18/16. When a patient comes to an outpatient appointment, a nurse smells alcohol. The nurse should:
a. explore the patient's reasons for drinking
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b. arrange admission to an inpatient psychiatric unit.
c. coordinate emergency admission to a detoxification unit.
d. tell the patient, "We cannot see you today because you have been drinking." - D
18/12. Which medication to maintain abstinence would most likely be prescribed for patients with either alcoholism or opioid addiction?
a. Bromocriptine (Parlodel)
b. Methadone (Dolophine)
c. Disulfiram (Antabuse)
d. Naltrexone (ReVia) - D
18/21. A nurse with a history of narcotic abuse became unconscious in the locker room after overdosing. After stabilization, the nurse was transferred to the inpatient psychiatric unit. Which action by nursing staff may be enabling?
a. Empathizing when the nurse discusses fears of disciplinary action by the state board of nursing.
b. Pointing out that work problems are the result, not the cause, of substance abuse.
c. Conveying understanding that pressures associated with nursing practice cause substance abuse.
d. Providing health teaching about stress management. - C
*23/18. A patient, aged 16 years, comes to the* crisis clinic and tells the nurse that an uncle tried to rape her yesterday. The patient had told her mother of the uncle's behavior, but the mother accused the daughter of lying and, contrary to the patient's hopes, indicated she would still allow the uncle to visit the family. The patient describes feeling "all confused" and shows minor lacerations on her forearms to the nurse, which she indicates she did out of desperation rather than a wish to die. Which nursing diagnosis would be most appropriate as her primary diagnosis?
a. Powerlessness
b. Disturbed thought processes
c. Rape-trauma syndrome
d. Interrupted family process - A
23/6. The crisis that occurs as an individual moves from young adulthood to middle age and becomes concerned with loss of his youthful appearance would be assessed by the nurse as a(n) ____ crisis.
a. situational
b. maturational
c. reactive
d. adventitious - B
23/8. A patient being interviewed on his first visit to the crisis center says he is there because he needs help, but then he falters and cannot continue his explanation. Which question would be of value in helping him relate his perception of the precipitating event?
a. "It will be hard to help you if we cannot get more information."
b. "Tell me about what happened that led you to come in today."
c. "Who is available to help and support you with your problem?"
d. "What things do you usually do to get through difficult times?" - B
23/11. A woman goes to the airport to pick up her husband, returning from one of many business trips. Persons awaiting his flight are directed to a conference room where airline counselors explain that the flight crashed into the ocean, and it is believed that there are no survivors. The woman tells a counselor that it is too soon to be sure, he might still be alive, clinging to wreckage and waiting to be found. The patient is demonstrating:
a. trial-and-error problem solving.
b. adaptive denial.
c. ineffective denial.
d. acute confusion. - B
23/12. A woman expecting to pick her husband up at the airport has instead just been told that he has been killed in an airplane crash. Crisis counselors are present to help loved ones cope with the sad and sudden news. Which response by the counselor would be most appropriate to make next?
a. State, "I will stay with you," and allow for a period of silence so she can process the news of her loss.
b. Ask, "What would help you in this difficult time? Would you like to speak with a chaplain?"
c. Ask, "Is there is someone who's supportive, who can take you home and spend time with you over the next few days?"
d. State, "We realize this is very sudden and unexpected and very upsetting. The airline is committed to helping you in this difficult time." - A
23/13. The assumption that will be most useful to the nurse planning crisis intervention for any patient who is experiencing a crisis is that the patient:
a. is experiencing a type of mental illness.
b. is experiencing a state of disequilibrium.
c. has high potential for self-injury.
d. poses a threat of violence to others. - B
23/15. An appropriate question for the nurse to ask to assess support systems is:
a. "Has anything upsetting occurred in the last few days?"
b. "What led you to seek help at this time?"
c. "How does this problem affect your life?"
d. "Who can be helpful to you during this time?" - D
23/16. The nursing diagnosis of Powerlessness related to impaired problem solving has been established for a patient seeking crisis counseling. An appropriate outcome for this nursing diagnosis would be that the patient will:
a. agree to sign a no-suicide contract within 30 minutes.
b. resume meeting pre-crisis role expectations within 36 hours.
c. state he feels less anxious within 4 hours of the interview.
d. describe two possible solutions during the first interview. - D
24/9. A 20-year-old economics major became severely depressed after failing two examinations in economics. She cried for 2 hours, then called her parents who live in a neighboring state, planning to ask if she could return home. However, her parents were in Europe. When her roommate went home for the weekend, the patient gave her three expensive sweaters to keep. Later, the dormitory resident assistant returned a book to the patient's room and found her unconscious on the floor, with an empty pill bottle nearby. The patient behavior that provided a clue to the suicide attempt was:
a. calling her parents.
b. staying in her dorm room.
c. giving away her sweaters.
d. excessive crying. - C
24/3. Which of these statements about suicide is accurate?
a. The majority of persons who attempt suicide have given overt or covert indications of their intentions to others.
b. A background in health care has a protective effect, leading to a lower rate of suicide among physicians and nurses than in the general public.
c. Most persons with previous suicide attempts survived because they did not truly intend to die; they are at lower risk than those making their first attempt.
d. Use of a low-lethality means or likelihood of being discovered in time to prevent death are merely suicide gestures, not genuine attempts. - A
24/12. A college student who attempted suicide by overdose was treated in the emergency department. Because she had no available social supports, she was hospitalized. An outcome related to the nursing diagnosis Risk for self-directed violence is that the patient will:
a. exercise self-control by refraining from attempting to harm herself.
b. verbalize a desire and intent to live by the end of the second hospital day.
c. demonstrate two new coping mechanisms by the fourth hospital day.
d. discuss two personal strengths by the end of first week of hospitalization. - A
24/13. A tearful, anxious man comes to the clinic with the chief complaint, "I should be dead." The first task of the nurse conducting the assessment interview is to:
a. assess the lethality of his suicide plan.
b. establish initial rapport with the patient.
c. encourage the expression of anger.
d. determine risk factors for suicide. - B
24/24. A staff nurse tells another nurse, "I just used the SAD PERSONS scale to evaluate a man who sometimes thinks about suicide; his score was 8. I'm wondering if I should send him home after arranging for follow-up." The best reply by the second nurse would be:
a. "That would seem appropriate, but I'd consult the on-call resident first."
b. "Be sure he is followed up closely; he may require hospitalization later on."
c. "I think you should consider hospitalization just to be safe."
d. "A score of 7 or higher usually requires immediate hospitalization." - D
24/27. The measure that would be considered a form of primary prevention for suicide is:
a. psychiatric hospitalization of a suicidal patient.
b. referral of a formerly suicidal patient to a support group.
c. helping school children learn to manage stress and be resilient.
d. suicide precautions for 24 hours for newly admitted patients. - C
25/3. Which situation would involve the highest risk for violence?
a. A nurse is about to set limits on a patient.
b. Shift change and report are about to begin.
c. A PRN medication is to be offered.
d. The patient is a young adult male. - A
25/5. A patient is pacing the hall near the nurses' station, swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say:
a. "Please quiet down."
b. "Hey, what's up?"
c. "You seem upset. Tell me about it."
d. "You need to go to your room to get control of yourself." - C
25/11. An elderly patient with multi-infarct dementia is striking out with her arms and kicking at people who walk past in the hall. Intervention by the nurse should begin by:
a. gently touching the patient's arm.
b. saying the patient's name to gain contact.
c. asking the patient what she needs.
d. approaching from behind to reassure her. - B
25/12. An elderly patient with multi-infarct dementia is striking out with her arms and kicking at people who walk past in the hall. After making contact with the patient, which intervention would be most appropriate?
a. Administering PRN sedation to calm the patient.
b. State: "You may not hit others; you are safe here."
c. Distract the patient into playing a board game.
d. State: "I notice you are trying to hit people." - D
25/13. An elderly patient with multi-infarct dementia is striking out with her arms and kicking at people who walk past in the hall. The nurse determines that the patient believes she is at home and that the other patients have broken into her home. The clinical nurse specialist suggests that staff use validation. Which of the following responses reflect this intervention?
a. "I'm a nurse who has come to check on you. Tell me about your home."
b. "You are in a nursing home. The others here are patients, just like you are."
c. "I wish you could be home, but you have been sick and are in a nursing home."
d. "You are not at home. This is a nursing home. It is September 10th, 2010." - A [Show Less]