Exam Review

A patient admitted to the psychiatric hospital and diagnosed with post-traumatic stress disorder (PTSD) asks the nurse what derealization means, as he hears the psychiatrist use that term. The nurse would say which of the following?
A)
“Derealization is an unreality of surroundings.”
B)
“Derealization is the same as hypervigilance.”
C)
“Derealization is a feeling of being detached or as if you are an outside observer.”
D)
“Derealization is a type of therapy used for persons with PTSD.”
Research has shown that there are many factors that affect military life. Which of the following is considered a paradox of military life?
A)
Defending democratic values while in a rigid hierarchy
B)
Frequent familial relocations, separations, and reunions
C)
Opportunity to see different areas of the world
D)
Job security with guaranteed paycheck
Which developmental characteristic should the nurse identify as typical of a client diagnosed with severe intellectual disability (ID)?
A)
The client communicates wants and needs via “acting out” behaviors.
B)
Other than possible coordination problems, the client's psychomotor skills are not affected.
C)
The client can perform some self-care activities independently.
D)
The client has advanced speech development.

Review the list of medications and identify which group these medications would fall under—widely used, primarily used, or long-term management used.

	Widely used for panic attack and status epilepticus	Primarily used in insomnia, anxiety, panic attacks	Used in long-term management of panic attacks and ETOH withdrawal
Diazepam	✓
Clonazepam			✓
Alprazolam		✓
Chlordiazepoxide			✓
Triazolam		✓
Temazepam		✓
Midazolam	✓
Lorazepam	✓

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Exam Review

A client diagnosed with chronic migraine headaches is considering acupuncture. The client asks a clinic nurse, "How does this treatment work?” Which is the best response by the nurse?
A)
“Your acupuncturist is the best resource for answering your specific questions.”
B)
“Acupuncture works by encouraging the body to increase its production of serotonin and norepinephrine.”
C)
“Western medicine believes that acupuncture stimulates the body’s release of pain-fighting chemicals called endorphins.”
D)
“I’m not sure why they suggested acupuncture. There are a lot of risks, including HIV.”
A family asks why their father is attending activity groups at the long-term care facility. The son states, "My father worked hard all of his life. He just needs some rest at this point." Which is the appropriate nursing reply?
A)
“If your father doesn't go to these activity groups, he will develop dementia."
B)
“The groups are optional. Only clients at high-functioning levels would benefit.”
C)
“I’m glad we discussed this. We’ll excuse him from the activity groups.”
D)
“The groups benefit your father by providing sensory stimulation and reality orientation.”
A client has recently been placed in a long-term care facility because of marked confusion and inability to perform most activities of daily living. Which nursing intervention is most appropriate to maintain the client's self-esteem?
A)
Modifying the daily schedule often to maintain variety
B)
Allowing the client to choose between two different outfits
C)
Leaving the client alone in the bathroom
D)
Assigning a variety of caregivers
Exhibits Complete the diagram by selecting the option choices to specify the two most immediate actions the nurse should take, the condition the client is most likely experiencing, and two parameters the nurse should monitor to assess the client's progress.
✓Complete a referral for dialectical behavior therapy.
✓Stay with the patient during periods of flashbacks and nightmares.
✓Post-traumatic stress disorder
✓Prevalence of nightmares and quality of sleep
✓Whether the patient can sleep without medication
Actions to Take
✓Complete a referral for dialectical behavior therapy.
✕Administer alprazolam (Xanax), which is to be continued after discharge.
✕Assign the different or new staff as often as possible.
✓Stay with the patient during periods of flashbacks and nightmares.
✕Administer lithium 200 mg PO bid.
Condition Most Likely
✕Grief
✕Generalized anxiety disorder
✕Obstructive sleep apnea
✓Post-traumatic stress disorder
Parameters to Monitor
✓Prevalence of nightmares and quality of sleep
✓Whether the patient can sleep without medication
✕Blood pressure and temperature
✕Complete blood count (CBC)
✕Level of lithium in blood

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Exam Review

A client's wife tells the nurse that her husband strongly believes that he is Jesus. She states that she tells her husband that he is not Jesus, but he truly believes that he is and that he can perform miracles. Which disorder does the nurse suspect the client has?
A)
Schizophrenia
B)
Anxiety
C)
Attention deficit-hyperactivity disorder (ADHD)
D)
Major depressive disorder (MDD)
When working with clients of any culture, which action would the nurse avoid?
A)
Assuming that all individuals within a culture or ethnic group are similar
B)
Using an interpreter to obtain health information during an assessment
C)
Maintaining eye contact to avoid being rude and making the client uncomfortable
D)
Supporting the client in participating in cultural and spiritual rituals
A patient who is being seen in the community mental health center for post-traumatic stress disorder (PTSD) is being considered for eye movement desensitization and reprocessing (EMDR). The nurse is asked to conduct an assessment to validate the patient’s appropriateness for this treatment. Which of the following data collected by the nurse are most important to document when determining appropriateness for treatment with EMDR? Select all that apply.
A)
The patient has a history of seizure disorder.
B)
The patient has been treated for a detached retina.
C)
The patient has been using alcohol in increasing quantities over the past 3 months.
D)
The patient has a history of electroconvulsive therapy (ECT).
E)
The patient reports suicidal ideation with a plan.
A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly stated, "That's wonderful. I’ll be fine all alone." How would the nurse interpret the mother's statements?
A)
The mother is using double-bind communication.
B)
The mother is communicating indirectly.
C)
The mother is withholding supportive messages.
D)
The mother is making denigrating remarks.

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Exam Review

In defiance of parental wishes, a teenager succumbs to peer pressure and gets a tattoo. According to Bowen’s family systems theory, how should the community health nurse interpret the teenager's action?
A)
The teenager is exhibiting antisocial traits.
B)
The teenager is cutting self-off emotionally.
C)
The teenager is attempting to differentiate self.
D)
The teenager is triangulating self.
Which of the following medications is considered to be a first-line medication of choice in the treatment of PTSD?
A)
Propranolol
B)
Paroxetine
C)
Alprazolam
D)
Carbamazepine
A nurse should recognize that clients who have a history of missed or late medical appointments are most likely to espouse which approach to time and orientation?
A)
Past time-oriented
B)
Past and future time-oriented
C)
Future time-oriented
D)
Present time-oriented
A clinic nurse is caring for a 40-year-old client who lives with his parents. One parent continues to do the client’s laundry and provides spending money. Which family dynamic does the nurse recognize in this situation?
A)
Making assumptions
B)
(Missing option filled) Enabling dependency
C)
Taking over
D)
Communicating indirectly

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Exam Review

A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home?
A)
The nuclear family living arrangement is the preferred environment for childrearing.
B)
Extended family living arrangements are common in some cultures.
C)
The parents have diffused boundaries and have allowed the grandparental subsystem to be present.
D)
The grandparental subsystem is not successfully managing separation from the parental subsystem.
The nurse is caring for a client who blinks when the nurse asks a question and coughs when the nurse looks at him. Which condition does the nurse suspect?
A)
Conduct disorder
B)
Tourette’s disorder
C)
Oppositional defiant disorder (ODD)
D)
Autism spectrum disorder (ASD)
Nursing Knowledge: The nursing assessment of a patient indicates positive signs for Neuroleptic Malignant Syndrome (NMS). Select all that apply.
A)
Low suspicion of anyone on antipsychotics.
B)
Cramps, tremors, delirium, agitation and seizure
C)
Muscular rigidity, Severe hypotension, or hypertension and tachycardia
D)
Low creatine phosphokinase (CPK) and Low Leukocytosis.
A nursing instructor is teaching about reminiscence therapy. Which student statement indicates that learning has occurred?
A)
“Reminiscence therapy encourages members to share positive memories of significant life transitions.”
B)
“Reminiscence therapy is a social group where members chat about past events and future plans.”
C)
“Reminiscence therapy is a group in which participants create collages representing significant aspects of their lives.”
D)
“Reminiscence therapy encourages members to share significant life memories to promote resolution.”

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Exam Review

The client, a 15-year-old whose father has been suffering from post-traumatic stress disorder (PTSD) since returning from combat, is now seeing a counselor himself with reports of flashbacks that are similar to his father's symptoms. Which of the following interpretations of the client's behavior is supported by evidence?
A)
The client’s experience is indicative of impending psychosis.
B)
It is not uncommon for children of parents with PTSD to experience secondary trauma.
C)
Military children often pretend to have symptoms of PTSD to get secondary gains.
D)
This is a common symptom of substance abuse and drug-seeking behavior.
The patient is an 18-year-old college student being treated in the community mental health clinic for an adjustment disorder after receiving news of her parent’s impending divorce. While talking about her feelings, she becomes angry and starts shouting and crying. She screams, “I wish they would both die!” Which of these is the most appropriate nursing response?
A)
Encourage the patient to talk more about her anger.
B)
Assess the patient for risk of harming herself or others.
C)
Contact the parents and the police to report that the client is expressing homicidal ideation.
D)
Instruct the patient that it is not acceptable to talk that way about her parents.
In planning care for a child diagnosed with autism spectrum disorder (ASD), which is a realistic client outcome? The client will
A)
Perform most self-care tasks independently.
B)
Establish trust with at least one caregiver by day 5.
C)
Communicate all needs verbally by discharge.
D)
Participate with peers in a team sport by day 4.
When working with clients of any culture, which action would the nurse avoid?
A)
Assuming that all individuals within a culture or ethnic group are similar
B)
Using an interpreter to obtain health information during an assessment
C)
Maintaining eye contact to avoid being rude and making the client uncomfortable
D)
Supporting the client in participating in cultural and spiritual rituals

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