NURS 2488 Final Exam Questions and Answers Latest Updated Graded A++

NURS 2488 Final Exam Questions and Answers Latest Updated Graded A++. An elderly client with cognitive impairment is combative and pulled out a nasogastric tube, intravenous line, and indwelling urinary catheter. What can the nurse anticipate that the health care provider will most likely prescribe? STUDEN T ANSWER : A small dose of a selective serotonin reuptake inhibitor Answers: A small dose of a selective serotonin reuptake inhibitor A large dose of a benzodiazepine A maintenance dose of buspirone A small dose of an atypical antipsychotic Explanati on Feedback : Aggressive behavior can be safely managed by antipsychotic medication. Initial dosing should be small and raised cautiously until behavior is controlled. Selective serotonin reuptake inhibitors are not indicated for aggressive behavior. If a benzodiazepine is used, the initial dose should be low. Buspirone is not effective if given on an as-needed basis. It is administered in small divided doses daily to control agitation. • Q# 4 A nursing care plan contains the intervention “monitor for complications of refeeding syndrome.” Which body system should a nurse most closely monitor for clinical manifestations of dysfunction? STUDEN T ANSWER : Central nervous Answers: Renal Central nervous Endocrine Cardiovascu lar Explanati on Feedback: Refeeding resulting in too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse; thus focused assessment becomes a necessity to ensure patient physiological integrity. The other body systems are not initially involved in the refeeding syndrome. • Q# 5 NURS 2488 LATEST EXIT EXAM 3 Which of the following is the best example of all-or-nothing thinking, a common cognitive distortion of patients with an eating disorder? STUDEN T ANSWER : “If I gain any weight, I’ll keep going until I’m huge.” Answers: “If I gain any weight, I’ll keep going until I’m huge.” “When people tell me I’m looking better, they really mean I’m fatter.” “No one likes me because I’m fat.” “When I’m thin, I’m perfect.” Explanati on Feedback: In all-or-nothing thinking, the person cannot see any middle ground between extremes; a person with an eating disorder will see themselves as either thin or immense. The other comments are common in eating disorders but are not examples of all-ornothing thinking. • Q# 6 A nurse reports to the interdisciplinary team that a patient with an antisocial personality disorder lies to other patients, verbally abuses a patient with Alzheimer’s disease, and flatters the primary nurse. This patient is detached and superficial during counseling sessions. Which behavior most clearly warrants limit setting? STUDEN T ANSWER : Flattering the nurse Answers: Lying to other patients Flattering the nurse Verbal abuse of another patient Detached superficiality during counseling Explanati on Feedback: Limits must be set in areas in which the patient’s behavior affects the rights of others. Limiting verbal abuse of another patient is a priority intervention. The other concerns should be addressed during therapeutic encounters. • Q# 7 Which of the following are primary characteristics of a person with borderline personality disorder? STUDEN T ANSWER : Demonstrated a self-defeating cycle of behavior Answers: Demonstrates flexibility and compromise NURS 2488 LATEST EXIT EXAM 3 Explanati on Feedback : Demonstrates socially appropriate behaviors Demonstrates eagerness to learn new coping skills Demonstrated a self-defeating cycle of behavior A self-defeating cycle of behavior is a hallmark of borderline personality disorder, creating difficulties is work, social and family relationships. Individuals with a borderline personality are inflexible and do not compromise easily. Socially inappropriate behavior is common in borderline personality, as is an unwillingness to change and learn new coping skills • Q# 8 A nurse is working with a patient with a histrionic personality disorder. Which of the following nursing interventions must be implemented throughout the inpatient stay? STUDEN T ANSWER : Setting appropriate limits on maladaptive behaviors Answers: Setting appropriate limits on maladaptive behaviors Offering relationship advice Providing multiple options when the patient makes frequent requests Having the patient approach different staff members for interpretation of unit rules Explanati on Feedback : Setting firm limits and maintaining consistency are essential elements in working with people with personality disorders. Flexibility and providing too many choices does not help the individual with boundaries and limits. Offering relationship advice is not professional behavior and can have a negative effect on the nurse-client relationship. Encouraging the patient to attend daily activities may be a part of the care plan, but is not as high of a priority as setting limits • Q# 9 A patient has blindness related to conversion disorder. In order to assist the patient with eating, which of the following interventions should the nurse implement? STUDEN T ANSWER : Expect the patient to feed himself after explaining arrangement of the food on the tray. NURS 2488 LATEST EXIT EXAM 3 Answers: Establish a “buddy” system with other patients who can feed this patient at each meal. Expect the patient to feed himself after explaining arrangement of the food on the tray. Address the needs of other patients in the dining room, then feed this patient. Direct the patient to locate items on the tray independently and feed himself unassisted. Explanati on Feedback: The patient is expected to maintain some level of independence by feeding self, while the nurse is supportive in a matter-of-fact way. The distracters support dependency or offer little support. • Q# 10 A patient is admitted for psychiatric observation after being arrested for breaking windows in the home of a former girlfriend who had refused to see him. His history reveals childhood abuse by a punitive father, torturing family pets, and an arrest for disorderly conduct. Which nursing diagnosis has priority in the plan of care? STUDEN T ANSWER : Post-trauma syndrome Answers: Risk for injury Post-trauma syndrome Disturbed thought processes Risk for other-directed violence Explanati on Feedback: The defining characteristics for Risk for other-directed violence include a history of being abused as a child, having committed other violent acts, and demonstrating poor impulse control. The defining characteristics for the other diagnoses are not present in the scenario • Q# 11 A patient is referred to the mental health center by the family health care provider. Over the past year, the patient has cooked gourmet meals for family members, but eats only tiny portions of the food. The patient wears layers of loose clothing, saying, “It’s just my style.” The patient’s weight has dropped from 130 to 95 pounds. The patient has amenorrhea. Which medical diagnosis are the history and symptoms are most consistent with? NURS 2488 LATEST EXIT EXAM 3 STUDEN T ANSWER : Anorexia nervosa Answers: Anorexia nervosa Bulimia nervosa Binge eating Eating disorder not otherwise specified Explanati on Feedback : Overly controlled eating behaviors, extreme weight loss, amenorrhea, preoccupation with food, and wearing several layers of loose clothing to appear larger are part of the clinical picture of an individual with anorexia nervosa. The individual with bulimia usually is near normal weight. The binge eater is often overweight. The patient with eating disorder not otherwise specified may be obese. • Q# 12 A patient sat in silence for 20 minutes after a therapy appointment. The patient appeared tense and vigilant. The patient abruptly stood up and paced back and forth across the day room, clenching and unclenching his fists. Next, he stopped and stared intently into the face of a psychiatric technician. Which of the following best explains the nurse’s observations of this patient? STUDEN T ANSWER : The patient is exhibiting clues to potential aggression. Answers: The patient is demonstrating withdrawal The patient is working off angry feelings. The patient is using relaxation strategies effectively. The patient is exhibiting clues to potential aggression. Explanati on Feedback: The description of the patient’s behavior shows the classic signs of someone whose potential for aggression is increasing. • Q# 13 A patient referred to the eating disorders clinic has lost 35 pounds during one summer. Which of the following Q#s would be best if the nurse wished to assess the patient’s eating patterns? STUDEN T ANSWER : “What do you think about your present weight?” NURS 2488 LATEST EXIT EXAM 3 Answers: “Do you often feel fat?” “Who plans the family meals?” “What do you eat in a typical day?” “What do you think about your present weight?” Explanati on Feedback : Although all the Q#s might be appropriate to ask, only “What do you eat in a typical day?” focuses on the patient’s eating patterns. Asking if the patient often feels fat focuses on distortions in body image. Q#s about family meal planning are unrelated to eating patterns. Asking for the patient’s thoughts on present weight explores the patient’s feelings about weight. • Q# 14 When a victim of sexual assault is discharged from the emergency department, which of the following interventions should the nurse perform? STUDEN T ANSWER : Provide referral information verbally and in writing Answers: Notify the patient’s family of the event to seek support for the patient Provide referral information verbally and in writing Offer to stay with the patient until stability is regained Advise the patient to try not to think about the assault Explanati on Feedback : Immediately after the assault, rape victims are often disorganized and unable to think well or remember what they have been told. Written information acknowledges this fact and provides a solution. The remaining options violate the patient’s right to privacy, evidence a rescue fantasy, and offer a platitude that is neither therapeutic nor effective. • Q# 15 A patient admitted for a heroin overdose received naloxone, which improved her breathing pattern. Two hours later the patient reports muscle aches, abdominal cramps, and gooseflesh, and says, “I feel terrible.” Which is the correct analysis of this assessment? STUDEN T ANSWER : The patient should be monitored closely for seizures Answers: A peculiar reaction to naloxone is occurring NURS 2488 LATEST EXIT EXAM 3 Explanati on Feedback: The patient should be monitored closely for seizures The patient is experiencing a relapse Symptoms are present due to abrupt cessation of narcotic The symptoms given in the Q# are consistent with narcotic withdrawal. Early symptoms of narcotic withdrawal are flulike in nature. Seizures are more commonly seen in alcohol withdrawal syndrome. • Q# 16 A health care provider writes these new prescriptions for a nursing home resident: 2-g sodium diet; restraints as needed for behavioral problems; limit fluids to 2000 mL daily; continue antihypertensive medication; milk of magnesia 30 mL orally one time as needed if no bowel movement for 3 days. Which of the following is most appropriate for the nurse to do first? STUDEN T ANSWER : Clarify the order for restraints Answers: Clarify the order for fluid restriction Clarify the order for restraints Transcribe all orders as written Clarify the order for milk of magnesia Explanati on Feedback : Restraints may be imposed only on the written order of the health care provider that specifies the duration during which the restraints can be used. The Joint Commission guidelines and Omnibus Budget Reconciliation Act regulations also mandate a number of other conditions that must be considered and documented before restraints are used. The other orders would be considered appropriate for implementation. • Q# 17 The son of an elderly client with dementia is talking to the nurse about discharge. He indicates that his father’s physician has given him 48 hours to decide on a living situation. The nurse discusses possible living arrangements and provides contact information. The nurse knows that the son requires further teaching when he says: STUDEN T ANSWER : I want the social worker to decide if he should stay home or go to assisted living so he doesn’t blame me. NURS 2488 LATEST EXIT EXAM 3 Answers: I have quite a decision to make. I want the social worker to decide if he should stay home or go to assisted living so he doesn’t blame me. Well I guess we can try him at home and if it doesn’t work out, I can move him to assisted living later. I think Dad would rather be at home and I think my sister and I can do it. We’ll talk to this home care agency. Explanati on Feedback : The son is avoiding making a decision and taking responsibility if he states that he wants the social worker to make the decision. Admitting that he has a difficult decision to make, realizing that he can change the living situation when needed, and making a decision to try home care are all healthy comments in this situation and show that he is accepting responsibility and is willing to make a decision. • Q# 18 A child with ADHD will begin medication therapy. Which of the following classifications of medications should the nurse prepare to teach the patient and family about? STUDEN T ANSWER : Central nervous system stimulants Answers: Central nervous system stimulants Monoamine oxidase inhibitors (MAOIs) Antipsychotic medications Anxiolytic medications Explanati on Feedback: Central nervous system stimulants, such as methylphenidate and pemoline (Cylert), increase blood flow to the brain and have proved helpful in reducing hyperactivity in children and adolescents with ADHD. The other medication categories listed would not be appropriate • Q# 19 Which of the following nursing interventions is the highest priority while working with a patient who has a somatoform disorder for the first time? STUDEN T ANSWER : Assess for objective data to support the patient’s report of each physical symptom. Answers: Help the patient shift focus from somatic symptoms to feelings. NURS 2488 LATEST EXIT EXAM 3 Explanati on Feedback : Imply that somatic symptoms are not real. Help the patient suppress feelings of anger. Assess for objective data to support the patient’s report of each physical symptom. Physical symptoms need to be investigated with the first patient encounter to rule out an underlying medical condition as cause of the reported symptoms; however, they do not need to be reinvestigated each time the patient reports them. Shifting the focus from somatic symptoms to feelings or to neutral topics conveys interest in the patient as a person rather than as a condition, but this is accomplished after ruling out a serious medical condition. The need to gain attention with the use of symptoms is reduced over the long term. A desired outcome would be that patient would express feelings, including anger if it is present. Once physical symptoms have been investigated, they do not need to be reinvestigated each time the patient reports them. • Q# 20 The nurse is assessing a patient who has been diagnosed with hypochondriasis. Which clinical manifestation would the nurse most likely assess in this patient? STUDEN T ANSWER : Misinterpretation of physical sensations as evidence of serious illness Answers: Loss of interest in formerly pleasurable activities Repetitive, time-consuming rituals Deliberate fabrication of symptoms for an obvious benefit Misinterpretation of physical sensations as evidence of serious illness Explanati on Feedback : People with hypochondriasis experience severe distress, and their ability to function in personal, social, and occupational roles often is impaired. Most patients with hypochondriasis present with somatic symptoms as well as total preoccupation with the belief of having a devastating sickness or disease. These individuals are thought to have prominent health anxiety (hypochondriasis), another form of hypochondriasis. They have minimal or no somatic symptoms but reveal a disproportionate or excessive preoccupation with having a serious illness. • Q# 21 NURS 2488 LATEST EXIT EXAM 3 While providing health teaching for a patient with binge-purge bulimia, what information is most important for the nurse to prioritize? STUDEN T ANSWER : self-esteem maintenance Answers: self-monitoring of daily food and fluid intake establishing the desired daily weight gain symptoms of hypokalemia self-esteem maintenance Explanati on Feedback : Hypokalemia results from potassium loss associated with vomiting. Physiological integrity can be maintained if the patient can self-diagnose potassium deficiency and adjust the diet or seek medical assistance. Self-monitoring of daily food and fluid intake is not useful if the patient purges. Daily weight gain may not be desirable for a patient with bulimia nervosa. Self-esteem is an identifiable problem but is of lesser priority than the risk for hypokalemia. • Q# 22 An 11-year-old is absent from school to stay at home and care for siblings while the parents work. The family cannot afford a babysitter. When asked about the parents, the child reluctantly says, “I don’t think my parents like me very much. They call me stupid and say I never do anything right.” Which type of abuse is most likely? STUDEN T ANSWER : Emotion al Answers: Physical Sexual Emotion al Econom ic Explanati on Feedback: Examples of emotional abuse include having an adult demean a child’s worth or frequently criticize or belittle the child. No data support physical battering or endangerment, sexual abuse, or economic abuse. • Q# 23 The student nurse is asked to provide a general and concise description of NURS 2488 LATEST EXIT EXAM 3 persons with personality disorders. Which of the following would be the best description? STUDEN T ANSWER : “They have difficulties in social, family and work relationships.” Answers: “They can tolerate high levels of stress.” “They have difficulties in social, family and work relationships.” “They are good at compromise and often function as mediators.” “They often seek instructions to learn better coping behaviors.” Explanati on Feedback : The defining characteristic of personality disorders is difficulty in social relationships. Most people with personality disorders do not respond well to stress and are generally inflexible and poor compromisers. People with personality disorders tend not to seek help on their own due to a variety of factors; for example, their adaptations make them feel that they are functioning well, they have little desire to change, and possess an overall distrust of others. • Q# 24 A nurse in the emergency department tells the daughter of an older adult woman, “Your mother had a severe stroke.” The daughter tearfully says, “Who will take care of me now? My mother always tells me what to do, what to wear, and what to eat. I need someone to reassure me when I get anxious.” This behavior could best be assessed as: STUDEN T ANSWER : Depende nt. Answers: Histrionic . Depende nt. Narcissist ic. Borderlin e. Explanati on Feedback: Clients with a dependent personality have an inability to complete anything on their own; they are unable to make decisions without excessive advice and reassurance as NURS 2488 LATEST EXIT EXAM 3 described by the client above. • Q# 25 Which behavior best describes physical aggression? STUDEN T ANSWER : Stomping away from the nurses’ station, going to the day room, and grabbing a pool cue from a patient standing at the pool table Answers: Stomping away from the nurses’ station, going to the day room, and grabbing a pool cue from a patient standing at the pool table Bursting into tears, leaving the community meeting, and sitting on a bed hugging a pillow and sobbing Telling the primary nurse, “When you told me that I could not have a second helping at lunch, I felt angry.” Telling the medication nurse, “I am not going to take that, or any other, medication.” Explanati on Feedback: Aggression is harsh physical or verbal action that reflects rage, hostility, and potential for physical or verbal destructiveness. Aggressive behavior violates the rights of others. The remaining options do not feature violation of another’s rights • Q# 26 Which nursing intervention(s) would be most likely included in a plan of care for a patient with bulimia nervosa? Select all that apply. STUDENT ANSWERs : Assist the patient to identify triggers to binge eating. Explore needs for health teaching. Answers: Assist the patient to identify triggers to binge eating. Provide remedial consequences for weight loss Assess for signs of impulsive eating. Explore needs for health teaching. Explanati on Feedback : For most patients with bulimia nervosa, certain situations trigger the urge to binge; purging then follows. Often the triggers are anxiety-producing situations. Identification of triggers makes it possible to break the binge-purge cycle. Because binge eating and purging directly affect physical status, the need to promote physical safety assumes highest priority. • Q# 27 NURS 2488 LATEST EXIT EXAM 3 An older adult patient with Alzheimer’s disease lives with family and goes to day care on weekdays. The nurse at the center observed poor hygiene and discussed this observation with the caregiver, the patient’s adult child. The caregiver became defensive and said, “It takes all my time and energy to care for my mother. She’s awake all night. Last night she fell down the stairs.” Which nursing intervention takes highest priority in this case? STUDEN T ANSWER : Secure additional safety measures for the mother’s evening and night care Answers: Teach the caregiver more about the effects of Alzheimer’s disease Secure additional safety measures for the mother’s evening and night care Support the caregiver to grieve the loss of the mother’s ability to function Teach the family how to give physical care more effectively and efficiently