Deck 27: Adults

Question 1

A person with serious and persistent mental illness enters a shelter for the homeless.Which intervention should be the nurse's initial priority?

A)Develop a relationship
B)Find supported employment
C)Administer prescribed medication
D)Teach appropriate health care practices

Answer 1

Develop a relationship

Question 2

A patient with schizophrenia tells the community mental health nurse,"I threw away my pills because they interfere with God's voice." The nurse identifies the cause of the patient's ineffective management of the medication regime as:

A)inadequate discharge planning
B)poor therapeutic alliance with clinicians
C)dislike of the side effects of antipsychotic medications
D)impaired reasoning secondary to the schizophrenia

Answer 2

impaired reasoning secondary to the schizophrenia

Question 3

A homeless patient with serious and persistent mental illness became suspicious and delusional.The patient was given depot antipsychotic medication,and housing for the patient was obtained in a local shelter.After 2 weeks,which statement by the patient indicates significant improvement?

A)"I am feeling safe and comfortable here.Nobody bothers me."
B)"They will not let me drink.They have many rules in the shelter."
C)"Those guys are always watching me.I think someone stole my shoes."
D)"That shot made my arm sore.I'm not going to take any more of them."

Answer 3

"I am feeling safe and comfortable here.Nobody bothers me."

Question 4

A nurse prepares a plan of care for a patient with adult attention deficit hyperactivity disorder (ADHD).Which intervention should be included?

A)Remind the patient of priorities and deadlines.
B)Teach work-related skills such as basic computer literacy.
C)Establish penalties for failing to organize and prioritize tasks.
D)Give encouragement and strategies for managing and organizing.

Question 5

A patient living independently has command hallucinations to report terrorism to the Federal Bureau of Investigation (FBI)and to shout warnings to neighbors.After a short hospitalization,the patient is prohibited from returning to the apartment.The landlord says,"You can't come back here.You cause too much trouble." What problem is the patient experiencing?

A)Grief
B)Stigma
C)Homelessness
D)Lack of insurance parity

Question 6

The treatment team believes medication will help a patient diagnosed with adult attention deficit hyperactivity disorder (ADHD).Which class of medications does the nurse expect will be prescribed?

A)Benzodiazepines
B)Psychostimulants
C)Antipsychotics
D)Anxiolytics

Question 7

Severe and persistent mental illness is characterized as a:

A)mental illness of longer than 2 weeks' duration
B)major chronic mental illness marked by significant functional impairments
C)mental illness accompanied by physical impairment and severe social problems
D)major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities

Question 8

A patient says,"I often make careless mistakes and have trouble staying focused.Sometimes it's hard to listen to what someone is saying.I have problems putting things in the right order and often lose equipment." Which problem should the nurse document?

A)Inattention
B)Impulsivity
C)Hyperactivity
D)Social impairment

Question 9

Which nursing diagnosis is likely to apply to an individual with severe and persistent mental illness who is homeless?

A)Insomnia
B)Substance abuse
C)Chronic low self-esteem
D)Impaired environmental interpretation syndrome

Question 10

An adult with attention deficit hyperactivity disorder (ADHD)says,"I've always been stupid.I never had friends when I was a child.My parents often punished me because I made mistakes.Now,I can't keep a job." The nurse managing care should first consider:

A)Aversive therapy to extinguish negative behaviors
B)Cognitive therapy to help address internalized beliefs
C)Group therapy to allow comparison of feelings with others
D)Vocational counseling to identify needed occupational skills

Question 11

An adult says,"When I was a child,I took medication because I couldn't follow my teachers' directions.I stopped taking it when I was about 13.I still have trouble getting organized,which causes difficulty doing my job." Which disorder is most likely?

A)Stress intolerance disorder
B)Generalized anxiety disorder
C)Borderline personality disorder
D)Adult attention deficit hyperactivity disorder (ADHD)

Question 12

A nurse prepares for an initial interview with a patient with suspected adult ADHD.Questions should be focused to elicit information about which problem?

A)Headaches
B)Inattention
C)Sexual impulses
D)Trichotillomania

Question 13

For patients with severe and persistent mental illness,what is the major advantage of case management? A case manager can:

A)modify traditional psychotherapy.
B)more efficiently use resources as the only manager responsible for coordinating services.
C)focus on social skills training and self-esteem building.
D)bring groups of patients together to discuss common problems.

Question 14

A 37-year-old is involuntarily committed to outpatient treatment after sexually molesting a 12-year-old child.The patient says,"That girl looked like she was 19 years old." Which defense mechanism is this patient using?

A)Denial
B)Identification
C)Displacement
D)Rationalization

Question 15

Health maintenance and promotion efforts for patients with severe and persistent mental illness should include education about the importance of regular:

A)home safety inspections
B)monitoring of self-care abilities
C)screening for cancer,hypertension,and diabetes
D)determination of adequacy of a patient's support system

Question 16

A patient who is severely and persistently mentally ill and lives in a homeless shelter has the nursing diagnosis Powerlessness.Which intervention should be included in the plan of care?

A)Encourage mutual goal setting.
B)Verbally communicate empathy.
C)Reinforce participation in activities.
D)Demonstrate an accepting attitude.

Question 17

The parent of an adult who is severely and persistently mentally ill asks the nurse,"Why are you making a referral to that vocational rehabilitation program? My child won't ever be able to hold a job." Which is the nurse's best reply?

A)"We make this referral to continue eligibility for federal funding."
B)"Are you concerned that we're trying to make your child too independent?"
C)"If you think the program would be detrimental,we can postpone it for a time."
D)"Most patients are capable of employment at some level,competitive or supported."

Question 18

Which nursing action should occur first when preparing to work with a patient who has a problem of sexual functioning?

A)Acquiring knowledge of the patient's sexual roles and preferences
B)Developing an understanding of human sexual responses
C)Assessing the patient's sexual functioning
D)Clarifying the nurse's own personal values

Question 19

A new staff nurse tells the clinical nurse specialist,"I'm unsure about my role when patients bring up sexual problems." Which information should the clinical nurse specialist provide? All nurses:

A)qualify as sexual counselors.Each has knowledge about the biopsychosocial aspects of sexuality throughout the life cycle.
B)should be able to screen for sexual dysfunction and give basic information about sexual feelings,behaviors,and myths.
C)should defer questions about sex to other health care professionals because of their limited knowledge of sexuality.
D)who are interested in sexual dysfunction can provide sex therapy for individuals and couples.

Question 20

The father of a child with schizophrenia says,"I lost my job,so we have no health insurance." The mother says,"I must watch this child all the time.Without supervision,our child becomes violent and destroys furniture." The sibling says,"My parents don't pay very much attention to me." These comments signify:

A)life-cycle stressors
B)psychobiologic issues
C)family burden of mental illness
D)stigma associated with mental illness

Question 21

Which statements most clearly indicate that the speaker views mental illness with stigma? Select all that apply.

A)"We are all a little bit crazy."
B)"If people with mental illness would go to church,their problems would be solved."
C)"Many mental illnesses are genetically transmitted.It's no one's fault that the illness occurs."
D)"Anyone can have a mental illness.War or natural disasters can be too stressful for healthy people."
E)"People with mental illness are lazy.They get government disability checks instead of working."

Question 22

An adult patient tells the case manager,"I don't have bipolar disorder anymore,so I don't need medicine.After I was in the hospital last year,you helped me get an apartment and disability checks.Now I'm bored and don't have any friends." Where should the nurse refer the patient? Select all that apply.

A)Psychoeducation classes
B)Vocational rehabilitation
C)Social skills training
D)Homeless shelter
E)Crisis intervention

Question 23

An adult man tells the nurse,"All my life,I have felt and acted like a woman while living in the body of a man.For the past year,I have lived and dressed as a woman.I'm changing jobs to protect my new identity." Which request is the patient likely to make to the health care provider?

A)"Can you refer me for psychological testing?"
B)"Will you prescribe estrogen therapy?"
C)"Will you alter my medical records?"
D)"What should I tell my parents?"

Question 24

A patient tells the nurse,"My sexual functioning is normal when my partner wears lace.Without it,I'm not interested in sex." This comment evidences:

A)exhibitionism
B)voyeurism
C)pedophilia
D)fetishism

Question 25

The manager of a health club put a hidden camera in the women's locker room and videotaped women as they showered and dressed.Which sexual dysfunction is evident?

A)Frotteurism
B)Exhibitionism
C)Pedophilia
D)Voyeurism

Question 26

.A patient with severe and persistent mental illness who recently moved to a homeless shelter says,"My life is out of control.I'm like a leaf at the mercy of the wind." The nurse formulates the diagnosis Powerlessness.Outcomes will focus on:

A)Instilling hope
B)Controlling anxiety
C)Planning activities
D)Developing personal autonomy

Question 27

Before working with patients regarding sexual concerns,a prerequisite for providing nonjudgmental care is:

A)sympathy
B)assertiveness training
C)sexual self-awareness
D)effective communication

Question 28

Which economic factors are most critical to the success of discharge planning for a patient with severe and persistent mental illness? Select all that apply.

A)Access to housing
B)Individual psychotherapy
C)Income to meet basic needs
D)Availability of health insurance
E)Ongoing interdisciplinary evaluation

Question 29

Which information should a nurse include in health teaching for adults who have with attention deficit hyperactivity disorder (ADHD)and their significant others? Select all that apply.

A)Tendency for genetic transmission
B)Prevention strategies related to substance abuse
C)Negative reinforcement to help modify behaviors
D)Psychostimulants for children (rarely effective in adults)
E)Cognitive therapy to challenge internalized negative beliefs about self

Question 30

An adult has been feeling significant tension since losing a home through foreclosure.This person goes to a park,feeds the birds,and then impulsively exposes himself to a group of parents and children.Which term applies to this behavior?

A)Voyeurism
B)Dyspareunia
C)Exhibitionism
D)Sexual masochism

Question 31

A nurse cares for a patient with paraphilia.The nurse expects the health care provider may prescribe which type of medication to reduce paraphilic behaviors?

A)Selective serotonin reuptake inhibitor (SSRI)
B)Erectile dysfunction medication
C)Atypical antipsychotic medication
D)Mood stabilizer