final exam nclex

final exam nclex 1. Sam, a 9-year-old patient, has deficits in social functioning, intellectual functioning, and cannot manage practical aspects of daily life and functioning. You suspect: intellectual development disorder (IDD). specific learning disorder. autism spectrum disorder (ASD). attention deficit hyperactivity disorder (ADHD). 2. A 12-year-old male patient diagnosed with Tourette’s disorder is visiting his provider. The provider tells you to provide education for the patient and his mother because the provider is starting the patient on medication. Based on your knowledge of medications approved to treat this disorder, you will prepare medication teaching on which class of medication? Mood stabilizers Antianxiety agents Anticholinesterase inhibitors Antipsychotics 3. Taylor is a 3-year-old boy just diagnosed with autism spectrum disorder. Taylor’s mom is tearful and states, “Dr. Coolidge said we need to start therapy right away. I just don’t understand how helpful it will be—he’s only 3 years old!” Your best response, based on knowledge of autism treatment, is: “You are right, 3 years old is very young to start therapy, but it will make you feel better to be doing something.” “Starting him on treatment now gives Taylor a much greater chance for a productive life.” “If Taylor starts therapy now, he will be able to stop therapy sooner.” “If you have questions, its best to ask Dr. Coolidge.” 4. Victoria is an 8-year-old patient newly diagnosed with attention deficit hyperactivity disorder (ADHD). Based on your knowledge of the diagnosis of ADHD, you know her symptoms of hyperactivity, inattention, and impulsivity have to be apparent: in times of severe stress. in supervised clinical observations. both at home and at school. on diagnostic testing tools. 5. Restraint and seclusion are controversial in children because: parents may initiate a lawsuit. nursing staff have conflicted feelings leading to ineffectiveness. they are psychologically harmful and may be physically harmful. staff are untrained in use of restraints in children. Chapter 17 1. Emily is a veteran returning from Iraq. Ever since Emily participated in a village raid where explosives were used, she has been unable to walk. All diagnostic testing has been negative for any physical abnormalities, and she was diagnosed with conversion disorder. She asks you what that means. Your best response would be: “Your legs don’t work because your brain is screwed up.” “Your emotional distress is being expressed as a physical symptom.” “You are making up your symptoms as a cry for help.” “You are overly anxious about having a severe illness.” 2. Shane, aged 23 years, is admitted to your medical-surgical unit with complaints of abdominal pain, dizziness, and headaches. Results of a physical workup have been negative so far. Today Shane tells you, “Now I am having back pain.” Which of the following in Shane’s medical record may alert you to the possibility of malingering? (select all that apply): Select all that apply. Shane has a court date this week for drunk driving. Shane was adopted at the age of 5 years. Shane has a history of physical abuse by his stepfather. Shane has a history of oppositional-defiant disorder. Shane was raised primarily by his mother. 3. In somatization disorders, it is important for the nurse to employ holistic strategies. This can be defined as: utilizing many different therapeutic strategies or modalities for enhanced coping. involving every member of the family as well as the patient in treatment. incorporating spirituality and religion into treatment. considering all dimensions of the patient, including biological, psychological, and sociocultural. 4. What would be an appropriate expected outcome of Emily’s treatment plan? Emily will walk unassisted within 1 week. Emily will return to a pre-illness level of functioning within 2 weeks. Emily will be able to state two new effective coping skills within 2 weeks. Emily will assume full self-care within 3 weeks. 5. Emily asks you what kind of therapy will help her. Your best response, based on current knowledge, is: “A combination of antianxiety and antidepressant therapy is the most effective therapy.” “Aversion therapy is often used because in effect you are punishing yourself by not being able to walk.” “Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome.” “Cognitive behavioral therapy has been shown to consistently provide the best outcome for these types of disorders.” Chapter 19 1. Ellie asks what medication may help her condition. Your response is based on the knowledge that: there is no effective medication treatment for hypersomnolence disorder. medication therapy with benzodiazepines may be initiated. Ellie may be prescribed a stimulant. Ellie will be started on an anticholinesterase inhibitor for increased cognition. 2. As you are talking with Ellie, she begins to cry and states, “I can’t keep going like this! I work in a bank and if I can’t function correctly I’ll lose my job. I just don’t think I’ll get better.” A therapeutic response would be: “Don’t worry! I’m sure with treatment everything will get better.” “You are not alone. Many people who come for sleep studies are going through the same thing.” “You seem so sad. May I ask if something else is troubling you?” “There is much hope for improvement through treatment. Let’s talk about some strategies for your problems at work.” 3. Kyla asks you to explain what basal sleep requirement is. Your best response is: “The basal temperature of your body needed to induce the best sleep.” “The sleep time by your body needed to repair cellular damage.” “The amount of sleep needed to be fully awake and perform well in the daytime.” “The amount of sleep needed to transition to REM sleep.” 4. Ellie, a 38-year-old patient referred for sleep studies, reports frequent daytime lethargy, unintended lapses into sleep, and never feeling rested on awakening in the morning. Ellie’s symptoms describe: circadian rhythm disorder. hypersomnolence. rapid eye movement (REM) sleep behavior disorder. breathing-related sleep disorder. 5. Which statement by Kyla, a patient you are educating in the sleep disorders clinic, indicates that she needs further teaching? “I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can.” “Getting less than 6 hours of sleep at night may increase my risk for medical problems.” “Getting enough sleep will increase my productivity at work.” “Since I have to drive for my job, getting enough sleep will help me avoid accidents.” Chapter 21 1. Which of the following statements are true regarding childhood-onset conduct disorder? (select all that apply): Select all that apply. It is more commonly diagnosed in males. It is characterized by feelings of remorse and regret. It is usually diagnosed in late teen years. It is characterized by disregard for the rights of others. Those with conduct disorder rationalize their aggressive behaviors. It is usually outgrown by early adulthood. 2. Which of the following classifications of medication may be prescribed in intermittent explosive disorder? Anticonvulsants Psychostimulants Antianxiety agents such as benzodiazepines MAO inhibitors 3. Assessment for oppositional defiant disorder should include: assessing the history, frequency, and triggers for violent outbursts. assessing moral development, belief system, and spirituality for the ability to understand the impact of hurtful behavior on others, to empathize with others, and to feel remorse. assessing issues that result in power struggles and triggers for outbursts. assessing sibling birth order to understand the dynamics of family interaction. 4. Eli is a 17-year-old patient admitted to the psychiatric unit with conduct disorder after threatening his mother during an argument. Which of the following would be an appropriate short-term outcome for Eli? Engages in appropriate coping skills to manage stressors Expresses feelings Maintains self-control during hospitalization Mother will improve communication skills to interact with Eli 5. Nursing interventions for intermittent explosive disorder include: providing intensive family therapy. establishing a trusting relationship with the patient. setting up loose boundaries so the patient will feel relaxed. limiting decision-making opportunities to avoid frustration. Chapter 24 1. Which is true of pharmacological therapies for treatment of personality disorders? Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients. 2. Which of the following are true of antisocial personality disorder (APD)? (select all that apply): Select all that apply. It is the least studied of the personality disorders. It is characterized by rigidity and inflexible standards of self and others. Persons with APD display magical thinking. Persons with APD are concerned with personal pleasure and power. It is characterized by deceitfulness, disregard for others, and manipulation. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. Frontal lobe dysfunction is a brain change identified in APD. 3. Mary Alice is a 37-year-old patient referred to the mental health clinic with a suspected personality disorder. She is withdrawn and suspicious and states she has always preferred to be alone. She describes herself as having “special powers” and states that she is thinking of opening a business where she gives “readings” to people about their future. She states, “I believe we can all read each other’s thoughts at times.” Based on this presentation, you suspect: obsessive-compulsive personality disorder. narcissistic personality disorder. avoidant personality disorder. schizotypal personality disorder (STPD). 4. Belinda is a 24-year-old patient with borderline personality disorder (BPD). She is admitted to the inpatient psychiatric unit following a suicide attempt. You are caring for Belinda. Which of the following statements by Belinda illustrates a primary coping style of persons with BPD? “My provider says I might get out of here tomorrow. Do you think I’m ready to go?” “Last night the nurse let me go outside and smoke. I can’t believe you aren’t letting me. I used to think you were the best nurse here.” “I will never again speak to any of my messed up family members. I know that this will help me be more functional.” “I promise I am not feeling suicidal. I won’t hurt myself.” 5. Patients with borderline personality disorder (BPD) exhibit negative effect, which includes emotional , described as rapidly moving from one emotional extreme to another. lability Chapter 27 1. You are working in the emergency department. You notice Matt, your patient’s husband, pacing in the hallway, muttering to himself, and looking angrily around the emergency department. Which of the following statements to Matt may help prevent escalation and/or violence? “You need to stay with your wife. She needs you.” “Hey, what’s up buddy? You look pissed.” “I am calling security to deal with your behavior.” “You appear upset. Can I help you with anything?” 2. One older concept that is being used currently that may help in violence reduction in patients is: aired grievances. trauma-informed care. shared governance. learned helplessness. 3. When you approach Katy, what considerations should you take? Stand close to Katy for reassurance and to convey caring. Have other staff as backup, and stand far enough away to avoid injury. Take Katy to her room so you can speak with her alone. Call security and wait until they arrive before approaching Katy. 4. You are working on an adolescent psychiatric unit. Katy, aged 16 years, has been angry all day because her boyfriend was not allowed to visit last night. Katy is in the hallway and begins yelling, “It’s not fair! You all hate me! I hate this place!” She begins pounding her fists on the wall. To deal with the situation and prevent further escalation, your best response would be to say: “Katy, I will help you calm down. Do you want to go to your room and talk or go to the quiet room?” “Katy, you may yell and bang your fists but you must do it in your own room so you don’t upset the other patients.” “Katy, stop that right now! You will not be allowed to behave like that!” “Katy, you will have to go into seclusion and restraints right now.” 5. Peter, a 21-year-old patient, asks you, “What’s wrong with my brain that I have such a problem with aggression?” Your response is based on the knowledge that: the prevailing theory is that diminishment of stress hormones causes anger and aggression. no abnormalities of the brain have been identified that correlate with anger and aggression. the limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression. personality type plays a much greater part in anger and aggression than physical factors. Chapter 28 1. Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present: with vague physical complaints such as insomnia or pain. with extreme anger and unpredictable behavior. with many family members there to support them. with psychosis and/or mania as a result of long-term abuse. 2. If it is determined that Mikayla has been sexually abused, what is the priority outcome for Mikayla? Mikayla’s mother will learn coping techniques to support Mikayla. Mikayla will be able to verbalize exactly what happened to her. Mikayla will no longer act out sexually. The sexual abuse will cease. 3. After arranging for a sexual assault nurse examiner (SANE) to see Lauren and Mikayla for further assessment for abuse and proper reporting and follow-up, Lauren tells you she lives with her boyfriend, Darrin, who is not Mikayla’s father. What statement by Lauren would make you suspect she is being emotionally abused? “Darrin has a good job and keeps control of all the finances but our electricity still got turned off last week.” “I didn’t tell Darrin I was coming because he is under so much stress at work I didn’t want to add to it.” “Darrin yells a lot and calls me names, but that’s because I am so stupid and make so many mistakes.” “Darrin is Latin American and has a fiery temper.” 4. Lauren brings her 4-year-old daughter, Mikayla, to the emergency department and states that Mikayla has been “acting funny.” Lauren states, “She touches her vagina and rubs herself down there all the time and she never did that before. She drew me a picture showing two people with one on top of the other and said they were ‘doing sex’ and I saw her acting that out with her dolls too. I didn’t know where else to go.” Based on Lauren’s description, you suspect that: this is normal developmental behavior in a 4-year-old child. Mikayla has been sexually abused. Lauren needs education in parenting skills. Mikayla has been exposed to graphic sexual images on television. 5. Which of the following persons has the highest risk factors for physical abuse? Emma, a 7-month-old baby who has colic and doesn’t sleep through the night Roland, a 53-year-old man with cardiovascular disease living with his son Penny, a 28-year-old wife whose husband has a diagnosis of an anxiety disorder Rose, a 77-year-old woman living with her daughter and son-in-law Chapter 29 1. Which of the following are myths surrounding rape? (select all that apply): Women are usually raped by a stranger. Women do not “ask” to be raped by their behavior or dress. Most rapes occur away from home areas such as alleys and behind buildings. Documented rape cases include women from 8 to 70 years old. Rape is an expression of aggression and anger. Rape is usually an impulsive, spur-of-the-moment decision by the rapist. Unless the assailant is armed, most women should be able to get away and avoid the rape. 2. It has now been 1 year since Nicole’s rape. Which of the following statements by Nicole would indicate that she has recovered from the trauma? “I don’t walk home anymore because I am terrified it may happen again.” “I am sleeping better but still only get about 5 hours of sleep at night because of bad dreams about the rape.” “I realize that I was partly to blame for the rape because of walking in an unsafe neighborhood.” “My husband and I are having sex again and I enjoy it.” 3. It has been 6 months since Nicole was raped, and she has undergone counseling. Which statement by Nicole would indicate that an important outcome has been met? “I keep having nightmares about the rape and I can’t sleep at night.” “My husband has been very supportive during this whole thing.” “I am not going to let that rapist be in control of my life. I know things will keep getting better.” “I am not pressing charges because I want this whole thing to be over with so I can move on.” 4. Nicole is a 28-year-old married patient who comes to the emergency department after being raped on her way home from work. You have been with her as she cries and talks about what happened. She asks you, “What if I am pregnant?” Your response is guided by the knowledge that: the risk of pregnancy after rape is high, up to 50%. about 5% of women who are raped become pregnant as a result. reproductive functions shut down during a violent attack, and as a result pregnancy does not occur. Nicole may be worried about how her spouse will accept the baby. 5. Nicole alternates between sobbing and being quiet and withdrawn. Which of the following illustrates best practice in giving care to a patient who has just been sexually assaulted? Sympathetic: “I’m so sorry for what you have been through.” Reassuring: “Don’t worry. It’s hard now, but everything will be alright.” Supportive: “I am going to stay with you. We can talk as long as you want to.” Assertive: “Let’s talk about new coping skills you can use.” Chapter 34 1. Grace wants to find out more about the Potter family and tells them she will do a genogram. Rhea asks what a genogram is. The best response would be: “A genogram will assess risk for mental illness in future generations.” “A genogram is a tool used for deciding on the best type of therapy for your family.” “A genogram will help me see your family structure, history, and current functioning.” “A genogram will help us determine the cause of Jeremy’s schizophrenia.” 2. Marnie is the nurse working with a family whose boundaries are not clear and whose members are overinvolved with each other. The term that describes this type of family dynamic is: clear boundaries. enmeshment. scapegoating. rigid boundaries. 3. The family that consists of a married mother and father and three biological children all living together is referred to as a(n): blended family. cohabitating family. nuclear family. other. 4. As Grace continues to work with the family, Rhea confides that she and her husband Todd have not been getting along well. She states that daughter Jasmine provides much support to her, and that Jasmine “doesn’t really like her dad much anymore and doesn’t talk to him.” Grace suspects: emotional abuse. neglect. boundary blurring. triangulation. 5. Grace is the nurse working with the Potter family, which consists of married parents Todd and Rhea, 16-year-old Jasmine, and 19-year-old Jeremy, who has recently been diagnosed with schizophrenia. The rest of the family is bewildered with Jeremy’s symptoms and express that they feel lost in knowing how to deal with things. Which of the following approaches to family therapy would Grace take at this time to provide support and give information to the family that will help them cope with Jeremy’s illness? Insight-oriented family therapy Psychoeducational family therapy Behavioral family therapy Multigenerational family therapy