Deck 31: Adult Transitions

Question 1

A nurse is interviewing a 57-year-old patient whose father died 4 years ago. The patient's mother, for whom the patient was the primary caregiver, recently died. The nurse recognizes that this patient may be at risk for which disorder? Select all that apply.

A) Anxiety
B) Depression
C) Panic disorder
D) Bipolar disorder
E) Complicated grief

Answer 1

Anxiety
Depression
Complicated grief

Question 2

A pregnant woman indicates to her nurse that since her pregnancy began she is experiencing sleep disturbance and horrible nightmares that wake her. What questions should the nurse include during the assessment? Select all that apply.

A) "Does your partner snore and disturb your sleep at night?"
B) "Are you taking any medications?"
C) "Have you had any past traumas that pregnancy might have reactivated?"
D) "Are there any significant family problems that are causing you concern?"
E) "Have you ever been diagnosed with a mental health problem?"

Answer 2

"Are you taking any medications?"
"Have you had any past traumas that pregnancy might have reactivated?"
"Are there any significant family problems that are causing you concern?"
"Have you ever been diagnosed with a mental health problem?"

Question 3

A nurse is seeing a 71-year-old patient with Parkinson disease. The patient has frequent episodes of crying and reports having panic attacks, during which she feels as though she can't breathe. How should the nurse respond?

A) Inform the patient that depression is a normal reaction to a diagnosis of physical illness and it will naturally improve over time.
B) Inform the patient that a diagnosis of depression is unrelated to a diagnosis of Parkinson disease and refer the patient for counseling.
C) Inform the patient that brain changes that occur with Parkinson disease may be associated with high levels of depression and anxiety and may respond to pharmacotherapy.
D) Inform the patient that pharmacological treatment for depression is usually unsuccessful in patients with Parkinson disease because of possible side effects.

Answer 3

Inform the patient that brain changes that occur with Parkinson disease may be associated with high levels of depression and anxiety and may respond to pharmacotherapy.

Question 4

The nurse at a local health clinic is assessing an older adult male who may have broken his leg. The patient's vital signs are within normal limits. The patient is alert and oriented to time, person, and place, but reports falling off the ladder while trying to change a light bulb. The patient states, "I'm just a mess. I'm no good at anything anymore." Which is the nurse likely to include as part of the assessment? Select all that apply.

A) A sleep assessment
B) A nutrition evaluation
C) A depression inventory
D) A substance abuse assessment
E) A pulmonary assessment

Question 5

A group of nurses are discussing the co-morbidity of physical and mental illness. Which patients would they assess to be at risk for depression? Select all that apply.

A) A patient with COPD
B) A patient with diabetes
C) A patient with celiac disease
D) A patient with Parkinson disease
E) A patient with cardiovascular disease

Question 6

A patient diagnosed with depression has been taking a selective serotonin-reuptake inhibitor (SSRI) throughout her pregnancy. What neonatal consequences are possible?

A) Malformations
B) High birth weight
C) Neural tube defects
D) Poorer neurobehavioral adaptation

Question 7

A patient diagnosed with depression tells the nurse that, on the advice of her friends, she discontinued her medication as soon as she discovered she was pregnant. What is the most appropriate way for the nurse to respond?

A) "That is a good idea. Those drugs can be dangerous."
B) "It is never a good idea to stop taking antidepressant medication."
C) "If you don't continue to take the medication, you are seriously endangering yourself."
D) "I think you should consult with your prescribing provider and get all the information you need to help you make the best decision."

Question 8

A nurse is seeing a patient who complains of knee pain. Her youngest child just left for college in another state. The previous day, the patient's pipes burst and the basement flooded. During the interview, the patient can't stop crying. What might the nurse consider?

A) Cumulative stressors may have overwhelmed the patient.
B) If the patient is referred for knee replacement surgery, she will be fine.
C) The patient needs to realize that she is experiencing normal challenges.
D) The patient should have an immediate evaluation for antidepressant medications.

Question 9

A 64-year-old patient expresses concern to the nurse that when he retires he'll just stop living. Which is the most appropriate statement by the nurse?

A) "Resting is not so bad at your age."
B) "I guess you'd just better find something else to do."
C) "You do have to make room for younger workers now."
D) "You don't have to keep on working to do something that is important."

Question 10

A patient who is planning to become pregnant asks the nurse to explain if genetics can influence the transmission of mental illness. How might the nurse respond?

A) Genetics have no influence on mental illness.
B) Genes are only involved in organic mental disorders.
C) Genes may influence many aspects of mental health disorders.
D) Environmental influences are completely responsible for mental illness.

Question 11

A twenty-year-old patient tells the nurse that his father has just been diagnosed with Huntington disease and he wants to know his own risk of contracting the disease. What can the nurse tell him?

A) "You have the same risk of contracting the disease as anyone else."
B) "No one can predict the risk of contracting Huntington disease for any individual."
C) "Every child of a person with Huntington disease has a 50% risk of contracting the disease."
D) "Children of someone who has been diagnosed with Huntington disease are immune from contracting the disease."

Question 12

A patient with bipolar disorder has unexpectedly become pregnant and is concerned about the possible impact of valproate on her and her baby. What can the nurse tell her?

A) "Valproate is not associated with any fetal risks."
B) "There is no problem if you stop your medications."
C) "Valproate has been associated with several significant fetal risks."
D) "If you take other medications, you can reduce the risks of valproate."

Question 13

A young couple is planning to start a family. The nurse is conducting an assessment of the genetic risk of mental health disorders. What factors should the nurse include as part of the assessment? Select all that apply.

A) Multigenerational family health history
B) Laboratory test for genetic malformations
C) Comprehensive health and physical assessments
D) Analysis of the history and physical assessment findings
E) Assessment of the couple's knowledge of genetic information

Question 14

A nurse is seeing a patient with diabetes who reports that she thinks her diabetes is worse. She is feeling tired all the time, has difficulty enjoying things, and has problems concentrating and sleeping. What should the nurse consider in her assessment?

A) The patient may have social phobia.
B) The patient may have panic disorder.
C) The patient may have bipolar disorder.
D) The patient may have depression.

Question 15

A prescribing practitioner has ordered cytochrome P450 testing for a patient who is not responding to his current antidepressant medication. Which is the best explanation the nurse can provide the patient for why the provider has ordered the test?

A) "It can help find the most beneficial medication."
B) "It provides important information for pharmacological research."
C) "It may rule out any organic causes of your depression."
D) "It helps determine the extent and severity of your depression."

Question 16

The nurse at a mental health clinic is conducting an initial assessment on a patient who has been referred by the student health center at the university the patient attends. The patient had been brought to the health center by a member of the faculty when the patient began hallucinating during class. Which factor revealed during the assessment will the nurse consider a priority for care?

A) The patient has poor hygiene.
B) The patient is 20 years old.
C) The patient is single and lives off campus with a roommate who "is never around."
D) The patient's grades have plummeted this semester.

Question 17

A nurse is conducting an initial interview with a 51-year-old single woman diagnosed with bipolar disorder. What particular possibility should the nurse consider in her assessment?

A) The patient may have an incorrect diagnosis
B) The patient may be experiencing financial problems.
C) The patient may not have an adequate support system.
D) The patient may be nonadherent with her medications.

Question 18

A patient presents with withdrawal, poor concentration, fatigue, weakness, anorexia and aches. What conditions should the nurse consider as part of a differential diagnosis?

A) Anxiety and multiple sclerosis
B) Depression and congestive heart failure
C) Anxiety and diabetes
D) Depression and acute inflammatory illness

Question 19

A 55-year-old patient, who has been the primary caregiver for her recently deceased father, tells the nurse that caring for her father has left her feeling exhausted and lonely. What condition should the nurse consider as a risk for this patient?

A) Bipolar disorder
B) Schizoaffective disorder
C) Complicated grief disorder
D) Generalized anxiety disorder

Question 20

A pregnant patient is taking an atypical antipsychotic. For what specific risk should the nurse monitor this patient?

A) Depression
B) Preeclampsia
C) Hypothyroidism
D) Gestational diabetes

Question 21

A patient wants to add an exercise program to their daily regimen. At this stage of change, what are some appropriate interventions the nurse should consider? Select all that apply.

A) Identify and assist in problem solving.
B) Help the patient identify social support for the change.
C) Identify and promote new, positive outcome expectations.
D) Verify skills the patient possesses to assist in making a change.
E) Encourage and provide feedback on small steps toward change.

Question 22

A patient with bipolar disorder drinks a six-pack of beer each day. He tells the nurse that it is the only way he can relax. What is an appropriate nursing intervention for this patient?

A) Plan for follow-up support.
B) Encourage re-evaluation of current behavior.
C) Encourage and provide feedback on small steps toward change.
D) Help the patient identify feelings of loss and contrast with long-term benefits.

Question 23

A patient with obsessive-compulsive disorder (OCD) has been invited to a family picnic. The patient tells the nurse that, although his family is supportive, he is concerned how he will handle his anxiety while at the picnic. Which nursing response would promote resiliency?

A) "It is important to maintain your relationships."
B) "You don't have to do anything you don't want to do."
C) "Your family will just have to understand if you don't go."
D) "Families often put too much pressure on people with mental health problems."

Question 24

A patient newly diagnosed with obsessive-compulsive disorder (OCD) needs assistance with setting goals. Which might be an appropriate goal for the patient to identify?

A) Increasing social contacts.
B) Stopping compulsive hand washing.
C) Identifying certain thoughts as OCD symptoms.
D) Stopping counting, tapping, or repeating certain words.

Question 25

A patient with schizophrenia who is part of the assertive community treatment (ACT) program indicates that he wants to offer an art class to other participants. Which is an appropriate statement by the nurse?

A) "That's a good idea. I think you should do it."
B) "Are you sure this you have the necessary skills to do this?"
C) "Have you had someone knowledgeable evaluate your talents?"
D) "Perhaps you should take your participation in the art world more slowly."

Question 26

A patient reports to the nurse that he has just been fired from his job. How might the nurse frame this event in order to make it an opportunity to promote resiliency?

A) Employment loss can provide the patient with a rest from the stresses of working.
B) Employment loss can provide the patient with a reason to withdraw from social pressures.
C) Employment loss can provide the patient with a way to develop a perspective on setbacks.
D) Employment loss can provide the patient with an opportunity to express his anger at his boss.

Question 27

A patient who gave up smoking recently began again. What might be an appropriate nursing intervention according to Prochaska's model?

A) Ask what the patient gets from smoking.
B) Teach the patient stress reduction strategies.
C) Discuss how smoking affects the lungs.
D) Bolster the patient's self-efficacy for managing barriers to change.

Question 28

The nurse is discussing strategies for self-care with a patient who has generalized anxiety disorder. What are some self-care strategies the nurse can encourage to promote resiliency? Select all that apply.

A) Exercise
B) Hobbies
C) Good nutrition
D) Good grooming
E) A regular sleep schedule