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1. John had a psychotic episode when he was 15 years old. He did not respond well to treatments available at the time and continued to have a significant number of residual symptoms. At the age of 42, he began taking Clozaril (clozapine), which significantly reduced his remaining symptoms, allowing him to leave his group home and live independently for the first time. However, once he was doing better and living in his own apartment, he was unsure of what to do with his time, what he wanted to be, how to go about getting a job, and how to meet his needs for romantic companionship appropriately. What type of crisis situation is represented by this case?
1. Maturational crisis
2. Situational crisis
3. Adventitious crisis
4. Phase 4 crisis |
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2. Mr. James witnessed a car suddenly careen out of control and onto the sidewalk where he and his best friend were walking. Mr. James's friend pushed him out of the way at the last second but was struck and killed instantly. Mr. James was treated for minor injuries and released but was referred for mental health evaluation because he was very distraught over the death of his friend. Which response should be used first during your assessment of Mr. James?
1. “Tell me about what happened that day.”
2. “What would you like to accomplish during your treatment?”
3. “Do you think you are coping well with this very tragic event?”
4. “Tell me what has been going through your mind since the accident.” |
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3. Mr. James confides that he feels so guilty that his friend died while pushing him to safety that he has found himself having impulses to kill himself by crashing his car. He says he almost did so yesterday when his guilt suddenly became overwhelming. Which intervention would be most therapeutic?
1. Admit Mr. James to an inpatient mental health unit to assure his safety until his condition can improve.
2. Work with Mr. James's family to ensure that he does not have access to a car, and set up emergency counseling sessions.
3. Persuade Mr. James to agree to remain safe pending counseling, as admitting him would only further traumatize him.
4. Consult with a prescribing physician or APRN so that Mr. James can be started immediately on antianxiety and antidepressant medications. |
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4. Sherie Johnson, a mother of two teenagers and veteran nurse with 15 years of experience in the crisis center, fails to show up for work several days in a row not long after providing crisis intervention to area high school students following a shooting at their school. Co-workers complain that she is not taking her share of crisis calls. As Sherie's manager, you attempt to address the issue, but she responds irritably and denies than anything is wrong. Sherie most likely:
1. is becoming burned out on crisis work.
2. is experiencing vicarious traumatization.
3. has developed a hidden substance abuse problem.
4. has lost her objectivity, owing to having children of her own. |
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5. A patient experiences a crisis after witnessing the brutal assault of her friend during a robbery on the way to their cars after work. Which outcome for the patient exposed to this highly traumatic event is the most appropriate?
1. The patient reports greater satisfaction with her life within 2 months.
2. The patient attends all treatment sessions specified in her treatment plan.
3. Within 3 weeks, the patient reports that she no longer feels distressed.
4. The patient returns to her pre-crisis level of functioning within 2 weeks. |
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1. Which statement about violence and nursing is accurate?
1. Unless working in psychiatric mental health settings, nurses are unlikely to experience patient violence.
2. About 1 in 10 nurses will face an injury due to patient violence during their careers.
3. Emergency, psychiatric, and step-down units have the highest rates of violence towards staff.
4. Violence primarily affects inexperienced or unskilled staff who cannot calm their patients. |
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2. A nurse working with a patient who describes himself as “always angry” should assess the patient for which problem(s)? Select all that apply.
1. Pain
2. Dementia
3. Tachycardia
4. Hypertension
5. Traumatic brain injury |
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3. Which statement(s) by a patient indicate an increased likelihood of violent behavior? Select all that apply.
1. “People push me, but they can only push me so far.”
2. “I have a right to feel angry, and right now I am angry.”
3. “You are really stupid. I'd get better nursing care from a monkey.”
4. “A man has to do what a man has to do when somebody crosses him.”
5. “This is frustrating; I wish people would leave me alone. That's what would help me.” |
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4. A nurse, Sarah, responds to loud, angry voices coming from the day room, where she finds that Mr. Christopher is pacing and shouting that he “isn't going to take this (expletive) anymore.” Which reaction by Sarah is likely to be helpful in deescalating Mr. Christopher?
1. Act calm, quiet, and in control.
2. State, “You are acting inappropriately and must calm yourself now.”
3. Match the patient's volume level so that he is able to hear over his own shouting.
4. Stand close to the patient so you can intervene physically if needed to protect others. |
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5. Andrea is a patient anxiously waiting her turn to speak with staff. The nurse is very busy, however, and asks if Andrea can wait a few minutes so she can finish her task. The nurse is distracted and forgets her promise temporarily, and 45 minutes pass before the nurse remembers and approaches Andrea. On seeing the nurse, Andrea accuses the nurse of lying and refuses to speak with her. Which response by the nurse is most likely to be therapeutic at this time?
1. “You seem angry that I didn't speak with you when I promised I would.”
2. “Look, I'm sorry for being late, but screaming at me is not the best way to handle it.”
3. “You are too angry to talk right now. I'll come back in 20 minutes and we can try again.”
4. “Why are you angry? I told you that I was busy and would get to you soon as I could.” |
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1. A man becomes frustrated when his children cry repeatedly and shoves his wife into the refrigerator. His wife explains to the neighbor who witnessed this that, “I should have made the children go to bed earlier so they wouldn't be so cranky.” This is an example of:
1. masochism.
2. emotional abuse.
3. tension reduction.
4. secondary prevention. |
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2. Which statement(s) about perpetrators and victims of abuse is accurate? Select all that apply.
1. Thirty or more percent of victims of intimate partner and family abuse are male.
2. Abusive behavior is usually the result of intoxication or stress.
3. Perpetrators tend to respond best to treatment if it is court ordered.
4. Victims do not report abuse, because they tacitly are accepting of it.
5. Victims of abuse stay in the relationship because they really do not want to leave.
6. Disruptive behavior may make older adults with dementia vulnerable to abuse. |
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3. A staff nurse, Chandra, is assisting a 30-year-old victim of domestic violence in the emergency department. The patient suffered numerous bruises and abrasions, is reluctant to be examined, seems very ashamed, and is very fearful that Children's Services will take custody of her young daughter, who has not been assaulted and is safe, if the police become involved. Which intervention is indicated?
1. Report the assault to the police, since reporting of domestic violence is mandatory.
2. Probe the patient for information to use as evidence in prosecuting the perpetrator.
3. Press the patient to disrobe so that she can be examined for signs of hidden injuries.
4. Guide and assist the patient to develop a safety plan for rapid escape should abuse recur. |
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4. Ms. Patel, a student nurse, is assigned to a patient recovering from injuries received during an episode of domestic violence, the third such assault for which she has received treatment. Ms. Patel left home at age 17 to escape an abusive father. Which statements about this situation are accurate? Select all that apply.
1. Ms. Patel may be prone to blame the patient for her injuries and abuse.
2. Ms. Patel's personal experiences give her special insight into the needs of this patient.
3. Ms. Patel's experiences are likely to make her more empathetic towards victims.
4. Caring for victims of abuse will help Ms. Patel cope with her own abuse experiences.
5. Ms. Patel may experience overwhelming anguish as a result of caring for abuse victims.
6. Ms. Patel would likely benefit from clinical supervision related to caring for abuse victims. |
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5. Perpetrators of domestic violence tend to:
1. belong to lower socioeconomic groups and be poorly educated.
2. have relatively poor social skills and to have grown up with poor role models.
3. believe they, if male, should be dominant and in charge in relationships.
4. force their mates to work and expect them to support the family.
5. be controlling and willing to use force to maintain their power in relationships.
6. prevent their mates from having relationships and activities outside the family. |
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1. The nurse is caring for a patient in the emergency department who has been raped just hours earlier. Which behaviors should the nurse expect if the patient were exhibiting controlled-style reactions?
1. Shock, numbness
2. Volatility, anger
3. Crying, sobbing
4. Smiling, laughing |
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2. The nurse is caring for a patient who has just been raped. Which is the appropriate initial nursing response?
1. “I will get you the number for the crisis intervention specialist.”
2. “May I get your consent to test you for pregnancy and HIV?”
3. “You are safe here.”
4. “I need to look at your bruises and cuts.” |
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3. A patient who has been raped has chosen to accept pregnancy prophylaxis medication. If the nurse does not believe in abortion, what is the appropriate nursing action?
1. Examine own feelings about abortion before entering the patient's room.
2. Encourage patient to take more time to consider her options.
3. Provide the patient with the number to Planned Parenthood.
4. Administer the pregnancy prophylaxis medication as ordered. |
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4. The nurse is working at a telephone hotline center when a rape victim calls. If the rape victim states she is fearful of going to the hospital, what is the appropriate nursing response?
1. “You don't need to go to the hospital if you don't want to.”
2. “I'm here to listen to you, and we can talk about your feelings.”
3. “Did you do something to make the other person attack you?”
4. “Why are you afraid to seek medical attention?” |
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5. The nurse is caring for a patient who is in the long-term reorganization phase of rape-trauma syndrome. Which symptom(s) should the nurse anticipate? Select all that apply.
1. Development of fear of locations that resemble the rape location
2. Emergence of acceptance of the rape
3. Dreams with violent content
4. A shift from anxiety to calm
5. Onset of phobia of being alone |
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1. A 73-year-old woman with pneumonia becomes agitated after being admitted to the intensive care unit through the emergency department. She is placed in soft restraints when she continues to try to leave her bed despite being too weak to walk. Her vital signs are erratic, and her thinking seems disorganized. During her first 24 hours in ICU, the patient varies from somnolent to agitated, and from laughing to angry. Her daughter reports that the patient “was never like this at home.” What is the most likely explanation for the situation?
1. Pneumonia has worsened the patient's early-stage dementia.
2. The patient is experiencing delirium secondary to the pneumonia.
3. The patient is sundowning due to the decreased stimulation of the intensive care unit.
4. The patient does not want to be in the hospital and is angry that staff will not let her leave. |
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2. Intervention(s) appropriate for a hospitalized patient experiencing delirium include which of the following? Select all that apply.
1. Immediately placing the patient in restraints if she begins to hallucinate or act irrationally or unsafely
2. Assuring that a clock and a sign indicating the day and date is displayed where the patient can see it easily
3. Being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care
4. Preventing sensory deprivation by placing the patient near the nurses’ station and leaving the television and multiple lights turned on 24 hours per day
5. Speaking with the patient frequently for short periods for reassurance, assisting the patient in remaining oriented, and ensuring the patient's safety
6. Anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering
7. Promoting normalized sleep patterns by encouraging the patient to remain awake during the day and facilitating rest at night |
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3. Which statement about dementia is accurate?
1. The majority of people over age 85 are affected by dementia.
2. Disorientation is the dominant and most disruptive symptom of dementia.
3. People with dementia tend to be distressed by it and complain about its symptoms.
4. Hypertension, diminished activity levels, and head injury increase the risk of dementia. |
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4. Mrs. Smith dies at the age of 82. In the 2 months following her death, her husband, aged 84 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate?
1. Arrange for an appointment with a therapist for evaluation and treatment of suspected depression.
2. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him.
3. Meet with family and support persons to help them accept, anticipate, and prepare for the progression of his stage II dementia.
4. Avoid touch and proximity; these are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented. |
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5. Which of the following intervention(s) would be beneficial for those caring for a loved one with Alzheimer's disease? Select all that apply.
1. Guide the family to restrict the patient's driving as soon as signs of forgetfulness are exhibited.
2. Recommend switching to hospital-type gowns to facilitate bathing, dressing, and other ph ysical care of the patient.
3. Discourage wandering by installing complex locks or locks placed at the tops of doors where the patient cannot readily reach them.
4. For situations in which the patient becomes upset, teach loved ones to listen briefly, provide support, and then change the topic.
5. Encourage caregivers to care for themselves, as well as the patient, via use of support resources such as adult day care or respite care.
6. If the patient is prone to wander away, encourage family to notify police and neighbors of the patient's condition, wandering behavior, and description. |
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1. The nurse is caring for a patient who is grieving. The patient has stated she is angry that she has been diagnosed with terminal cancer. Which behavior should the nurse anticipate next as the patient reconciles her anger?
1. Denial that she has cancer
2. Depression over the diagnosis of cancer
3. Acceptance that her cancer is a reality
4. Begging God to remove the cancer from her body |
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2. The nurse is planning hospice care for a dying patient. Which outcome is most appropriate?
1. Patient will regain health
2. Patient will remain pain-free
3. Patient will not fear death
4. Patient will decline all medications |
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3. Which patient statement regarding spirituality would require further nursing teaching?
1. “I am not religious, so therefore I am not spiritual.”
2. “Death scares me.”
3. “My family is what gives my life meaning.”
4. “I believe in a higher power.” |
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4. The nurse identifies that a patient is experiencing dysfunctional grieving related to the loss of her spouse. Which evaluation finding would indicate that a treatment plan is appropriate? The patient:
1. no longer thinks of her spouse.
2. copes without the need for a support system.
3. states she should have taken her spouse to the doctor more often.
4. laughs occasionally with her grandchildren. |
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5. The nurse is caring for a patient whose partner—with whom she was having an affair—died suddenly after a myocardial infarction. The patient had told no one about the affair, so no friends or family were aware that she experienced a loss. How should the nurse document the patient's grieving?
1. Disenfranchised grief
2. Dysfunctional grief
3. Maladaptive grief
4. Normal bereavement |
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1 The nurse is caring for an older adult patient. Which symptom should the nurse recognize as a normal part of aging?
1 Depression
2 Memory loss
3 Situational grieving
4 Delirium |
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2 The nurse is caring for a patient experiencing delirium. Which nursing response is appropriate when the patient's daughter asks, “Will he ever stop acting like this?”
1 “I'm sorry, your father will likely be in this state from now on.”
2 “Once we know the cause of the delirium, we can begin treatment to attempt to reverse the process.”
3 “Delirium is caused by infections and electrolyte imbalances, and the damage is permanent.”
4 “A benzodiazepine will help alleviate the delirium.” |
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3 A patient with dementia exhibits difficulty feeding himself despite the fact that there is nothing wrong with his motor functions. Which term should the nurse use to document this finding?
1 Aphasia
2 Apraxia
3 Agnosia
4 Disinhibition |
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4 An older adult patient experiencing pain states that she is going to use kava kava, which she has heard provides pain relief. Which nursing response is appropriate?
1 “Kava kava is an appropriate herb to use for pain relief.”
2 “Older adults should not use herbal preparations.”
3 “Willow bark would be a better herbal supplement to use.”
4 “Are you using any other treatments for pain relief?” |
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5 The nurse is caring for a patient who is a “DNR-CCO.” Which nursing action would be appropriate if the patient were to go into cardiac arrest?
1 Immediately call for the code team
2 Prepare for intubation by physician
3 Administer morphine for pain control
4 Initiate cardiopulmonary resuscitation |
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