Archive for September 2018

How can you diagnose secondary dysmenorrhea?

How can you diagnose secondary dysmenorrhea?



Answer: Laparoscopy is often done if medications for PRIMARY dysmenorrhea is ineffective.

What is secondary dysmenorrhea?

What is secondary dysmenorrhea?



Answer: Menstrual pain caused by specific organic conditions such as endometriosis, uterine fibroids, adenomyosis, pelvic adhesions, IUD's, or PID.

How do you treat primary dysmenorrhea?

How do you treat primary dysmenorrhea?



Symptomatic control.

Analgesics like aspirin or tylenol to relieve cramping or low back pain.

Prostaglandin synthetase inhibitors (Ibuprofen, naproxen, mefenamic acid, indomethacin) are more specific for dysmenorrhea.

Oral contraceptives: for ovulation suppression and symptomatic relief.

What mnfts occur in severe primary dysmenorrhea?

What mnfts occur in severe primary dysmenorrhea?



Answer: systemic manifestations like: headache, nausea, vomiting, diarrhea, fatigue, irritability, dizziness, syncope.

What are the mnfts of primary dysmenorrhea (not severe)?

What are the mnfts of primary dysmenorrhea (not severe)?



Answer:

Full, lower abdominal crampy or achy pain, spasmodic or colicky;
often radiates to lower back, labia, or upper thighs.

When does primary dysmenorrhea start?

When does primary dysmenorrhea start?



Answer: It occurs with ovulatory menstruation beginning 6 months to 2 years after menarche (first period).

Describe the pathogenesis of dysmenorrhea?

Describe the pathogenesis of dysmenorrhea?



Answer:

excessive production of prostaglandins --> causing painful contraction of the uretus and arteriolar vasospasm.
ALSO
Psychological factors may also contribute, like anxiety and tension.
As women grow older, dysmenorrhea often decreases and often completely resolves after childbirth.

How do you treat amenorrhea?

How do you treat amenorrhea?



Answer: Based on correcting underlying cause with cyclic progesterone or combined estrogen-progesterone regimens to balance hormones.

How do you diagnose amenorrhea?

How do you diagnose amenorrhea?



Answer:

Depends on cause.
Hx & Px w/ emphasis on bleeding pattern
Endocrine tests (FSH/LH ratio, prolactin, testosterone)
Beta-hCG pregnancy test
US of endometrium with a biopsy
Hysteroscopy (check uterus to find reasons for abn bleeding)
Progesterone withdrawal tests
CT scan or MRI.

What are some causes of secondary amenorrhea?

What are some causes of secondary amenorrhea?



Answer:


Ovarian, pituitary, or hypothalamic dysfunction
Intrauterine adhesions
Infections (TB)
pituitary tumour
anorexia
strenuous physical exercise (alters body fat-muscle ratio needed for menses to occur)

What is secondary amenorrhea?

What is secondary amenorrhea?



Answer: The cessation of menses for at least 6 months in a woman who once had normal cycles.

A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? Select all that apply.

A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? Select all that apply.



a. Flexible mealtimes
b. Unscheduled weight checks
c. Adherence to a selected menu
d. Observation during and after meals
e. Monitoring during bathroom trips
f. Privileges correlated with emotional expression


Answer: C, D, E
Priority milieu interventions support restoration of weight and normalization of eating patterns. This requires close supervision of the patient's eating and prevention of exercise, purging, and other activities. There is strict adherence to menus. Observe patients during and after meals to prevent throwing away food or purging. Monitor all trips to the bathroom. Mealtimes are structured, not flexible. Weighing is performed on a regular schedule.

A patient referred to the eating disorders clinic has lost 35 pounds in 3 months. For which physical manifestations of anorexia nervosa should a nurse assess? Select all that apply.

A patient referred to the eating disorders clinic has lost 35 pounds in 3 months. For which physical manifestations of anorexia nervosa should a nurse assess? Select all that apply.



a. Peripheral edema
b. Parotid swelling
c. Constipation
d. Hypotension
e. Dental caries
f. Lanugo


Answer: A, C, D, F

A 5-year-old child was diagnosed with encopresis. Which assessment finding would the nurse expect associated with this diagnosis? The child:

A 5-year-old child was diagnosed with encopresis. Which assessment finding would the nurse expect associated with this diagnosis? The child:



a. frequently smears feces on clothing and toys.
b. experiences frequent nocturnal episodes of bedwetting.
c. has accidents of defecation at kindergarten three times a week.
d. has occasional episodes of voiding accidents at the day care center.


Answer: C
Encopresis refers to unsuccessful bowel control. Bowel control is expected by age 5, so frequent involuntary defecation is associated with this diagnosis.

Three months ago a patient diagnosed with binge eating disorder weighed 198 pounds. Lorcaserin (Belviq) was prescribed. Which current assessment finding indicates the need for reevaluation of this treatment approach? The patient:

Three months ago a patient diagnosed with binge eating disorder weighed 198 pounds. Lorcaserin (Belviq) was prescribed. Which current assessment finding indicates the need for reevaluation of this treatment approach? The patient:


a. now weighs 196 pounds.
b. says, "I am using contraceptives."
c. says, "I feel full after eating a small meal."
d. reports problems with dry mouth and constipation.


Answer: A
Lorcaserin is designed to make people feel full after eating smaller meals by activating a serotonin 2c receptor in the brain and blocking appetite signals. According to the FDA, this drug should be stopped if a patient does not have 5% weight loss after 12 weeks of use. If the patient now weighs 196 pounds, the medication has not been effective.

Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges?

Which nursing diagnosis is more appropriate for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges?



a. Powerlessness
b. Ineffective coping
c. Disturbed body image
d. Imbalanced nutrition: less than body requirements


Answer: D

A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Which response by the nurse is appropriate?

A nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight. Which response by the nurse is appropriate?



a. "You and I will have to sit down and discuss this problem."
b. "It bothers me to see you exercising. I am afraid you will lose more weight."
c. "Let's discuss the relationship between exercise, weight loss, and the effects on your body."
d. "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."


Answer: D

Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization?

Which assessment finding for a patient diagnosed with an eating disorder meets criteria for hospitalization?



a. Urine output 40 mL/hr
c. Serum potassium 3.4 mEq/L
b. Pulse rate 58 beats/min
d. Systolic blood pressure 62 mm Hg


Answer: D
Systolic blood pressure less than 70 mm Hg is an indicator for inpatient care. Many people without eating disorders have bradycardia (pulse less than 60 beats/min). Urine output should be more than 30 mL/hr. A potassium level of 3.4 mEq/L is within the normal range.

Physical assessment of a patient diagnosed with bulimia often reveals:

Physical assessment of a patient diagnosed with bulimia often reveals:



a. prominent parotid glands.
b. peripheral edema.
c. thin, brittle hair.
d. 25% underweight.


Answer: A
Prominent parotid glands are associated with repeated vomiting. The other options are signs of anorexia nervosa and not usually seen in bulimia.

A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of:

A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of:



a. maintaining patients' concentration and attention.
b. shifting the patients' focus from food to psychotherapy.
c. promoting processing of anxiety associated with eating.
d. focusing on weight control mechanisms and food preparation.


Answer: C
Eating produces high anxiety for patients with eating disorders. Anxiety levels must be lowered if the patient is to be successful in attaining therapeutic goals. Shifting the patients' focus from food to psychotherapy and focusing on weight control mechanisms and food preparation are not desirable.

A nurse provides health teaching for a patient diagnosed with binge-purge bulimia. Priority information the nurse should provide relates to:

A nurse provides health teaching for a patient diagnosed with binge-purge bulimia. Priority information the nurse should provide relates to:



a. self-monitoring of daily food and fluid intake.
b. establishing the desired daily weight gain.
c. how to recognize hypokalemia.
d. self-esteem maintenance.


Answer: C
Hypokalemia results from potassium loss associated with vomiting. Physiological integrity can be maintained if the patient can self-diagnose potassium deficiency and adjust the diet or seek medical assistance.

A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed?

A nurse provides care for an adolescent patient diagnosed with an eating disorder. Which behavior by this nurse indicates that additional clinical supervision is needed?



a. The nurse interacts with the patient in a protective fashion.
b. The nurse's comments to the patient are compassionate and nonjudgmental.
c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene.
d. The nurse refers the patient to a self-help group for individuals with eating disorders.


Answer: A
In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assumption of a parental role. Protective behaviors are part of the parent's role.

A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy?

A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy?



a. "What are your feelings about not eating foods that you prepare?"
b. "You seem to feel much better about yourself when you eat something."
c. "It must be difficult to talk about private matters to someone you just met."
d. "Being thin doesn't seem to solve your problems. You are thin now but still unhappy."


Answer: D

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction?

The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "monitor for complications of refeeding." Which system should a nurse closely monitor for dysfunction?



a. Renal
b. Endocrine
c. Integumentary
d. Cardiovascular



Answer: D
Refeeding resulting in too-rapid weight gain can overwhelm the heart, resulting in cardiovascular collapse.

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies?

A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies?



a. Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss
b. Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia
c. Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia
d. Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia


Answer: D

Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor?

Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor?



a. Weight, muscle, and fat congruence with height, frame, age, and sex
b. Calorie intake is within required parameters of treatment plan
c. Weight reaches established normal range for the patient
d. Patient expresses satisfaction with body appearance


Answer: D

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?

Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?




a. Binge eating
b. Bulimia nervosa
c. Anorexia nervosa
d. Eating disorder not otherwise specified


Answer: C

Which presentations suggest the possibility of a factitious disorder, self-directed type? Select all that apply.

Which presentations suggest the possibility of a factitious disorder, self-directed type? Select all that apply.



a. History of multiple hospitalizations without findings of physical illness
b. History of multiple medical procedures or exploratory surgeries
c. Going from one doctor to another seeking the desired response
d. Claims illness to obtain financial benefit or other incentive
e. Difficulty describing symptoms


Answer: A, B

A patient diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The patient says, "Although I'm still having pain, I notice it less and am able to perform more activities." The nurse should evaluate the treatment plan as:

A patient diagnosed with a somatic symptom disorder has been in treatment for 4 weeks. The patient says, "Although I'm still having pain, I notice it less and am able to perform more activities." The nurse should evaluate the treatment plan as:




a. marginally successful.
c. partially successful.
b. minimally successful.
d. totally achieved.


Answer: C

A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results were normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect?

A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results were normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect?



a. Conversion (functional neurological) disorder
b. Illness anxiety disorder (hypochondriasis)
c. Somatic symptom disorder
d. Factitious disorder


Answer: B

A patient who experienced a myocardial infarction was transferred from critical care to a step-down unit. The patient then used the call bell every 15 minutes for minor requests and complaints. Staff nurses reported feeling inadequate and unable to satisfy the patient's needs. When the nurse manager intervenes directly with this patient, which comment is most therapeutic?

A patient who experienced a myocardial infarction was transferred from critical care to a step-down unit. The patient then used the call bell every 15 minutes for minor requests and complaints. Staff nurses reported feeling inadequate and unable to satisfy the patient's needs. When the nurse manager intervenes directly with this patient, which comment is most therapeutic?



a. "I'm wondering if you are feeling anxious about your illness and being left alone."
b. "The staff are concerned that you are not satisfied with the care you are receiving."
c. "Let's talk about why you use your call light so frequently. It is a problem."
d. "You frustrate the staff by calling them so often. Why are you doing that?"


Answer: A

A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient?

A nurse assesses a patient diagnosed with conversion (functional neurological) disorder. Which comment is most likely from this patient?



a. "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion."
b. "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry, and I think I'm getting seriously dehydrated."
c. "Sexual intercourse is painful. I pretend as if I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage."
d. "I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."


Answer: A

A patient with fears of serious heart disease was referred to the mental health center by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, "My chest is tight, and my heart misses beats. I'm often absent from work. I don't go out much because I need to rest." Which health problem is most likely?

A patient with fears of serious heart disease was referred to the mental health center by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, "My chest is tight, and my heart misses beats. I'm often absent from work. I don't go out much because I need to rest." Which health problem is most likely?



a. Dysthymic disorder
b. Somatic symptom disorder
c. Antisocial personality disorder
d. Illness anxiety disorder (hypochondriasis)


Answer: D

Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)?

Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)?



a. Voluntary control of symptoms
c. Results of diagnostic testing
b. Patient's style of presentation
d. The role of secondary gains


Answer: B
Patients with illness anxiety disorder (hypochondriasis) tend to be more anxious about their concerns and display more obsessive attention to detail, whereas the patient with conversion (functional neurological) disorder often exhibits less concern with the symptom they are presenting than would be expected.

A nurse plans health teaching for a patient with generalized anxiety disorder who begins a new prescription for lorazepam (Ativan). What information should be included? Select all that apply.

A nurse plans health teaching for a patient with generalized anxiety disorder who begins a new prescription for lorazepam (Ativan). What information should be included? Select all that apply.



a. Caution in use of machinery
b. Foods allowed on a tyramine-free diet
c. The importance of caffeine restriction
d. Avoidance of alcohol and other sedatives
e. Take the medication on an empty stomach


Answer: A, C, D

A patient performs ritualistic hand washing. Which action should the nurse implement to help the patient develop more effective coping?

A patient performs ritualistic hand washing. Which action should the nurse implement to help the patient develop more effective coping?



a. Allow the patient to set a hand-washing schedule.
b. Encourage the patient to participate in social activities.
c. Encourage the patient to discuss hand-washing routines.
d. Focus on the patient's symptoms rather than on the patient.


Answer: B

A patient experiencing panic suddenly began running and shouting, "I'm going to explode!" Select the nurse's best action.

A patient experiencing panic suddenly began running and shouting, "I'm going to explode!" Select the nurse's best action.



a. Ask, "I'm not sure what you mean. Give me an example."
b. Capture the patient in a basket-hold to increase feelings of control.
c. Tell the patient, "Stop running and take a deep breath. I will help you."
d. Assemble several staff members and say, "We will take you to seclusion to help you regain control."


Answer: C

A person speaking about a rival for a significant other's affection says in an emotional, syrupy voice, "What a lovely person. That's someone I simply adore." The individual is demonstrating:

A person speaking about a rival for a significant other's affection says in an emotional, syrupy voice, "What a lovely person. That's someone I simply adore." The individual is demonstrating:



a. reaction formation.
b. repression.
c. projection.
d. denial.


Answer: A
Reaction formation is an unconscious mechanism that keeps unacceptable feelings out of awareness by using the opposite behavior. Instead of expressing hatred for the other person, the individual gives praise.

Two staff nurses applied for promotion to nurse manager. The nurse not promoted initially had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse's response?

Two staff nurses applied for promotion to nurse manager. The nurse not promoted initially had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse's response?



a. Altruism
b. Suppression
c. Intellectualization
d. Reaction formation


Answer: A

Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, "The nurse manager had a headache the day I was interviewed." Which defense mechanism is evident?

Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, "The nurse manager had a headache the day I was interviewed." Which defense mechanism is evident?



a. Introjection
b. Conversion
c. Projection
d. Splitting


Answer: C

A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask?

A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask?



a. "Have you been a victim of a crime or seen someone badly injured or killed?"
b. "Do you feel especially uncomfortable in social situations involving people?"
c. "Do you repeatedly do certain things over and over again?"
d. "Do you find it difficult to control your worrying?"


Answer: D

A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention?

A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention?



a. Offering hope allays and defuses the patient's anxiety.
b. Concerns stated aloud become less overwhelming and help problem solving begin.
c. Anxiety is reduced by focusing on and validating what is occurring in the environment.
d. Encouraging patients to explore alternatives increases the sense of control and lessens anxiety.


Answer: B

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate?

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate?



a. Reassure the patient that all nurses are skilled in providing postoperative care.
b. Present the information again in a calm manner using simple language.
c. Tell the patient that staff is prepared to promote recovery.
d. Encourage the patient to express feelings to family.


Answer: B

A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety?

A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety?



a. Mild
b. Moderate
c. Severe
d. Panic


Answer: B
Moderate anxiety causes the individual to grasp less information and reduces problem-solving ability to a less-than-optimal level. Mild anxiety heightens attention and enhances problem solving. Severe anxiety causes great reduction in the perceptual field. Panic-level anxiety results in disorganized behavior.

A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first?

A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first?



a. Verify the patient's learning style.
b. Lower the patient's current anxiety.
c. Create outcomes and a teaching plan.
d. Assess how the patient uses defense mechanisms.


Answer: B

A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, "I took a few extra tablets earlier today and now I feel bad." Which assessments are most critical? Select all that apply.

A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, "I took a few extra tablets earlier today and now I feel bad." Which assessments are most critical? Select all that apply.



a. Vital signs
b. Urinary frequency
c. Psychomotor retardation
d. Presence of abdominal pain and diarrhea
e. Hyperactivity or feelings of restlessness


Answer: A, D, E

A patient diagnosed with major depression shows vegetative signs of depression. Which nursing actions should be implemented? Select all that apply.

A patient diagnosed with major depression shows vegetative signs of depression. Which nursing actions should be implemented? Select all that apply.



a. Offer laxatives if needed.
b. Monitor food and fluid intake.
c. Provide a quiet sleep environment.
d. Eliminate all daily caffeine intake.
e. Restrict intake of processed foods.


Answer: A, B, C

A student nurse caring for a patient diagnosed with depression reads in the patient's medical record, "This patient shows vegetative signs of depression." Which nursing diagnoses most clearly relate to the vegetative signs? Select all that apply.

A student nurse caring for a patient diagnosed with depression reads in the patient's medical record, "This patient shows vegetative signs of depression." Which nursing diagnoses most clearly relate to the vegetative signs? Select all that apply.


a. Imbalanced nutrition: less than body requirements
b. Chronic low self-esteem
c. Sexual dysfunction
d. Self-care deficit
e. Powerlessness
f. Insomnia

Answer: A, C, D, F
Vegetative signs of depression are alterations in body processes necessary to support life and growth, such as eating, sleeping, elimination, and sexual activity. These diagnoses are more closely related to vegetative signs than diagnoses associated with feelings about self. See relationship to audience response question.

The admission note indicates a patient diagnosed with major depression has anergia and anhedonia. For which measures should the nurse plan? Select all that apply.

The admission note indicates a patient diagnosed with major depression has anergia and anhedonia. For which measures should the nurse plan? Select all that apply.



a. Channeling excessive energy
b. Reducing guilty ruminations
c. Instilling a sense of hopefulness
d. Assisting with self-care activities
e. Accommodating psychomotor retardation


Answer: C, D, E
Anergia refers to a lack of energy. Anhedonia refers to the inability to find pleasure or meaning in life; thus, planning should include measures to accommodate psychomotor retardation, assist with activities of daily living, and instill hopefulness. Anergia is lack of energy, not excessive energy. Anhedonia does not necessarily imply the presence of guilty ruminations.

A patient diagnosed with depression repeatedly tells staff, "I have cancer. It's my punishment for being a bad person." Diagnostic tests reveal no cancer. Select the priority nursing diagnosis.

A patient diagnosed with depression repeatedly tells staff, "I have cancer. It's my punishment for being a bad person." Diagnostic tests reveal no cancer. Select the priority nursing diagnosis.



a. Powerlessness
b. Risk for suicide
c. Stress overload
d. Spiritual distress


Answer: B
A patient diagnosed with depression who feels so worthless as to believe cancer is deserved is at risk for suicide. Safety concerns take priority over the other diagnoses listed.

A patient diagnosed with major depression does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective?

A patient diagnosed with major depression does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective?



a. Make observations.
b. Ask the patient direct questions.
c. Phrase questions to require yes or no answers.
d. Frequently reassure the patient to reduce guilt feelings.


Answer: A
Making observations about neutral topics such as the environment draws the patient into the reality around him or her but places no burdensome expectations for answers on the patient. Acceptance and support are shown by the nurse's presence.

Major depression resulted after a patient's employment was terminated. The patient now says to the nurse, "I'm not worth the time you spend with me. I am the most useless person in the world." Which nursing diagnosis applies?

Major depression resulted after a patient's employment was terminated. The patient now says to the nurse, "I'm not worth the time you spend with me. I am the most useless person in the world." Which nursing diagnosis applies?



a. Powerlessness
b. Defensive coping
c. Situational low self-esteem
d. Disturbed personal identity


Answer: C

What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment?

What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment?



a. Nutrition and hydration
b. Supporting physiological stability
c. Reducing disorientation and confusion
d. Assisting the patient to identify and test negative thoughts


Answer: B
During the immediate post-treatment period, the patient is recovering from general anesthesia; hence, the priority need is to establish and support physiological stability. Reducing disorientation and confusion is an acceptable intervention but not the priority.

A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about:

A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about:



a. restricting sodium intake to 1 gram daily.
b. minimizing exposure to bright sunlight.
c. reporting increased suicidal thoughts.
d. maintaining a tyramine-free diet.


Answer: C

A nurse worked with a patient diagnosed with major depression, severe withdrawal, and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is most at risk for feelings of:

A nurse worked with a patient diagnosed with major depression, severe withdrawal, and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is most at risk for feelings of:



a. guilt and despair.
b. over-involvement.
c. interest and pleasure.
d. ineffectiveness and frustration.


Answer: D

A patient diagnosed with major depression tells the nurse, "Bad things that happen are always my fault." Which response by the nurse will best assist the patient to reframe this overgeneralization?

A patient diagnosed with major depression tells the nurse, "Bad things that happen are always my fault." Which response by the nurse will best assist the patient to reframe this overgeneralization?



a. "I really doubt that one person can be blamed for all the bad things that happen."
b. "Let's look at one bad thing that happened to see if another explanation exists."
c. "You are being extremely hard on yourself. Try to have a positive focus."
d. "Are you saying that you don't have any good things happen?"


Answer: B

A patient diagnosed with depression is receiving imipramine (Tofranil) 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?

A patient diagnosed with depression is receiving imipramine (Tofranil) 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?



a. Dry mouth
b. Blurred vision
c. Nasal congestion
d. Urinary retention


Answer: D

A patient says to the nurse, "My life doesn't have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." The nurse documents this report as an example of:

A patient says to the nurse, "My life doesn't have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." The nurse documents this report as an example of:



a. dysthymia.
b. anhedonia.
c. euphoria.
d. anergia.


Answer: B

Anhedonia is a common finding in many types of depression. It refers to feelings of a loss of pleasure in formerly pleasurable activities. Dysthymia is a diagnosis. Euphoria refers to an elated mood. Anergia means "without energy."

An adult diagnosed with major depression was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest?

An adult diagnosed with major depression was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest?



a. Social skills training
c. Desensitization techniques
b. Relaxation training classes
d. Use of complementary therapy


Answer: A

A patient became depressed after the last of the family's six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis Situational low self-esteem related to feelings of abandonment. The patient will:

A patient became depressed after the last of the family's six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis Situational low self-esteem related to feelings of abandonment. The patient will:



a. verbalize realistic positive characteristics about self by (date).
b. agree to take an antidepressant medication regularly by (date).
c. initiate social interaction with another person daily by (date).
d. identify two personal behaviors that alienate others by (date).


Answer: A

A patient became severely depressed when the last of the family's six children moved out of the home 4 months ago. The patient repeatedly says, "No one cares about me. I'm not worth anything." Which response by the nurse would be the most helpful?

A patient became severely depressed when the last of the family's six children moved out of the home 4 months ago. The patient repeatedly says, "No one cares about me. I'm not worth anything." Which response by the nurse would be the most helpful?




a. "Things will look brighter soon. Everyone feels down once in a while."
b. "Our staff members care about you and want to try to help you get better."
c. "It is difficult for others to care about you when you repeatedly say the same negative things."
d. "I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you."


Answer: D

A nurse prepares to administer a second-generation antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring for adverse effects will be most important if the patient has which co-morbid health problems? Select all that apply.

A nurse prepares to administer a second-generation antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring for adverse effects will be most important if the patient has which co-morbid health problems? Select all that apply.



a. Parkinson's disease
b. Grave's disease
c. Hyperlipidemia
d. Osteoarthritis
e. Diabetes


Answer: A, C, E

Consider these medications: carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin). Which medication below also belongs with this group?

Consider these medications: carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin). Which medication below also belongs with this group?



a. Galantamine (Reminyl)
c. Buspirone (BuSpar)
b. Valproate (Depakote)
d. Tacrine (Cognex)


Answer: B
The medications listed in the stem are mood stabilizers, anticonvulsant types. Valproate (Depakote) is also a member of this group. The distracters are drugs for treatment of Alzheimer's disease and anxiety.

An obese patient has a diagnosis of schizophrenia. Medications that block which receptors would contribute to further weight gain?

An obese patient has a diagnosis of schizophrenia. Medications that block which receptors would contribute to further weight gain?



a. H1 c. Acetylcholine
b. 5 HT2 d. Gamma-aminobutyric acid (GABA)


Answer: A
H1 receptor blockade results in weight gain, which is undesirable for an obese patient. Blocking of the other receptors would have little or no effect on the patient's weight.

A drug blocks the attachment of norepinephrine to 1 receptors. The patient may experience:

A drug blocks the attachment of norepinephrine to 1 receptors. The patient may experience:



a. hypertensive crisis.
c. severe appetite disturbance.
b. orthostatic hypotension.
d. an increase in psychotic symptoms.


Answer: B
Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of 1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Teach patients ways of minimizing this phenomenon.

The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3. Select the nurse's best action.

The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3. Select the nurse's best action.


a. Report the results to the health care provider immediately.
b. Administer the next dose as prescribed.
c. Give aspirin and force fluids.
d. Repeat the laboratory test.


Answer: A
These laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy. These results must be immediately reported to the health care provider, and the drug should be withheld

A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of:

A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of:



a. cardiac dysrhythmia.
b. hypotensive shock.
c. hypertensive crisis.
d. hypoglycemia.


Answer: C
Patients taking MAO-inhibiting drugs must be on a low tyramine diet to prevent hypertensive crisis.

A nurse cares for a group of patients receiving various medications, including haloperidol (Haldol), carbamazepine (Tegretol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient who takes:

A nurse cares for a group of patients receiving various medications, including haloperidol (Haldol), carbamazepine (Tegretol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient who takes:



a. carbamazepine.
b. haloperidol.
c. phenelzine.
d. trazodone.


Answer: C

A nurse can anticipate anticholinergic side effects are likely when a patient takes:

A nurse can anticipate anticholinergic side effects are likely when a patient takes:



a. lithium (Lithobid).
c. imipramine (Tofranil).
b. buspirone (BuSpar).
d. risperidone (Risperdal).


Answer: C
Imipramine (Tofranil) is a tricyclic antidepressant with strong anticholinergic properties, resulting in dry mouth, blurred vision, constipation, and urinary retention.

A patient tells the nurse, "My doctor prescribed Paxil (paroxetine) for my depression. I assume I'll have side effects like I had when I was taking Tofranil (imipramine)." The nurse's reply should be based on the knowledge that paroxetine is a(n):

A patient tells the nurse, "My doctor prescribed Paxil (paroxetine) for my depression. I assume I'll have side effects like I had when I was taking Tofranil (imipramine)." The nurse's reply should be based on the knowledge that paroxetine is a(n):



a. selective norepinephrine reuptake inhibitor.
b. tricyclic antidepressant.
c. MAO inhibitor.
d. SSRI.


Answer: D

A patient diagnosed with bipolar disorder has an unstable mood, aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group?

A patient diagnosed with bipolar disorder has an unstable mood, aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group?



a. Psychostimulants
c. Anticholinergics
b. Mood stabilizers
d. Antidepressants


Answer: B

Medicare rules state that the use of verbal orders should be infrequent and used only when the orders cannot be written or given electronically. In addition, verbal orders must be:

Medicare rules state that the use of verbal orders should be infrequent and used only when the orders cannot be written or given electronically. In addition, verbal orders must be:


A. written within 24 hours of the patient's admission.
B. accepted by charge nurses only.
C. cosigned by the attending physician within 4 hours of giving the order.
D. recorded by persons authorized by hospital regulations and procedures.


Answer: D. recorded by persons authorized by hospital regulations and procedures.

A qualitative analysis of OB records reveals a pattern of inconsistent data entries when comparing documentation of the same data elements captured on both the prenatal form and labor and delivery form. The characteristic of data quality that is being compromised in this case is data:

A qualitative analysis of OB records reveals a pattern of inconsistent data entries when comparing documentation of the same data elements captured on both the prenatal form and labor and delivery form. The characteristic of data quality that is being compromised in this case is data:


A. reliability.
B. accessibility .
C. legibility.
D. completeness.


Answer: A. reliability.

Before making recommendations to the Executive Committee regarding new physicians who have applied for active membership, the Credentials Committee must query the:

Before making recommendations to the Executive Committee regarding new physicians who have applied for active membership, the Credentials Committee must query the:


A. peer review organization.
B. National Practitioner Data Bank.
C. risk manager.
D. Health Plan Employer Data and Information Set.


Answer: B. National Practitioner Data Bank.

The new electronic system recently purchased at your physician practice allows for e-prescribing, exchange of data to a centralized immunization registry, and it allows your physicians to report on key clinical quality measures. In all likelihood, your practice has succeeded in choosing a (an)

The new electronic system recently purchased at your physician practice allows for e-prescribing, exchange of data to a centralized immunization registry, and it allows your physicians to report on key clinical quality measures. In all likelihood, your practice has succeeded in choosing a (an) 



A. Joint Commission-approved system.
B. Certified EHR.
C. Functional EMR.
D. AMA-approved product.


Answer: B. Certified EHR.

A primary focus of screen format design in a health record computer application should be to ensure that:

A primary focus of screen format design in a health record computer application should be to ensure that:


A. programmers develop standard screen formats for all hospitals.
B. the user is capturing essential data elements.
C. paper forms are easily converted to computer forms.
D. data fields can be randomly accessed.


Answer: B. the user is capturing essential data elements.

In preparation for an upcoming site visit by Joint Commission, you discover that the number of delinquent records for the preceding month exceeded 50% of discharged patients. Even more alarming was the pattern you noticed in the type of delinquencies. Which of the following represents the most serious pattern of delinquencies? Fifteen percent of delinquent records show:

In preparation for an upcoming site visit by Joint Commission, you discover that the number of delinquent records for the preceding month exceeded 50% of discharged patients. Even more alarming was the pattern you noticed in the type of delinquencies. Which of the following represents the most serious pattern of delinquencies? Fifteen percent of delinquent records show:


A. missing signatures on progress notes.
B. missing discharge summaries.
C. absence of SOAP format in progress notes
D. missing operative reports


Answer: D. missing operative reports

As the Coding Supervisor, your job description includes working with agents who have been charged with detecting and correcting overpayments made to your hospital in the Medicare Fee for Service program. You will need to develop a professional relationship with:

As the Coding Supervisor, your job description includes working with agents who have been charged with detecting and correcting overpayments made to your hospital in the Medicare Fee for Service program. You will need to develop a professional relationship with: 



A. the OIG
B. MEDPAR representatives.
C. QIO physicians.
D. recovery audit contractors.


Answer: D. recovery audit contractors.

Which of the following is a secondary data source that would be used to quickly gather the health records of all juvenile patients treated for diabetes within the past 6 months?

Which of the following is a secondary data source that would be used to quickly gather the health records of all juvenile patients treated for diabetes within the past 6 months? 


A. disease index
B. patient register
C. pediatric census sheet
D. procedure index


Answer: A. disease index

Stage I of meaningful use focused on data capture and sharing. Which of the following is included in the menu set of objectives for eligible hospitals in this stage?

Stage I of meaningful use focused on data capture and sharing. Which of the following is included in the menu set of objectives for eligible hospitals in this stage? 


A. Use CPOE for medication orders
B. Smoking cessation counseling for MI patients
C. Appropriate use of HL-7 standards
D. Establish critical pathways for complex, high-dollar cases


Answer: A. Use CPOE for medication orders

The information security officer is revising the policies at your rehabilitation facility for handling all patient clinical information. The best resource for checking out specific voluntary accreditation standards and guidelines is the:

The information security officer is revising the policies at your rehabilitation facility for handling all patient clinical information. The best resource for checking out specific voluntary accreditation standards and guidelines is the: 


A. Conditions of Participation for Rehabilitation Facilities.
B. Medical Staff Bylaws, Rules, and Regulations.
C. Joint Commission
D. CARF manual


Answer: D. CARF manual

Based on the following documentation in an acute care record, where would you expect this excerpt to appear?

Based on the following documentation in an acute care record, where would you expect this excerpt to appear?


"Initially the patient was admitted to the medical unit to evaluate the x-ray findings and the rub. He
was started on Levaquin 500 mg initially and then 250 mg daily. The patient was hydrated with IV
fluids and remained afebrile. Serial cardiac enzymes were done. The rub, chest pain, and shortness of
breath resolved. EKGs remained unchanged. Patient will be discharged and followed as an outpatient."

A. discharge summary
B. physical exam
C. admission note
D. clinical laboratory report


Answer: A. discharge summary

Select the appropriate situation for which a final progress note may legitimately be substituted for a discharge summary in an inpatient medical record.

Select the appropriate situation for which a final progress note may legitimately be substituted for a discharge summary in an inpatient medical record. 


A. Patient admitted with COPD 1/4/2016 and discharged 1/7/2016
B. Baby Boy Hiltz, born 1/5/2016, maintained normal status, discharged 1/7/2016
C. Baby Boy Hiltz's mother admitted 1/5/2016, C-section delivery, and discharged 1/7/2016
D. Baby Boy Doe admitted 1/3/2016, died 1/4/2016


Answer: B. Baby Boy Hiltz, born 1/5/2016, maintained normal status, discharged 1/7/2016

As the Compliance Officer for an acute care facility, you are interested in researching recent legislation designed to provide significant funding for health information technology for your next committee meeting. You begin by googling:

As the Compliance Officer for an acute care facility, you are interested in researching recent legislation designed to provide significant funding for health information technology for your next committee meeting. You begin by googling:




A. EMTALA.
B. Health Care Quality Improvement Act.
C. HIPAA.
D. ARRA.


Answer: D. ARRA.

The 2014 AHIMA Foundation's "Clinical Documentation Improvement Job Description Summative Report" identified that most Clinical Documentation Improvement Specialists report directly to the:

The 2014 AHIMA Foundation's "Clinical Documentation Improvement Job Description Summative Report" identified that most Clinical Documentation Improvement Specialists report directly to the:


A. HIM Department.
B. CEO.
C. Quality Management Department.
D. CFO.


Answer: A. HIM Department.

Accreditation by Joint Commission is a voluntary activity for a facility and it is:

Accreditation by Joint Commission is a voluntary activity for a facility and it is: 


A. considered unnecessary by most health care facilities.
B. required for state licensure in all states.
C. conducted in each facility annually .
D. required for reimbursement of certain patient groups.


Answer: D. required for reimbursement of certain patient groups.

As a new HIM manager of an acute care facility, you have been asked to update the facility's policy for a physician's verbal orders in accordance with Joint Commission standards and state law. Your first area of concern is the qualifications of those individuals in your facility who have been authorized to record verbal orders. For this information, you will consult the

As a new HIM manager of an acute care facility, you have been asked to update the facility's policy for a physician's verbal orders in accordance with Joint Commission standards and state law. Your first area of concern is the qualifications of those individuals in your facility who have been authorized to record verbal orders. For this information, you will consult the


A. Consolidated Manual for Hospitals.
B. Federal Register.
C. Policy and Procedure Manual.
D. Hospital Bylaws, Rules, and Regulations.


Answer: D. Hospital Bylaws, Rules, and Regulations.

As a trauma registrar working in an emergency department, you want to begin comparing your trauma care services to other hospital-based emergency departments. To ensure that your facility is collecting the same data as other facilities, you review elements from which data set?

As a trauma registrar working in an emergency department, you want to begin comparing your trauma care services to other hospital-based emergency departments. To ensure that your facility is collecting the same data as other facilities, you review elements from which data set?


A. DEEDS
B. UHDDS
C. MDS
D. ORYX


Answer: A. DEEDS

Though you work in an integrated delivery network, not all systems in your network communicate with one another. As you meet with your partner organizations, you begin to sell them on the concept of an important development intended to support the exchange of health information across the continuum within a geographical community. You are promoting that your organization join a:

Though you work in an integrated delivery network, not all systems in your network communicate with one another. As you meet with your partner organizations, you begin to sell them on the concept of an important development intended to support the exchange of health information across the continuum within a geographical community. You are promoting that your organization join a:


A. data warehouse.
B. regional health information organization.
C. continuum of care.
D. data retrieval portal group.


Answer: B. regional health information organization.

Which method of identification of authorship or authentication of entries would be inappropriate to use in a patient's health record?

Which method of identification of authorship or authentication of entries would be inappropriate to use in a patient's health record? 


A. written signature of the provider of care
B. identifiable initials of a nurse writing a nursing note
C. a unique identification code entered by the person making the report
D. delegated use of computer key by radiology secretary


Answer: D. delegated use of computer key by radiology secretary

In your facility it has become critical that information regarding patients who are transferred to the oncology unit be sent to an outpatient scheduling system to facilitate outpatient appointments. This information can be obtained most efficiently from:

In your facility it has become critical that information regarding patients who are transferred to the oncology unit be sent to an outpatient scheduling system to facilitate outpatient appointments. This information can be obtained most efficiently from:


A. generic screens used by record abstractors.
B. disease index.
C. R-ADT system.
D. indicator monitoring program.


Answer: C. R-ADT system.

The health care providers at your hospital do a very thorough job of periodic open record review to ensure the completeness of record documentation. A qualitative review of surgical records would likely include checking for documentation regarding

The health care providers at your hospital do a very thorough job of periodic open record review to ensure the completeness of record documentation. A qualitative review of surgical records would likely include checking for documentation regarding 


A. the presence or absence of such items as preoperative and postoperative diagnosis, description
of findings, and specimens removed.
B. whether a postoperative infection occurred and how it was treated.
C. the quality of follow-up care.
D. whether the severity of illness and/or intensity of service warranted acute level care.


Answer: A. the presence or absence of such items as preoperative and postoperative diagnosis, description of findings, and specimens removed.

The Conditions of Participation requires that the medical staff bylaws, rules, and regulations address the status of consultants. Which of the following reports would normally be considered a consultation?

The Conditions of Participation requires that the medical staff bylaws, rules, and regulations address the status of consultants. Which of the following reports would normally be considered a consultation? 


A. tissue examination done by the pathologist
B. impressions of a cardiologist asked to determine whether patient is a good surgical risk
C. interpretation of a radiologic study
D. technical interpretation of electrocardiogram


Answer: B. impressions of a cardiologist asked to determine whether patient is a good surgical risk

Which of the following least likely to be identified by deficiency analysis technician?

Which of the following least likely to be identified by deficiency analysis technician? 


A. missing discharge summary
B. need for physician authentication of two verbal orders
C. discrepancy between post-op diagnosis by the surgeon and pathology diagnosis by the pathologist
D. x-ray report charted on the wrong record


Answer: C. discrepancy between post-op diagnosis by the surgeon and pathology diagnosis by the pathologist

During a retrospective review of Rose Hunter's inpatient health record, the health information clerk notes that on day 4 of hospitalization there was one missed dose of insulin. What type of review is this clerk performing?

During a retrospective review of Rose Hunter's inpatient health record, the health information clerk notes that on day 4 of hospitalization there was one missed dose of insulin. What type of review is this clerk performing? 


A. utilization review
B. quantitative review
C. legal review
D. qualitative review


Answer: D. qualitative review

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