions. Providing a simple activity might help the patient focus on the here and now and provide a basis for reality-oriented communication. Watching television together does nothing to build trust. Medication education might be of little benefit if the patient is hallucinating and unable to pay attention to what is being taught. Asking what the voices are saying time after time is not beneficial to the patient, who needs to be distracted from them and focus on the real world.

 

DIF:    Cognitive level: Applying               REF:   p. 256

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. Parents of a 17-year-old patient diagnosed with schizophrenia ask the nurse what the future will be like for their child. The nurse’s answer should be based on knowledge that the usual course of illness is:
a. a steady lessening of symptoms until stability is achieved.
b. characterized by alternating acute and stable phases.
c. totally different for each individual patient.
d. progressive deterioration.

 

 

ANS:  B

Most patients with schizophrenia experience alternating acute and stable phases throughout life. Complete and permanent remission is rare. The course of the illness might be somewhat different from individual to individual, but the alternating phases are seen more often than any other course.

 

DIF:    Cognitive level: Applying               REF:   p. 248

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. The nurse should focus assessment for a patient with type I schizophrenia primarily on gathering data about:
a. cognition and perception.
b. attention and motivation.
c. grooming and hygiene.
d. abstract thinking skills.

 

 

ANS:  A

Altered perception includes hallucinations, illusions, and paranoid thinking. These positive symptoms, along with abnormal thoughts, are hallmarks of type I schizophrenia. The other options are more often seen in patients with type II schizophrenia.

 

DIF:    Cognitive level: Applying               REF:   p. 249

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. When a patient experiencing a first episode of type I schizophrenia is hospitalized, the nurse can expect to administer:
a. a typical antipsychotic drug.
b. an atypical antipsychotic drug.
c. a mood-stabilizing anticonvulsant.
d. a selective serotonin reuptake inhibitor.

 

 

ANS:  A

Delusions, hallucinations, and other symptoms of type I schizophrenia usually respond to the typical antipsychotic medications. Positive symptoms are considered to be the result of a subcortical dopaminergic process. The typical antipsychotics are dopamine blockers.

 

DIF:    Cognitive level: Analyzing             REF:   pp. 249, 251, 255

TOP:   Nursing process: Planning              MSC:  NCLEX: Physiologic Integrity

 

  1. The family of a patient with type I schizophrenia asks, “Did this illness occur because of all the chaos in our family?” Select the nurse’s best response.
a. “It is likely that the chaos in your family caused the disorder. It is very important for every family member to keep calm.”
b. “Stress in your family may make the disorder more difficult to manage, but it is not the cause.”
c. “Too little is known about the cause of this illness for anyone to speculate.”
d. “That question would be best answered by the psychiatrist.”

 

 

ANS:  B

The concept of disordered family interaction as the cause of schizophrenia is largely outdated. There is more reliance on the dopamine hypothesis or the stress-vulnerability model at present. Two options are dismissive, and the other suggests that the nurse is not qualified to give information.

 

DIF:    Cognitive level: Applying               REF:   p. 255

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A newly admitted patient is mute, immobile, and holds a fixed body position for long periods. The nurse caring for this patient should:
a. assign unlicensed assistance personnel to feed the patient.
b. provide a stimulating, active environment.
c. encourage independent social behaviors.
d. forewarn the patient before touching.

 

 

ANS:  D

Nurses should explain the need for and purpose of touch to patients before actually touching. This is particularly true for patients who are at highest risk for misinterpreting touch: those who are inattentive to reality or those who are suspicious. The environment should be calm and predictable. A patient who is mute and motionless is incapable of independent social behaviors. The patient’s oral intake should be monitored, but the correct response also applies to feeding, if it is necessary.

 

DIF:    Cognitive level: Applying               REF:   p. 255

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient tells the nurse, “Air Force jets flying overhead are looking for me. They want to capture me.” The patient has not previously verbalized this information. The nurse’s initial interventions should:
a. set firm limits on disruptive behaviors.
b. forcefully refute all perceptual distortions.
c. encourage complete description of delusions.
d. voice doubt about delusions without arguing.

 

 

ANS:  D

A nurse cannot agree with a delusion, but arguing is counterproductive, because it might cause the patient to cling to the idea. Voicing doubt and stating one’s own perception of reality is therapeutic. Encouraging discussion of the delusion reinforces it. Because the behavior described is not disruptive, this principle is not relevant.

 

DIF:    Cognitive level: Applying               REF:   p. 255

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. Which type of perceptual alteration is most commonly displayed by patients with schizophrenia?
a. Auditory hallucinations
b. Inappropriate affect
c. Loose associations
d. Illusions

 

 

ANS:  A

Auditory hallucinations are the most commonly experienced perceptual alteration noted in schizophrenia. Illusions are less common. The other symptoms are not altered perceptions.

 

DIF:    Cognitive level: Understanding       REF:   p. 251

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. Research on neurostructural theories of schizophrenia indicates that pathoanatomic findings often include:
a. ventricular enlargement, brain atrophy, and diminished cerebral blood flow.
b. ventricular blocking, brain swelling, and enhanced cerebral blood flow.
c. decreased cortical thickness and hippocampal hyperplasia.
d. increased cortical thickness and temporal lobe scarring.

 

 

ANS:  A

Theorists have suggested that type II schizophrenia is the result of pathoanatomy, specifically increased ventricular brain ratios, brain atrophy, and decreased cerebral blood flow. The other alterations are not supported by research findings.

 

DIF:    Cognitive level: Understanding       REF:   p. 253

TOP:   Nursing process: Assessment          MSC:  NCLEX: Physiologic Integrity

 

  1. Genetic evidence regarding twins and the risk for schizophrenia supports which fact?
a. Identical and fraternal twins are equal in concordancy for schizophrenia.
b. Monozygotic twins have a lower concordancy rate for schizophrenia than the general population.
c. Fraternal twins have a higher concordancy rate for schizophrenia than monozygotic twins.
d. Monozygotic twins are significantly more likely than the general population to be concordant for schizophrenia.

 

 

ANS:  D

Concordancy rates are 50% for monozygotic twins. This rate is 50 times higher than for the general population. The other options are not accurate representations of research data.

 

DIF:    Cognitive level: Understanding       REF:   p. 253-254

TOP:   Nursing process: Assessment          MSC:  NCLEX: Physiologic Integrity

 

  1. A therapist believes that persons diagnosed with schizophrenia have ego disintegration. This concept is based on which model?
a. Biologic
b. Interpersonal
c. Developmental
d. Stress-vulnerability

 

 

ANS:  C

The concept of ego disintegration is distinctly freudian. Freud is considered a developmental theorist. This theory is not considered biologic, interpersonal, or stress-vulnerability based.

 

DIF:    Cognitive level: Applying               REF:   p. 253-254

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient diagnosed with schizophrenia expresses fear of being pursued by hostile forces. The patient carries a tablet and writes notes in a code. The patient says, “I’m the only one who understands this code.” How should the nurse document these findings?
a. Grandiose and paranoid delusions
b. Affective blunting and anhedonia
c. Autism and loose associations
d. Delusions of reference

 

 

ANS:  A

Delusions are fixed false beliefs. Paranoid delusions reflect the idea that the person is being persecuted. Grandiose delusions are characterized by the idea that one is of great importance. The scenario does not describe any of the behaviors that would be consistent with the other options.

 

DIF:    Cognitive level: Applying               REF:   p. 251-252

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient diagnosed with schizophrenia expresses fear of being pursued by hostile forces. The patient carries a tablet and writes notes in a code. The patient says, “I’m the only one who understands this code.” What is the priority nursing diagnosis?
a. Impaired environmental interpretation syndrome related to inability to reason
b. Disturbed thought processes related to thinking not based on reality
c. Risk for other-directed violence related to persecutory delusions
d. Powerlessness related to feelings of persecution

 

 

ANS:  B

Disturbed thought processes based on thinking not based on reality is a priority diagnosis for a delusional patient. Impaired environmental interpretation is more useful for an individual who has been disoriented for more than 3 months. Risk for violence might be considered if the patient had given any indication of wishing to attack his persecutors or of willingness to fight back if personally attacked. Further investigation is necessary. No information was presented to suggest that the patient feels powerless. This would require further investigation.

 

DIF:    Cognitive level: Applying               REF:   p. 257            TOP:   Nursing process: Evaluation

MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient diagnosed with schizophrenia expresses fear of being pursued by hostile forces. The patient carries a tablet and writes notes in a code. The patient says, “I’m the only one who understands this code.” Select a realistic and desirable outcome for this patient. The patient will:
a. express a willingness to be supervised by staff by day 2.
b. report feeling safe from harm by others by day 3.
c. allow the nurse to read coded writings by day 2.
d. recognize the need for medication by day 1.

 

 

ANS:  B

Reporting that he is no longer afraid of harm emanating from hostile forces would suggest a reduction in delusions. Allowing the nurse to read the coded writings or wishing to have a staff member nearby do not necessarily suggest improvement in reality-based thinking. Stating that he needs medication to clear his thinking by day 1 is not realistic, because delusions are fixed beliefs.

 

DIF:    Cognitive level: Applying               REF:   p. 257            TOP:   Nursing process: Planning

MSC:  NCLEX: Psychosocial Integrity

 

  1. An initial short-term outcome for a withdrawn, socially isolated patient diagnosed with schizophrenia is that the patient will:
a. participate in scheduled activities.
b. identify barriers to social communication.
c. consistently interact with an assigned nurse.
d. share feelings of isolation with group members.

 

 

ANS:  C

Consistently interacting with one person reduces isolation. One-to-one interaction is the basis for developing trust and a therapeutic nurse–patient relationship. Later, the patient’s willingness to participate in activities or discuss feelings indicates progress.

 

DIF:    Cognitive level: Applying               REF:   p. 257            TOP:   Nursing process: Planning

MSC:  NCLEX: Psychosocial Integrity

 

  1. A highly suspicious patient tells the nurse, “When I sit in the dayroom I can see other people whispering about me and laughing. It makes me want to punch them.” The direction that the nurse should give staff is:
a. “Gently and frequently touch the patient while conversing.”
b. “Stop laughing immediately when the patient enters the room.”
c. “Be direct. Do not whisper, laugh, or look sideways at the patient.”
d. “Engage the patient in conversation by leaning close to speak softly.”

 

 

ANS:  C

Suspicious patients misinterpret the actions of others as being potentially harmful to self. Be direct and open, and avoid behaviors that can be misinterpreted, such as whispering or laughing. In addition, the suspicious patient needs additional personal space. Leaning close is ill-advised. Touching should be avoided because of the high potential for misinterpretation of staff members’ motives by the suspicious patient. To stop laughing abruptly when the patient appears would make the individual even more suspicious.

 

DIF:    Cognitive level: Applying               REF:   pp. 255-256

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. Which therapeutic activity would be most important in helping a patient diagnosed with schizophrenia remain in the work force?
a. Social skills training
b. Physical therapy to develop muscle strength
c. Occupational therapy to improve coordination
d. Group therapy to improve motivation for working

 

 

ANS:  A

Patients with schizophrenia often cannot obtain and hold jobs, not from lack of work skills but from inability to cope socially on the job. Social skills training would therefore be of greatest assistance if work skills are present. This premise is especially true for an individual with residual schizophrenia, since active psychosis is no longer present.

 

DIF:    Cognitive level: Applying               REF:   p. 250

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. A nurse at the mental health clinic plans a series of psychoeducational groups for persons with schizophrenia. Which topics would take priority?
a. The importance of taking your medication correctly
b. How to complete an application for employment
c. How to dress when attending community events
d. How to give and receive compliments
e. Ways to quit smoking

 

 

ANS:  A, E

Stabilization is maximized by adherence to the antipsychotic medication regime. Because so many persons with schizophrenia smoke cigarettes, this topic relates directly to the patients’ physiologic well-being. The other topics are also important, but are not priority topics.

 

DIF:    Cognitive level: Analyzing             REF:   pp. 253          TOP:   Nursing process: Planning

MSC:  NCLEX: Psychosocial Integrity

 

Chapter 36: Soldiers and Veterans

 

MULTIPLE CHOICE

 

  1. A soldier was diagnosed with post-traumatic stress disorder (PTSD). The soldier’s spouse reports that when a telephone rings during the night, the soldier rolls out of bed and assumes an aggressive stance. How will the nurse document this finding?
a. Flashback
b. Avoidance
c. Hyperarousal
d. Reexperiencing

 

 

ANS:  C

Hyperarousal includes exaggerated responses to noises and other environmental stimuli. It is part of the constellation of problems that impair sleep for persons with PTSD. Flashbacks are an aspect of reexperiencing. Avoidance is another criterion for PTSD.

 

DIF:    Cognitive level: Applying               REF:   p. 485

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. Which social event would likely be most disturbing for this soldier diagnosed with PTSD?
a. Halloween festival with neighborhood children
b. Picnic and fireworks display on July 4th
c. Singing carols around a Christmas tree
d. A family outing to the seashore

 

 

ANS:  B

The exploding noises associated with fireworks are likely to provoke exaggerated responses from this soldier. The distracters are not associated with offensive sounds.

 

DIF:    Cognitive level: Analyzing             REF:   p. 485            TOP:   Nursing process: Evaluation

MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse counsels an 87-year-old veteran of World War II who tearfully shares memories of sights associated with Nazi concentration camps. Which term will be most familiar to this veteran?
a. Shell shock
b. Battle fatigue
c. Soldier’s heart
d. PTSD

 

 

ANS:  B

Consequences of exposure to traumatic events associated with war have been addressed by different terms over generations. Battle fatigue was the term used in World War II. Soldier’s heart was the term used after the Civil War. Shell shock was the term used in World War I. PTSD was the term used beginning with the Vietnam War.

 

DIF:    Cognitive level: Applying               REF:   p. 484            TOP:   Nursing process: Planning

MSC:  NCLEX: Psychosocial Integrity

 

  1. When is it most important for the nurse to screen for signs and symptoms of post-combat PTSD?
a. Screening should be ongoing
b. Before departing to return to the United States
c. Immediately upon return from the combat zone
d. One year after returning from the combat experience

 

 

ANS:  A

PTSD can have a very long lag time; in some instances, it can be 20 years or more. Screening should be ongoing. The other options are too limited.

 

DIF:    Cognitive level: Understanding       REF:   p. 485

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse assesses soldiers in a combat zone. When is it most important for the nurse to screen for signs and symptoms of traumatic brain injury (TBI)?
a. After exposure to a blast
b. Before departing to return home.
c. One year after returning from combat
d. Immediately upon return to the United States

 

 

ANS:  A

TBI manifests shortly after the injury and usually resolves in days or weeks. It would be most important to screen after exposure to an explosion and before returning to the United States. PTSD can have a very long lag time; in some instances, it can be 20 years or more.

 

DIF:    Cognitive level: Understanding       REF:   p. 487

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. General George Patton led U.S. troops in Europe and Africa during World War II. His career was marred by an incident of scolding a distressed, frightened soldier as “a coward” and “yellow.” Patton’s behavior embodied which phenomenon associated with symptom delay in PTSD?
a. Stigma
b. Lag time
c. Obscuration
d. Co-morbidity

 

 

ANS:  A

Many soldiers and veterans fight the symptoms of mental illness associated with combat. They fear appearing weak or inadequate. These phenomena contribute to the stigma associated with war-related psychiatric illnesses.

 

DIF:    Cognitive level: Analyzing             REF:   p. 485            TOP:   Nursing process: Evaluation

MSC:  NCLEX: Psychosocial Integrity

 

  1. A soldier in a combat zone tells the nurse, “I saw a child get blown up over a year ago, but I keep seeing bits of flesh everywhere. I see something red and the visions race back to my mind.” The soldier is describing which phenomenon associated with PTSD?
a. Reexperiencing
b. Hyperarousal
c. Avoidance
d. Psychosis

 

 

ANS:  A

The soldier has described intrusive thoughts and visions associated with reexperiencing the traumatic event. This description does not indicate psychosis, hypervigilance, or avoidance.

 

DIF:    Cognitive level: Applying               REF:   p. 485

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A soldier who served in a combat zone tells the nurse, “I saw a child get blown up over 2 years ago, but even now when I see something red, the visions race back to my mind and I smell burnt flesh.” How should the nurse document this experience?
a. Thought intrusion
b. Repetitive dreams
c. Hallucinations
d. Flashbacks

 

 

ANS:  D

The soldier describes an event while awake related to reexperiencing the trauma. The description applies to flashbacks, which are common in PTSD. The statement is not associated with the remaining options.

 

DIF:    Cognitive level: Applying               REF:   p. 485

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A soldier who served in a combat zone returned home to the United States. The soldier’s spouse reports to the nurse, “We had planned to start a family right away, but now he won’t talk about it. He won’t even look at children.” The spouse is describing which symptom associated with PTSD?
a. Reexperiencing
b. Hyperarousal
c. Avoidance
d. Psychosis

 

 

ANS:  C

Avoidance is exemplified by a sense of foreshortened future and estrangement. There is no evidence that this soldier is having hyperarousal or reexperiencing war-related traumas. Psychosis is not evident.

 

DIF:    Cognitive level: Applying               REF:   p. 485

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A soldier returned home last year after deployment to a war zone. The soldier’s spouse reports, “We had planned to start a family right away, but now he won’t talk about it. He won’t even look at children. I wonder if we’re going to make it as a couple.” Select the nurse’s best response.
a. “PTSD often changes a person’s sexual functioning.”
b. “I encourage you to continue to participate in social activities where children are present.”
c. “Have you talked with your spouse about these reactions? Sometimes we just need to confront behavior.”
d. “PTSD often strains relationships. Here are some community resources for help.”

 

 

ANS:  D

PTSD precipitates changes that often lead to divorce. It’s important to provide support to both the veteran and spouse. Confrontation will not be effective. While it’s important to provide information, ongoing support will be more effective.

 

DIF:    Cognitive level: Applying               REF:   pp. 485-487

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse manages a program providing day treatment services to combat veterans diagnosed with PTSD. During breaks between activities, which type of music would be most appropriate?
a. Rap
b. Jazz
c. Rock
d. Hip-hop

 

 

ANS:  B

Hypervigilance is a common symptom of PTSD and leads to difficulty with relaxation. Music can soothe if it is not overpowering. Jazz is mellow and would not contribute to hyperarousal. Rap, rock, and hip-hop would be overstimulating.

 

DIF:    Cognitive level: Analyzing             REF:   p. 485

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A soldier experienced a TBI associated with acceleration–deceleration forces. Which part of the neuron was most likely damaged?
a. Axon
b. Dendrite
c. Telomere
d. Cell body

 

 

ANS:  A

Acceleration–deceleration forces cause shearing of axons not dendrites, which result in TBIs. The cell body is not believed to be traumatized. Telomeres are part of DNA, not neurons.

 

DIF:    Cognitive level: Understanding       REF:   p. 488

TOP:   Nursing process: Assessment          MSC:  NCLEX: Physiologic Integrity

 

  1. A veteran with a suspected TBI is scheduled for diffusion tensor imaging (DTI). What information should the nurse provide?
a. “This test will help show whether tracts in your central nervous system are damaged.”
b. “This test will measure changes in chemicals that transmit messages between your brain and spinal cord.”
c. “This test will help predict what types of medication will be effective for treating your symptoms.”
d. “This test will help your health care provider decide whether or not a computed tomography (CT) scan is needed to further diagnose your injuries.”

 

 

ANS:  A

DTI is a form of magnetic resonance imaging that produces detailed microscopic images of neural tracts and related injuries. It provides better imaging of subtle injuries than CT scans. It does not measure neurotransmitters.

 

DIF:    Cognitive level: Applying               REF:   p. 488

TOP:   Nursing process: Implementation   MSC:  NCLEX: Physiologic Integrity

 

  1. A combat veteran diagnosed with a mild TBI returned to college after discharge from the armed forces. The veteran began tutoring after scoring poorly in three courses. Which strategy can the tutor use to assist the veteran’s academic achievement?
a. Decrease extraneous stimuli to improve attention span.
b. Practice deep breathing to increase the brain’s oxygen supply.
c. Increase caffeine intake to counteract drowsiness and fatigue.
d. Play background music while studying to improve concentration.

 

 

ANS:  A

TBI produces multiple cognitive problems that are likely to interfere with memory and learning. Many persons with these injuries have difficulty excluding sensory stimuli, which impairs concentration and attention span. Background music would further impair concentration. Caffeine would increase stimulation but not improve cognitive processing. Deep breathing is helpful for producing relaxation for anyone, but it would not support memory and learning.

 

DIF:    Cognitive level: Applying               REF:   pp. 485, 488

TOP:   Nursing process: Implementation   MSC:  NCLEX: Physiologic Integrity

 

  1. Excitotoxicity in persons diagnosed with TBIs is associated primarily with which neurotransmitter?
a. Norepinephrine
b. Glutamate
c. Dopamine
d. Serotonin

 

 

ANS:  B

Excitotoxicity is associated with overfiring of neurons secondary to activation of glutamate. The remaining options are not associated with this reaction.

 

DIF:    Cognitive level: Understanding       REF:   p. 488

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A combat veteran with TBI, depression, and anxiety begins new prescriptions for sertraline (Zoloft) and lorazepam (Ativan). In recognition of potential long-term repercussions, the nurse should provide teaching related to which topic?
a. Nonpharmacologic strategies for managing anxiety
b. Identifying signs and symptoms of hepatotoxicity
c. Recognizing evidence of tardive dyskinesia
d. Strategies for preventing obesity

 

 

ANS:  A

Lorazepam is a benzodiazepine, which has a high probability of causing dependence if taken long term. The nurse should teach nonpharmacologic strategies for managing anxiety to facilitate the patient’s readiness to discontinue the lorazepam. Tardive dyskinesia is associated with antipsychotic drugs. Weight gain is associated with atypical antipsychotic drugs. Hepatotoxicity is not a likely complication.

 

DIF:    Cognitive level: Applying               REF:   p. 490

TOP:   Nursing process: Implementation   MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse talks with the caregiver of a combat veteran with severe traumatic brain injury. The caregiver says, “I don’t know how much longer I can do it. My whole life is consumed with taking care of my partner.” Which resource should the nurse suggest?
a. Al-Anon
b. Pastoral care
c. Meals on Wheels
d. Multifamily support group

 

 

ANS:  D

A multifamily support group will provide education, support, and socialization. These services support the needs of this caregiver. Pastoral care will offer support but not education and socialization. There is no indication of substance abuse or problems with meal preparation.

 

DIF:    Cognitive level: Analyzing             REF:   p. 491; Box 36-3

TOP:   Nursing process: Planning              MSC:  NCLEX: Psychosocial Integrity

 

  1. A combat veteran diagnosed with moderate traumatic brain injuries is agitated and aggressive. Which pharmacologic intervention would the nurse expect to be effective?
a. Bupropion (Wellbutrin)
b. Benztropine (Cogentin)
c. Propranolol (Inderal)
d. Buspirone (BuSpar)

 

 

ANS:  C

Beta blockers such as propranolol (Inderal) effectively manage agitation and aggression in persons with TBIs. A dopamine-norepinephrine reuptake inhibitor such as bupropion would increase agitation. Anxiety is not the central problem for this patient. The patient does not have extrapyramidal side effects or Parkinson’s disease.

 

DIF:    Cognitive level: Applying               REF:   p. 490            TOP:   Nursing process: Planning

MSC:  NCLEX: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

  1. A nurse assesses the health status of soldiers returning from Afghanistan. Screening will be a priority for signs and symptoms of which health problems? Select all that apply.
a. Schizophrenia
b. Eating disorder
c. Traumatic brain injury
d. Seasonal affective disorder
e. PTSD

 

 

ANS:  C, E

TBI and PTSD each occur in approximately 20% of soldiers returning from Afghanistan. Some soldiers have both problems. The incidence of disorders identified in the distracters would be expected to parallel the general population.

 

DIF:    Cognitive level: Understanding       REF:   pp. 484, 487

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. Which terms have historically been applied to soldiers suffering psychiatric distress related to exposure to the horrors of war? Select all that apply.
a. Shell shock
b. Battle fatigue
c. Soldier’s heart
d. Cyclothymic disorder
e. PTSD

 

 

ANS:  A, B, C, E

Soldier’s heart, shell shock, battle fatigue, and PTSD are terms that have been used over time to describe psychiatric distress related to exposure to the horrors of war. Cyclothymic disorder is an affective disturbance not related to traumatic experiences.

 

DIF:    Cognitive level: Understanding       REF:   p. 484

TOP:   Nursing process: Assessment          MSC:  NCLEX: Psychosocial Integrity

 

  1. A combat veteran diagnosed with moderate traumatic brain injury (TBI) will begin pharmacologic therapies that include psychotropic medication. What information should the nurse provide? Select all that apply.
a. “We will monitor you closely for how each medication affects you.”
b. “Medications can be expected to dramatically improve your symptoms.”
c. “Please be patient as your health care provider identifies the best drugs for your problems.”
d. “The blood levels of most medications you take will need to be checked with laboratory testing.”
e. “Be prepared for frequent dose changes as your health care provider adjusts the dose to meet your needs.”

 

 

ANS:  A, C, E

Patients with TBIs are frequently overly sensitive to psychotropic medications, so close monitoring is important. However, TBI can also create drug resistance. As a consequence of both dynamics, medication adjustments are frequent and frustrating for the patient. Very few of the medications need serum monitoring; it would be misleading to say “most” do. It’s important not to make promises related to how effective the drugs may or may not be.

 

DIF:    Cognitive level: Analyzing             REF:   pp. 489-490

TOP:   Nursing process: Implementation   MSC:  NCLEX: Physiologic Integrity

 

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