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 1
Psycho-Social-Cultural Integrity
 
1.
 
A 10-year-old client with AIDS asks if he is going to die. The best response is:a.
 
"Let's talk about getting well instead of dying."b.
 
"What do you think?"c.
 
"I don't know."d.
 
"Ask your doctor"
One of the most important concepts is to listen to client concerns. Options #1, #3, and #4 will take away this opportunity.
2.
 
A 1-year-old is scheduled for open-heart surgery. The mother begins to cry and says, "I'm a terrible mother?" The bestresponse is:a.
 
"Do you want to talk about the surgery?"b.
 
to place a comforting arm around the mother.c.
 
"Is your family here to be with you?"d.
 
"You have done everything that you can and the baby is in the best of hands."
Option #4 is the priority answer. It is important to promote a sense of hope. Option #1 would provide for listening to client/familyconcerns, and Options #2 and #3 may provide comfort.
3.
 
The physician has ordered chlorpromazine (Thorazine) to control an alcoholic client's restlessness, agitation, and irritabilityfollowing surgery. The nurse would check the order with the physician because:a.
 
the client's symptoms reflect alcohol withdrawal.b.
 
the client may be allergic to this medication.c.
 
the client is not psychotic.d.
 
physician's orders are routinely checked.
This medication is contraindicated for the treatment of alcohol withdrawal symptoms. The medication will lower the client'sseizure threshold and blood pressure, causing potentially serious medical consequences. Options #2, #3, and #4 are not the bestrationale for checking with the physician about this order.
4.
 
A client with a terminal diagnosis asks the nurse what she thinks about complementary medicine for the treatment of cancer. The nurse notices that the client has stopped her 5-FU (fluorouracil) treatments. What is an appropriate response?a.
 
Inquire about the type of complementary therapy the client is using.b.
 
Question the client as to how she felt while taking the 5-FU injections.c.
 
Explain the importance of taking the 5-FU, as it is the only approved therapy for her type of cancer.d.
 
Tell the client she is making a big mistake as alternative or complementary medicine is considered "quackery."
It is important for the nurse to respect a client's wishes for stopping treatment and choosing other forms of care, such as the useof complementary medicine. Offering information and having an open attitude about alternative therapies are part of a holisticapproach to nursing management of the client.
5.
 
The client throws her lunch tray and yells that nobody cares for her. Which intervention has priority?a.
 
Remove the client from the lunch room.b.
 
Try to gain her trust.c.
 
Speak strongly and ask her to stop.d.
 
Administer her PRN medication.
Option #1 is the answer. It is important to remove the combative client from a setting where she might harm herself andothers. Option #2 is important, but if she is yelling it would not be the top priority. Option #3 is setting limits and is anappropriate second action. Option #4 would be last if all else fails.
6.
 
A newly married female is brought into the clinic by her parents. They relate to the nurse that their daughter's husband waskilled three days ago, and she has been uncontrollably screaming and crying since the boating accident. The nurse would:a.
 
anticipate administering diazepam (Valium).b.
 
ask the parents to leave the room.c.
 
refer the client and her parents to a family therapist to assist in breaking through the emotional barrier thatexists.d.
 
try to get the client to talk about her feelings by offering a reassuring hug or gesture.
Reassuring gestures may assist the client to begin to talk about the loss and open up the family to work through the processof grieving for their loss. Although medications may be used, they invariably delay the grief reaction. After this visit, it wouldbe appropriate to refer the family for counseling, if they so desire.
7.
 
A client with a severe thought disturbance has not been taking medication and appears to be more activelyhallucinating. The client claims that the medicine makes him too drowsy during the day. Which action by the nurse ismost likely to increase medication compliance?a.
 
Ask the physician to schedule the client's entire dose at bedtime.b.
 
Tell the client he is getting sicker and must take his medicine.c.
 
Teach the client about the side effects of the medication.d.
 
Ask the family to talk to the client about this problem.
Medication dose non-compliance is often associated with negative side effects and a multiple dosing daily schedule. When theclient has only one daily dose at bedtime, it is easier for him to remember to take the medication. The other advantage is that the
 
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sedative effects of the drug peak while the client is sleeping. Options #2 and #4 do not offer concrete solutions and may fosterdependent behaviors. Option #3 may help to some degree, but a more concrete solution is possible.
8.
 
A client, admitted for treatment of alcohol dependence, displays the following symptoms: slurred speech, ataxia,uncoordinated movements, and headache. Which nursing action should be taken first?a.
 
Observe the client for 8 hours to collect additional data.b.
 
Perform a complete physical assessment.c.
 
Collect a urine specimen for a drug screen.d.
 
Encourage the client to talk about whatever is bothering him.
The best way to identify possible physical complications of alcohol dependence is through a complete physical assessment.Option #1 is important but will not provide the data that a physical assessment would. This may be a medical emergencyrequiring an immediate intervention. Option #3 is also a helpful source of data but can be done after the physical assessment isfinished. Option #4 is inaccurate since the symptoms are most likely caused by physical and not psychological stressors.
9.
 
When a client has dementia, which stressor would be identified as the most critical for the family?a.
 
Client s unwillingness to eat food with the family.b.
 
Client's inability to recognize and communicate with the family.c.
 
Lack of knowledge about community resources for day care.d.
 
Client's loss of continence.
This confirms a deteriorating condition and increases feelings of loss among family members. Options #1, #3, and #4 are allstressors for those dealing with a family member with dementia but are usually less critical.
10.
 
Before giving medication to a client who identifies himself as Jesus Christ, which action by the nurse is necessary?a.
 
Ask several nursing assistants to be available for safety.b.
 
Ask the priest to come and speak with the client.c.
 
Check the client's name band to make sure of the client's identity.d.
 
Make sure the client has eaten a full meal.
It is always necessary for the nurse to verify the client's identity before administering medications, particularly when the clientcannot verbalize his identity. Options #1, #2, and #4 will be unnecessary.
11.
 
Because of a borderline client's mood swings, limited problem-solving strategies, and self-concept disturbance, thetreatment team has determined the client is at high risk for violence, either directed at self or others. The nurse shouldobserve the client for early clues to which behavior?a.
 
Intense but disruptive relationshipsb.
 
Superficial interactions.c.
 
Persistent sense of boredom and loneliness.d.
 
Self-mutilation or suicidal gestures.
This is a common form of behavior displayed by the borderline client, which places her at a great risk for violence. Options #1, #2,and #3 are behaviors the client is likely to display, but they are not as clearly related to the high risk for violent behavior.
12.
 
Which symptom will the nursing assessment for a client with late AIDS dementia complex most likely reveal?a.
 
Hyperacute deep tendon reflexes.b.
 
Peripheral neuropathy affecting the hands.c.
 
Disorientation to person, place and time.d.
 
Impaired concentration and memory loss.
Approximately 65% of AIDS clients demonstrate a progressive dementia staged according to severity of debilitation. Late stage istypified by cognitive confusion and disorientation. Options #1 and #2 are not relevant to this condition. Option #4 is a sign oearly onset dementia.
13.
 
An elderly man diagnosed with major depression is demonstrating decreased problem-solving ability, psychomotorretardation, and social isolation. In planning activities for this client during the early phase of hospitalization, which nursingaction would be appropriate?a.
 
Prepare and give him a schedule of activities to follow and monitor his participation.b.
 
Encourage him to choose his own activities.c.
 
Allow him some time to get acclimated to the milieu before scheduling activities.d.
 
Allow him to rest quietly to restore his energy
and
fatigue level.
A regular daily routine of scheduled activities provides structure and decreases the degree of problem-solving. Depressed clientsneed to have structure provided because of impairment in decision-making and problem-solving. Options #2, #3, and #4 maypromote further social isolation and increase the client's impairments. This may further decrease the client's self esteem.
14.
 
A suicide has occurred on an in-patient psychiatric unit. The staff members meet to discuss the suicide. What is the purposeof this meeting?a.
 
Review of the client's record by hospital administration.b.
 
Decide who will speak with the client's family members.c.
 
Allow ventilation of staff members' feelings and a review of the case.d.
 
Determine who is responsible for the break in observation.
 
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An in-hospital successful suicide can be emotionally distressing to the staff members. They need an opportunity to discuss theirfeelings, which can be varied (grief, anger, guilt, sadness, feeling of inadequacy, fear). An organized meeting allows for a sharedexperience to explore these feelings in a "psychological autopsy," which includes a review of the case. Options # 1, #2, and #4 arenot the purpose of this type of staff meeting.
15.
 
Which client description is indicative of inappropriate behavior?a.
 
A physician who has just been diagnosed with multiple sclerosis tells his physical colleague that his physical checkwas just fine.b.
 
A client who tells you that she has been sad and depressed over the loss of her parakeet and has been unable to goto work for the past 2 days.c.
 
A primipara who delivers a healthy newborn and begins to develop tearfulness, guilt, anorexia, and depression onthe 4th postpartum day which lasts for a few days and then disappears.d.
 
A nurse who drinks several glasses of wine each evening and reports to her friend that she has missed work a fewtimes, as she didn't feel well after "partying over the weekend."
Daily drinking, along with alteration in social and occupational functioning, are critical criteria for establishing the diagnosis of alcohol dependence. This is inappropriate coping behavior (i.e., numbing feelings). The physician is experiencing denial which is/anormal defense mechanism. The loss of a pet can lead to an acute episode of grief in which sadness and depression would benormal symptoms. Option #3 describes postpartum blues which are a normal response that occurs in 5&-80% of women andresolves within a few days.
16.
 
A client is started on doxepin hydrochloride (Sinequan) 75 mg PO TID. The nurse should recommend a change in the client'stherapy if which response occurs? The client:a.
 
refuses to speak and sits quietly in the room.b.
 
becomes excitable and develops tremors.c.
 
refuses to eat breakfast.d.
 
sleeps 18 hours a day.
Doxepin HCL (Sinequan) is an antidepressant. Signs of overdosage include excitability and tremors. Options #1, #3, and #4 are notrelevant to this condition.
17.
 
An elderly man diagnosed as chronically mentally ill due to schizophrenia, is being followed in a partial hospitalizationprogram. He has been on long-term antipsychotic medication and recently has developed some symptoms oftardivedyskinesia. The documentation on this client should include:a.
 
assessment of ADL (self-care) ability.b.
 
Folstein Mini-Mental Status Examination.c.
 
AIMS (Abnormal Involuntary Movement Scale).d.
 
MOAS (Modified Overt Aggression Scale).
While all of these assessment tools are relevant to a thorough assessment of an elderly, chronically, mentally ill client, the AIMS(Abnormal Involuntary Movement Scale) is the most widely accepted examination to test for the presence oftardive dyskinesia.Option #1 is incorrect because it assesses activities of daily living and is not specific for tardive dyskinesia. Option #2 is to measurecognitive function. Option #4 is an assessment tool for determining the nature, severity, and prevalence of aggression.
18.
 
The nurse should instruct a client taking Disulfiram (Antabuse) to avoid which medication?a.
 
Over-the-counter cough/cold preparations.b.
 
Cardiac and antihypertensive medications.c.
 
Aspirin and/or Tylenol.d.
 
Antacids.
Clients started on Disulfiram (Antabuse) must avoid any form of alcohol or they will develop a severe reaction. Most over-the-counter cough/ cold preparations contain varying levels of alcohol and will produce a strong reaction. A client who ingests evensmall amounts of alcohol may experience flushed skin, pounding headache, tachycardia, chest pain, shortness of breath, blurredvision, hypotension, and possible confusion. Option #2 needs to be evaluated by the client's physician and should not bediscontinued. Options #3 and #4 are over-the-counter medications that do not contain alcohol and will not produce an adversereaction.
19.
 
Which comment by a client is most indicative of dissociative disorder?a.
 
"I keep having recurring nightmares."b.
 
"I have a headache and my stomach has bothered me for a week."c.
 
"I always check the door locks 3 times before I leave home."d.
 
"I don't know who I am or where I live."
Dissociative disorders are characterized by either a sudden or gradual disruption in the integrative functions of identity, memoryor consciousness. The disruption may be transient or become a well established pattern. Development of these disorders is oftenassociated with exposure to a traumatic event. Option #1 is characterized by anxiety and stress symptoms that occur after anintense traumatic event. Characteristic symptoms are hypervigilance, insomnia, and recurring nightmares. Option #2 is concernedwith physical and emotional health. It is accompanied by various bodily complaints for which there is no physical basis. Option #3reflects the compulsive checking behavior of the anxiety associated with obsessive-compulsive disorder.
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