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PMH exam 3 practice questions

Terms in this set (69)

which statement made by the primary caregiver of a pt diagnosed with dementia demonstrates accurate understanding of providing the pt with a safe environment

a. the local PD know that he has wandered off before
b. I keep the noise level low in the house
c. we've installed locks on the outside doors
d. our telephone number is always attached to the inside of his shirt pocket
c
which statement made by a family member tends to support a diagnosis of delirium rather than dementia

a. she was fine last night but this morning she was confused
b. dad doesn't seem to recognize us anymore
c. shes convinced that snakes come into her room at night
d. he can't remember when to take his pills or whether hes bathed
a
when considering the patho responsible for both delirium and dementia, which intervention is appropriate for delirium specifically

a. assist with needs r/t nutrition, elimination, hydration and personal hygiene
b. monitor neuro status on an ongoing basis
c. place identification bracelet on pt
d. give one simple direction at a time in a respectful tone of voice
b
what side effects should the nurse monitor for when caring for a patient prescribed donepezil? SATA

a. insomnia
b. constipation
c. bradycardia
d. signs of dizziness
e. reports of HA
a,c,d,e
what is the rationale for providing a patient dx with dementia easily accessible finger foods throughout the day

a. increases input throughout the day
b. the person may be anorexic
c. assist with monitoring food intake
d. helps prevent constipation
a
Ophelia, a 69-year-old retired nurse, attends a reunion of her former coworkers. Ophelia is concerned because she usually knows everyone, and she cannot recognize faces today. A registered nurse colleague recognizes Ophelia's distress and "introduces" Ophelia to those attending. The nurse practitioner recognizes that Ophelia seems to have a deficit in:
a. Lower-level cognitive domain
b. Delirium threshold
c. Executive function
d. Social cognition
d
Nancy is a nurse. After talking with her mother, she became concerned enough to drive over and check on her. Her mother's appearance is disheveled, words are nonsensical, smells strongly of urine, and there is a stain on her dressing gown. Nancy recognizes that her mother's condition is likely temporary due to:
a. Early onset dementia
b. A mild cognitive disorder
c. A urinary tract infection
d. Skipping breakfast
c
Darnell is an 84-year-old widower who has lived alone since his wife died 6 years ago. A neighbor called Darnell's son to tell him that Darnell was trying to start his car from the passenger's side. He became angry and aggressive when the car would not start. After a medical assessment, Darnell was diagnosed with a major neurocognitive disorder. The nurse realized additional family teaching is necessary when Darnell's son states:
a. "My father's diagnosis is interfering with his daily functioning."
b. "This neurocognitive disorder will probably progress."
c. "Advancing age is a risk factor in my father's diagnosis."
d. "With person-centered care, my father will be able to remain in his home."
d
in the 2 months after his wifes death, aaron, aged 90 and in good health , has begun to pay less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his meds, and eat, all of which he then does. Which response is most appropriate

a. reorient Mr smith by pointing out the day and date each time you have occasion to interact with him
b. meet with family and support them to accept, anticipate, and prepare for the progression of his stage 2 dementia
c. avoid touch and proximity: these are likely to be uncomfortable for Mr smith and may provoke aggression when he is disoriented
d. arrange for an appointment with a therapist for evaluation and treatment of suspected depression
d
nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels. Specialized skills training and continuing education are helpful to difficuse nursing stress, as well as: SATA

a. expressing emotions by journaling
b. describing stressful events on facebook
c. engage in exercise and relaxation activities
d. having realistic patient expectations
e. happy hour after work to blow off steam
a,c,d
which statement made by the psych nurse demonstrates an accurate understanding of the factors that affect an individuals personality

a. therapy will help her identify that her problems are personality related
b. I'll need to learn more about this pts cultural beliefs
c. its encouraging to know that personality disorders respond well to treatment
d. a persons personality is fluid and adjusts to current social situations
b
when assessing a pt diagnosed with a boarderline PD, which statement by the pt warrants immediate attention

a. my mother died 10 years ago
b. I haven't needed medication in weeks
c. my dad never loved me
d. I'd really like to hurt her for hurting me
d
what is the current accepted professional view of the effect of culture on the development of personality disorder

a. there aren't sufficient studies to confirm the role that ethnicity and race have on the prevalence of personality disorders
b. the north american and australian cultures produce higher incidences of personality disorders among their populations
c. neither culture nor ethnic background is generally considered in the development of personality disorder
d. personality disorders have been found to be primarily the products of genetic factors, not cultural factors
a
which personality disorders are generally associated with behaviors described as odd or eccentric? SATA

a. paranoid
b. schizoid
c. histrionic
d. OCPD
e. avoidant
a,b
which behaviors are examples of a primitive defense mechanism often relied upon by those diagnosed with a personality disorder? SATA

a. regularly attempts to split the staff
b. attempts to undo feelings of anger by offering to do favors
c. regresses to rocking and humming to sooth themselves when fearful
d. lashes out verbally when confronted with criticism
e. destroys another persons belongings when angry
a,b,c
personality disorders often co-occur with mood and eating disorders. A young woman s undergoing treatment at an eating disorder clinic and her nurse suspects the pt may also have a cluster B personality disorder due to the young womans

a. desire to avoid eating
b. dramatic response to frustration
c. excessive exercise routine
d. morose personality traits
b
Larry is from a small town and began displaying aggressive and manipulative traits while still a teenager. Now at 40 years old, Larry is serving a life sentence for the murders of his wife and her brother. John, the prison psychiatric nurse practitioner, recognizes that Larry's treatment will most likely:
a. Transform Larry to a model prisoner
b. Not improve Larry's coping skills
c. Reaffirm Larry's high-risk behaviors
d. Manifest as small incremental changes
d
Connor is a 28-year-old student, referred by his university for a psychiatric evaluation. He reports that he has no friends at the university and people call him a loner. Recently, Connor has been giving lectures to pigeons at the university fountains. Connor is diagnosed as schizotypal, which differs from schizophrenia in that persons diagnosed as schizotypal:
a. Can be made aware of their delusions
b. Are far more delusional than schizophrenics
c. Have a greater need for socialization
d. Do not usually respond to antipsychotic medications
a
Garret's wife of 8 years is divorcing him because the marriage never developed a warm or loving atmosphere. Garrett states in therapy, "I have always been a loner," and was never concerned about what others think. The nurse practitioner suggests that Garrett try a trial of bupropion (Wellbutrin) to:
a. Improve his flat emotions
b. Assist in getting a good night's sleep
c. Increase the pleasure of living
d. Prepare Garrett for group therapy
c
Josie, a 27 year old patient, complains that most of the staff do not like her or care what happens to her, but you are special and she can tell that you are a caring person. She talks with you about being unsure of what she wants to do with her life and her "mixed-up feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it "makes the numbness stop." Given this presentation, which personality disorder would you suspect?

a. obsessive-compulsive
b. borderline
c. antisocial
d. schizotypal
b
which patient statement does not demonstrate an understanding of a suicide safety plan

a. I know that when I start thinking about my dad, I'm going to start thinking about killing myself
b. going for a really long, hard run helps clear my mind and stops the suicidal thoughts
c. my sister is always there for me when I start getting suicidal
d. I keep the suicide prevention phone number in my wallet
b
which interventions will help make the environment on the unit safer for suicidal patients? SATA

a. all windows are kept locked
b. every shower has a breakaway shower rod
c. eating utensils are counted when trays are collected
d. pt doors are kept open
e. staying within listening distance of the pt
a,b,c,d
what are the nursing responsibilities to a patient expressing suicidal thoughts? SATA

a. instituting one on one
b. documenting the patients whereabouts and mood every 15-30min
c. ensuring that the pt has no contact with glass or metal utensils
d. ensuring that pt has swallowed each individual dose of medication
e. discussing triggers of depression
a,b,c,d
when considering community suicide prevention programs, what population should the nurse plan to service with regular suicide screenings? SATA

a. 10-34 year olds
b. males
c. college educated adults
d. rural population
e. native americans
a,c,e
research supports which intervention implemented on a long term basis significantly reduces the incidence of suicide and suicide attempts in a pt diagnosed with bipolar disorder

a. SSRI
b. ECT
c. one on one
d. lithium
d
Gladys is seeing a therapist because her husband committed suicide 6 months ago. Gladys tells her therapist, "I know he was in pain, but why didn't he leave me a note?" The therapist's best response would be:
a. "He probably acted quickly on his impulse to kill himself."
b. "He did not want to think about the pain he would cause you."
c. "He was not able to think clearly due to his emotional pain."
d. "He thought you may think it was an accident if there was no note."
c
Martin is a 23-year-old male with a new diagnosis of schizophrenia, and his family is receiving information from a home health nurse. The topic of education is suicide prevention, and the nurse recognizes effective teaching when the mother says:
a. "Persons with schizophrenia rarely commit suicide."
b. "Suicide risk is greatest in the first few years after diagnosis."
c. "Suicide is not common in schizophrenia due to confusion."
d. "Most persons diagnosed with schizophrenia die of suicide."
b
which person is at the highest risk of suicide

a. a 50 year old married white male with depression who has a plan to OD if circumstances at work do not improve
b. a 45 year old married white female who recently lost her parents, suffers from bipolar disorder, and attempted suicide once as a teen
c. a young single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend and has ready access to a gun he has hidden
d. an older hispanic male who is catholic is living with a debilitating chronic illness, is recently widowed and who states " I wish that God would take me soon"
c
Kara is a 23-year-old patient admitted with depression and suicidal ideation. Which intervention(s) would be therapeutic for Kara? Select all that apply.
a. Focus primarily on developing solutions to the problems leading the patient to feel suicidal.
b. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate.
c. Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior.
d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings.
e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group.
f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.
b,d,e,f
which individuals are most at risk for displaying aggressive behavior? SATA

a. an adolescent embarrassed in front of friends
b. a young male who feels rejected by social group
c. a young adult depressed after the death of a friend
d. a middle aged adult who feels that concerns are going unheard
e. a pt who was discovered telling a lie
a,b,d,e
a newly admitted male pt has a long hx of aggressive behavior toward staff. Which statement by the nurse demonstrates the need for more info about the use of restraint

a. if his behavior warrants restraints someone will stay with him the entire time hes restrained
b. I'll call the primary provider and get an as needed order
c. if he is restrained be sure to offer food and fluids regularly
d. remember that physical restraints are our last resort
b
which interventions should the nurse implement when helping a pt who is expressing anger in an inappropriate manner? SATA

a. approach the pt in a calm reassuring manner
b. provide suggestions regarding acceptable ways of communicating anger
c. warn the pt that being angry is not a healthy emotional state
d. set limits on the angry behavior that will be tolerated
e. allow any expression of anger as long as no one is hurt
a,b,d
which guidelines should direct nursing care when deescalating an angry patient? SATA

a. intervene as quickly as possible
b. identify the trigger for the anger
c. behave calmly and respectfully
d. recognize the patients need for increased personal space
e. demands are agreed to as long as they won't result in harm to anyone
a,b,c,d
Which comorbid condition would result in cautious use of a selective serotonin reuptake inhibitors for a patient with chronic aggression?
a. Asthma
b. Anxiety disorder
c. Glaucoma
d. Bipolar disorder
d
John Patrick is a widower with four daughters. He has enjoyed a healthy relationship with all of them until they reached puberty. As each girl began to mature physically, he acted in an aggressive manner, beating her without provocation. John Patrick is most likely acting on:
a. Self-protective measures
b. Stress of raising four daughters
c. Frustration of unhealthy desire
d. Motivating his daughters to be chaste
c
a nurse named darryl has been hired to work in a psych ICU. He has undergone training on recognizing escalating anger. Which statement indicates that he understands danger signs in regard to aggression

a. I need to be aware of patients who are withdrawn and sitting alone
b. an obvious change in behavior is a risk factor for aggression
c. patients who seek constant attention are more likely to be violent
d. patient who talk to themselves are the most dangerous
b
an effective method of preventing escalation in an environment with violent offender is to develop a level of trust through

a. a casual authoritative demeanor
b. keeping patients busy
c. brief, frequent, nonthreatening encounters
d. threats of seclusion or punishment
c
twenty four hour observation is a good choice for restraint in which of the following patients

a. an inmate with suicidal ideation on hospice care
b. a sex offender in the psych ICU
c. an aggressive female with antisocial personality disorder
d. an inmate diagnosed with paranoid schizophrenia
a
COPD, spinal injury, seizure disorder, and pregnancy are conditions that:

a. frequently result in out of control behavior
b. respond well to therapeutic holding
c. necessitate the use of only two point restraint
d. contraindicated restraint and seclusion
d
which statement made by a new mother should be explored further by the nurse?

a. I have three children that's enough
b. I think the baby cries just to make me angry
c. I wish my husband could help more with the baby
d. babies are a blessing but they are a lot of work
b
which problem is observed in children who regularly witness acts of violence in their family? SATA

a. phobias
b. low self esteem
c. major depressive disorder
d. narcissistic personality disorder
e. PTSD
a,b,c,e
what situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver

a. the caregiver is a single male relative
b. the caregiver was neglected as a child
c. the caregiver is under age 30
d. the caregiver has little experience with elderly
b
What safety-related responsibility does the nurse have in any situation of suspected of abuse?

a. Protect the patient from future abuse by the abuser.
b. Inform the suspected abuser that the authorities have been notified.
c. Arrange for counseling for all involved parties but especially the patient.
d. Report suspected abuse to the proper authorities.
d
the nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone number should be available to the client? SATA

a. police
b. an abuse hotline
c. a responsible friend or family member
d. a domestic violence shelter
e. hospital ED
a,b,c,d
secondary effects of abuse often manifest as arrested development in children due to the fact that

a. coping is easier than emotional growth
b. energy for development is diverted to coping
c. children cannot differentiate love from abuse
d. abuse fosters a sense of belonging, even if dysfunctional
b
The use of a patient-centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and:

a. Establish trust and rapport
b. Ask lots of questions
c. Interrupt the patients' story to allow for decompression
d. Utilize closed-ended questions
a
The abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and the elderly due to:

a. The love they have for parents or children.
b. Their limited options.
c. The need to feel safe at home.
d. Other relatives do not want them.
b
an appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be

a. a decrease in family interaction so that there are fewer opportunities for abuse to occur
b. the perpetrator will recognize destructive patterns of behavior and learn alternate responses
c. the perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy
d. a triad of treatment modalities, including medication, counseling, and role playing opportunities
b
Perpetrators of domestic violence tend to: Select all that apply.

a. Have relatively poor social skills and to have grown up with poor role models.
b. Believe they, if male, should be dominant and in charge in relationships.
c. Force their mates to work and expect them to handle the financial decisions.
d. Be controlling and willing to use force to maintain their power in relationships.
e. Prevent their mates from having relationships and activities outside the family.
a,b,d,e
during an interview with a patient which question asked of an older adult is associated with the patient determination act

a. who besides yourself may have access to your medical information
b. have you discussed your end of life choices with your family or designated surrogate
c. do you have the information you need to make an informed decision about your treatment
d. how can I help you feel comfortable about this interview and any decisions you need to made
b
which statement made by a nurse requires immediate correction by the supervisor

a. many older patients are depressed
b. retirement is a difficult time for older patients
c. cognitive decline is normal in patients who are 65 and older
d. sleep related problems are often reported by older adults
c
Considering psychosocial role theory, which patient demonstrates healthy adjustment to aging?
a. The 70-year-old who is training for a 5-mile running race
b. The older adult who controls diabetes with diet and exercise
c. The retiree who volunteers 3 days a week at the local library
d. The 80-year-old who is upbeat and hopeful during chemotherapy for lung cancer
c
The older patient is discussing chronic pain and asks the primary care provider for a prescription. Which medication should the nurse anticipate being ordered rather than an opioid?

a. Gabapentin
b. Acetaminophen
c. Morphine
d. Fentanyl
a
which statement by an older patient with mild neurocognitive disorder demonstrates a safe response to beginning a new medication

a. I read the info the pharmacist gave em when I got the prescription filled
b. my daughter comes with me to appointments so that we get all the info we need
c. I know I can call by dr if I think of any questions later
d. I always follow the instructions on the medication bottle
b
Anxiety problems in older adults can manifest as a fear of falling, greatly influencing an older adult's personal freedom. A home health nurse checking on a patient with mild dementia and anxiety related to falling should question which new order?
a. Yoga and tai-chi
b. Xanax
c. Relaxation techniques
d. Electric wheelchair
b
Fred is an older adult with spinal stenosis and who is being treated with a short-term prescription of opioids for an acute episode of back pain. His nurse recognizes additional teaching is necessary when Fred states:
a. "Sitting up straight seems to reduce the pain."
b. "Sometimes I use a heating pad on my back."
c. "Once I get moving for the day my pain gets better."
d. "My wife and I share my Norco for our aches and pains."
d
Ling works as a registered nurse in an Alzheimer's care home. Ling has a specialized rapport-building technique she uses called reminiscence. She uses this technique by:

a. Telling the residents stories about her grandparents' lives.
b. Playing music from the residents' formative years.
c. Reviewing movies that the residents enjoy.
d. Encouraging the residents to talk about pleasurable past events.
d
Marco, age 83, has dementia and difficulty feeding himself despite the fact that there is nothing wrong with his motor functions. Which term should the nurse use to document this finding?
a. Aphasia
b. Apraxia
c. Agnosia
d. Disinhibition anergia
b
you are caring for ellie, age 91, whose provider has written a DNR-CCO order. Which nursing action would be appropriate if ellie were to go into cardiac arrest?

a. immediately call for the code team
b. notify the attending physician and family of the change in status
c. admin prescribed med morphine for pain control
d. initiate cardiopulmonary resuscitation
b
which statement made by a patient diagnosed with SMI reflect a common situation associated with this disorder in today's healthcare system? SATA

a. I have been in a state institution most of my life
b. I;ve been homeless for years
c. once a care provider knows my psych history my physical problems are not taken seriously
d. no one wants to hire a person with a mental illness
e. my family doesn't want to be around me because I hear voices
b,c,d,e
what is a primary reason the nurse should include the family of a patient with a serious mental illness in treatment planning

a. they know the pt better than anyone
b. the pt is likely willing to listen to them
c. they are likely the patients support system
d. the pt will turn to them first when needing help
c
a 73 year old man was diagnosed with a serious mental illness at age 20. Subsequently, he was frequently hospitalized. Two years ago, he was transferred to a group home. When considering the effects of institutionalization, which behavior demonstrates adaptation to the new environment

a. willingly takes his medications
b. keeps his room neat and clean
c. makes himself lunch when he is hungry
d. enjoys spending the afternoon watching TV
c
Due to the need to self-medicate for anxiety, a patient diagnosed with schizophrenia smokes two packs of cigarettes a day. What unique risk does nicotine pose to this patient's health?

a. Lung cancer
b. Cardiovascular constriction
c. Impaired psychotropic medication therapy
d. Increased incidence of lung-reacted disorders
c
which functions are often simultaneously impaired when a patient is experiencing a SMI? SATA

a. cognition
b. emotions
c. perceptions
d. social interactions
e. self care
a, b, c, d, e
Charlie is coping well with a severe mental illness diagnosis. He and his 91-year-old father live together on the family farm. This stable and secluded life has allowed Charlie to live with minimal stimulation, and his relapses have been few. Charlie's caseworker makes a visit to open up a conversation on where Charlie will live when his father can no longer care for him. By bringing up the topic now, the caseworker is hoping to:

a. Arrange housing for Charlie for when his father dies.
b. Avert a relapse and preserve stability in Charlie's life.
c. Rescue Charlie when the crisis occurs.
d. Make Charlie realize he will soon live independently.
b
Jimmy has been hospitalized three times for schizophrenia. Typically, he is very disorganized, spends his money irresponsibly, and loses his housing when he does not pay the rent. In turn, Jimmy cannot be located by his case manager, which leads to treatment nonadherence and relapse. Which response would be most therapeutic? Select all that apply.

a. Advise Jimmy that if he does not pay his rent, he will be placed in a group home instead of independent housing.
b. Discuss with Jimmy the option of having a guardian who will ensure that the rent is paid and that his money is managed to meet his basic needs.
c. Suggest to Jimmy and his prescribing clinician that he be placed on a long-acting injectable form of antipsychotic medication to improve treatment nonadherence.
d. Encourage Jimmy's case manager to hold him responsible for the outcomes of his poor decisions by allowing periods of homelessness to serve as a natural consequence.
b,c
individuals with SMI diagnoses can suffer from ineffective healthcare. Providers may be unaccustomed to working with this population or not comprehend obscure details described by the person seeking medical attention. This hurdle can be overcome by

a. seeking medical attention at the ED
b. having a community clinic in the area where the SMI live
c. medicate the pt before a medical exam
d. integrating mental and physical health in one setting
d
A female consumer with severe and recurrent mania argues with outpatient staff about her medication. She does not believe she has a mental illness. Although she takes medication during hospitalizations, she stops taking them after discharge. Which intervention is most helpful in promoting medication adherence?

a. Assign a new outpatient staff to reduce the conflicts she is experiencing with her current providers.
b. Explain that the medications will help her and that all medications have side effects, but she can learn to live with these.
c. Involve her in a medication group that will teach her the types and names of psychotropic medications, their purpose, and possible side effects.
d. Explore her perceptions and experiences regarding medication and help her to connect taking medications with achieving her goals.
d
isadora is a middle aged woman living in a group home after being discharged from a psych institution nearly 20 years ago. Isadora keeps to herself, stays in her room most of the day, and only ventures out for meals. Cassandra, the house manager encourages Isadora to

a. begin looking for a job
b. join a day treatment program clubhouse
c. assist in the kitchen washing dishes
d. taken on a roommate so as not be be alone
b
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