ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING-CONCEPTS OF CARE IN EVIDENCE-BASED PRACTICE, 7TH EDITION BY MARY C Test Bank

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ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING-CONCEPTS OF CARE IN EVIDENCE-BASED PRACTICE, 7TH EDITION BY MARY C Test Bank

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ESSENTIALS OF PSYCHIATRIC MENTAL HEALTH NURSING-CONCEPTS OF CARE IN EVIDENCE-BASED PRACTICE, 7TH EDITION BY MARY C Test Bank

Chapter 2: Biological Implications

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   A depressed client states, I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again. Which nursing response is appropriate?

1. Medications only address biological factors. Environmental and interpersonal factors must also be considered.
2. Because biological factors are the sole cause of depression, medications will improve your mood.
3. Environmental factors have been shown to exert the most influence in the development of depression.
4. Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment).

 

 

____    2.   A client diagnosed with major depressive disorder asks, What part of my brain controls my emotions? Which nursing response is appropriate?

1. The occipital lobe governs perceptions, judging them as positive or negative.
2. The parietal lobe has been linked to depression.
3. The medulla regulates key biological and psychological activities.
4. The limbic system is largely responsible for ones emotional state.

 

 

____    3.   Which part of the nervous system should a nurse identify as playing a major role during stressful situations?

1. Peripheral nervous system
2. Somatic nervous system
3. Sympathetic nervous system
4. Parasympathetic nervous system

 

 

____    4.   Which client statement reflects an understanding of circadian rhythms in psychopathology?

1. When I dream about my mothers horrible train accident, I become hysterical.
2. I get really irritable during my menstrual cycle.
3. Im a morning person. I get my best work done before noon.
4. Every February, I tend to experience periods of sadness.

 

 

____    5.   Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community?

1. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy
2. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill
3. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents
4. Studies in which monozygotic twins were raised together by mentally ill biological parents
5. All of the above

 

 

____    6.   Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective?

1. Neuroendocrinology
2. Psychoneuroimmunology
3. Diagnostic technology
4. Neurophysiology

 

 

____    7.   A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior?

1. Dendrites
2. Axons
3. Neurotransmitters
4. Synapses

 

 

____    8.   An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron?

1. Regeneration
2. Reuptake
3. Recycling
4. Retransmission

 

 

____    9.   A nurse concludes that a restless, agitated client is manifesting a fight-or-flight response. The nurse should associate this response with which neurotransmitter?

1. Acetylcholine
2. Dopamine
3. Serotonin
4. Norepinephrine

 

 

____  10.   A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the clients neurotransmitters should a nurse expect to be elevated?

1. Serotonin
2. Dopamine
3. Gamma-aminobutyric acid (GABA)
4. Histamine

 

 

____  11.   A clients wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The clients therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapists recommendations?

1. The therapist is using an interpersonal approach.
2. The client has an alteration in neurotransmitters.
3. It is routine practice to remind clients about nutrition, exercise, and rest.
4. The client is susceptible to illness because of effects of stress on the immune system.

 

 

____  12.   Which mental illness should a nurse identify as being associated with an increase in prolactin hormone level?

1. Major depressive episode
2. Schizophrenia
3. Anorexia nervosa
4. Alzheimers disease

 

 

____  13.   Which cerebral structure should a nursing instructor describe to students as the emotional brain?

1. The cerebellum
2. The limbic system
3. The cortex
4. The left temporal lobe

 

 

____  14.   A nurse understands that the abnormal secretion of growth hormone may play a role in which illness?

1. Acute mania
2. Schizophrenia
3. Anorexia nervosa
4. Alzheimers disease

 

 

____  15.   A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms?

1. Abnormal levels of serotonin
2. Decreased levels of dopamine
3. Increased levels of norepinephrine
4. Decreased levels of acetylcholine

 

 

____  16.   A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness?

1. Bipolar disorder: mania
2. Schizophrenia spectrum disorder
3. Generalized anxiety disorder
4. Major depressive episode

 

 

____  17.   A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness?

1. Schizophrenia spectrum disorder
2. Major depressive disorder
3. Body dysmorphic disorder
4. Parkinsons disease

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____  18.   Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? (Select all that apply.)

1. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa.
2. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa.
3. There is a possible correlation between low levels of gonadotropin and anorexia nervosa.
4. There is a possible correlation between increased levels of prolactin and anorexia nervosa.
5. There is a possible correlation between altered levels of oxytocin and anorexia nervosa.

 

 

____  19.   Which of the following symptoms should a nurse associate with the development of decreased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? (Select all that apply.)

1. Depression
2. Fatigue
3. Increased libido
4. Mania
5. Hyperexcitability

 

 

Completion

Complete each statement.

 

  1. ____________________________ is the study of the biological foundations of cognitive, emotional, and behavioral processes.

 

 

Chapter 2: Biological Implications

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  1

Chapter: Chapter 2, Biological Implications

Objective: Recognize various theorized influences in the development of psychiatric disorders including brain physiology, genetics, endocrine function, immune system, and psychosocial, and environmental factors.

Page: 1519

Headings: The Parietal Lobes, The Occipital Lobes, Limbic System, Medulla

Integrated Processes: Teaching and Learning

Client Need: Psychosocial Integrity

Cognitive Level: Analysis [Analyzing]

Concept: Mood

Difficulty: Easy

 

  Feedback
1 The nurse should advise the client that medications address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression.
2 The statement is false because biological factors are not the sole cause of depression.
3 It is false that environmental factors have been shown to exert the most influence in the development of depression.
4 Researchers have demonstrated a link between nature and nurture.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  4

Chapter: Chapter 2, Biological Implications

Objective: Identify gross anatomical structures of the brain and describe their functions.

Page: 16

Headings: The Nervous System: An Anatomical Review > The Brain

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 The occipital lobes are the area of visual reception and interpretation.
2 Somatosensory input (touch, taste, temperature, etc.) occurs in the parietal lobes.
3 The medulla contains vital centers that regulate heart rate and reflexes.
4 The nurse should explain to the client that the limbic system is largely responsible for ones emotional state. This system is often called the emotional brain and is associated with feelings, sexuality, and social behavior.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  3

Chapter: Chapter 2, Biological Implications

Objective: Discuss the physiology of neurotransmission in the central nervous system.

Page: 21

Heading: Autonomic Nervous System

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 The peripheral nervous system does not play a major role during stressful situations.
2 The somatic nervous system is part of the peripheral nervous system.
3 The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response.
4 The parasympathetic nervous system is dominant when an individual is in a nonstressful state.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  3

Chapter: Chapter 2, Biological Implications

Objective: Discuss the physiology of neurotransmission in the central nervous system.

Page: 2930

Heading: Circadian Rhythms

Integrated Processes: Teaching and Learning

Client Need: Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Analysis [Analyzing]

Concept: Sleep and Rest

Difficulty: Moderate

 

  Feedback
1 This statement does not indicate understanding of circadian rhythms.
2 The menstrual cycle is not affected by the circadian rhythm.
3 By stating, I am a morning person, the client demonstrates an understanding that circadian rhythms may influence a variety of regulatory functions, including the sleep-wake cycle, regulation of body temperature, and patterns of activity. Most humans follow a 24-hour cycle that is largely affected by lightness and darkness.
4 Experiencing periods of sadness is not indicative of the circadian rhythm.

 

 

PTS:   1                    CON:  Sleep and Rest

 

  1. ANS:  5

Chapter: Chapter 2, Biological Implications

Objective: Discuss the implications of psychobiological concepts to the practice of psychiatric/mental health nursing.

Page: 31

Heading: Genetics > Adoptions Studies

Client Need: Physiological Integrity: Physiological Adaptation

Concept: Evidence-based Practice

Cognitive Level: Analysis [Analyzing]

Integrated Processes: Teaching and Learning

Difficulty: Moderate

 

  Feedback
1 This type of adoption study can provide information on children with mentally ill biological parents who are raised by adoptive parents who are mentally healthy parents.
2 This type of adoption study can provide information on children with mentally healthy biological parents who are raised by adoptive parents who are mentally ill.
3 This type of adoption study provides important information on monozygotic twins from mentally ill parents who were raised separately by different adoptive parents.
4 This type of adoption study provides important information on monozygotic twins who were raised together by mentally ill biological parents.
5 The nurse should determine that all of the studies could possibly benefit the psychiatric community. The studies may reveal research findings relating genetic links to mental illness. Adoption studies allow comparisons to be made of the influences of the environment versus genetics.

 

 

PTS:   1                    CON:  Evidence-based Practice

 

  1. ANS:  2

Chapter: Chapter 2, Biological Implications

Objective: Discuss the influence of psychological factors on the immune system.

Page: 31

Heading: Psychoneuroimmunology > Implications of the Immune System in Psychiatric Illness

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Stress

Difficulty: Moderate

 

  Feedback
1 Neuroendocrinology is the study of the interaction between the nervous system and the endocrine system.
2 Psychoneuroimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system. Studies of the biological response to stress hypothesize that individuals become more susceptible to physical illness following exposure to stressful stimuli.
3 Diagnostic testing assists in diagnosing.
4 Neurophysiology is the physiology of the nervous system.

 

 

PTS:   1                    CON:  Stress

 

  1. ANS:  3

Chapter: Chapter 2, Biological Implications

Objective: Describe the role of neurotransmitters in the central nervous system.

Page: 21

Heading: The Nervous System: An Anatomical Review > Neurotransmitters

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 Dendrites are processes that transmit impulses toward the cell body.
2 Axons transmit impulses away from the cell body. A junction between two neurons is a synapse.
3 The nurse should recognize that neurotransmitters play an essential function in the role of human emotion and behavior. Neurotransmitters are targeted and affected by many psychotropic medications.
4 A junction between two neurons is a synapse.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  2

Chapter: Chapter 2, Biological Implications

Objective: Describe the role of neurotransmitters in the central nervous system.

Page: 21

Heading: The Nervous System: An Anatomical Review > Neurotransmitters

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 Regeneration is incorrect wording to describe this process.
2 The nursing instructor should explain that the process by which neurotransmitters are released into the synaptic cleft and returned to the presynaptic neuron is termed reuptake. Reuptake is the process by which neurotransmitters are stored for reuse.
3 Recycling is incorrect wording to describe this process.
4 Retransmission is incorrect wording to describe this process.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  4

Chapter: Chapter 2, Biological Implications

Objective: Describe the role of neurotransmitters in the central nervous system.

Page: 21

Heading: Monoamines > Norepinephrine

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 Acetylcholine functions include pain, arousal, and pain perception.
2 Dopamine functions include regulation of movement and coordination.
3 Serotonin plays a role in sleep, libido, and appetite.
4 The nurse should associate the neurotransmitter norepinephrine with the fight-or-flight response. Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, and sleep and arousal.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  2

Chapter: Chapter 2: Biological Implications

Objective: Describe the role of neurotransmitters in the central nervous system.

Page: 21

Heading: Monoamines > Norepinephrine

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 Serotonin plays a role in sleep, libido, and appetite.
2 The nurse should expect that elevated dopamine levels might be an attributing factor to the clients current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability.
3 GABA prevents postsynaptic excitation.
4 Histamine mediates allergic and inflammatory reactions.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  4

Chapter: Chapter 2: Biological Implications

Objective: Discuss the influence of psychological factors on the immune system.

Page: 31

Heading: Psychoneuroimmunology > Implications of the Immune System in Psychiatric Illness

Integrated Processes: Planning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Stress

Difficulty: Moderate

 

  Feedback
1 This approach is not proven by evidence-based research.
2 This rationale is not proven by evidence-based research.
3 Reminding clients about nutrition, exercise and rest is routine but is not proven by evidence-based research.
4 The therapists recommendations should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk to develop illness because of the effects of stress on the immune system. The study of this branch of medicine is called psychoneuroimmunology.

 

 

PTS:   1                    CON:  Stress

 

  1. ANS:  2

Chapter: Chapter 2, Biological Implications

Objective: Recognize various theorized influences in the development of psychiatric disorders including brain physiology, genetics, endocrine function, immune system, and psychosocial, and environmental factors.

Page: 29

Heading: Psychoneuroimmunology > Prolactin

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Stress

Difficulty: Moderate

 

  Feedback
1 There is no known correlation between increased levels of prolactin and major depressive disorder.
2 Although the exact mechanism is unknown, there may be some correlation between increased levels of the hormone prolactin and schizophrenia.
3 There is no known correlation between increased levels of prolactin and anorexia nervosa.
4 There is no known correlation between increased levels of prolactin and Alzheimers disease.

 

 

PTS:   1                    CON:  Stress

 

  1. ANS:  2

Chapter: Chapter 2, Biological Implications

Objective: Identify gross anatomical structures of the brain and describe their functions.

Page: 19

Heading: The Nervous System: An Anatomical Review > Limbic System

Integrated Processes: Teaching and Learning

Client Need: Psychosocial Integrity

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Easy

 

  Feedback
1 The cerebellum is concerned with involuntary movement, posture, and equilibrium.
2 The limbic system is often referred to as the emotional brain. The limbic system is largely responsible for ones emotional state and is associated with feelings, sexuality, and social behavior.
3 The cortex is identified by numerous folds called gyri and sulci.
4 The left temporal lobe is concerned with auditory functions.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  3

Chapter: Chapter 2, Biological Implications

Objective: Discuss the association of endocrine functioning to the development of psychiatric disorders.

Page: 31

Heading: Psychoneuroimmunology > Growth Hormone

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 There is no correlation between abnormal levels of growth hormone and acute mania.
2 There is no correlation between abnormal levels of growth hormone and schizophrenia.
3 The nurse should understand that research has found a correlation between abnormal levels of growth hormone and anorexia nervosa. The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life.
4 There is no correlation between abnormal levels of growth hormone and Alzheimers Disease.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  4

Chapter: Chapter 2, Biological Implications

Objective: Describe the role of neurotransmitters in human behavior.

Page: 31

Heading: Psychoneuroimmunology > Acetylcholine

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 Abnormal levels of serotonin do not cause memory deficits and decreased motor functions.
2 Abnormal levels of dopamine do not cause memory deficits and decreased motor functions.
3 Abnormal levels of norepinephrine do not cause memory deficits and decreased motor functions.
4 The nurse should correlate memory deficits and decreased motor function with decreased levels of acetylcholine. Acetylcholine is a major chemical effector of the autonomic nervous system. Functions of acetylcholine include sleep regulation, pain perception, the modulation and coordination of movement, and memory.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  4

Chapter: Chapter 2, Biological Implications

Objective: Discuss the physiology of neurotransmitters in human behavior.

Page: 21

Heading: Monoamines > Norepinephrine

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 A decrease in norepinephrine would not lead to mania.
2 A decrease in norepinephrine would not lead to schizophrenia.
3 A decrease in norepinephrine would not lead to generalized anxiety disorder.
4 The nurse should recognize that a decrease in norepinephrine level would play a significant role in the development of major depressive disorder. The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  1

Chapter: Chapter 2, Biological Implications

Objective: Discuss the physiology of neurotransmitters in human behavior.

Page: 21, 24

Heading: Psychoneuroimmunology > Dopamine

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 The nurse should expect that an increase in dopamine activity might play a significant role in the development of schizophrenia spectrum disorder. Functions of dopamine include regulation of emotions, coordination, and voluntary decision-making ability. Increased dopamine activity is also associated with mania.
2 Increased dopamine activity is not associated with major depressive disorder.
3 Increased dopamine activity is not associated with body dysmorphic disorder.
4 Increased dopamine activity is not associated with Parkinsons disease.

 

 

PTS:   1                    CON:  Mood

 

MULTIPLE RESPONSE

 

  1. ANS:  1, 3

Chapter: Chapter 2, Biological Implications

Objective: Discuss the association of endocrine functioning to the development of psychiatric disorders.

Page: 29

Headings: Growth Hormone > Gonadotropic Hormones

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1. The nurse should explain to the client that there is a possible correlation between anorexia nervosa and decreased levels of growth hormones.
2. There is no correlation between anorexia nervosa and antidiuretic hormone levels.
3. Research shows that there is possible correlation between low levels of gonadotropin and anorexia nervosa.
4. There is no correlation between anorexia nervosa and increased prolactin levels.
5. There is no correlation between anorexia nervosa and altered levels of oxytocin.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  1, 2

Chapter: Chapter 2, Biological Implications

Objective: Discuss the association of endocrine functioning to the development of psychiatric disorders.

Page: 28

Heading: Neuroendocrinology > The Anterior Pituitary (Adenohypophysis)

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1. The nurse should associate depression with decreased levels of TSH.
2. The nurse should associate fatigue with decreased levels of TSH.
3. Decreased libido is associated with decreased levels of TSH.
4. Mania is not associated with decreased levels of TSH.
5. Hyperexcitability is not associated with decreased levels of TSH.

 

 

PTS:   1                    CON:  Mood

 

COMPLETION

 

  1. ANS:

Psychobiology

Chapter: Chapter 2 Biological Implications

Objective: Discuss the implications of psychobiological concepts to the practice of psychiatric/mental health nursing.

Page: 15

Heading: Introduction

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

Feedback: Psychobiology is the study of the biological foundations of cognitive, emotional, and behavioral processes. In recent years, a greater emphasis has been placed on the study of the organic basis for psychiatric illness.

 

PTS:   1                    CON:  Mood

 

Chapter 14: Substance Use and Addictive Disorders

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal?

1. Risk for injury R/T central nervous system stimulation
2. Disturbed thought processes R/T tactile hallucinations
3. Ineffective coping R/T powerlessness over alcohol use
4. Ineffective denial R/T continued alcohol use despite negative consequences

 

 

____    2.   A nurse evaluates a clients patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance addiction?

1. Narcotic pain medication is contraindicated for all clients with active substance use disorders.
2. Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control.
3. There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance.
4. The client is experiencing alcohol withdrawal symptoms and needs accurate assessment.

 

 

____    3.   On the first day of a clients alcohol detoxification, which nursing intervention should take priority?

1. Strongly encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days.
2. Educate the client about the biopsychosocial consequences of alcohol abuse.
3. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol.
4. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

 

 

____    4.   Which client statement indicates a knowledge deficit related to a substance use disorder?

1. Although its legal, alcohol is one of the most widely abused drugs in our society.
2. Tolerance to heroin develops quickly.
3. Flashbacks from lysergic acid diethylamide (LSD) use may reoccur spontaneously.
4. Marijuana is like smoking cigarettes. Everyone does it. Its essentially harmless.

 

 

____    5.   A lonely, depressed divorce has been self-medicating with small amounts of cocaine for the past year. Which term should a nurse use to best describe this individuals situation?

1. Psychological addiction
2. Codependence
3. Substance induced disorder
4. Social induced disorder

 

 

____    6.   Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during the substance induced disorder of alcohol withdrawal?

1. Antagonist therapy
2. Deterrent therapy
3. Codependency therapy
4. Substitution therapy

 

 

____    7.   A client diagnosed with chronic alcohol addiction is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to AA, would be most appropriate for a nurse to discuss with the client during discharge teaching?

1. After discharge, the client will immediately attend 90 AA meetings in 90 days.
2. After discharge, the client will rely on an AA sponsor to help control alcohol cravings.
3. After discharge, the client will incorporate family in AA attendance.
4. After discharge, the client will seek appropriate deterrent medications through AA.

 

 

____    8.   A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client symptom should be the nurses first priority?

1. Hearing and visual impairment
2. Blood pressure of 180/100 mm Hg
3. Mood rating of 2/10 on numeric scale
4. Dehydration

 

 

____    9.   Which client statement demonstrates positive progress toward recovery from a substance use disorder?

1. I have completed detox and therefore am in control of my drug use.
2. I will faithfully attend Narcotic Anonymous when I cant control my cravings.
3. As a church deacon, my focus will now be on spiritual renewal.
4. Taking those pills got out of control. It cost me my job, marriage, and children.

 

 

____  10.   A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurses rationale for this intervention?

1. To assess for emotional strength
2. To assess for Wernicke-Korsakoff syndrome
3. To assess for tachycardia
4. To assess for fine tremors

 

 

____  11.   A client presents with symptoms of alcohol withdrawal and states, I havent eaten in three days. A nurses assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis?

1. Knowledge deficit
2. Fluid volume excess
3. Imbalanced nutrition: less than body requirements
4. Ineffective individual coping

 

 

____  12.   A clients wife has been making excuses for her alcoholic husbands work absences. In family therapy, she states, His problems at work are my fault. Which is the appropriate nursing response?

1. Why do you assume responsibility for his behaviors?
2. I think you should start to confront his behavior.
3. Your husband needs to deal with the consequences of his drinking.
4. Do you understand what the term enabler means?

 

 

____  13.   Which medication orders should a nurse anticipate for a client who has a history of benzodiazepine-withdrawal delirium?

1. Haloperidol (Haldol) and fluoxetine (Prozac)
2. Carbamazepine (Tegretol) and donepezil (Aricept)
3. Disulfiram (Antabuse) and lorazepan (Ativan)
4. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

 

 

____  14.   A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur?

1. 50 mg/dL
2. 100 mg/dL
3. 250 mg/dL
4. 300 mg/dL

 

 

____  15.   A client diagnosed with major depressive episode and substance use disorder has an altered sleep pattern and demands a psychiatrist to prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions?

1. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance.
2. Sedative-hypnotics are expensive and have numerous side effects.
3. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep.
4. Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.

 

 

____  16.   A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the clients physician to treat this disorder. The nurse would give the client information on which medications?

1. Escitalopram (Lexapro) and clozapine (Clozaril)
2. Citalopram (Celexa) and olanzapine (Zyprexa)
3. Lithium carbonate (Lithobid) and sertraline (Zoloft)
4. Naltrexone (ReVia) and ziprasidone (Geodon)

 

 

____  17.   A nurse is assessing a pathological gambler. What would differentiate this clients behaviors from the behaviors of a non-pathological gambler?

1. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not.
2. Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men.
3. Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course.
4. Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief.

 

 

____  18.   A nursing instructor is teaching about the impaired nurse and the consequences of this impairment. Which statement by a student indicates that further instruction is needed?

1. The state board of nursing must be notified with factual documentation of impairment.
2. All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice.
3. Many state boards of nursing require an impaired nurse to successfully complete counseling treatment programs prior to a return to work.
4. After a return to practice, a recovering nurse may be closely monitored for several years.

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____  19.   Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with a substance-related disorder? (Select all that apply.)

1. I am easily manipulated and need to work on this prior to caring for these clients.
2. Because of my fathers alcoholism, I need to examine my attitude toward these clients.
3. I need to review the side effects of the medications used in the withdrawal process.
4. Ill need to set boundaries to maintain a therapeutic relationship.
5. I need to take charge when dealing with clients diagnosed with substance disorders.

 

 

____  20.   A nursing instructor is teaching nursing students about cirrhosis of the liver. Which of the following statements about the complications of hepatic encephalopathy should indicate to the nursing instructor that further student teaching is needed? (Select all that apply.)

1. A diet rich in protein will promote hepatic healing.
2. This condition results from a rise in serum ammonia, leading to impaired mental functioning.
3. In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity.
4. Neomycin and lactulose are used in the treatment of this condition.
5. This condition is caused by the inability of the liver to convert ammonia to urea.

 

 

____  21.   A clinic nurse is about to meet with a client diagnosed with a gambling disorder. Which of the following symptoms and/or behaviors is the nurse likely to assess? (Select all that apply.)

1. Stressful situations precipitate gambling behaviors.
2. Anxiety and restlessness can only be relieved by placing a bet.
3. Winning brings about feelings of sexual satisfaction.
4. Gambling is used as a coping strategy.
5. Losing at gambling meets the clients need for self-punishment.

 

 

____  22.   A nursing supervisor is about to meet with a staff nurse suspected of diverting client medications. Which of the following assessment data would lead the supervisor to suspect that the staff nurse is impaired? (Select all that apply.)

1. The staff nurse is frequently absent from work.
2. The staff nurse experiences mood swings.
3. The staff nurse makes elaborate excuses for behavior.
4. The staff nurse frequently uses the restroom.
5. The staff nurse has a flushed face.

 

 

____  23.   A nursing supervisor is offering an impaired staff member information regarding employee assistance programs. Which of the following facts should the supervisor include? (Select all that apply.)

1. A hotline number will be available in order to call for peer assistance.
2. A verbal contract detailing the method of treatment will be initiated prior to the program.
3. Peer support is provided through regular contact with the impaired nurse.
4. Contact to provide peer support will last for one year.
5. One of the program goals is to intervene early in order to reduce hazards to clients.

 

 

____  24.   A nursing counselor is about to meet with a client suffering from codependency. Which of the following data would further support the assessment of this dysfunctional behavior? (Select all that apply.)

1. The client has a long history of focusing thoughts and behaviors on other people.
2. The client, as a child, experienced overindulgent and overprotective parents.
3. The client is a people pleaser and does almost anything to gain approval.
4. The client exhibits helpless behaviors but actually feels very competent.
5. The client can achieve a sense of control only through fulfilling the needs of others.

 

 

Other

 

  1. Order the following stages of the codependency recovery process according to Cermak.

________ The Core Issues Stage

________ The Reintegration Stage

________ The Survival Stage

________ The Reidentification Stage

 

Completion

Complete each statement.

 

  1. The concept of _______________________ arose out of a need to define the dysfunctional behaviors that are evident among members of the family of a chemically dependent person.

 

 

Chapter 14: Substance Use and Addictive Disorders

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  1

Chapter: Chapter 14, Substance Use and Addictive Disorders

Objective: Identify nursing diagnoses common to clients with substance-related and addictive disorders, and select appropriate nursing interventions for each.

Page: 284

Heading: Substance Use Disorder, Defined > Substance Withdrawal

Integrated Processes:

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