Mental Health Questions with correct answers

Mental Health Questions During a psychiatric nursing assessment, Sally reports to the nurse that she was sexually assaulted 6 months ago and since then has had trouble concentrating at work. Her employer tells her he is sensitive to the amount of stress she is under, since she also recently went through a divorce, but that she needs to seek help for her anxiety and depression to avoid further consequences at work. Which of these data support the diagnosis of PTSD according to DSM-5 criteria? Select all that apply. 1) She directly experienced a traumatic event. 2) She is a single female. 3) She has had difficulty concentrating at work. 4) Her anxiety and depression are interfering with job functioning. 5) Her symptoms have been present for more than 6 months. - correct answer 1) She directly experienced a traumatic event. 3) She has had difficulty concentrating at work. 4) Her anxiety and depression are interfering with job functioning. 5) Her symptoms have been present for more than 6 months. Jared returned from active duty in the military and has beendiagnosed with PTSD. Which of the following interventions has been strongly advocated for as an effective strategy in this population? 1) Group therapy with patients who have a variety of diagnoses 2) Group therapy with patients who have anger management issues 3) Group therapy with patients who have experienced similar traumas 4) Group therapy with patients who have experienced different types of trauma - correct answer 3) Group therapy with patients who have experienced similar traumas The family of a patient being treated for PTSD asks the nurse to describe EMDR (eye movement desensitization and reprocessing), since it is being recommended for this patient. Which of the following teaching points are accurate descriptions of this intervention? Select all that apply. 1) EMDR has been shown to be effective in the treatment of all mental illnesses, including schizophrenia. 2) The process involves rapid eye movement while processing painful memories. 3) This process is contraindicated for patients with retinal detachment or glaucoma. 4) This process is thought to relieve anxiety so that the trauma can be processed from a more detached perspective. 5) The biological mechanism that makes EMDR effective is that it releases opioid-like chemicals in the brain. - correct answer 2) The process involves rapid eye movement while processing painful memories. 3) This process is contraindicated for patients with retinal detachment or glaucoma. 4) This process is thought to relieve anxiety so that the trauma can be processed from a more detached perspective. 4.The nurse is conducting an intake assessment for a patient with PTSD. Which of the following pieces of information support this diagnosis? Select all that apply. 1) The patient reports having nightmares but can't remember what they are about. 2) The patient states that he heard a loud noise when he was walking down the street and thought he was back in the war zone where he had last been deployed. 3) The patient took antidepressants when he was in junior high school and reports they didn't help. 4) The patient denies any history of substance abuse or dependence. - correct answer 1) The patient reports having nightmares but can't remember what they are about. 2) The patient states that he heard a loud noise when he was walking down the street and thought he was back in the war zone where he had last been deployed. 5.One type of intervention useful for patients with adjustment disorders is a short-term therapy focused on problem-solving skills and restoring adaptive functioning. This type of therapy is ____________________. - correct answer Crisis intervention 6.Carol has sought treatment for an adjustment disorder after divorcing her husband of 30 years. The nurse assesses that Carol is experiencing complicated grieving. Which of the following would be an appropriate intervention to address Carol's symptoms? 1) Explore with Carol the stages of normal grieving. 2) Tell Carol that expressing anger will only keep her fixated at that stage of grieving. 3) Encourage Carol that these symptoms usually go away on their own. 4) All of the above. - correct answer 1) Explore with Carol the stages of normal grieving. 7.Beth is being treated for an adjustment disorder following a job demotion 2 months ago. Since the demotion, she has frequently called in sick, complains of incapacitating migraines, and has been disciplined for yelling at her boss. Her husband asks the nurse why his wife is still having so much trouble functioning, since he knows people who have lost their jobs entirely and have since resolved their concerns. Which of these statements by the nurse accurately reflects understanding of the dynamics of different kinds of stressors in patient recovery? 1) Women have more difficulty managing work-related stressors than men. 2) Ongoing stressors are associated with more maladaptive behaviors than sudden-shock types of stressors. 3) Job demotion is associated with longer-term recovery because it is so uncommon. 4) Carol probably had pre-existing difficulties managing stressors as a child. - correct answer 2) Ongoing stressors are associated with more maladaptive behaviors than sudden-shock types of stressors. 8.An adult male has sought counseling at a community mental health center for PTSD. He reports during assessment that he witnessed the murder of a close friend last year in a random, drive-by shooting in his neighborhood. Since this loss he has had recurrent nightmares, explosive episodes, and frequently incapacitating anxiety. Which of the following nursing diagnoses would be appropriate, based on this assessment data? Select all that apply. 1) Post Trauma Syndrome R/T distressing events, as evidenced by recurrent nightmares. 2) Complicated grieving R/T loss of a friend in the traumatic event, as evidenced by explosive outbursts and reports of incapacitating anxiety. 3) Isolation R/T unresolved anxiety, as evidenced by complaints of incapacitating anxiety. 4) Risk for suicide R/T survivor guilt. - correct answer 1) Post Trauma Syndrome R/T distressing events, as evidenced by recurrent nightmares. 2) Complicated grieving R/T loss of a friend in the traumatic event, as evidenced by explosive outbursts and reports of incapacitating anxiety. 9.The nurse is conducting an assessment for a patient diagnosed with PTSD. She recognizes that people with PTSD are at high risk for several comorbid conditions. Which of the following will she need to assess carefully because of the high risk in people with PTSD? Select all that apply. 1) Trichotillomania 2) Depression and suicide ideation 3) Substance abuse 4) Verbal or physical aggression 5) Narcissistic Personality Disorder - correct answer 2) Depression and suicide ideation 3) Substance abuse 4) Verbal or physical aggression 10.The nurse is developing a plan of care for a patient diagnosed with PTSD. Which of the following variables will have an impact on the patient's response to interventions? Select all that apply. 1) Patient's self-esteem 2) Socioeconomic status 3) History of psychopathology 4) Amount of control over recurrence 5) Temperament 6) Immediate crisis debriefing - correct answer 1) Patient's self-esteem 2) Socioeconomic status 3) History of psychopathology 4) Amount of control over recurrence 5) Temperament 11.John has been in counseling for an adjustment disorder related to losing his management position in a health care facility. He tells the counselor he feels ready to terminate counseling. Which of these statements by the patient supports his readiness to terminate counseling? 1) "Counseling isn't going to get me another job, so what's the point?" 2) "I don't feel angry anymore and I've learned how to relax better." 3) "I've decided I'm never going to work again, so I'm applying for disability." 4) "As long as I continue to take antianxiety medication, I'll be okay." - correct answer 2) "I don't feel angry anymore and I've learned how to relax better." 12.A patient admitted to the psychiatric unit, who has been experiencing flashbacks and troubling nightmares, reports to the nurse that he just awoke from a nightmare and is still having chest pain. Which of these nursing interventions is a priority? 1) Encourage the patient to return to bed and try to calm down. 2) Administer prn antianxiety medication as ordered. 3) Assess the patient's cardiovascular status. 4) Encourage the patient to reflect on the troubling dream. - correct answer 3) Assess the patient's cardiovascular status. 13.A patient with PTSD who has been having nightmares is prescribed propranolol to treat PTSD symptoms. He asks the nurse why this medication was ordered since he doesn't have high blood pressure. Which of the following is the most appropriate response by the nurse at this point? 1) Call the doctor and question this order. 2) Discontinue the medication and check the patient's blood pressure. 3) Explain that propranolol has been shown to be effective in reducing nightmares associated with PTSD. 4) Explain that this medication is used to treat hypertension that often accompanies PTSD. - correct answer 3) Explain that propranolol has been shown to be effective in reducing nightmares associated with PTSD. 14.A female patient, Sally, was admitted to the psychiatric inpatient unit with PTSD following a rape 6 months ago in which she suffered several physical injuries. This evening she was approached from behind by a male patient who touched her on the shoulder, and Sally began screaming "I'm going to kill you for what you did to me!" Which of these immediate interventions by the nurse demonstrates a safe and effective care environment? Select all that apply. 1) Place the patient in seclusion for the safety of others. 2) Offer the patient reassurance that she is in a safe environment. 3) Tell the patient to share the details that she remembers about the traumatic event. 4) Stay with the patient. 5) Acknowledge and validate the patient's feelings as they are expressed. - correct answer 2) Offer the patient reassurance that she is in a safe environment. 4) Stay with the patient. 5) Acknowledge and validate the patient's feelings as they are expressed 15.Jennifer is working with the nurse on her care plan related to post trauma syndrome. Jennifer repeatedly asks the nurse why she is writing down everything and who will be seeing this information. Which of these interpretations by the nurse reflects an understanding of the post trauma patient? 1) Post trauma patients may be suspicious of others in their environment. 2) Post trauma patients need a lot of redirection. 3) Female post trauma patients are often very confused about details. 4) Post trauma patients are always confrontational and challenging with health care professionals. - correct answer 1) Post trauma patients may be suspicious of others in their environment. 16.A patient who has recently been diagnosed with PTSD asks the nurse what his options are for treatment of this disorder. Which of the following items should the nurse include in teaching the patient about primary treatments for PTSD? Select all that apply. 1) Prolonged exposure therapy 2) Cognitive therapy 3) ECT 4) Antipsychotic medication 5) EMDR - correct answer 1) Prolonged exposure therapy 2) Cognitive therapy 5) EMDR 1.Jeremy is a 7-year-old boy diagnosed with separation anxiety disorder. The nurse recommends that the parents have him evaluated for a group play therapy program. The parents question the nurse about the benefits of play therapy for Jeremy, since he has never had problems playing with other children. Which of the following teaching points made by the nurse are evidence-based statements according to Landreth and Bratton (2007) about the benefits of group play therapy? Select all that apply. 1) Play provides a means for children to express their inner feelings. 2) Playing with toys allows children to transfer anxieties and fears to objects rather than people. 3) Play allows children the opportunity to change unmanageable situations into manageable ones through symbolic representation. 4) Play therapy allows children the opportunity to relax and avoid discussing anxieties and fears. 5) Play therapy is designed to help children learn age-appropriate games and activities. - correct answer 1) Play provides a means for children to express their inner feelings. 2) Playing with toys allows children to transfer anxieties and fears to objects rather than people. 3) Play allows children the opportunity to change unmanageable situations into manageable ones through symbolic representation. 2.Which approach should the nurse use when planning client care for an adolescent diagnosed with conduct disorder? 1) The client and the entire family should all be included when planning care. 2) The adolescent is the identified client and should be the sole focus of care. 3) Teaching parenting skills should be the primary intervention. 4) Responsibility for treatment choices rests solely with the adolescent. - correct answer 1) The client and the entire family should all be included when planning care. 3.A client diagnosed with autism spectrum disorder was recently admitted to the hospital. This client grabs a toy and hits another child. Which is the most appropriate nursing action? 1) Isolate the client for 24 hours. 2) Encourage the client to explain the hostile behavior. 3) Assume a nonpunitive attitude and remove the client from the conflict. 4) Call the parents for input regarding behavioral management. - correct answer 3) Assume a nonpunitive attitude and remove the client from the conflict. 4.The disorder that is characterized by the presence of multiple motor tics and one or more vocal tics is called ____________. - correct answer Tourette's disorder 5.Joey, a 12-year-old boy diagnosed with ADHD, is being assessed to determine appropriateness for behavioral therapy-based group treatment. The nurse should also assess for symptoms of which disorders that commonly co-occur with ADHD? Select all that apply. 1) Oppositional defiant disorder (ODD) 2) Narcissistic personality disorder 3) Schizophrenia 4) Conduct disorder 5) Substance abuse - correct answer 1) Oppositional defiant disorder (ODD) 4) Conduct disorder 5) Substance abuse 6.A client diagnosed with attention-deficit/hyperactivity disorder (ADHD) is prescribed the neurotransmitter-altering drug methylphenidate (Ritalin). Another client, diagnosed with narcolepsy, also receives Ritalin. Why is Ritalin given for these two opposing problems? 1) ADHD responds positively to a decreased level of neurotransmitters, whereas narcolepsy responds positively to an increased level of neurotransmitters. 2) Narcolepsy responds positively to a decreased level of neurotransmitters, whereas ADHD responds positively to an increased level of neurotransmitters. 3) Both ADHD and narcolepsy respond positively to a decreased level of neurotransmitters. 4) Both ADHD and narcolepsy respond positively to an increase in levels of neurotransmitters. - correct answer 4) Both ADHD and narcolepsy respond positively to an increase in levels of neurotransmitters. 7.Conduct disorder is a precursor to the diagnosis of which personality disorder? 1) Narcissistic personality disorder 2) Antisocial personality disorder 3) Histrionic personality disorder 4) Obsessive-compulsive disorder - correct answer 2) Antisocial personality disorder 8.An adolescent diagnosed with attention-deficit/hyperactivity disorder (ADHD) is having difficulty maintaining concentration in the inpatient milieu. Which nursing intervention would help improve the client's task performance? 1) Mandate that the client remain in her room until all homework is complete. 2) Remove privileges if homework is not completed within a 2-hour period. 3) Encourage dividing tasks into smaller, attainable steps and reward successful completion. 4) Seek a physician's order to discontinue the stimulant methylphenidate (Ritalin). - correct answer 3) Encourage dividing tasks into smaller, attainable steps and reward successful completion. 9.A client is admitted to an inpatient adolescent psychiatric unit for treatment of oppositional defiant disorder (ODD). The nurse anticipates this client to exhibit which characteristic? 1) Cruelty to animals 2) Use of weapons to inflict harm 3) Negativistic, disobedient behaviors toward authority figures 4) Destruction of property - correct answer 3) Negativistic, disobedient behaviors toward authority figures 10.Which is a potential side effect from the prolonged use of methylphenidate (Ritalin)? 1) Psychosis 2) A decreased intelligence quotient (IQ) 3) Sore throat 4) A decrease in rate of growth and development - correct answer 4) A decrease in rate of growth and development 1.Tori has been talking to the nurse about her husband's behavior. She claims that although her husband is very controlling, he can't be described as manifesting intimate partner violence because he has never struck her. Which of these responses by the nurse is an accurate description of intimate partner violence? 1) Intimate partner violence is only physical abuse, but controlling behavior is dysfunctional, too. 2) The National Coalition Against Domestic Violence describes battering as different from intimate partner violence. 3) The U.S. Department of Justice defines intimate partner violence as any pattern of abusive behavior used to control an intimate partner, which can include physical, psychological, and other threats of intimidation or control. 4) Intimate partner violence relates to only acts of fatal violence. - correct answer 3) The U.S. Department of Justice defines intimate partner violence as any pattern of abusive behavior used to control an intimate partner, which can include physical, psychological, and other threats of intimidation or control. 2.A frightened young woman calls the ED and tearfully tells the nurse, "I've been raped. Please help me!" Which nursing questions take priority? 1) "Are you injured, and are you in a safe place?" 2) "Do you know your whereabouts, and do you have transportation?" 3) "Have you notified the police and do you know your assailant?" 4) "Have you bathed, douched, or changed your clothes?" - correct answer 1) "Are you injured, and are you in a safe place?" 3.Veronica presents at the emergency room with multiple bruises, a black eye, and a broken leg, which her husband states were the result of falling on a patch of ice. He requests to stay with her, and the nurse notices that Veronica appears fearful. Which of these is the best approach to conducting assessment? 1) Tell the husband how much you appreciate his support and engage him in the assessment process. 2) Instruct the husband that hospital policy dictates that certain aspects of physical assessment be done in private, and interview the client alone. 3) Ask Veronica if she would like her husband to be present throughout the interview. 4) Confront the husband about the suspiciousness of Veronica's injuries. - correct answer 2) Instruct the husband that hospital policy dictates that certain aspects of physical assessment be done in private, and interview the client alone. 4.Sarah convinces her husband to make an appointment at the health center and tells the intake nurse that her husband has been exhibiting violent behavior for the first time in their 14-year marriage. Which of the following should the nurse explore when assessing the husband for the origins of his behavior? Select all that apply. 1) History or evidence of brain diseases such as encephalitis or epilepsy 2) Substance use and medication history 3) Evidence of PTSD 4) History of abuse in his family of origin 5) Evidence of codependent personality traits in Sarah - correct answer 1) History or evidence of brain diseases such as encephalitis or epilepsy 2) Substance use and medication history 3) Evidence of PTSD 4) History of abuse in his family of origin 5.The expression of power and dominance by means of sexual violence is called ____________. - correct answer Rape 6.Chronic failure of a parent or caretaker to provide a child in his or her care with hope, love, and support necessary for developing a sound, healthy personality is defined as ____________ - correct answer Emotional Neglect 7.A young mother in a severely abusive relationship is admitted to psychiatric unit after an attempted suicide. The client tells the nurse, "I'm sure things will be better between us once I go home." Which is the most appropriate nursing response? 1) "Research shows that men who batter get worse rather than improve." 2) "Aren't you concerned about your children?" 3) "You really shouldn't return home to that violent situation." 4) "Let's develop a safety plan in case he becomes violent in the future." - correct answer 4) "Let's develop a safety plan in case he becomes violent in the future." 8.From a biological theory perspective, which predisposes individuals to be abusive? 1) Unmet needs for security, resulting in an underdeveloped ego and a weak super ego 2) Imitation of individuals who have a predisposition toward aggressive behavior 3) Various levels of norepinephrine, dopamine, and serotonin 4) The influence of culture and social structure - correct answer 3) Various levels of norepinephrine, dopamine, and serotonin 9.A 12-year-old female suddenly refuses to change for gym or participate in physical activities, has difficulty walking and sitting, and will not eat her food at lunchtime. What should the school nurse consider when assessing this child's symptoms? 1) Sexual abuse 2) Emotional neglect 3) Physical neglect 4) Incest - correct answer 1) Sexual abuse 10.After an examination and treatment for rape, the nurse prepares to discharge a client from the ED. Which discharge teaching should the nurse provide? (If one part of an answer is incorrect, the entire answer is incorrect.) 1) Information on available community resources 2) The names and phone numbers of local attorneys who defend rape victims 3) When to return to the ED for follow-up care 4) The phone number of the battered women's shelter and the crisis intervention center - correct answer 1) Information on available community resources 11.The nurse is planning care for Carla, who, despite suffering several broken bones as a result of spousal abuse, has decided not to leave her husband. In order to provide patient-centered care, the nurse must understand that which of these factors may contribute to the victim's desire to stay in the relationship? Select all that apply. 1) Fear of retaliation 2) Grandiose delusions 3) Concern for children 4) Lack of financial resources 5) Large support networks - correct answer 1) Fear of retaliation 3) Concern for children 4) Lack of financial resources 12.Dolores is seeing the nurse at the community mental health clinic for depression and reveals that her husband was physically abusive to her but "things are better now because he felt terrible and he has been great to me ever since." Which of the phases in the cycle of battering is Dolores describing? 1) The tension-building phase 2) The acute battering incident 3) The "honeymoon" phase 4) The resolution phase - correct answer 3) The "honeymoon" phase 1.A despondent, recently widowed woman tells the home health nurse, "My husband's lucky! I'm so lonely, there's no one to talk to, and life is not worth living with this arthritis pain." Which nursing diagnosis takes priority? 1) Risk for Suicide 2) Social Isolation 3) Pain 4) Complicated Grieving - correct answer 1) Risk for Suicide 2.The parents of an adult son with schizophrenia ask the community nurse what community resources are typically available for someone with this illness. Which of the following would be important for the nurse to inform the family about? Select all that apply. 1) Assertive Community Treatment 2) Partial hospitalization 3) Community residential facilities 4) Bipolar support groups 5) Alcoholics Anonymous (AA) - correct answer 1) Assertive Community Treatment 2) Partial hospitalization 3) Community residential facilities 3.The New Freedom Commission on Mental Health made several recommendations to promote better mental health care delivery. Which of the following is identified as a priority with regard to screening? 1) Screening for substance abuse should be separated from screening for mental illness. 2) Screening for mental disorders should occur in primary health care across the lifespan. 3) Screening for mental disorders should never occur in ERs. 4) Screening for mental disorders should be conducted only by psychiatrists. - correct answer 2) Screening for mental disorders should occur in primary health care across the lifespan. 4.In developing a community-based care plan, the community health nurse should address which of the following ongoing problems for homeless individuals? Select all that apply. 1) Alcoholism and thermoregulation 2) Sexually transmitted diseases 3) Conditions related to dietary deficiencies 4) Tuberculosis 5) The aging process - correct answer 1) Alcoholism and thermoregulation 2) Sexually transmitted diseases 3) Conditions related to dietary deficiencies 4) Tuberculosis 5.The community mental health nurse is conducting a community assessment to identify the region's priority mental health issues. Which of the following should be included in the assessment because of their correlation to emotional illness? Select all that apply. 1) The level of poverty in the region 2) Environmental conditions 3) Traumas 4) The number of residents who rent versus own their home - correct answer 1) The level of poverty in the region 2) Environmental conditions 3) Traumas 6.The nurse is teaching a community education class on drugs of abuse as a primary prevention strategy. One of the participants asks about the negative effects of alcohol on the body. Which of the following would be important to include in responding to this question? Select all that apply. 1) Cirrhosis of the liver 2) Peripheral nerve damage 3) Pulmonary hemorrhage 4) Pancreatitis 5) Sexual dysfunction - correct answer 1) Cirrhosis of the liver 2) Peripheral nerve damage 4) Pancreatitis 5) Sexual dysfunction 7.The community health nurse should include which tertiary level of prevention intervention for a homeless, unemployed individual with severe and persistent mental illness? 1) Providing education and support to reduce the incidence of mental illness. 2) Referring to a homeless shelter 3) Teaching daily living skills to encourage independence 4) Referring to an inpatient psychiatric hospital - correct answer 3) Teaching daily living skills to encourage independence 8.Based on the public health model of primary level of prevention, which services would the community nurse provide? 1) Teaching recovering clients daily living skills and encouraging independence 2) Monitoring effectiveness of aftercare services through home health visits 3) Providing ongoing assessment of individuals at high risk for illness exacerbation 4) Teaching parenting skills and child development to prospective new parents - correct answer 4) Teaching parenting skills and child development to prospective new parents 9.The community mental health nurse is making a home visit to an 82-year-old homebound client diagnosed with major depressive disorder. Which of the following is the highest priority assessment to conduct for this patient? 1) Medications 2) Suicide risk 3) Support network 4) ADLs - correct answer 2) Suicide risk 10.Mallory arrives at her community mental health center appointment appearing drowsy and with constricted pupils. She admits to using "stuff." The nurse recognizes that Mallory is experiencing the effect of which of the following drugs? 1) Cocaine 2) Alcohol 3) Opioids 4) Hallucinogens - correct answer 3) Opioids 11.Which homebound status criterion must be validated before an individual can receive home health care? 1) The client takes fluphenazine (Prolixin) by mouth (PO) for schizophrenia. 2) The client is unable to leave home without assistance. 3) The client does not have available family support. 4) The client has been diagnosed with major depression. - correct answer 2) The client is unable to leave home without assistance. 12.The community mental health nurse is teaching a class to families about barriers to treatment for people with mental illness. Which of the following were identified by The New Freedom Commission on Mental Health as significant barriers? Select all that apply. 1) Lack of effective medications for treatment of many mental illnesses 2) Stigma associated with mental illness 3) 90% unemployment rate among adults with serious mental illness 4) Older adults with mental illness are not receiving care - correct answer 2) Stigma associated with mental illness 3) 90% unemployment rate among adults with serious mental illness 4) Older adults with mental illness are not receiving care 1.A client diagnosed with end-stage liver disease states, "If only I could live until Christmas to see my grandchildren, I would be satisfied." The nurse recognizes this as which stage of grief as described by Kübler-Ross? 1) Denial 2) Anger 3) Bargaining 4) Depression 5) Acceptance - correct answer 3) Bargaining 2.Elderly individuals often experience a convergence of losses, the timing of which makes it impossible for the aging individual to complete the grief process in response to one loss before another occurs. What term is used to describe this situation? 1) Prolonged grieving 2) Distorted grief response 3) Bereavement overload 4) Delayed grief response - correct answer 3) Bereavement overload 3.A client's husband died a year ago. She has recently started dating a man from her grief support group. This behavior is indicative of which of the grief tasks described by Worden? 1) Task I: Accepting the reality of the loss 2) Task II: Processing the pain of grief 3) Task III: Adjusting to a world without the lost entity 4) Task IV: Finding an enduring connection with the lost entity in the midst of embarking on a new life - correct answer 4) Task IV: Finding an enduring connection with the lost entity in the midst of embarking on a new life 4.A patient in hospice is struggling with financial issues and medical bills. To which member of the interdisciplinary team should the nurse refer these concerns? 1) The physician 2) The social worker 3) The counselor 4) The attendant - correct answer 2) The social worker 4.A patient in hospice is struggling with financial issues and medical bills. To which member of the interdisciplinary team should the nurse refer these concerns? 1) The physician 2) The social worker 3) The counselor 4) The attendant - correct answer 3) The counselor 5.A client's wife died 1 year ago. He states, "I just can't get it together. I'll never recover from this. All I want is to be left alone." According to Bowlby, this statement is evidence of which stage of grief? 1) Stage I: Numbness or Protest 2) Stage II: Disequilibrium 3) Stage III: Disorganization and Despair 4) Stage IV: Reorganization - correct answer 3) Stage III: Disorganization and Despair 6.Which would the nurse identify as a maladaptive grieving response? 1) An individual thought she saw her dead husband when she was out shopping. 2) A client is experiencing marked feelings of worthlessness and low self-esteem. 3) A woman has not cried since the death of her husband. 4) A year after his death, a wife maintains all of her husband's belongings. - correct answer 2) A client is experiencing marked feelings of worthlessness and low self-esteem. 7.Winifred lost her teenage son 6 months ago and is being assessed for complaints of difficulty functioning at work. Which of the following statements by Winifred suggest clinical depression rather than a normal grief response? Select all that apply. 1) "I feel like I can't do anything right." 2) "I feel so depressed about the loss of my son and sometimes I feel like I wasn't there for him." 3) "I don't feel like doing anything and I'd rather be alone." 4) "I don't think I'll ever feel right again." - correct answer 1) "I feel like I can't do anything right." 3) "I don't feel like doing anything and I'd rather be alone." 4) "I don't think I'll ever feel right again." 8.The nurse is facilitating a support group on loss and bereavement. Of the following people who wish to attend, which ones would be appropriate for this group? Select all that apply. 1) Jerry lost a pet that has been in his family for the last 16 years. 2) Thomas lost his vision after a viral infection. 3) Sandy lost her full-time job and is suffering with depression. 4) Lenore lost her house in a fire. - correct answer 1) Jerry lost a pet that has been in his family for the last 16 years. 2) Thomas lost his vision after a viral infection. 3) Sandy lost her full-time job and is suffering with depression. 4) Lenore lost her house in a fire. 9.The nurse is evaluating a client's response to interventions for complicated grieving after losing his wife to cancer. Which of the following are indications that grief work has been successful? Select all that apply. 1) The client states that he and his family have been talking a lot about their feelings related to the loss. 2) The client states that his wife was a saint and no one will ever be able to live up to her character and integrity. 3) The client states that he was struggling with anger toward his children for not being more helpful to their mother when she was ill but he now recognizes that this anger was part of his grief response. 4) The client has returned to church and expresses feeling supported by others. - correct answer 1) The client states that he and his family have been talking a lot about their feelings related to the loss. 3) The client states that he was struggling with anger toward his children for not being more helpful to their mother when she was ill but he now recognizes that this anger was part of his grief response. 4) The client has returned to church and expresses feeling supported by others. 10.Veronica, who lost her father 3 years ago, continues to have difficulty at family functions and states, "I just can't stand to be around those people. They just don't realize that my stepmother never took care of Dad the way she should have and he probably died sooner because of her." According to Kübler-Ross' model, which stage of grief has Veronica not yet resolved? 1) Denial 2) Anger 3) Bargaining 4) Depression - correct answer 2) Anger 11.Which statement would indicate to the nurse that a widow is nearing the end of the grief process? 1) "My husband left me so quickly. I'm furious that he is not here for me!" 2) "My husband was often grumpy, but I know he loved me unconditionally." 3) "I feel so guilty that I was out with my girlfriend when he had his heart attack." 4) "My husband was the best husband in the world." - correct answer 2) "My husband was often grumpy, but I know he loved me unconditionally." 12.Dennis, an African American man who lost his father 2 days ago, is now involved in a Celebration of Life Service in which friends and relatives are being encouraged to share stories and anecdotes from their experiences with Dennis' father. According to Engel's model, in which stage of grief is Dennis participating? 1) Recovery 2) Developing awareness 3) Restitution 4) Resolution - correct answer 3) Restitution 1.Betty is being treated for PTSD after return from active duty in the military. She reports difficulty sleeping, feelings of depression with suicide ideation, and troubling nightmares, most of which she can't remember. She reports that she's not sure why she is having such difficulty since she was never in an active combat zone. Which of the following understandings may assist the nurse in assessment of this client? 1) Among military veterans, women experience more amnesia than men who suffer from PTSD. 2) The leading cause of PTSD among female veterans is combat trauma. 3) The leading cause of PTSD among female veterans is sexual trauma. 4) Among military veterans, women experience more severe PTSD than men. - correct answer 3) The leading cause of PTSD among female veterans is sexual trauma. 2.Jeremy returned from active duty 3 months ago and was taken to an ER after an altercation with a patron in a local bar. He admits to regular cannabis use and drinking "about a six-pack" of beer each night. He tells the ER nurse it doesn't matter what happens at the bar because he's not going to be around much longer anyway. He has several bruises on his arms that he says are a result of the barroom fight. Which of these assessments is the first priority, on the basis of Jeremy's presentation in the ER? 1) Conduct an assessment for history of substance abuse 2) Conduct an assessment for PTSD 3) Conduct a suicide risk assessment 4) Conduct a neurological assessment to evaluate for symptoms of a concussion - correct answer 3) Conduct a suicide risk assessment 3.Posttraumatic stress disorder (PTSD) is associated with high rates of ____________________ among veterans. - correct answer Alcoholism 4.Kelly recently relocated to a new high school because of her father's relocation to a different military base. In talking to the school nurse, she reveals several concerns. Which of these are commonly associated with children of military personnel? Select all that apply. 1) Menstrual irregularities 2) Feeling different from her peers in class 3) Hearing voices telling her to kill herself 4) Several episodes of after-school detention for aberrant behavior 5) Fear of being behind academically in comparison with her peers - correct answer 2) Feeling different from her peers in class 4) Several episodes of after-school detention for aberrant behavior 5) Fear of being behind academically in comparison with her peers 5.Of the five stages in the cycle of deployment, the stage which is most critical for the soldier and spouse is ________________________________. - correct answer Post-deployment 6.Martin has been seeing the nurse at the VA hospital for his monthly injection of Haldol. He has a history of schizophrenia and also has a traumatic brain injury. Both Martin and the nurse agree that he would benefit from referral to a physician who can assist him with physical rehabilitation needs. Which of these health care professionals would meet these criteria? 1) Neuropsychologist 2) Psychiatrist 3) Physiatrist 4) Occupational therapist - correct answer 3) Physiatrist with intimacy in his marriage. He discloses that he feels he has to keep "military focus" in the forefront. Which of these is a reality of current military lifestyle that may be contributing to Paul's struggles? 1) Men in the military are often victims of sexual assault. 2) Many service personnel are being deployed multiple times. 3) Spousal intimacy is discouraged among military personnel. 4) The discipline that is taught in the military is focused on solitude. - correct answer 2) Many service personnel are being deployed multiple times. 8.Sheila brings her 13-year-old son to see the pediatrician because he has been complaining of having troubling nightmares and "flashbacks" of being in a combat zone. She tells the assessment nurse that she thinks her son in making up these stories, which are similar to his father's PTSD symptoms, so he can get out of going to school. Which of these teaching points is accurate for the nurse to share with Sheila? 1) Borderline Personality Disorder (BPD) traits, including lying, are common in teenage boys of military parents. 2) There is no evidence that an individual can have flashbacks unless they have directly experienced trauma. 3) It will be important to avoid exploring her son's reports so the behavior will be extinguished. 4) It is not uncommon for children of parents with PTSD to experience secondary trauma. - correct answer 4) It is not uncommon for children of parents with PTSD to experience secondary trauma. 9.Kelly is being treated for a traumatic brain injury (TBI) she sustained while on active duty. She has been working at a local market since her return from deployment but sought treatment because she was having some difficulty remembering things at work. The nurse decides to provide some education and to focus on recovery rather than treat the immediate symptoms as something that will always be present. Which of the following is the best rationale for this approach? 1) Evidence supports that the majority of TBIs are mild cases and that most patients can experience full recovery. 2) Education is always the priority when responding to someone with a TBI. 3) Evidence supports that focusing on recovery is important regardless of the patient's symptoms. 4) Education and talking about recovery are more effective than cognitive behavioral therapy. - correct answer 1) Evidence supports that the majority of TBIs are mild cases and that most patients can experience full recovery. 10.Marsha, who returned from active duty 3 months ago, began seeing a counselor for depression. Her husband urged her to seek treatment and confides to the counselor that he believes she may have been sexually assaulted during her tour of duty. Marsha repeatedly tells the counselor that it's "his problem" and that she doesn't want to talk about "military stuff." Which of the following are common issues among women in the military that may be contributing factors in Marsha's difficulty in disclosing concerns? Select all that apply. 1) Fears of accidentally disclosing classified information contributes to victimization. 2) Women who report sexual assault are often told to minimize the issue or pretend it didn't happen. 3) There is often fear of being discharged from the service. 4) There is often fear of being diagnosed with a mental illness. 5) Paranoid delusions are common among women in the military. - correct answer 2) Women who report sexual assault are often told to minimize the issue or pretend it didn't happen. 3) There is often fear of being discharged from the service. 4) There is often fear of being diagnosed with a mental illness. 11.Robert recently retired after a long and distinguished career in the military. He reported to his nurse practitioner that he has had difficulty sleeping, has had frequent fights with his wife, and has been having troubling nightmares ever since he retired. He is requesting medication for insomnia. Which of these understandings about military experience will guide the nurse in providing appropriate intervention for this client? 1) Retirement has been shown to be a significant precipitating factor in PTSD. 2) Very few people with distinguished military careers ever develop PTSD. 3) Most military career personnel have marital conflict in retirement. 4) Insomnia at the time of retirement is frequently associated with fear of losing military benefits. - correct answer 1) Retirement has been shown to be a significant precipitating factor in PTSD. 12.The nurse is assessing a veteran who sustained a traumatic brain injury (TBI) during the Persian Gulf War. Which of these other conditions should the nurse assess for, because of higher associated risk in this population? Select all that apply. 1) Signs of Alzheimer's disease 2) Symptoms of Parkinson's disease 3) Symptoms of ulcerative colitis 4) Signs of depression - correct answer 1) Signs of Alzheimer's disease 2) Symptoms of Parkinson's disease 4) Signs of depression 13.Sandy was seen at the mental health clinic because, since her return from active duty, she has been experiencing flashbacks, nightmares, and insomnia and reports feeling "depressed all the time." She is prescribed antidepressants. In light of her diagnoses of PTSD and depression, which of these medications should most likely be the first line of treatment? 1) Haloperidol 2) Escitalopram 3) Diazepam 4) Lithium carbonate - correct answer 2) Escitalopram 14.John is seeing his family physician to get medication for migraine headaches. He reports that he has been struggling with these since returning from his last tour of duty. He also reports the following issues to the nurse conducting his assessment. Which of these are common signs of adjustment difficulty associated with returning from active duty? Select all that apply. 1) "I get this uncomfortable feeling in my chest and sometimes I get nauseated, too." 2) "I like to go out drinking with my buddies but if someone gets in my face, I get mean real quick." 3) "Sometimes I can't remember what I was about to do." 4) "I feel like there's no one more important than my war buddies. I'd do anything for them." 5) "I feel like I'm on 'high alert' all the time so I see everything that's going on around me even if it's across the room." - correct answer 2) "I like to go out drinking with my buddies but if someone gets in my face, I get mean real quick." 3) "Sometimes I can't remember what I was about to do. 5) "I feel like I'm on 'high alert' all the time so I see everything that's going on around me even if it's across the room." 15.Sarah is being treated at the VA hospital for PTSD. She tells the nurse she would rather try strategies other than medication to treat her symptoms and asks what might be some options. When the nurse provides education in response to the patient's inquiry, which of these alternative (complementary) treatments is supported by evidence-based research as being helpful in alleviating symptoms of PTSD? 1) St. John's wort 2) Acupuncture 3) Therapeutic touch 4) Transcranial magnetic stimulation (TMS) - correct answer 2) Acupuncture 16.During Pam's interview with the mental health nurse, she discloses the following information: She is seeking help because she has been having trouble sleeping since her return from active duty 6 months ago. She is thinking about telling her husband she wants a divorce since they have been fighting "constantly." She states, "I can't go on like this. I know he won't let me have a divorce. He's a violent, controlling man and I just want to end it all." Prioritize each of the following nursing interventions from 1 to 5, with 1 being the highest priority. • Discuss with Pam the possibility of marital counseling. • Conduct a suicide lethality assessment. • Assess sleep history and current patterns. • Assess Pam for symptoms of PTSD. • Explore issues related to their relational conflicts. - correct answer 1 Conduct a suicide lethality assessment. 2 Assess sleep history and current patterns. 3 Explore issues related to their relational conflicts 4 Assess Pam for symptoms of PTSD. 5 Discuss with Pam the possibility of marital counseling. 17.A veteran is being assessed for complaints of trouble sleeping and marital problems. Which of these statements by the patient reflect common conflicts between military culture and civilian culture? Select all that apply. 1) "My wife doesn't understand that my soldiers have to come first." 2) "We were separated for six months the last time I was deployed and I may be getting redeployed in a few months." 3) "My kids complain that they can never make friends because we have to relocate again." 4) "My wife and I are always fighting about how to discipline the kids. She thinks I'm too strict." - correct answer 1) "My wife doesn't understand that my soldiers have to come first." 2) "We were separated for six months the last time I was deployed and I may be getting redeployed in a few months." 3) "My kids complain that they can never make friends because we have to relocate again." 4) "My wife and I are always fighting about how to discipline the kids. She thinks I'm too strict." 18.Janice is attending a support group for wives of military personnel. The group facilitator is teaching the group about common problems encountered by spouses of people in active duty. Which of the following are recognized as common concerns in this population? Select all that apply. 1) Loneliness 2) Alcoholism 3) Financial stressors 4) Difficulty managing escalating misbehavior in their children - correct answer 1) Loneliness 3) Financial stressors 4) Difficulty managing escalating misbehavior in their children