Question 1

The nurse utilizes a sound theoretical knowledge base about adolescent growth and development to:

Accepted Answer

Understanding typical adolescent development allows the nurse to differentiate between normal and abnormal behavior or responses. Assessing cognitive abilities (A) and incorporating good and evil (B) are not directly related to growth and development theory. Integrating truth and fiction (D) is not relevant to adolescent growth and development theory.

Question 2

Following a difficult family session, an adolescent client in the inpatient psychiatric-mental health unit has become combative. Prior to communicating with this client, the nurse must consider:

Accepted Answer

The answer of Following a difficult family session, an adolescent...

Question 3

During an admission to the inpatient adolescent unit, a client tells the nurse that his foster parents punish him too severely. The appropriate response of the nurse is to:

Accepted Answer

The appropriate initial response of the nurse is to gather data from the foster parents regarding their disciplinary practices in order to facilitate communication and collaboration among all parties involved in the client's care. This will help determine the appropriate intervention for the situation. Jumping to conclusions or taking drastic measures such as informing the psychiatrist or notifying the authorities without gathering data from all parties involved can be harmful to the client's trust in the healthcare system and the foster parents. Telling the parents they need to be more therapeutic, not punitive may cause them to feel defensive and may not address the root of the problem.

Question 4

During group, the adolescents are asked to identify their role models. One of the teens responds, "My parents." The nurse recognizes this response as:

Accepted Answer

It is developmentally appropriate for adolescents to identify their parents as role models. Adolescents often look up to their parents for guidance and support during this time of transition and growth.

Question 5

A nurse making rounds hears sounds coming from an adolescent's room. When checking on the client, the nurse hears noises coming from the bathroom, and suspects that the client is masturbating. Which are the most appropriate actions in this situation?
Select all that apply.

Accepted Answer

C: Knocking on the door before entering the bathroom is appropriate because it maintains the client's privacy and dignity. It also allows the nurse to inform the client that their behavior is not appropriate in a discreet manner.
D: Examining personal feelings is appropriate as it helps the nurse to confront her own values and facilitates effective communication. This approach allows the nurse to remain non-judgmental while still addressing the client's behavior. A non-judgmental approach is important to build rapport and trust with the client.

Options A, B, and E are not appropriate. Discussing the inappropriate behavior is not suitable because it shames and humiliates the client, leading to negative effects on the therapeutic relationship. Waiting for the client to come out of the bathroom before approaching them is infringing on their privacy, and pretending not to hear anything is neglecting the issue at hand.

Question 6

An adolescent client is being verbally abusive toward staff and is refusing to comply with the unit's rules. The first action is to:

Accepted Answer

Separating the client from others can help de-escalate the situation and prevent the behavior from affecting or influencing other clients. It also provides an opportunity to address the behavior in a more controlled environment.

Question 7

Prior to intervening with an adolescent projecting anger on the nurse, the nurse should:

Accepted Answer

Before intervening with the angry adolescent, the nurse should engage in introspection to examine how he/she reacts to others when they are angry. This will help the nurse to approach the situation with a calm and collected demeanor, potentially diffusing the aggressive behavior of the adolescent. Organizing a rapid response team or enlisting an adolescent peer to intervene should only be done if the situation escalates and becomes dangerous. Encouraging reflection may also be helpful, but it is not the best initial step.

Question 8

A parent brings an adolescent child to the doctor's office. The nurse will be assessing both physical and psychosocial concerns. Which of the following actions by the nurse demonstrates a developmental approach to interviewing the adolescent?

Accepted Answer

This demonstrates a developmental approach because it acknowledges that adolescents may have concerns they may not want to discuss in front of their parents. Giving the adolescent privacy allows them to feel comfortable and more likely to open up about their concerns. It also shows respect for their growing autonomy and encourages them to become more independent.

Question 9

The primary role of the school nurse's mental health work with adolescents is:

Accepted Answer

The primary role of the school nurse's mental health work with adolescents is prevention and early recognition of mental health problems. This may include providing education on coping skills, stress management, and healthy relationships, as well as identifying and addressing any potential mental health issues before they become more severe. Referral to community mental health services and informing parents may also be part of the nurse's role, but these are not the primary focus. Intensive treatment of symptoms of mental illness would require the services of a mental health professional.

Question 10

The registered nurse working with adolescents in the mental health setting has the opportunity to do which of the following?
Select all that apply.

Accepted Answer

A registered nurse can serve in an advisory capacity and counsel adolescents on preventing problems related to normal growth and development. However, providing family therapy, adjusting medication dosages, and conducting individual therapy typically require advanced practice credentials or specific licensure.

Question 11

The nurse completing an assessment for an adolescent from a humanistic interactionist perspective will include which of the following assessments? Choose the best response.

Accepted Answer

The answer of The nurse completing an assessment for an...

Question 12

Psychiatric-mental health nurses provide interventions for primary, secondary, and tertiary prevention. An example of a primary prevention for adolescents is:

Accepted Answer

Primary prevention is aimed at preventing the occurrence of a problem before it happens. An assembly program on the dangers of substance abuse is an example of primary prevention as it is aimed at educating and informing adolescents about the dangers of substance abuse before they engage in such behavior. Dissemination of condoms to students with sexually transmitted diseases is an example of secondary prevention as it is aimed at preventing the spread of the disease to others. Parenting classes for first-time teenage parents and a weekly group for adolescents who are known to be abused are examples of tertiary prevention as they are aimed at preventing further complications or problems resulting from the initial problem.

Question 13

The wife of an older client is concerned that her husband has recently experienced memory lapses, is unusually aggressive and was involved in three traffic accidents in the past month. In planning a response, the nurse is guided by the knowledge that:

Accepted Answer

The combination of memory lapses, aggression, and multiple traffic accidents may indicate alcohol abuse as a possible cause. Further assessment is needed to determine if this is the case. Depression and dementia can also cause memory lapses and behavior changes, but the presence of traffic accidents raises concerns about possible intoxication. Normal aging does not typically lead to these specific symptoms. Elder abuse is a possibility, but there is no evidence in the scenario to support this as the primary cause of the client's symptoms.

Question 14

Which of the following behaviors would indicate that the nurse's remotivation therapy group for long-term care residents was effective?

Accepted Answer

The answer of Which of the following behaviors would indicate...

Question 15

The nurse is assessing the social and financial status of an older adult. Which of the following questions would be appropriate to ask?

Accepted Answer

Asking about transportation to doctor's appointments is appropriate as it assesses the older adult's ability to access healthcare, which is a key aspect of their social and financial status.

Question 16

The nurse plans to increase self-esteem and reduce social isolation for residents living at the long-term care facility. Which one of the following strategies should the nurse include to meet these goals?

Accepted Answer

Reminiscence therapy involves discussing past experiences and memories, which can increase self-esteem by allowing residents to share their life stories and feel valued. It also provides an opportunity for residents to socialize and reduce social isolation by connecting with others who may have similar memories or experiences. Restorative care focuses on improving physical abilities, respite services provide temporary relief for caregivers, and reality orientation is used to help individuals with dementia understand their surroundings. While these strategies may also be helpful in a long-term care facility, they do not directly address the goals of increasing self-esteem and reducing social isolation.

Question 17

Which of the following nursing diagnoses would be most appropriate for an older adult who recently lost his wife of 50 years after a long history of breast cancer?

Accepted Answer

Ineffective Role Performance would be the most appropriate nursing diagnosis for an older adult who recently lost his wife of 50 years after a long history of breast cancer. This diagnosis addresses the challenges the patient may face in adapting to life without his spouse and the potential impact on his ability to fulfill his usual roles and responsibilities. The other choices do not address the specific emotional and social factors related to this particular situation.

Question 18

The nurse's evaluation of the outcomes of care for an older adult mentally ill client should be guided by the knowledge that:

Accepted Answer

The nurse should consider the values and preferences of the client when evaluating the outcomes of care. This involves understanding and respecting the client's unique needs and wishes, which can vary depending on factors such as culture and personal history. Additionally, involving family and significant others in the evaluation process can also be valuable in ensuring that the client's care is holistic and comprehensive. While the absence of symptoms is a desirable outcome, it should not be considered the only measure of success, as other factors such as client satisfaction and quality of life should also be taken into account.

Question 19

The nurse suspects a 75-year-old male client is contemplating suicide. Which of the following factors also place him at greater risk for suicide?
Select all that apply.

Accepted Answer

Frequent alcohol consumption and chronic pain caused by cancer are both risk factors for suicide. Being married, having a high socio-economic status, and being non-Hispanic Black are not necessarily risk factors for suicide.

Question 20

During the nursing assessment of the older adult female client, the nurse finds the client believes others are poisoning her food. Which of the following psychiatric disorders would not be indicated?

Accepted Answer

Adjustment disorder is characterized by emotional and behavioral symptoms in response to a specific stressor, which does not typically include delusions or false beliefs about being poisoned. Anxiety disorder, dementia, and delirium can all present with paranoia or delusions.

Quiz 3: Clients With Mental Disorders, and Vulnerable Populations