ch 10/1. The adult child of a patient diagnosed with major depression asks, "Do you think depression and physical illness are connected? Since my father's
... [Show More] death, my mother has had shingles and the flu, but she's usually not one who gets sick." Which answer by the nurse best reflects current knowledge about psychoneuroimmunology?
a. "It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system."
b. "You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses."
c. "So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link."
d. "Negative emotions and stress may interfere with the body's ability to protect itself and can increase the likelihood of infection." - D
10/2. A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize?
a. Engaging in activity without using any supplemental oxygen
b. Sleeping comfortably and soundly, without respiratory distress
c. Feeling relaxed and taking regular deep breaths when leaving home
d. Having a younger, healthier body that knows no exercise limitations - C
10/3. A nurse leads a psychoeducational group for depressed patients. The nurse plans to implement an exercise regime for each patient. The rationale to use when presenting this plan to the treatment team is that exercise:
a. has an antidepressant effect comparable to selective serotonin reuptake inhibitors.
b. prevents damage from overstimulation of the sympathetic nervous system.
c. detoxifies the body by removing metabolic wastes and other toxins.
d. improves mood stability for patients with bipolar disorders. - A
10/4. A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S. resident for 10 years. The family member says, "The immigration to America has been very difficult." Considering cultural background, which expression of stress by this patient would the nurse expect?
a. Motor restlessness. c. Memory deficiencies
b. Somatic complaints. d. Sensory perceptual - B
10/5. A patient nervously says, "Financial problems are stressing my marriage. I've heard rumors about cutbacks at work; I am afraid I might get laid off." The patient's pulse is 112/minute; respirations are 26/minute; and blood pressure is 166/88. Which nursing intervention will the nurse implement?
a. Advise the patient, "Go to sleep 30 to 60 minutes earlier each night to increase rest."
b. Direct the patient in slow and deep breathing via use of a positive, repeated word.
c. Suggest the patient consider that a new job might be better than the present one.
d. Tell the patient, "Relax by spending more time playing with your pet." - B
10/6. According to the Recent Life Changes Questionnaire, which situation would most necessitate a complete assessment of a person's stress status and coping abilities?
a. A person who has been assigned more responsibility at work
b. A parent whose job required relocation to a different city
c. A person returning to college after an employer ceased operations
d. A man who recently separated from his wife because of marital problems - C
A person returning to college after losing a job is dealing with two significant stressors simultaneously. Together, these stressors total more life change units than any of the single stressors cited in the other options.
10/7. A patient newly diagnosed as HIV-positive seeks the nurse's advice on how to reduce the risk of infections. The patient says, "I used to go to church and I was in my best health then. Maybe I should start going to church again." Which response will the nurse offer?
a. "Religion does not usually affect health, but you were younger and stronger then."
b. "Contact with supportive people at church might help, but religion itself is not especially helpful."
c. "Studies show that spiritual practices can enhance immune system function and coping abilities."
d. "Going to church would expose you to many potential infections. Let's think about some other options." - C
10/ 8. When a nurse asks a newly admitted patient to describe social supports, the patient says, "My parents died last year and I have no family. I am newly divorced, and my former in-laws blame me. I don't have many friends because most people my age just want to go out drinking." Which action will the nurse apply?
a. Advise the patient that being so particular about potential friends reduces social contact.
b. Suggest using the Internet as a way to find supportive others with similar values.
c. Encourage the patient to begin dating again, perhaps with members of the church.
d. Discuss how divorce support groups could increase coping and social support. - D
10/11. A patient tells the nurse, "I know that I should reduce the stress in my life, but I have no idea where to start." What would be the best initial nursing response?
a. "Physical exercise works to elevate mood and reduce anxiety."
b. "Reading about stress and how to manage it might be a good place to start."
c. "Why not start by learning to meditate? That technique will cover everything."
d. "Let's talk about what is going on in your life and then look at possible options." - D
10/ 12. A patient tells the nurse, "My doctor thinks my problems with stress relate to the negative way I think about things and suggested I learn new ways of thinking." Which response by the nurse would support the recommendation?
a. Encourage the patient to imagine being in calm circumstances.
b. Provide the patient with a blank journal and guidance about journaling.
c. Teach the patient to recognize, reconsider, and reframe irrational thoughts.
d. Teach the patient to use instruments that give feedback about bodily functions. - C
10/ 13. A patient who had been experiencing significant stress learned to use progressive muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2 weeks later, which finding most clearly shows the patient is coping more effectively with stress?
a. The patient's systolic blood pressure has changed from the 140s to the 120s mm Hg.
b. The patient reports, "I feel better, and that things are not bothering me as much."
c. The patient reports, "I spend more time napping or sitting quietly at home."
d. The patient's weight decreased by 3 pounds. - A
10/ 14. A patient tells the nurse, "I will never be happy until I'm as successful as my older sister." The nurse asks the patient to reassess this statement and reframe it. Which reframed statement by the patient is most likely to promote coping?
a. "People should treat me as well as they treat my sister."
b. "I can find contentment in succeeding at my own job level."
c. "I won't be happy until I make as much money as my sister."
d. "Being as smart or clever as my sister isn't really important." - B
10/ 16. A patient reports, "I am overwhelmed by stress." Which question by the nurse would be most important to use in the initial assessment of this the patient?
a. "Tell me about your family history. Do you have any relatives who have problems with stress?"
b. "Tell me about your exercise. How much activity do you typically get in a day?"
c. "Tell me about the kinds of things you do to reduce or cope with your stress."
d. "Stress can interfere with sleep. How much did you sleep last night?" - C
10/17. Which scenario best demonstrates an example of eustress? An individual:
a. loses a beloved family pet.
b. prepares to take a one-week vacation to a tropical island with a group of close friends.
c. receives a bank notice there were insufficient funds in their account for a recent rent payment.
d. receives notification their current employer is experiencing financial problems and some workers will be terminated. - B
10/18. A person with a fear of heights drives across a high bridge. Which structure will stimulate a response from the autonomic nervous system?
a. Thalamus. c. Hypothalamus
b. Parietal lobe. d. Pituitary gland - C
10/ 19. A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system will be stimulated in response to this experience?
a. Limbic system.
c. Sympathetic nervous system
b. Peripheral nervous system
d. Parasympathetic nervous system - C
The autonomic nervous system is comprised of the sympathetic (fight or flight response) and parasympathetic nervous system (relaxation response). In times of stress, the sympathetic nervous system is stimulated. A person fearful of heights would experience stress associated with the experience of driving across a high bridge.
10/1. Which changes reflect short-term physiological responses to stress? Select all that apply.
a. Muscular tension, blood pressure, and triglycerides increase.
b. Epinephrine is released, increasing heart and respiratory rates.
c. Corticosteroid release increases stamina and impedes digestion.
d. Cortisol is released, increasing glucogenesis and reducing fluid loss.
e. Immune system functioning decreases, and risk of cancer increases.
f. Risk of depression, autoimmune disorders, and heart disease increases. - A, B, C, D
10/2. Which nursing comments are likely to help a patient to cope by addressing the mediators of stress? Select all that apply.
a. "A divorce, while stressful, can be the beginning of a new, better phase of life."
b. "You said you used to jog; getting back to aerobic exercise could be helpful."
c. "Journaling often promotes awareness of how experiences have affected people."
d. "Slowing your breathing by counting to three between breaths will calm you."
e. "Would a short-term loan make your finances less stressful?"
f. "There is a support group for newly divorced persons in your neighborhood." - A, C, E, F
Stress mediators are factors that can help persons cope by influencing how they perceive and respond to stressors; they include personality, social support, perceptions, and culture.
10/3. The nurse wishes to use guided imagery to help a patient relax. Which comments would be appropriate to include in the guided imagery script? Select all that apply.
a. "Imagine others treating you the way they should, the way you want to be treated ..."
b. "With each breath, you feel calmer, more relaxed, almost as if you are floating ..."
c. "You are alone on a beach, the sun is warm, and you hear only the sound of the surf ..."
d. "You have taken control, nothing can hurt you now. Everything is going your way..."
e. "You have grown calm, your mind is still, there is nothing to disturb your well-being ..."
f. "You will feel better as work calms down, as your boss becomes more understanding ..." - B, C, E
12/1. A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response.
a. "Everyone here is trying to help you. No one wants to harm you."
b. "Feeling that people want to destroy you must be very frightening."
c. "That is not true. People here are trying to help you if you will let them."
d. "Staff members are health care professionals who are qualified to help you." - B
12/2. A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as:
a. echolalia. c. a delusion of infidelity.
b. an idea of reference. d. an auditory hallucination. - B
12/ 4. When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the patient?
a. Sedation and muscle stiffness
b. Sweating, nausea, and diarrhea
c. Mild fever, sore throat, and skin rash
d. Headache, watery eyes, and runny nose - A
12/7. A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate?
a. Clozapine (Clozaril) c. Olanzapine (Zyprexa)
b. Ziprasidone (Geodon). d. Aripiprazole (Abilify) - D
Aripiprazole is a third-generation atypical antipsychotic effective against both positive and negative symptoms of schizophrenia. It causes little or no weight gain and no increase in glucose, high- or low-density lipoprotein cholesterol, or triglycerides, making it a reasonable choice for a patient with obesity or heart disease.
12/9. A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance?
a. Self-esteem. c. Physiological
b. Psychosocial. d. Self-actualization - C
Physiological needs must be met to preserve life. A patient with waxy flexibility must be fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological integrity. Higher level needs are of lesser concern.
12/10. A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient's activities of daily living are severely compromised. An appropriate outcome would be that the patient will:
a. demonstrate increased interest in the environment by the end of week 1.
b. perform self-care activities with coaching by the end of day 3.
c. gradually take the initiative for self-care by the end of week 2.
d. accept tube feeding without objection by day 2. - B
12/13. A community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia. The patient lives at home with a supportive family. Select the nurse's best plan.
a. Visit daily for 4 days, then every other day for 1 week; stay with patient for 20 minutes, accept silence; state when the nurse will return.
b. Arrange to spend 1 hour each day with the patient; focus on asking questions about what the patient is thinking or experiencing; avoid silences.
c. Visit twice daily; sit beside the patient with a hand on the patient's arm; leave if the patient does not respond within 10 minutes.
d. Visit every other day; remind the patient of the nurse's identity; encourage the patient to talk while the nurse works on reports. - A
12/14. Withdrawn patients diagnosed with schizophrenia:
a. are usually violent toward caregivers.
b. universally fear sexual involvement with therapists.
c. exhibit a high degree of hostility as evidenced by rejecting behavior.
d. avoid relationships because they become anxious with emotional closeness. - D
12/16. A patient diagnosed with schizophrenia has taken fluphenazine (Prolixin) 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms?
a. Neuroleptic malignant synd c. Pseudoparkinsonism
b. Hepatocellular effects. d. Akathisia - C
12/17. A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol (Haldol), the patient is calm. Two hours later the nurse sees the patient's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely?
a. An acute dystonic reaction. c. Waxy flexibility
b. Tardive dyskinesia. d. Akathisia - A
Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back. Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies requiring immediate intervention.
12/A patient took trifluoperazine 30 mg po daily for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect?
a. Agranulocytosis c. Tourette's syndrome
b. Tardive dyskinesia d. Anticholinergic effects - B
Tardive dyskinesia is a neuroleptic-induced condition involving the face, trunk, and limbs. Involuntary movements, such as tongue thrusting; licking; blowing; irregular movements of the arms, neck, and shoulders; rocking; hip jerks; and pelvic thrusts, are seen. These symptoms are frequently not reversible even when the drug is discontinued
12/21. The nurse assesses a patient diagnosed with schizophrenia. Which assessment finding would the nurse regard as a negative symptom of schizophrenia?
a. Auditory hallucinations
b. Delusions of grandeur
c. Poor personal hygiene
d. Psychomotor agitation - C
Positive symptoms are those a client has/does that they should not have
Negative symptoms are those the client should have/do yet they do not
12/ 22. What assessment findings mark the prodromal stage of schizophrenia?
a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion
b. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting
c. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility
d. Loose associations, concrete thinking, and echolalia neologisms - A
Withdrawal, misinterpreting, poor concentration, and preoccupation with religion are prodromal symptoms, the symptoms that are present before the development of florid symptoms. The incorrect options each list the positive symptoms of schizophrenia that might be apparent during the acute stage of the illness.
12/24. A patient diagnosed with schizophrenia begins a new prescription for lurasidone HCL (Latuda). The patient is 5'6" and currently weighs 204 lbs. Which topic is most important for the nurse to include in the teaching plan related to this medication?
a. How to recognize tardive dyskinesia
c. Ways to manage constipation
b. Weight management strategies
d. Sleep hygiene measures - B
Lurasidone HCL (Latuda) is a second-generation antipsychotic medication. The incidence of weight gain, diabetes, and high cholesterol is high with this medication. The patient is overweight now, so weight management will be especially important. The incidence of tardive dyskinesia is low with second-generation antipsychotic medications. Constipation may occur, but it is less important than weight management. This drug usually produces drowsiness.
12/ 25. A patient diagnosed with schizophrenia says, "It's beat. Time to eat. No room for the cat." What type of verbalization is evident?
a. Neologism. c. Thought broadcasting
b. Idea of reference. d. Associative looseness - D
Looseness of association refers to jumbled thoughts incoherently expressed to the listener. Neologisms are newly coined words. Ideas of reference are a type of delusion. Thought broadcasting is the belief that others can hear one's thoughts.
12/26. A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication?
a. Haloperidol (Haldol)
c. Chlorpromazine (Thorazine)
b. Olanzapine (Zyprexa)
d. Diphenhydramine (Benadryl) - B
Olanzapine is a second-generation atypical antipsychotic that targets both positive and negative symptoms of schizophrenia. Haloperidol and chlorpromazine are conventional antipsychotics that target only positive symptoms. Diphenhydramine is an antihistamine.
See relationship to audience response question.
12/29. A patient diagnosed with schizophrenia begins to talks about "macnabs" hiding in the warehouse at work. The term "macnabs" should be documented as:
a. a neologism. c. thought insertion.
b. concrete thinking. d. an idea of reference. - a
12/30. A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should:
a. sit close to the patient.
b. place an arm protectively around the patient's shoulders.
c. place a hand on the patient's arm and exert light pressure.
d. maintain a normal social interaction distance from the patient. - D
The patient is describing phenomena that indicate personal boundary difficulties and depersonalization.
12/32. A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 1030. By 1200, the patient has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations 26; 150/90. The patient is diaphoretic. Select the nurse's best analysis and action.
a. Agranulocytosis; institute reverse isolation.
b. Tardive dyskinesia; withhold the next dose of medication.
c. Cholestatic jaundice; begin a high-protein, high-cholesterol diet.
d. Neuroleptic malignant syndrome; notify health care provider stat. - d
12/34. The nurse is developing a plan for psychoeducational sessions for several adults diagnosed with schizophrenia. Which goal is best for this group? Members will:
a. gain insight into unconscious factors that contribute to their illness.
b. explore situations that trigger hostility and anger.
c. learn to manage delusional thinking.
d. demonstrate improved social skills. - D
Improved social skills help patients maintain relationships with others. These relationships are important to management of the disorder
12/35. A client says, "Facebook has a new tracking capacity. If I use the Internet, Homeland Security will detain me as a terrorist." Select the nurse's best initial action.
a. Tell the client, "Facebook is a safe website. You don't need to worry about Homeland Security."
b. Tell the client, "You are in a safe place where you will be helped."
c. Administer a prn dose of an antipsychotic medication.
d. Tell the client, "You don't need to worry about that." - B
The patient is experiencing paranoia and delusional thinking, which leads to fear. Explaining that the patient is in a safe place will help relieve the fear. It is not therapeutic to disagree or give advice. Medication will not relieve the immediate concern.
12/36. Which finding constitutes a negative symptom associated with schizophrenia?
a. Hostility c. Poverty of thought
b. Bizarre behavior d. Auditory hallucinations - C
Negative symptoms include apathy, anhedonia, poor social functioning, and poverty of thought.
12/37. A patient insistently states, "I can decipher codes of DNA just by looking at someone." Which problem is evident?
a. Visual hallucinations c. Idea of reference
b. Magical thinking d. Thought insertion - B
12/2. A patient diagnosed with schizophrenia was hospitalized after arguing with co-workers and threatening to harm them. The patient is aloof, suspicious, and says, "Two staff members I saw talking were plotting to kill me." Based on data gathered at this point, which nursing diagnoses relate? Select all that apply.
a. Risk for other-directed violence
b. Disturbed thought processes
c. Risk for loneliness
d. Spiritual distress
e. Social isolation - A, B
Delusions of persecution and ideas of reference support the nursing diagnosis of disturbed thought processes. Risk for other-directed violence is substantiated by the patient's feeling endangered by persecutors. Fearful individuals may strike out at perceived persecutors or attempt self-harm to get away from persecutors. Data are not present to support the other diagnoses.
13/ 3. A patient with a long history of hypertension and diabetes now develops confusion. The health care provider wants to make a differential diagnosis between Alzheimer's disease and multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient for first?
a. Skull x-rays
b. Computed tomography (CT) scan
c. Positron-emission tomography (PET)
d. Single-photon emission computed tomography (SPECT) - B
13/4. A patient's history shows drinking 4 to 6 liters of fluid and eating more than 6,000 calories per day. Which part of the central nervous system is most likely dysfunctional for this patient?
a. Amydala c. Hippocampus
b. Parietal lobe d. Hypothalamus - D [Show Less]