Principles And Practice Of Psychiatric Nursing 10th Edition by Gail Wiscarz Stuart – Test Bank

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Chapter 5: Biological Context of Psychiatric Nursing Care

Test Bank

 

MULTIPLE CHOICE

 

  1. When a patient asks the nurse, “What are neurotransmitters?” The nurse replies that neurotransmitters are:
a. “the chemical messengers that cause brain cells to turn on or off.”
b. “small clumps of cells that alert the other brain cells to receive messages.”
c. “tiny areas of the brain that are responsible for controlling our emotions.”
d. “weblike structures that provide connections among various parts of the brain.”

 

 

ANS:  A

Neurotransmitters are chemicals manufactured in the brain responsible for exciting or inhibiting brain cells in the production of an action.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 73

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A patient tells a nurse, “My doctor says my problem may be with the neurotransmitters in my brain but I don’t understand what that means.” The nurse responds:
a. “Let’s begin with exploring what your doctor has told you about your problem.”
b. “We should start with a discussion about any concerns you have about having a neurotransmitter disorder.”
c. “First let me say that neurotransmitter problems can usually be treated or cured with medication therapy.”
d. “What you need to understand is that neurotransmitters are chemical messengers in the brain responsible for brain communication.”

 

 

ANS:  A

The correct option assesses the patient’s understanding of his condition, the initial step in any educationally focused discussion. None of the remaining options—defining the role of a neurotransmitter, exploring the patient’s concerns, or providing an explanation of a typical treatment plan—address the patient’s question concerning a lack of understanding.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 73

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Which part of the brain is responsible for fine motor coordination?
a. Medulla
b. Thalamus
c. Cerebellum
d. Temporal lobe

 

 

ANS:  C

The cerebellum is responsible for fine motor coordination, posture, balance, and integration of emotional processes.

 

DIF:    Cognitive Level: Knowledge            REF:   Text Pages: 73-74

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Which neurotransmitter is located only in the brain, particularly in the raphe nuclei of the brainstem, and is implicated in depression?
a. Norepinephrine
b. Acetylcholine
c. Dopamine
d. Serotonin

 

 

ANS:  D

Serotonin, also called 5-HT, is derived from tryptophan, a dietary amino acid. It is located only in the brain, particularly in the raphe nuclei of the brainstem. It plays a role in regulation of mood through its mood-elevating capacity.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 76

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. What part of the brain is responsible for regulating pituitary hormones and is known to regulate the body’s temperature?
a. Thalamus
b. Cerebellum
c. Limbic system
d. Hypothalamus

 

 

ANS:  D

The hypothalamus is responsible for regulation of metabolism, temperature, and emotions.

 

DIF:    Cognitive Level: Knowledge            REF:   Text Page: 73

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Which neurotransmitter is involved in the movement disorders seen in Parkinson disease and in the deficits seen in schizophrenia and other psychoses?
a. Dopamine
b. Melatonin
c. Serotonin
d. Norepinephrine

 

 

ANS:  A

Dopamine is derived from tyrosine, is located mostly in the brainstem, and is involved in control of complex movements, motivation, and cognition. It is involved in movement disorders such as Parkinson disease and in many of the deficits seen in schizophrenia and other forms of psychosis. This is not necessarily true of the other options.

 

DIF:    Cognitive Level: Knowledge            REF:   Text Page: 76

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A nurse explains to a patient undergoing diagnostic testing which brain imaging technique measures brain structure?
a. Computed tomography (CT)
b. Positron emission tomography (PET)
c. Brain electrical activity mapping (BEAM)
d. Single-photon emission computed tomography (SPECT)

 

 

ANS:  A

CT can image brain structures through a series of radiographs that are computer constructed into “slices” of the brain that can be stacked by the computer, giving the image a three-dimensional appearance. PET and SPECT image brain activity and function through the tracking of radioactive substances as they travel through the brain. BEAM images brain activity and function through recordings of the brain’s electrical activity.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Pages: 74-77

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The objective information that has helped mental health professionals understand that schizophrenia has a biological component has been obtained primarily from which of the following?
a. Genetic studies
b. Patient histories
c. Comparisons of blood chemistries
d. Magnetic resonance imaging (MRI) studies

 

 

ANS:  D

When results of studies such as MRI are coupled with neuropsychological test results, the deficits in a person’s performance, such as language or cognitive or sensory information processing, can be linked to the activity in the region of the brain responsible for those functions.

 

DIF:    Cognitive Level: Knowledge            REF:   Text Pages: 74-77

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A genetic counselor is called to see patients with genetic questions or concerns. With which patient would it be most appropriate for the counselor to speak?
a. A pregnant patient with sickle cell anemia
b. A patient who has made a recent suicide attempt
c. A patient prescribed the most drugs for the treatment of chronic disorders
d. A patient with schizophrenia who had multiple hospital admissions in the last year

 

 

ANS:  A

Several hundred genetic tests are in clinical use for illnesses such as muscular dystrophies, cystic fibrosis, and sickle cell anemia. Although research is being conducted, there is no proof of a definitive genetic cause for schizophrenia. The remaining options do not deal with conditions that have a proven link to a genetic cause.

 

DIF:    Cognitive Level: Analysis                REF:   Text Pages: 81-83

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient tells a nurse, “My daughter is pregnant with our first grandchild and my son-in-law has a sibling with cystic fibrosis. Is there a chance the baby might have this disease?” Which response is best?
a. “This is not an inherited disorder.”
b. “You should speak to a genetic counselor.”
c. “Science has not yet developed gene testing for this disease.”
d. “There are new treatments for this illness that are readily available.”

 

 

ANS:  B

Genetic counselors are trained to diagnose and explain disorders from a genetic perspective. They can review available options for testing and treatment and provide emotional support to individuals or families who have genetic disorders, are at risk for them, or need information about risks to their offspring.

 

DIF:    Cognitive Level: Application           REF:   Text Pages: 81-82

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. Pharmacogenetics will eventually allow researchers to do which of the following?
a. Remove the genes that cause illness.
b. Allow the design of custom drugs.
c. Develop foods that fight disease.
d. Splice genes to improve health.

 

 

ANS:  B

Pharmacogenetics is a discipline that blends pharmacology with genomic capabilities and will eventually allow researchers to match DNA variants with individual responses to medical treatments. It will allow for custom drugs based on individual genetic profiles.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 82

TOP:   Nursing Process: N/A

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. A patient tells a nurse, “My doctor thinks my problem is serious but it can be treated with medications. Does that mean I’ll always have to be treated with drugs?” The nurse replies:
a. “How would you feel about being on medications for a lifetime?”
b. “What concerns do you have about having a serious mental disorder?”
c. “Did your doctor suggest your problem was related to neurotransmitter problems?”
d. “What do you know about this condition that the doctor is preparing to treat with medications?”

 

 

ANS:  A

The initial concern expressed by the patient is being prescribed medications for a lifetime. The correct option explores this concern.

 

DIF:    Cognitive Level: Application           REF:   Text Pages: 83-84

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

  1. The function of the limbic system is to:
a. regulate emotional behavior.
b. perform abstract reasoning.
c. facilitate critical decision making.
d. coordinate stress-related responses.

 

 

ANS:  A

The limbic system is concerned with subjective emotional experiences and with changes in body functions associated with emotional states.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 73

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A patient states, “I’m going to have a positron emission tomography (PET) scan. What are the doctors going to learn from it?” The best reply would be that they focus on:
a. “identifying structures like tumors and scars.”
b. “highlighting activity in various portions of the brain.”
c. “outlining the structures of the brain more clearly.”
d. “providing data to support new treatment modalities.”

 

 

ANS:  B

PET scanning allows for the imaging of brain activity and function with the use of an injected radioactive substance that travels to the brain and shows up as a bright spot on the scan.

 

DIF:    Cognitive Level: Application           REF:   Text Pages: 75-77

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient mentions, “My doctor told me I was going to have a PET scan that would show where my brain has bright spots. Does that mean I’m getting an electrical jolt like in electroconvulsive therapy (ECT)?” The best reply would be:
a. “PET scans and ECT treatments are entirely different.”
b. “A PET scan is a diagnostic test, and an ECT treatment is a form of therapy.”
c. “A PET scan involves a substance, not electricity, that travels to the brain and produces a bright spot where the brain is active.”
d. “PET scans show us the electrical activity of the brain in the form of light bands.”

 

 

ANS:  C

PET scanning allows for the imaging of brain activity and function with the use of an injected radioactive substance that travels to the brain and shows up as a bright spot on the scan. There is no electrical “jolt” involved. Two of the options address an assumption made by the nurse that the patient is referring to ECT, and PET scans do not produce light bands of measurable degrees of brightness.

 

DIF:    Cognitive Level: Application           REF:   Text Pages: 77-78

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. A patient diagnosed with depression tells a nurse, “I don’t feel rested. It’s as though I didn’t sleep at all.” Comments by night shift staff show that the patient slept through most of the night. How can these two observations be reconciled?
a. The patient is considered the more accurate reporter.
b. The staff observations are more objective than the patient’s statement.
c. Studies show that people with depression have disturbed sleep cycles that can result in sleep deprivation.
d. People with depression characteristically underreport sleep satisfaction because of cognition flaws.

 

 

ANS:  C

Studies show that with depression, REM sleep is excessive, the deeper stages of sleep are decreased, and dreams may be unusually intense, leading to patient reports of fatigue, poor concentration, and irritability associated with sleep deprivation.

 

DIF:    Cognitive Level: Application           REF:   Text Pages: 79-80

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Health Promotion and Maintenance

 

  1. The spouse of a patient recently diagnosed with cancer asks, “What do you think about the relationship of stress and the development of cancer? My spouse has been under a huge amount of stress at work, and now they’ve diagnosed cancer.” The answer that best reflects the current thinking about psychoneuroimmunology is:
a. “It’s thought that the immune system is negatively affected by high stress.”
b. “The research hasn’t been focused directly on the link between cancer and stress.”
c. “Your spouse’s situation may reflect a coincidence. There is little concrete evidence that stress makes one prone to physical illness.”
d. “Grief and depression are known to cause physical illness, but other types of stress have not been implicated as illness producers.”

 

 

ANS:  A

Natural killer cells, which are believed to play a role in tumor surveillance and the control of viral infections, seem to decrease with increasing levels of stress.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 81

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient’s spouse asks a nurse, “Why are they wasting money doing all these tests on my spouse? The hallucinations and delusions make the mental illness obvious!” The best reply would be:
a. “Don’t be upset. We are using the most modern approach to caring for your spouse.”
b. “I know you must be worried about costs, but having these tests is very necessary.”
c. “Physical illnesses can cause psychiatric symptoms. We must be sure of what we are treating.”
d. “I think that you are upset about your spouse’s illness and not thinking clearly. To avoid harm, physical illness must be ruled out.”

 

 

ANS:  C

Only after a patient has been carefully screened can it be determined that the problems are amenable to psychiatric intervention. These symptoms can be a result of a physiological problem and this situation must be assessed appropriately. It is never appropriate to be disrespectful or demeaning to a patient or family members.

 

DIF:    Cognitive Level: Application           REF:   Text Pages: 83-84

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

  1. A couple tells a nurse that they are concerned about having children because there is bipolar disorder in first-degree relatives of each of them. What advice should the nurse give?
a. “Do not have children.”
b. “Seek genetic counseling.”
c. “Do as your conscience dictates.”
d. “Bipolar disorder is not hereditary.”

 

 

ANS:  B

Current evidence suggests that there is a significant genetic role in the cause of recurrent depression and bipolar disorder. A genetic counselor is well prepared to discuss the concerns of these individuals.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 82

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A patient demonstrates disoriented thinking and irrational ideas. A nurse can anticipate that a PET scan would most likely show dysfunction in the brain’s _____ lobe.
a. frontal
b. parietal
c. occipital
d. temporal

 

 

ANS:  A

The frontal lobe is responsible primarily for intellectual functioning, including learning, abstracting, reasoning, and inhibition of impulses.

 

DIF:    Cognitive Level: Application           REF:   Text Pages: 71-72

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

  1. A family member asks a mental health nurse, “I am reading a lot of information about gene therapy in the news lately. Will gene therapy be able to help my spouse, who has schizophrenia?” Which response by the nurse is best?
a. “Gene therapy for schizophrenia is common in Europe but has not yet become popular in the United States.”
b. “Gene therapy for schizophrenia is available, but the high cost prohibits most people from taking advantage of it.”
c. “Gene therapy is still an experimental field and is not likely to be used to treat mental health disorders in the near future.”
d. “Gene therapy has already shown promise in treating schizophrenia, but not enough large-scale studies have been carried out to date.”

 

 

ANS:  C

Gene therapy is still an experimental field. It holds potential for treating or even curing genetic and acquired diseases such as cancer or AIDS, but it is not likely to be clinically applicable in psychiatry in the near future.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 82

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient with a history of depression reports not feeling well rested in recent weeks. Before making the assumption that the complaint is related to depression, a nurse should investigate whether the patient has had any recent changes in:
a. work schedule that affect the hours of sleep.
b. vacations taken within the same time zone.
c. fluid intake with reduced overall intake of water.
d. food intake with decreased intake of heavy foods before bedtime.

 

 

ANS:  A

Changes in schedule that affect circadian rhythms, such as work shifts that alter usual sleep patterns, can result in fatigue that is not related to mental health status. Other factors that alter sleep include changes in light and darkness and temperature changes. Vacations in the same time zone should not affect sleep, whereas food and fluid intake should enhance sleep by reducing risk of nocturia or indigestion.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 79

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Basic Care and Comfort

 

MULTIPLE RESPONSE

 

  1. A depressed patient scheduled for an MRI asks about the purpose of the test and whether it will hurt. The response would include that the test: (Select all that apply.)
a. takes a picture of the brain.
b. is used to diagnose mental illness.
c. should not produce any physical pain.
d. may be uncomfortable if tight spaces bother you.
e. machinery produces loud noises while the test is being conducted.

 

 

ANS:  A, C, D, E

The function of an MRI is to visualize brain structure and detect abnormal brain formations. MRIs are not painful but require that the patient lie still in a confined space. The MRI machine produces a loud noise during the test. MRIs are not used in the diagnosis of mental illness.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 77

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Physiological Integrity: Reduction of Risk Potential

 

 

 

 

Chapter 25: Sexual Responses and Sexual Disorders

Test Bank

 

MULTIPLE CHOICE

 

  1. Parents are upset after learning that their child is homosexual. They ask the nurse, “What causes homosexuality; was it something we did?” The nurse responds best when stating:
a. “The cause of homosexuality has not been determined as of yet.”
b. “It’s thought that homosexuality is transmitted via the X chromosome.”
c. “Many people consider homosexuality to be an expression of normal sexual behavior.”
d. “You sound as though you are expressing concern about both your child and yourself.”

 

 

ANS:  A

Giving a direct answer is appropriate because the patient is seeking information. To mention a possible genetic origin may cause the parent to needlessly feel responsible. Saying that homosexuality is a normal expression of sexual behavior denies the parent’s right to be distressed. Suggesting that the patient is concerned for self may be considered challenging.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 502

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

  1. A person states, “I feel as though I’m really a woman trapped in this male body.” This type of statement is characteristically expressed by someone who is a:
a. transsexual.
b. transvestite.
c. pedophile.
d. homosexual.

 

 

ANS:  A

A transsexual is a person who is anatomically a male or female but who expresses strong conviction that he or she has the mind and feelings of the opposite gender.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 503

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse requests that a patient assignment be changed, saying, “I learned in school that homosexuality is not an illness and I want to be therapeutic, but every time I see my patient with a same-sex partner, I think it’s a sickness!” The nurse is experiencing which stage of the self-awareness process?
a. Anger
b. Anxiety
c. Choosing values
d. Cognitive dissonance

 

 

ANS:  D

Cognitive dissonance arises when two opposing beliefs exist at the same time.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Pages: 500-501

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse shares with a mentor, “When my patient brought up the subject of resuming sexual relations after surgery, I felt flustered. While I realized I wasn’t letting the patient express concerns, I couldn’t stop monopolizing the conversation.” The nurse describes experiencing the stage of the self-awareness process called:
a. anger.
b. action.
c. anxiety.
d. cognitive dissonance.

 

 

ANS:  C

In the stage of anxiety, the nurse may exhibit behaviors that hinder the discussion of sexual issues, such as talking too much, failing to listen, and being preoccupied with facts rather than feelings.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 501

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient is hospitalized for an acute episode of schizophrenia. A nurse finds the patient in the lounge nude and telling everyone, “I am the body beautiful.” The most appropriate intervention for the nurse would be to:
a. tell the patient to put on clothes immediately and to not undress in public again.
b. take the patient back to the assigned room and then assist the patient with getting appropriately dressed.
c. ignore the behavior and share with the other patients that the patient has no control over it.
d. seclude the patient until control can be regained and clearly define why the behavior is unacceptable.

 

 

ANS:  B

The sexual expression of patients with psychiatric illness may be inappropriate and, at times, intrusive. The patient may not be able to understand or control sexual thoughts or impulses. Nursing intervention should protect the patient from the consequences of poor judgment whenever possible and should be achieved in a neutral, nonjudgmental manner.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 505

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient is seeking help after being diagnosed with hypertension. A nurse plans to include questions about sexual health in the assessment. Which question would be most effective to introduce this topic?
a. “Which elements of sexual dysfunction have you noticed since your diagnosis of hypertension?”
b. “I assume your hypertension hasn’t caused you any significant problems with sex, has it?”
c. “How are you and your partner getting along sexually since you’ve developed hypertension?”
d. “Can you identify any changes in your sexual activity since you learned about your hypertension?”

 

 

ANS:  D

This open-ended question is more sensitive than the other answers and is worded so as to make the patient more comfortable in answering, encouraging the patient to share information.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 502

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. A patient hospitalized for depression will be discharged tomorrow. The patient asks a nurse, “Could the two of us meet for coffee away from the hospital sometime?” The most therapeutic response by the nurse would be:
a. “That sounds nice, but I’m already in a romantic relationship with someone.”
b. “The hospital has a policy that does not allow professional staff to date patients.”
c. “I guess there would be no harm in meeting for coffee, if we know in advance that we’re meeting just as friends.”
d. “We’ve developed a positive working relationship, and meeting socially would have a negative impact on that relationship.”

 

 

ANS:  D

Termination is a time for evaluating progress and bidding farewell. Patients who view their nurses in a positive fashion are often reluctant to terminate and seek to continue the relationship on a social basis after discharge. Helping the patient clarify the therapeutic aspect of the nursing role is appropriate.

 

DIF:    Cognitive Level: Application           REF:   Text Pages: 517-518

TOP:   Nursing Process: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care

 

  1. A patient being treated for cellulitis tells a nurse, “I feel like you and I should get romantic tonight. What do you say to closing the door and crawling into bed with me?” The nurse should respond by saying:
a. “Stop joking around. You’ve got to be kidding.”
b. “Now that you’ve gotten my attention, tell me what you really need.”
c. “Sex is not part of our relationship. Your comment makes me uncomfortable.”
d. “I wonder what I did to make you think I would be willing to have sex with you.”

 

 

ANS:  C

When patients behave seductively toward nurses, it is appropriate to set limits firmly and matter-of-factly.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 512

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

  1. A couple come to the clinic for treatment of sexual dysfunction. A therapist obtains a detailed sexual history and decides to employ the Masters and Johnson model of therapy. The nurse expects that treatment planning will include:
a. examination of performance failures.
b. enhancing mutual feelings of warmth.
c. exploring the couple’s early sexual experiences.
d. delving into the early growth and development of each person.

 

 

ANS:  B

Masters and Johnson believe that attitudes and ignorance are responsible for most sexual dysfunction. Their therapeutic model emphasizes education about sexual function, alleviation of performance anxiety, and an increase in warm, comfortable feelings between partners. There is no attempt to employ the uncovering used in psychoanalytical treatment.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 516

TOP:   Nursing Process: Planning               MSC:  NCLEX: Psychosocial Integrity

 

  1. What factor is most important during evaluation of effectiveness of sexual counseling or intervention?
a. Patient satisfaction with treatment
b. Patient reduction in use of fantasy
c. Nursing involvement in forming the sex education plan
d. Patient agreement with the moral norms of the community

 

 

ANS:  A

Evaluation factors include patient sense of well-being, functioning ability, and satisfaction with treatment.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Pages: 517-518

TOP:   Nursing Process: Evaluation            MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse assesses a patient who reports that she is unable to have intercourse because of involuntary contractions at the vaginal opening. The nurse can correctly assess this as:
a. vaginismus.
b. dyspareunia.
c. arousal disorder.
d. orgasmic dysfunction.

 

 

ANS:  A

Vaginismus is defined as recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with coitus.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 503 | Text Page: 509

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Which nursing diagnosis could be applied to both a patient who is upset that she has developed vaginismus associated with fear of pregnancy as well as a patient with diabetes who is concerned that he cannot attain an erection?
a. Sexual dysfunction
b. Sexual arousal disorder
c. Sexual aversion disorder
d. Ineffective sexuality pattern

 

 

ANS:  A

Sexual dysfunction is a state in which an individual expresses concern about his or her sexuality. This diagnosis would be equally applicable to either of the patients described above.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 503

TOP:   Nursing Process: Diagnosis|Nursing Process: Application

MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse consults with local elementary and secondary school teachers about implementing strategies to reinforce the concept of “say no to unwanted sexual advances.” The most helpful method the nurse can suggest is:
a. pretesting for accurate sexual knowledge.
b. explaining why saying “no” is appropriate for teens.
c. role playing assertive behavior in potentially difficult sexual situations.
d. brainstorming examples of behaviors that will promote good sexual health.

 

 

ANS:  C

Understanding that one should say “no” is much simpler than saying “no” when under pressure. A sex education program must give students tools with which to make appropriate decisions and the behavioral skills necessary to implement the decisions. Role playing assertive ways of saying “no” is the most effective behaviorally focused intervention listed.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 511

TOP:   Nursing Process: Planning               MSC:  NCLEX: Health Promotion and Maintenance

 

  1. Which statement made by a patient shows a correct understanding of human sexuality?
a. “Oral intercourse is dangerous.”
b. “Sex during menstruation should be avoided.”
c. “Advanced age is not by itself a deterrent to sexual function.”
d. “Alcohol ingestion enhances sexual pleasure and performance.”

 

 

ANS:  C

Sexually, men and women in good health can function effectively throughout the life span. The other answers are sexual myths that the nurse should address.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 510

TOP:   Nursing Process: Evaluation            MSC:  NCLEX: Psychosocial Integrity

 

  1. A nurse caring for an attractive patient of similar age and background begins fantasizing about having a social and sexual relationship with the patient. The most effective means of dealing with these feelings is to:
a. make a personal promise to not act on the feelings.
b. limit contact with the patient to include only care.
c. ask to change patient assignments immediately.
d. seek advice from an experienced peer.

 

 

ANS:  D

Sexual attraction and fantasy are part of the human experience. Nurses are not immune. Nurses, however, must recognize and deal appropriately with the feelings or risk interference with the quality of care. The feelings should not be denied, nor should they be tested or shared with the patient. It is the nurse’s responsibility to preserve professional boundaries. Consultation is a constructive way of dealing with the situation.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 511

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient with a new colostomy tells a nurse, “This surgery is the end of my sex life.” This statement should lead the nurse to take the initial step of:
a. making a referral to an ostomy self-help group.
b. bringing the patient’s partner into the discussion.
c. helping the patient fully express fears and feelings.
d. reframing the effect of illness on the patient’s sexual functioning.

 

 

ANS:  C

Exploration of fears and feelings should be the initial intervention after the patient’s statement of concern. Each of the other interventions might be appropriate at a later time.

 

DIF:    Cognitive Level: Application           REF:   Text Pages: 512-513

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

 

  1. What is the rationale for seeking information about the effects of prescribed medications on a patient’s sexual function?
a. Sexual dysfunction may result from use of prescription medications.
b. The question eases the transition to questioning about sexual practices.
c. Patients are more comfortable talking about medications than about sex.
d. The question provides an opening to question about nonprescription drug use.

 

 

ANS:  A

A nursing history should include questions about sexual health. The side effects of several groups of drugs include impotence or delayed ejaculation in men and diminished responsiveness in women.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 505

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. Which classification of drugs has the greatest potential for causing sexual dysfunction?
a. Diuretics
b. Antihypertensives
c. Appetite suppressants
d. Gastrointestinal (GI) antiinflammatory agents

 

 

ANS:  B

Antihypertensive medications, antihistamines, anticholinergics, chemotherapeutic agents, and antiseizure drugs can cause reduced sexual desire and/or orgasmic disorders in both men and women. The other drug classes listed are not known for these types of effects.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 505

TOP:   Nursing Process: Assessment

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. When a patient tells a nurse, “I think I’m impotent,” which response by the nurse would be most therapeutic?
a. “That must be very scary for you.”
b. “How is your overall health?”
c. “What medications are you currently taking?”
d. “Please tell me what you mean by ‘impotent.’”

 

 

ANS:  D

Validating terminology is a vital first step. After the nurse understands the patient’s complaint, further assessment can take place.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 502

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

  1. The best expected outcome for a patient with maladaptive sexual response is, “The patient will
a. identify sexual questions and problems.”
b. implement one new behavior to improve sexual functioning.”
c. state comfort and satisfaction with gender identity and sexual orientation.”
d. achieve a mutually acceptable level of sexual response with a consenting partner.”

 

 

ANS:  D

An expected outcome is a broad statement relating to resolution of maladaptive sexual response. The remaining options are more circumscribed and are considered short-term goals.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 499

TOP:   Nursing Process: Outcome Identification

MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient with a sexual response disorder reports hypersexuality. During the interview, a nurse should inquire about a history of which psychiatric disorder?
a. Mania
b. Depression
c. Personality disorder
d. Obsessive-compulsive disorder

 

 

ANS:  A

Hypersexuality may be the first symptom of a manic episode. In depression, sexuality responses tend to be decreased. There are no specific patterns of altered sexuality associated with personality disorders or obsessive-compulsive disorder.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 505

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

  1. A couple reports having rare-to-occasional variations in their sexual response patterns. The nurse should conclude that this couple has:
a. no medically diagnosed health problem.
b. behaviors in accordance with sexual dysfunction.
c. engaged in sexual perversion or deviations regularly.
d. at least one partner who experiences a gender identity disorder.

 

 

ANS:  A

Many people who have transient variations in sexual response do not have a medically diagnosed health problem. Those with more severe or persistent problems are classified as having one of the disorders outlined in the remaining options.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 507

TOP:   Nursing Process: Diagnosis|Nursing Process: Analysis

MSC:  NCLEX: Psychosocial Integrity

 

  1. A patient with gender identity disorder (gender dysphoria) tells a nurse about a wish to undergo a “sex change operation.” Which statement correctly reflects one prerequisite for sexual reassignment surgery?
a. The patient must be of legal age.
b. At least three clinicians must agree that the reassignment is appropriate.
c. The patient must live in the role of the preferred gender for at least 6 months.
d. The patient must undergo approximately 5 years of psychotherapy after surgery.

 

 

ANS:  A

Patients who believe they are transsexual and request surgical reassignment must be of legal age, have two therapists agree that the surgery is indicated, and live in the preferred gender identity role for at least 1 year. Although follow-up care also is generally recommended, there is no specific time requirement.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 515

TOP:   Nursing Process: Implementation     MSC:  NCLEX: Psychosocial Integrity

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