Exam 4 V1: NU 160 / NU160 (Latest 2026 / 2027) Mental Health Concepts | 100% Correct Questions & Answers – Galen

Exam 4 V1: NU 160 / NU160 (Latest 2026 / 2027) Mental Health Concepts | 100% Correct Questions & Answers – Galen Question : Sleep disorders characterized by abnormal behavioral or physical events during sleep are called: a. hypersomnias b. dyssomnias c. parasomnias d. insomnias c. parasomnias RATIONALE: Parasomnias are defined as sleep disorders characterized by abnormal behavioral, physical, or experiential events that occur during sleep or during transitions between sleep and wakefulness, including conditions such as sleepwalking, sleep terrors, nightmares, and REM sleep behavior disorder. Dyssomnias are disorders involving disturbances in the amount, quality, or timing of sleep such as insomnia, narcolepsy, and sleep apnea, and are focused on the sleep itself rather than abnormal behaviors occurring during sleep. Insomnia is a specific dyssomnia characterized by difficulty falling asleep or staying asleep and does not describe abnormal behaviors or physical events occurring during the sleep period. Hypersomnia refers to excessive daytime sleepiness or prolonged nighttime sleep and is also a dyssomnia focused on the quantity of sleep rather than abnormal events occurring while the person is asleep. A 17-year-old female is admitted for a significant loss of weight. She is withdrawn and nonverbal. She likely has which disorder? A. strep throat B. anorexia nervosa C. renal calculus D. attention-deficit/hyperactivity disorder B. anorexia nervosa RATIONALE: Anorexia nervosa is the most consistent diagnosis with this clinical picture because the patient is a 17-year-old female, which falls within the peak age of onset of 14 to 18 years, and is presenting with significant weight loss combined with social withdrawal and being nonverbal, which are characteristic behavioral and psychological features of the disorder. Anorexia nervosa disproportionately affects adolescent females and the withdrawn, nonverbal presentation reflects the shame, denial, and emotional guardedness that commonly accompany this illness. Strep throat is a bacterial infection of the throat that causes fever, sore throat, and difficulty swallowing and would not account for significant weight loss or withdrawn nonverbal behavior in an adolescent. Renal calculus refers to kidney stones which cause severe flank pain, hematuria, and nausea but do not cause the pattern of significant weight loss and psychological withdrawal described in this scenario. Attention-deficit/hyperactivity disorder is a neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity and while it may coexist with eating disorders it does not itself cause significant weight loss or the withdrawn nonverbal presentation described here. A condition that repeatedly disrupts an individual's sleep pattern is a: A. pre-sleep period B. rumination disorder C. pica D. sleep-wake disorder D. sleep-wake disorder RATIONALE: A sleep-wake disorder is defined as a condition that repeatedly disrupts an individual's normal sleep pattern, causing disturbances in the amount, quality, timing, or continuity of sleep that result in significant distress or impaired daytime functioning. The pre sleep period refers to the time before sleep onset and is not a disorder but rather a normal phase of the sleep process during which the body prepares for sleep. Rumination disorder is an eating disorder characterized by the repeated regurgitation and re-chewing of food after eating and has no connection to sleep disruption. Pica is also an eating disorder involving the persistent consumption of non-food substances such as dirt, clay, or paper and is entirely unrelated to sleep patterns or disturbances. During the treatment phase for a client with anorexia nervosa, the client should be: A. placed in front of a mirror daily B. maintained on bedrest C. weighed daily D. force fed Answer: C. Weighed daily Rationale: Daily weighing is a standard component of treatment for anorexia nervosa because it allows the treatment team to objectively monitor the client's nutritional rehabilitation and weight restoration progress, which is the primary medical goal of treatment. Weighing should be done consistently at the same time each day, typically in the morning, with the same clothing and scale to ensure accuracy and track meaningful trends over time. Placing the client in front of a mirror daily is contraindicated because patients with anorexia nervosa have severe body dysmorphia and distorted body image, meaning mirror exposure would reinforce their distorted perception of themselves as overweight and worsen psychological distress. Bedrest is not a standard intervention for anorexia nervosa and would not be therapeutic unless the client is medically unstable, as activity and structured daily routines are part of a healthy recovery environment. Force feeding is not a therapeutic intervention and violates the client's dignity and autonomy, though in life-threatening situations where the client refuses all nutrition, medical teams may pursue legal authorization for nasogastric feeding as a last resort, which is distinct from force feeding. Which of the following individuals is most likely to experience a sleep disorder? A. adolescent B. child C. infant D. older adult D. older adult RATIONALE: Older adults are most likely to experience sleep disorders because aging causes significant changes in sleep architecture including reduced deep sleep, more frequent nighttime awakenings, and earlier sleep and wake times. Older adults also have higher rates of medical conditions, chronic pain, and medications that disrupt sleep quality. While adolescents, children, and infants all experience sleep changes, these are typically normal developmental patterns rather than true sleep disorders. A client states that they do not identify as exclusively male nor female. Which term will the nurse use to document this client statement? A. transgender B. nonbinary C. cisgender D. genderfluid B. nonbinary RATIONALE: Nonbinary describes a person who does not identify exclusively as male or female, which matches exactly what the client stated. Transgender means the person's gender identity differs from their birth assignment but does not specifically mean they reject both categories. Cisgender means their identity matches their birth assignment, which is the opposite of what the client described. Genderfluid means their identity shifts over time, which is different from simply not identifying as exclusively male or female. When does an individual determine their gender identity? A. at birth B. in late adulthood C. at an individualized time D. in the toddler years Answer: C. At an individualized time Rationale: Gender identity development occurs at an individualized time that varies from person to person, meaning there is no single universal age or stage at which all individuals come to understand and internalize their gender identity, as this process is influenced by a complex interaction of biological, psychological, social, and cultural factors unique to each individual. While many children begin to develop an awareness of gender identity in early childhood and most can identify their natal sex by age 2, the full development and articulation of one's gender identity, particularly for individuals whose gender identity differs from their assigned sex at birth, may not become clear until childhood, adolescence, adulthood, or even later in life. Birth is not correct because gender identity is not simply determined by biological sex at birth and the internal psychological experience of gender develops over time through a complex developmental process rather than being fully formed at the moment of delivery. Late adulthood as a fixed answer is also incorrect because while some individuals do come to understand their gender identity later in life, this is not universally true and many people have a clear sense of their gender identity much earlier. The toddler years represent an important period in early gender development but stating that all individuals determine their gender identity during this single developmental stage oversimplifies a deeply personal and variable process that unfolds differently for every individual across the lifespan. Which drug blocks the pleasure receptor in the brain that responds to addictive conditions like compulsive sexual behavior? A. Bupropion B. Naltrexone C. Clonazepam D. Duloxetine B. Naltrexone RATIONALE: Naltrexone is an opioid receptor antagonist that works by blocking the mu-opioid receptors in the brain that are responsible for the pleasurable and rewarding effects associated with addictive behaviors, including compulsive sexual behavior, alcohol use disorder, and opioid use disorder. The brain's reward pathway releases endogenous opioids during pleasurable activities including sexual behavior, and by blocking these receptors naltrexone reduces the rewarding sensation that drives compulsive repetition of the behavior, thereby decreasing the urge to engage in it. Bupropion is an antidepressant that works on dopamine and norepinephrine reuptake and is used to treat depression, aid in smoking cessation, and counteract SSRI-induced sexual dysfunction, but it does not work by blocking pleasure receptors associated with addictive behavior. Clonazepam is a benzodiazepine used for anxiety disorders, seizures, and parasomnias such as REM sleep behavior disorder, and has no mechanism of action related to blocking reward or pleasure receptors in the context of addictive behavior. Duloxetine is a serotonin norepinephrine reuptake inhibitor used primarily for depression, anxiety, and chronic pain conditions and does not function as a pleasure receptor blocker in the treatment of compulsive or addictive behaviors. Which characteristics are part of someone’s gender expression? Select all that apply. A. mannerisms B. vocal inflection C. clothing D. sexual partner preference E. hair style A. mannerisms B. vocal inflection C. clothing E. hair style RATIONALE: Gender expression is the external, outward presentation of one's gender through clothing, behavior, hairstyle, mannerisms, and appearance. A person's biological sex does not determine their gender identity. Their gender identity does not determine their gender expression. Their gender expression does not determine their sexual orientation. Most children can accurately identify their own natal sex by which age? A. 3 B. 2 C. 4 D. 5 B. 2 RATIONALE: Most children can accurately identify their own natal sex by approximately age 2, which is consistent with early childhood psychosexual development when toddlers begin to recognize and label themselves according to their biological sex as part of normal gender identity formation. This early identification occurs alongside rapid language development and growing self-awareness that characterizes the toddler years, when children begin to apply the labels "boy" and "girl" to themselves and others in their environment. By age 3, children have typically moved beyond simple identification of natal sex and begin to develop a more stable sense of gender identity, understanding not just what sex they are but beginning to internalize what that means in terms of roles and behaviors. Ages 4 and 5 represent more advanced stages of gender development where children achieve gender constancy, meaning they understand that their gender remains stable over time regardless of changes in clothing, hairstyle, or activities. The nurse should be aware of this developmental milestone because deviations from expected gender development, such as a persistent and consistent identification with a gender different from natal sex beginning in early childhood, may be an early indicator of gender dysphoria warranting sensitive and affirming clinical assessment. A client with severe weight loss may require which therapy? A. tube feeding B. parenteral nutrition C. regular diet D. intravenous therapy Answer: B. Parenteral nutrition Rationale: A client with severe weight loss, such as that seen in anorexia nervosa or other conditions causing extreme malnutrition, may require parenteral nutrition when oral intake is insufficient or impossible to meet the body's nutritional needs, as this method delivers nutrients directly into the bloodstream through an intravenous line bypassing the gastrointestinal tract entirely. Parenteral nutrition is indicated when the gastrointestinal tract is not functioning adequately or when the patient is so severely malnourished that standard oral or enteral feeding cannot safely restore nutritional status quickly enough to prevent life-threatening complications. Tube feeding, also called enteral nutrition, delivers nutrients directly into the stomach or small intestine through a nasogastric or gastrostomy tube and may also be used in severe cases, but parenteral nutrition is the most aggressive and comprehensive intervention for the most critically malnourished patients. A regular diet assumes the patient is able and willing to consume adequate nutrition orally, which is not realistic in a client with severe weight loss who may be medically unstable or actively refusing food. Intravenous therapy typically refers to fluid and electrolyte replacement rather than complete nutritional support, and while it is an important component of care for the malnourished patient, it does not provide the calories, proteins, fats, and micronutrients needed to address severe weight loss the way parenteral nutrition does. When caring for a client with anorexia nervosa, the nurse should be aware that the client will be: A. overweight B. underweight C. obese D. of normal weight B. underweight RATIONALE: Anorexia nervosa is characterized by self-imposed starvation driven by an intense fear of weight gain and a severely distorted body image, resulting in a significantly low body weight that is below what is minimally expected for the individual's age, sex, and developmental trajectory. Patients with anorexia nervosa restrict their caloric intake to dangerously low levels and may also engage in excessive exercise, resulting in a body weight that is objectively and often severely underweight with a BMI typically below 17.5. Being overweight or obese is inconsistent with anorexia nervosa and would instead be more associated with binge eating disorder, which involves recurrent binge eating without compensatory behaviors leading to weight gain over time. Normal weight is more characteristic of bulimia nervosa, where patients engage in a binge-purge cycle that often maintains their weight within a normal range, making their disorder less visually apparent than anorexia. The nurse must also be aware that despite being dangerously underweight, patients with anorexia nervosa typically deny that there is a problem and genuinely perceive themselves as overweight due to severe body dysmorphia, which is one of the most challenging clinical features of the disorder. An uncommon condition in which an individual has repeated attacks of sleep is called: A. pickwickian syndrome B. parasomnia C. narcolepsy D. insomnia C. narcolepsy RATIONALE: Narcolepsy is a chronic neurological disorder characterized by recurrent, uncontrollable attacks of sleep and excessive daytime sleepiness regardless of how much nighttime sleep the person has obtained, making it the condition that most accurately matches the description of repeated attacks of sleep. Narcolepsy is caused by the loss of hypocretin producing neurons in the hypothalamus and is also associated with cataplexy, sleep paralysis, and hypnagogic hallucinations. Insomnia is the opposite condition, involving difficulty falling asleep or staying asleep rather than uncontrollable episodes of falling asleep. Parasomnia refers to abnormal behaviors or events that occur during sleep such as sleepwalking, sleep terrors, or REM sleep behavior disorder, none of which involve sudden uncontrollable attacks of sleep during waking hours. Pickwickian syndrome, also known as obesity hypoventilation syndrome, involves chronic hypoventilation and excessive daytime sleepiness related to obesity and is a distinct condition from narcolepsy, though both can cause daytime drowsiness. Consuming an amount of food within a certain time that is larger than most individuals would eat in similar circumstances is known as: A. a regular diet B. parenteral nutrition C. anorexia nervosa D. binge eating D. binge eating RATIONALE: Binge eating is defined as consuming an unusually large amount of food within a discrete period of time, typically two hours or less, in an amount that is definitively larger than what most people would eat under similar circumstances and in a similar time period. A key feature of binge eating is the accompanying sense of loss of control over eating during the episode, meaning the person feels unable to stop eating or control what or how much they are consuming. A regular diet describes normal eating patterns without the excessive quantity or loss of control that defines a binge episode. Parenteral nutrition is a medical intervention in which nutrients are delivered intravenously, bypassing the digestive system entirely, and has nothing to do with excessive oral food consumption. Anorexia nervosa is characterized by severe restriction of food intake and self-imposed starvation driven by intense fear of weight gain, which is the opposite of the excessive consumption described in this question. Which disorder is associated with a pattern of sexual arousal gained by touching or rubbing oneself against a non-consenting individual? A. Frotteuristic disorder B. Exhibitionistic disorder C. Fetishistic disorder D. Pedophilic disorder A. Frotteuristic disorder RATIONALE: Frotteuristic disorder is defined as recurrent and intense sexual arousal obtained specifically from touching or rubbing against a non-consenting person, typically in crowded public spaces such as subways or elevators where the perpetrator can make contact and escape without detection. The non-consent of the victim is a central and defining feature of this disorder, meaning the arousal is derived from the violation itself. This distinguishes it from exhibitionistic disorder, which involves exposing genitals to an unsuspecting person rather than physical contact. Fetishistic disorder involves arousal to non-living objects or specific body parts and does not involve non-consenting contact with another person. Pedophilic disorder involves sexual arousal specifically directed toward prepubescent children and is not defined by the act of rubbing or touching in public spaces. Which component is part of the “five Ps” that make up a sexual history? Select all that apply. A. panic attacks B. pregnancy C. past STI history D. partners E. positivity B. pregnancy C. past STI history D. partners RATIONALE: The Five Ps of Sexual History P — Partners How many partners do you have? Do you have sex with men, women, or both? P — Practices What types of sexual activity do you engage in? Vaginal, anal, oral? P — Protection Do you use condoms or other forms of protection? How consistently? P — Past STI history Have you ever been diagnosed with an STI? Have you or your partners been tested? P — Pregnancy Are you trying to get pregnant? Are you using contraception? Could you currently be pregnant? A person's collection of perceptions, thoughts, feelings, and behaviors as related to one's body size and appearance is: A. an unhealthy behavior B. body image C. cataplexy D. an eating regulation response B. body image RATIONALE: Body image is defined as a person's collection of perceptions, thoughts, feelings, and behaviors related to their own body size and appearance, encompassing both how a person sees their body and how they feel about what they see. Body image is a core component of self concept and plays a central role in eating disorders such as anorexia nervosa and bulimia nervosa, where severely distorted body image causes individuals to perceive themselves as overweight despite objective evidence to the contrary. An unhealthy behavior is a broad, non specific term that does not capture the psychological and perceptual dimensions of how a person relates to their own body. Cataplexy is a sudden, brief loss of muscle tone triggered by strong emotions and is a hallmark feature of narcolepsy, having no connection to body perception or appearance. An eating regulation response refers to the physiological and behavioral mechanisms that control hunger and food intake and does not describe the psychological relationship a person has with their own body size and appearance. Which term is used to describe pain associated with sexual intercourse which includes tightening of the pelvic floor muscles? A. Orgasmic disorder B. Sexual interest/arousal disorder C. Genito-pelvic pain/penetration disorder D. Hypoactive sexual disorder C. Genito-pelvic pain/penetration disorder RATIONALE: Genito-pelvic pain/penetration disorder is specifically defined as persistent difficulties with vaginal penetration, recurrent pain during or associated with sexual intercourse, and involuntary tightening or contraction of the pelvic floor muscles during attempted penetration, which directly matches the description in this question. This disorder was created in DSM-5 by combining the previously separate diagnoses of vaginismus, which involved involuntary pelvic floor muscle contraction, and dyspareunia, which involved recurrent genital pain before, during, or after intercourse, into one unified diagnosis. Orgasmic disorder involves difficulty achieving or being unable to reach orgasm despite adequate stimulation and does not involve pain or pelvic floor muscle contraction. Sexual interest/arousal disorder involves absent or reduced desire and arousal rather than physical pain or muscle tightening during intercourse. Hypoactive sexual desire disorder involves deficient or absent sexual thoughts and desire for sexual activity and is related to motivation and interest rather than pain or pelvic floor dysfunction during intercourse. Which term is used to identify the sex of a baby at birth? a. natal sex b. gender fluidity c. cisgender d. gender identity a. natal sex RATIONALE: Natal sex refers to the biological sex assigned to an individual at birth based on physical characteristics including genitalia, chromosomes, and hormones, making it the correct term for identifying the sex of a baby at birth. Gender fluidity describes a gender identity that shifts or changes over time between or among different genders and has nothing to do with biological sex assignment at birth. Cisgender describes a person whose gender identity matches their natal sex assignment but is a descriptor of alignment between identity and birth sex rather than the term for the sex assigned at birth itself. Gender identity refers to a person's internal, deeply held psychological sense of their own gender which develops over time and is entirely separate from the biological sex identified at the moment of birth. Which symptom is associated with compulsive sexual behavior? A. limited sexual encounters B. fear of the consequences of having sex C. use of sexual encounters as a coping device D. severe mood changes around sexual activity C. use of sexual encounters as a coping device RATIONALE: Using sexual behavior as a coping mechanism for stress, anxiety, emotional pain, or negative mood states is a hallmark feature of compulsive sexual behavior, where the person repeatedly turns to sexual activity not primarily for intimacy or pleasure but to regulate overwhelming emotions or escape from psychological distress. Limited sexual encounters is the opposite of compulsive sexual behavior, which is characterized by excessive, repetitive, and uncontrollable sexual activity that the person feels unable to stop despite negative consequences. Fear of the consequences of having sex is more consistent with sexual anxiety disorders or avoidant patterns rather than compulsive sexual behavior, where the person continues the behavior despite awareness of negative consequences rather than avoiding it out of fear. Severe mood changes around sexual activity are more characteristic of conditions such as premenstrual dysphoric disorder or mood disorders and while mood disturbances can co-occur with compulsive sexual behavior, they are not the defining symptom that distinguishes this disorder from others. Identify the eating disorder. An overweight female fights with her mother, then eats 5 cheeseburgers. A. Anorexia B. Binge Eating Disorder C. Pica D. Bulimia B. Binge Eating Disorder Identify the eating disorder. An underweight male patient says his coach wants him to win at any cost. A. Anorexia B. Binge Eating Disorder C. Pica D. Bulimia A. Anorexia Identify the eating disorder. A female patient says she eats cupcakes in the bathroom then vomits. A. Anorexia B. Binge Eating Disorder C. Pica D. Bulimia D. Bulimia Identify the eating disorder. A 6 year old puts small toys in his mouth and digests them. A. Anorexia B. Binge Eating Disorder C. Pica D. Bulimia C. Pica Identify the eating disorder. A straight A student is morbidly underweight. A. Anorexia B. Binge Eating Disorder C. Pica D. Bulimia A. Anorexia Identify the eating disorder. A mother says her daughter eats hair from her hairbrush. A. Anorexia B. Binge Eating Disorder C. Pica D. Bulimia C. Pica Identify the eating disorder. A woman enters the ER with a ruptured stomach. A. Anorexia B. Binge Eating Disorder C. Pica D. Bulimia D. Bulimia (OR BINGE ED??* ASK TEACHER*) Identify the eating disorder. A young girl suffers kidney failure from using excessive laxatives. A. Anorexia B. Binge Eating Disorder C. Pica D. Bulimia D. Bulimia Which characteristic matches the disorder: Anorexia or Bulimia. Yellow skin. Anorexia Which characteristic matches the disorder: Anorexia or Bulimia. Risk taking behaviors such as gambling or shoplifting. Bulimia Which characteristic matches the disorder: Anorexia or Bulimia. Less than expected body weight for height/health. Anorexia Which characteristic matches the disorder: Anorexia or Bulimia. Often identified first by dentists. Bulimia Which characteristic matches the disorder: Anorexia or Bulimia. Hypotension Anorexia Which characteristic matches the disorder: Anorexia or Bulimia. Lanugo Anorexia Which characteristic matches the disorder: Anorexia or Bulimia. Presents with dental caries, decayed enamel, chipped teeth. Bulimia Which characteristic matches the disorder: Anorexia or Bulimia. Bradycardia Anorexia Which characteristic matches the disorder: Anorexia or Bulimia. Dry skin Anorexia Which characteristic matches the disorder: Anorexia or Bulimia. Amenorrhea Anorexia Which characteristic matches the disorder: Anorexia or Bulimia. Eating too litte/starvation Anorexia Which characteristic matches the disorder: Anorexia or Bulimia. Cardiomyopathy Bulimia Which characteristic matches the disorder: Anorexia or Bulimia. Recurrent episodes of binge eating by purging, fasting Bulimia Which characteristic matches the disorder: Anorexia or Bulimia. Overly sensitive to cold Anorexia Which characteristic matches the disorder: Anorexia or Bulimia. Typically in normal weight range, but not always Bulimia Which of the following conditions are eating disorders? (Select all that apply.) A. Binge eating B. Cataplexy C. Pica D. Hypersomnia E. Purging F. Nocturnal myoclonus A. Binge eating C. Pica E. Purging RATIONALE: These are types of eating disorders. The other options describe sleeping disorders. Which are key features of anorexia nervosa? (Select all that apply.) A. Introverted personality B. Purging C. Severe weight loss D. Excessive laxative use E. Hunger is denied A. Introverted personality C. Severe weight loss E. Hunger is denied RATIONALE: These are some of the key features of anorexia nervosa. Excessive laxative use and purging are characteristic of bulimia. The average age for onset of anorexia nervosa is: A. 40 years old. B. 13 years old. C. 33 years old. D. 17 years old. D. 17 years old. RATIONALE: Anorexia nervosa usually is not seen before puberty, with an average age of onset of 17 years. This disorder is seldom seen after the age of 40 years. A disorder that interrupts normal sleep patterns and is characterized by repeated, brief jerks of the arms and legs that occur every 20 to 60 seconds during the beginning of sleep is called: A. nocturnal myoclonus. B. hypersomnia. C. narcolepsy. D. insomnia. A. nocturnal myoclonus. RATIONALE: Nocturnal myoclonus consists of repeated, brief jerks, most often in the legs, that occur at the beginning of sleep and disrupt the normal sleep pattern. These movements generally decrease during stage 4 NREM sleep. The nurse who is caring for a 23-year-old client with bulimia knows that the most common method of purging to monitor this client for is: A. excessive enema use. B. starvation. C. use of syrup of ipecac. D. vomiting. D. vomiting. RATIONALE: Vomiting and the use of diuretics and laxatives are the most common methods of purging. Less often used are enemas and syrup of ipecac. Starvation is a typical behavior of anorexia nervosa. With which group does the nurse anticipate a 13-year-old client will most closely identify? A. the opposite natal-sex parent. B. opposite natal-sex peers. C. same natal-sex peers. D. the same natal-sex parent. C. same natal-sex peers. RATIONALE: During the early teen years, most children identify with same natal sex peers. Which assessment finding does the nurse anticipate when a client states that they are asexual? A. The client never has sex B. The client has experienced abuse as a result of sex C. The client has little interest in physical sex D. The client is afraid of sex C. The client has little interest in physical sex RATIONALE: Clients who report being asexual may have little interest in the physical aspect of sex, yet desire emotional intimacy with others. At which age do most individuals gather their information about sexuality and gender identity from their peers? a. 5 b. 10 c. 18 d. 34 c. 18 RATIONALE: Adolescents and young adults gain much of their information about sexuality and gender identity from peers. Younger individuals gain much of their information from parents or caretakers. Middle age and older adults gain their information from self-awareness. Which characteristic most strongly influences the ability of the nurse to talk with a client about sexual or gender topics? A. assessment abilities. B. self-awareness. C. self-confidence. D. sexual knowledge. B. self-awareness. RATIONALE: Although self-confidence, sexual knowledge, and assessment abilities can influence the ability of the nurse to talk with a client about these topics, self-awareness most influences this ability. The nurse must be aware of their values regarding sexuality and gender. Judgment and disapproval are easily conveyed, often through nonverbal messages, if the nurse is unaware of their own values. Which psychosocial problem is related to sexuality and gender identity concerns? (Select all that apply.) A. Impaired coping B. Despair C. Anxiety D. Denial E. Loss of power A, B, C, D, and E. All of the above. Rationale: The primary psychosocial problems related to sexuality and gender identity concerns include denial, despair, anxiety, loss of power, and impaired coping. What are the criteria for the diagnosis of bulimia? (Select all that apply.) A. Eating binges at least twice per week for at least 3 months B. Refusal to maintain body weight that is more than 15% below normal C. Excessive emphasis placed on body shape and weight D. Occasional episodes of binge eating A. Eating binges at least twice per week for at least 3 months C. Excessive emphasis placed on body shape and weight A and C are correct. A client with a diagnosis of anorexia is admitted to an inpatient setting. Which therapeutic intervention is used with caution prior to stabilization and weight gain? A. Establish rapport and trust B. Daily weights C. IV or tube feeding D. Administering antidepressants D. Administering antidepressants RATIONALE: Administering antidepressants to clients with anorexia before they regain weight may be hazardous if the individual has a history of cardiac problems or presently has a low serum potassium level. Be sure to check the laboratory results of clients with eating disorders. The nurse who works in a sleep clinic knows that approximately __________% of adults suffer from insomnia. A. 10 to 20 B. 30 to 40 C. 70 to 80 D. 50 to 60 B. 30 to 40 RATIONALE: Thirty to forty percent of the adult population suffers from insomnia, and the incidence increases with age and in women. The nurse has taken most of a sexual history from a natal sex female client, including the number of partners, how they practice sexual expression, which contraception is used, and whether the client or partners have ever had and/or been treated for a sexually transmitted infection. Which remaining question does the nurse need to ask? A. "Do you wish to have children in the near future?" B. "At which age did you become sexually active?" C. "How many times have you been pregnant?" D. "How often do you engage in sexual intercourse?" A. "Do you wish to have children in the near future?" RATIONALE: A basic sexual health history includes the "five Ps": partners, practices, protection from sexually transmitted infections (STIs), past history of STIs, and pregnancy. The nurse needs to ask if the client wishes to have children so education about further contraception or practices that may impede pregnancy can take place. The other questions do not complete the "five Ps". Which term will the nurse use to document a client's expression of sexuality with only members of the opposite natal sex? A. pansexual. B. bisexual. C. asexual. D. heterosexual. D. heterosexual. RATIONALE: Persons who express their sexuality with members of the opposite natal sex are described as heterosexual. Asexual is the adjective used to describe someone who may not have interest in the physical aspect of sex, yet desires emotional intimacy. Bisexual is the adjective used to describe someone who is attracted to both natal sexes. Pansexual is the adjective used to describe someone who is attracted to all people regardless of gender identity A client with persistent back pain because of a work injury states, "I'm afraid I'll never be able to have sex again due to my back pain." Which nursing response is appropriate? a. "You can enjoy a satisfying sex life with some adaptation." b. "You will not be able to engage in sexual activity." c. "You eventually will return to the preinjury level of functioning." d. "You will become more sexually active after you recover from the injuries." a. "You can enjoy a satisfying sex life with some adaptation." RATIONALE: Many people with different health conditions and different abilities are able to enjoy rich and satisfying sex lives with some adaptation. The other options provide inaccurate information. When is an individual's natal sex determined? a. At birth b. In middle childhood. c. In early adulthood. d. In adolescence a. At birth RATIONALE: Natal sex is determined by the genitalia present at birth. Gender identity develops throughout the lifespan. At which age is a child most likely to identify its parents by their natal sex group? a. 4 b. 1 c. 2 d. 3 c. 2 RATIONALE: Around the age of 2 years, children learn to identify natal sex groups. What is the main issue for adolescents with anorexia? a. Body image b. Control c. Anxiety d. Appropriate behavior b. Control RATIONALE: The main issue for teenage anorectics is control. During an episode of binge eating, what type of food is usually consumed in large amounts? a. Cakes, donuts, or sweets b. Fruits c. Fried or high fat content foods d. Red meat a. Cakes, donuts, or sweets RATIONALE: Binge eating is defined as consuming an amount of food that is definitely larger than most individuals would eat in similar circumstances. During a binge an individual consumes large quantities of certain foods, usually carbohydrates. The nurse has been assigned to care for a male client with pedophilic disorder who has been incarcerated. Which action is appropriate when the nurse recognizes their own bias against clients with this disorder? a. Do nothing b. Refuse to work with the client c. Seek out the nurse manager to discuss the situation d. Provide mediocre care c. Seek out the nurse manager to discuss the situation RATIONALE: Caregivers' values often are communicated to clients. Disapproval dampens the effectiveness of the therapeutic relationship. If the nurse is troubled about their ability to care for this client, they must discuss the situation with the nurse manager to see if other arrangements can be made for someone else to assume care. It is inappropriate to do nothing, as care may be compromised. It is inappropriate to provide only mediocre care, as all clients must be given compassionate care. It is unprofessional to refuse to work with the client; rather, the nurse needs to follow the chain of command by discussing the situation with the nurse manager. An older adult male with diabetes reports having erectile difficulties and is not sure if it is from his medical condition or the medication he is taking. Which nursing diagnosis is appropriate? A. Family processes, dysfunction B. Sexual dysfunction C. Coping, ineffective D. Injury, risk for B. Sexual dysfunction RATIONALE: Sexual dysfunction is a disturbance in one of the four stages of the sexual response cycle. The causes are often related to psychological concerns, medication or illicit drug use, and/or physical conditions. Arthritis, diabetes, and chronic illness can result in various sexual dysfunctions or alterations in sexual desire. The other nursing diagnoses do not apply in this situation, as there are no other pieces of assessment data that substantiate them. Which term describes the sexual continuum that includes actions harmful to self or others? A. maladaptive. B. homosexual. C. functional. D. adaptive. A. maladaptive. RATIONALE: As the continuum moves toward maladaptive, sexual behaviors become impaired or dysfunctional. The adaptive end of the continuum consists of satisfying sexual behaviors that respect the rights and wishes of others. The other options do not relate to the continuum. A client being cared for a correctional nurse was incarcerated after being found guilty of having inappropriate pictures of prepubescent children. Which diagnosis does the nurse anticipate will be assigned? A. pedophilic disorder. B. sexual masochism disorder. C. sexual sadism disorder. D. voyeuristic disorder A. pedophilic disorder. RATIONALE: Pedophilic disorder is characterized by is recurrent, intense sexual fantasies, urges, or behaviors involving children (usually less than 13 years old). Sexual sadism disorder is characterized sexual arousal achieved by inflicting pain or humiliation on someone else, and voyeuristic disorder is sexual arousal achieved by observing unsuspecting persons in the act of disrobing or engaging in sexual activity. Sexual masochism disorder is sexual arousal achieved by being bound, humiliated, tortured, or beaten. Which documentation is relevant to a client's gender identity? A. "Reports having pain with intercourse." B. "Engages in sexual activity several times weekly." C. "States is bisexual and has two partners." D. "Says that their pronouns are 'they/them'". D. "Says that their pronouns are 'they/them'". RATIONALE: Pronouns are associated with gender identity. All other statements are associated with sexuality. The persistent eating of nonfood items such as clay, laundry starch, insects, leaves, or pebbles that lasts for longer than 1 month is called: A. regurgitation. B. rumination. C. pica. D. bulimia. C. pica. RATIONALE: Pica is the persistent eating of nonfood items that lasts for longer than 1 month and often is associated with a severe vitamin or mineral deficiency. Bulimia refers to an eating disorder that is commonly characterized by bingeing and purging; rumination is a rare disorder that refers to regurgitation and rechewing of food; and regurgitation refers to partially digested food brought up into the mouth. A policeman complains of feeling tired and not able to sleep for an extended period of time after being assigned to work the night shift. He is most likely suffering from: A. narcolepsy. B. primary hypersomnia. C. circadian rhythm sleep disorder. D. obstructive sleep apnea syndrome. C. circadian rhythm sleep disorder. RATIONALE: Circadian rhythm sleep disorder is a sleep disruption that results from a mismatch between body rhythms and environmental demands. Primary hypersomnia occurs when a person sleeps during the night but naps during the day. Narcolepsy results in repeated attacks of sleep, and obstructive sleep apnea is a breathing-related sleep disorder and not a change in sleep time. The inability to fall asleep or stay asleep is called: A. nocturnal myoclonus. B. hypersomnia. C. narcolepsy. D. insomnia. D. insomnia. RATIONALE: Insomnia is a disorder of falling asleep or sustaining sound sleep. Narcolepsy refers to a condition in which an individual repeatedly experiences periods of sleep, regardless of activity or the situation; hypersomnia refers to prolonged sleep episodes; and nocturnal myoclonus refers to an individual who moves limbs involuntarily during sleep and has symptoms or problems related to this movement. Which method of protection from sexually transmitted infections (STIs) can the nurse recommend to adolescents and young adults? (Select all that apply.) A. birth control pills B. birth control ring C. condoms D. contraceptive implant E. intrauterine device C. condoms RATIONALE: Condoms are the only method of protection against sexually transmitted infections (STIs). The birth control ring, birth control pills, an intrauterine device, and a contraceptive implant are used for protection from pregnancy. Which of the following persons is most likely a candidate for primary hypersomnia? A. An 18-year-old college student whose mother complains he sleeps all night and still naps during the day. B. A 6-year-old who wakes up in the middle of the night after having a nightmare and is tired the next day. C. A 50-year-old who has wakeful periods during the night and naps during the day following the death of her husband. D. An obese 40-year-old who has snoring and periods of apnea at night and is tired the next day. A. An 18-year-old college student whose mother complains he sleeps all night and still naps during the day. RATIONALE: Primary hypersomnia begins between 15 and 30 years of age. Nighttime sleep may last from 8 to 12 hours and daytime naps may last for more than 1 hour, not caused by any other physical or mental health disorder. Which disorder is associated with persons with a body weight that is normal or even slightly above average? A. Bulimia B. Anorexia nervosa C. Pica D. Obesity A. Bulimia RATIONALE: Often, a bulimic has a body weight that is normal or even slightly above average. Pica is a disorder in which the individual is eating abnormal substances. Obese individuals are above normal weight, and individuals with anorexia nervosa have less than normal weight. The main focus of medical management for anorexia is to: A. teach more appropriate food choices. B. encourage rapid weight gain. C. keep the client from developing additional problems. D. encourage the client to eat voluntarily. D. encourage the client to eat voluntarily. RATIONALE: The main focus is to encourage the client to consume food voluntarily because this will allow for continued normal food consumption. Too rapid weight gain will lead to a feeling of loss of control, which could induce inappropriate eating behaviors again. Teaching appropriate food choices and keeping the client from developing additional problems occur as a part of the psychological management of the disorder. A client confides in the nurse that intercourse has been painful since she became menopausal. Which nursing response is appropriate? A. "Don't worry; it will pass." B. "I understand how difficult it is to discuss sex." C. "Are you still sexually active?" D. "Let's talk about this together with your health care provider." D. "Let's talk about this together with your health care provider." RATIONALE: Many sexual dysfunctions are treatable, so clients should be referred to their health care provider. Saying that the pain will pass is a nontherapeutic response that disregards the feelings of the client; asking the client if she is still sexually active is irrelevant because the client has just expressed that she is; and empathizing with the client is helpful but does not address the problem. The death rate from anorexia is higher than any other mental illness. Death usually results from which of the following? (Select all that apply.) A. Dehydration B. Suicide C. Diabetes D. Loss of critical muscle mass E. Electrolyte imbalances A. Dehydration B. Suicide D. Loss of critical muscle mass E. Electrolyte imbalances A, B, D, and E are correct. D is incorrect. Sleep terrors usually occur only once a night, during stages 3 and 4 of NREM sleep. They are often accompanied by which physical sign? a. Physical strength b. Intense motor activity c. Sexual arousal d. Intense stress d. Intense stress rationale: Sleep terrors often are accompanied by physical signs of intense stress, such as increased heart rate, respirations, and muscle tone. Which behavior is associated with compulsive sexual behavior? (Select all that apply.) A. Using sex as a coping mechanism B. Engaging in sexual behavior with two partners C. Persisting with behaviors despite consequences D. Inability to stop engaging in sexual behavior E. Preferring to have sex with lights on A. Using sex as a coping mechanism C. Persisting with behaviors despite consequences D. Inability to stop engaging in sexual behavior RATIONALE: Behaviors associated with compulsive sexual behavior include an inability to stop the behavior, using sex as a coping mechanism, persisting with behaviors despite consequences that occur. Preferring sex with the lights on or having sex with two partners are not behaviors that are associated with compulsive sexual behavior. Trends that have contributed to the recent increase in eating disorders in the United States include a(n): A. increase in the number of nonnutritional foods consumed. B. more competitive workplace. C. focus on being thin as a measure of attractiveness. D. increase in the number of divorces. C. focus on being thin as a measure of attractiveness. RATIONALE: In most modern societies, a high value is placed on a slim body. Which client behavior does the nurse associate with a healthy or adaptive sexual response? (Select all that apply.) A. conducted in mutually agreed-upon privacy. B. satisfies the parties that are involved. C. refrains from force or coercion of any kind. D. conducted between consenting adults. E. serve to meet only the needs of the person initiating sex. A. conducted in mutually agreed-upon privacy. B. satisfies the parties that are involved. C. refrains from force or coercion of any kind. D. conducted between consenting adults. RATIONALE: All of these client behaviors are considered adaptive with the exception of serving to meet only the needs of the initiating person. That can be harmful to another person. Sexual acts that in some way or degree are physically or psychologically harmful to the individual and/or others are considered to be maladaptive. Due to the proximal to distal physical development of the child, which of the following motor skills is able to be accomplished by the toddler? A. Buttoning a shirt B. Eating finger foods C. Tying shoes D. Cutting food with a fork and knife Answer: B. Eating finger foods. Rationale: Proximal to distal development means motor skills develop from the center of the body outward. Toddlers first master large muscle groups close to the body before developing fine motor skills in the hands and fingers. Eating finger foods requires only gross grasp, which develops early. Buttoning, tying shoes, and cutting with utensils all require fine motor dexterity that develops much later in childhood. Breath-holding spells typically occur when a child becomes extremely frustrated, cries, and either intentionally or unintentionally holds his or her breath. This rarely occurs in children younger than the age of: A. 24 months B. 6 months C. 12 months D. 18 months Answer: D. 18 months. Rationale: Breath-holding spells are a behavioral response to frustration or distress that requires a degree of emotional and neurological development not yet present in very young infants. They rarely occur before 18 months of age and are most common in toddlers and preschool-aged children. They are frightening to observe but are generally benign and self-limiting. Adult disorders such as chronic anxiety and depression often are associated with childhood: A. fears. B. abuse. C. education. D. illnesses. Answer: B. abuse. Rationale: Childhood abuse is one of the strongest predictors of adult psychiatric disorders including chronic anxiety, depression, PTSD, substance use disorders, and personality disorders. Adverse childhood experiences (ACEs) create lasting neurobiological changes that increase vulnerability to mental illness throughout the lifespan. While childhood fears and illnesses can contribute to distress, abuse specifically is the most strongly associated factor with chronic adult mental health conditions. A male adolescent client tells the nurse that he is almost positive that he is homosexual. This realization most likely has occurred during the developmental period of: A. middle adolescence. B. early adolescence. C. late childhood. D. late adolescence. Answer: A. middle adolescence. Rationale: Middle adolescence, approximately ages 15 to 17, is the developmental period during which sexual identity formation becomes a central focus. During this stage adolescents are actively exploring who they are including their sexual orientation. Early adolescence involves initial puberty and peer conformity. Late adolescence involves consolidating identity. Late childhood precedes the significant hormonal and identity changes of puberty that bring sexual orientation into awareness. A 15-year-old female started going to parties earlier in the year where drinking and drug use occurred. Her friends now notice that she actively looks for a party every weekend and attends even when her friends are not invited. If they suggest an alternate activity, she refuses to go with them, and she is avoiding them at school. What stage of chemical dependency is she exhibiting? A. Burnout B. Preoccupation C. Actively seeking D. Experimentation Answer: B. Preoccupation. Rationale: This adolescent has moved beyond simple experimentation and is now preoccupied with finding opportunities to use substances. She is actively seeking out parties even without her friends, refusing alternative activities, and her peer relationships are suffering. Preoccupation is the third stage of chemical dependency in which obtaining and using the substance becomes a central focus of the person's life. Experimentation is the earliest stage involving occasional casual use. Burnout describes the chronic late stage of addiction. The child in early adolescence experiences developmental issues with his or her identity as evidenced by: A. being idealistic. B. feeling stable with his or her self-esteem. C. being very self-centered. D. conforming to group norms. Answer: D. conforming to group norms. Rationale: Early adolescence is characterized by intense peer orientation and conformity to group norms. The early adolescent is highly sensitive to peer evaluation and seeks belonging through conforming to what the group does, wears, and values. Self-esteem in early adolescence is typically unstable and fragile, not stable. Idealism and abstract thinking emerge more in middle to late adolescence as cognitive development matures. The nurse is implementing validation therapy with an elderly male client to assist him in resolving old conflicts and making peace with himself. Which is one of the techniques used? A. Contacting old acquaintances for their interpretation of the client's life B. Empathy C. Sympathy D. Helping the client write a paragraph about his life Answer: B. Empathy. Rationale: Validation therapy uses empathy as a core technique, entering into and accepting the emotional reality of the client rather than correcting or challenging their perceptions. The therapist validates the feelings and experiences of the client without judgment. Sympathy differs from empathy in that it involves feeling sorry for the person rather than truly entering their experience. Contacting acquaintances and writing paragraphs are not established validation therapy techniques. Which intervention will be most effective when one is teaching a client about his or her medications and their administration? A. Referring to medications by name and providing written instructions B. Pointing out the colors of the medications for easier identification C. Encouraging the client to hold all questions until the end of the discussion so the nurse will not have to repeat information D. Quizzing the client on each medication's purpose, side effects, and drug interactions Answer: A. Referring to medications by name and providing written instructions. Rationale: Referring to medications by their correct names and reinforcing teaching with written instructions improves accuracy, reduces confusion, and provides a reference the client can use at home. Written instructions are especially important for older adults who may have difficulty retaining verbal information. Identifying medications only by color is unreliable because colors can change with generic substitutions. Discouraging questions and quizzing the client in a high pressure format are non-therapeutic and interfere with learning. What percentage of older adults are living at poverty level? A. 26% B. 18% C. 12% D. 23% Answer: C. 12%. Rationale: According to Morrison-Valfre, approximately 12% of older adults are living at or below the poverty level. This financial vulnerability is significant clinically because it affects ability to afford medications, food, heat, and healthcare. Depression-era attitudes about money and stigma around accepting assistance further complicate financial hardship in this population. Nurses must assess financial barriers to care at every encounter. A 75-year-old male client is brought to the clinic by his son. The son states, "Ever since Mom died, Dad hasn't been the same. At first he just seemed sad, but now he seems to get mixed up about everything." The nurse is aware that based on the client's history, the source of confusion is most likely: A. delirium from medications. B. dementia. C. hypoxia of the brain. D. depression from the loss of his wife. Answer: D. Depression from the loss of his wife. Rationale: This client has a clear precipitating event, the death of his wife, followed by sadness that has progressed to confusion. This presentation is consistent with pseudodementia, which is cognitive impairment caused by depression that mimics true dementia. Depression in older adults frequently presents with cognitive symptoms rather than expressed sadness. Unlike true dementia which has a gradual insidious onset, this confusion followed directly after a major loss. Treatment of the underlying depression often resolves the cognitive symptoms. An elderly woman is brought to the clinic by her daughter. The client states that she has had a cold for several days. Her daughter states that her mother has been confused about when her routine medications are to be taken and that her mother has never experienced confusion about her medications before. Based on this information, it is important that the nurse ask the client whether: A. she has taken any over-the-counter medications for her cold. B. she has been given a diagnosis of a mental health disorder in the past. C. she can recall her last visit to a physician. D. there is a history of mental illness in the family. Answer: A. She has taken any over-the-counter medications for her cold. Rationale: The most likely cause of new onset confusion in an elderly patient with a recent cold is over-the-counter cold medications. Many OTC cold preparations contain antihistamines such as diphenhydramine (Benadryl) which have strong anticholinergic effects causing confusion, disorientation, and urinary retention in older adults. Older adults metabolize and excrete drugs more slowly making them highly sensitive to medications that younger people tolerate without issue. This is a classic presentation of drug-induced delirium from OTC medication use. The elderly spouse of a 74-year-old male client states that she has noticed that her husband does not remember as well as he used to. She explains that he has been putting on his coat before his shirt, and that he can never get their checkbook to balance as it did in the past. The client is exhibiting signs and symptoms typical of: A. vascular dementia. B. Alzheimer's disease. C. aging. D. acute delirium. Answer: B. Alzheimer's disease. Rationale: The client is demonstrating apraxia, which is the inability to perform learned purposeful tasks in the correct sequence as evidenced by putting a coat on before a shirt, and executive function impairment evidenced by the inability to balance a checkbook that he previously managed without difficulty. These are classic early to middle stage features of Alzheimer's disease. Normal aging does not cause these functional deficits. Vascular dementia typically follows a stepwise pattern associated with vascular events. Acute delirium has sudden onset with fluctuating consciousness, not the gradual functional decline described here. A learning disorder can be described as which of the following? A. Performance in school that is worse than expected based on intelligence tests B. Inability to read C. Forgetfulness D. Disruptive behavior in school Answer: A. Performance in school that is worse than expected based on intelligence tests. Rationale: A learning disorder is defined as academic performance that is significantly below what would be expected given the person's age, intelligence level, and educational opportunities. The child has average or above average intelligence but performs below expectations in specific academic areas such as reading, writing, or math. It is not simply an inability to read, forgetfulness, or behavioral problems, though those may accompany a learning disorder. Pica is described as: A. Occasionally picking up food from the floor and eating it. B. Persistent eating of nonfood items. C. Refusing to eat. D. Intentionally dropping food on the floor. Answer: B. Persistent eating of nonfood items. Rationale: Pica is an eating disorder characterized by the persistent consumption of non-food substances such as dirt, clay, chalk, paper, hair, or ice for at least one month. It is associated with nutritional deficiencies especially iron, pregnancy, developmental disabilities, and young children. Occasionally picking up food from the floor is normal exploratory behavior in toddlers. Refusing to eat describes avoidant restrictive food intake disorder or anorexia. Who described the child's intellectual development stages? A. Maslow B. Erikson C. Piaget D. Freud Answer: C. Piaget. Rationale: Jean Piaget described the four stages of cognitive and intellectual development in children: sensorimotor (birth to 2 years), preoperational (2 to 7 years), concrete operational (7 to 11 years), and formal operational (12 years and beyond). Erikson described psychosocial developmental stages. Maslow described the hierarchy of needs. Freud described psychosexual developmental stages. An ever-present emotional state that colors one's perception of the world is called: A. Behavior B. Hyperactivity C. Mood D. Cognition Answer: C. Mood. Rationale: Mood is defined as a pervasive and sustained emotional state that colors a person's perception of the world. Unlike affect, which is the outward observable expression of emotion that changes moment to moment, mood is the underlying emotional tone that persists over time. Examples include depressed mood, elevated mood, and anxious mood. Cognition refers to thinking and mental processing. Behavior refers to observable actions. Which of the following is characterized by the physical and psychological need for a drug? A. Experimentation B. Recreational drug use C. Placebo effect D. Chemical dependency Answer: D. Chemical dependency. Rationale: Chemical dependency is characterized by both a physical need (the body has adapted to the presence of the drug and experiences withdrawal without it) and a psychological need (the person feels unable to cope or function without the drug). Experimentation involves occasional use without dependence. Recreational drug use involves using for pleasure without physical need. The placebo effect is a perceived benefit from an inactive substance. The most therapeutic approach to the older adult client is for the nurse to treat the person: A. With disdain B. With indifference C. With respect D. Like a child Answer: C. With respect. Rationale: Older adults must be treated with the same dignity and respect as any other patient. Ageism, the stereotyping and discrimination of people based on age, is a significant barrier to quality care for older adults. Treating older adults like children, speaking to them in a condescending tone, or assuming incompetence are all forms of ageism that damage the therapeutic relationship and undermine patient autonomy and self-esteem. The nurse should instruct the elderly client to: A. Eat whatever tastes good. B. Bring all medications to every doctor's appointment. C. Limit activity and increase rest. D. Try to perform ADLs more quickly. Answer: B. Bring all medications to every doctor's appointment. Rationale: Bringing all medications including prescriptions, over-the-counter drugs, vitamins, and herbal supplements to every appointment allows the provider to review for polypharmacy, drug interactions, duplicate therapies, and inappropriate medications. This is critically important in older adults who are the highest-risk group for adverse drug reactions. Limiting act