Chapter 21. Caring for Patients with Mental Illness and Substance Use
Disorders in General Practice Settings
1. The nurse in the emergency department (ED) is assessing a client with a long history
of depression. The nurse finds that the client has gained weight, has dry skin, and has
cold sensitivity. The nurse determines the client's depression is exacerbating; further
examination and testing reveal the client has hypothyroidism. Which phenomenon
occurred?
a. Depression screening
b. Social distancing
c. Trauma-informed caring
d. Diagnostic overshadowing
Answer: D
Diagnostic overshadowing occurs when a client's physical symptoms are attributed to
an existing mental health diagnosis rather than being investigated as a separate
medical condition, delaying recognition of hypothyroidism in this case. Depression
screening (A) refers to assessing for depressive symptoms, not misattributing physical
symptoms. Social distancing (B) and trauma-informed caring (C) are unrelated
concepts to this scenario.
2. The client arrives to the ED complaining of severe abdominal pains. The attending
health-care provider determines that the client is in labor. Upon further investigation,
the nurse discovers that the client uses illegal substances and did not seek prenatal
, care. Which of the following would best explain this lack of prenatal care?
a. Many states consider substance use during pregnancy as child abuse.
b. The client was never educated about the need for prenatal care.
c. The client had children at home and considered prenatal care unnecessary.
d. The client did not have the financial resources to obtain prenatal care.
Answer: A
Many states classify substance use during pregnancy as child abuse with legal
consequences, and health-care professionals are required to report suspected
prenatal drug use, which discourages clients from seeking prenatal care out of fear of
legal repercussions. Lack of education (B) is not the best explanation. Prenatal care
remains important regardless of having other children at home (C). While cost can be a
barrier, resources exist to help mothers obtain care (D), making it a less complete
explanation than legal fear.
3. The client with a myocardial infarction tells the intensive care nurse, "You won't have
to care for me pretty soon. I will not be a burden to you or others." Which initial action
should the nurse take?
a. Screen the client for suicide.
b. Transfer the client to the medical unit.
c. Allow the client some private, quiet time.
d. Reinforce independence with self-care.
Answer: A
Disorders in General Practice Settings
1. The nurse in the emergency department (ED) is assessing a client with a long history
of depression. The nurse finds that the client has gained weight, has dry skin, and has
cold sensitivity. The nurse determines the client's depression is exacerbating; further
examination and testing reveal the client has hypothyroidism. Which phenomenon
occurred?
a. Depression screening
b. Social distancing
c. Trauma-informed caring
d. Diagnostic overshadowing
Answer: D
Diagnostic overshadowing occurs when a client's physical symptoms are attributed to
an existing mental health diagnosis rather than being investigated as a separate
medical condition, delaying recognition of hypothyroidism in this case. Depression
screening (A) refers to assessing for depressive symptoms, not misattributing physical
symptoms. Social distancing (B) and trauma-informed caring (C) are unrelated
concepts to this scenario.
2. The client arrives to the ED complaining of severe abdominal pains. The attending
health-care provider determines that the client is in labor. Upon further investigation,
the nurse discovers that the client uses illegal substances and did not seek prenatal
, care. Which of the following would best explain this lack of prenatal care?
a. Many states consider substance use during pregnancy as child abuse.
b. The client was never educated about the need for prenatal care.
c. The client had children at home and considered prenatal care unnecessary.
d. The client did not have the financial resources to obtain prenatal care.
Answer: A
Many states classify substance use during pregnancy as child abuse with legal
consequences, and health-care professionals are required to report suspected
prenatal drug use, which discourages clients from seeking prenatal care out of fear of
legal repercussions. Lack of education (B) is not the best explanation. Prenatal care
remains important regardless of having other children at home (C). While cost can be a
barrier, resources exist to help mothers obtain care (D), making it a less complete
explanation than legal fear.
3. The client with a myocardial infarction tells the intensive care nurse, "You won't have
to care for me pretty soon. I will not be a burden to you or others." Which initial action
should the nurse take?
a. Screen the client for suicide.
b. Transfer the client to the medical unit.
c. Allow the client some private, quiet time.
d. Reinforce independence with self-care.
Answer: A
