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An old woman came to the hospital with symptoms of hand shaking, palpitation, and weight decrease. She was diagnosed as suffering from hyperthyroidism from the results of her blood test. Surgery, isotope treatment, and oral treatment could be an option for cures. Her doctor explained to her the details of benefits, risks, and expected issues from each treatment well, and took enough time to answer her questions. Eventually, the patient, however, said to the doctor, “I want you to do what you think the best. You are my doctor”. The doctor replied that she should feel free to take the decision.
1-There are 2 main ethical principles discussed in the above mentioned case. Discuss and verify.
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2-Name the other ethical principles that should be applied in practice.
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3-Define an ethical dilemma.
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2- Carol has been a dental hygienist for 10 years and works in a general-practice setting. Her best friend`s husband, Bob, has been a patient of record for the past seven years. Upon updating his medical history at a recent visit, Bob stated that he was HIV-positive. After the initial shock, Carol asked Bob how long he had been aware of his current health status. He told her that he had just been diagnosed HIV-positive within the past month. He also informed the hygienist that his wife was not aware of his condition. Carol wondered what she should do. Although Bob had informed her of his seroconversion, how could she not tell his wife? Carol recalled her most recent conversation with her best friend and remembered that she had shared that Bob had been acting withdrawn for the last few months. Perhaps, Carol thought, she should inform her best friend about her husband`s health status. However, she knew that her patient`s records were confidential. The relevant section from the American Dental Hygienists` Code of Ethics reads: “We respect the confidentiality of client information and relationships as a demonstration of the value of individual autonomy. We acknowledge our obligation to justify any violation of a confidence.”
1- Explain the ethical dilemma in the above case.
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2-List the conditions upon which confidentiality could be breached.
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3- Is the theory of utilitarian ethics applied in the above case? Explain.
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3-A patient X, 34 years old and her husband 36 years old married for 8 years, trying for baby since 12 months. The patient had history of epilepsy for which she was taking antiepileptic drugs. Ultrasound showed less egg reserve and was counseled for IVF. They tried one unsuccessful IVF cycle with self-eggs. The dose of antiepileptic drugs was increased. Pregnancy may worsen epilepsy and vice versa. So, surrogacy was recommended to the couple. With the help of IVF and surrogacy, women get a chance to have their own genetic child. It is indeed a miracle of modern science!!
Name the types of surrogacy that could be offered for the couple in the above mentioned case.
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Is IVF offered for the couple legal? Verify your answer.
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If it was concluded from semen analysis that the husband is sterile, determine the assisted reproductive technique that could be done in this case. Explain the opinion of Islam in the applicability of such technique giving reasons.
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4-Kate is a 17 years old patient, unmarried and 8 weeks pregnant. She is a rather remarkable girl in that she lives independently while still a senior in a high school. She tells you that she was an adoptee given back to foster care, and then abused in that system. She is now an emancipated minor who works 30 hours per week at a service industry job while also earning a 4.0 GPA in school. Kate has absolutely no family support, and the former boyfriend who is the father of her unborn child simply disappeared upon learning of the pregnancy. Your patient is scared, uninsured, and says she doesn’t want to be pregnant or a mom (“Perhaps someday, but not now!”). She requests abortion only, at this hospital where she has always received medical care.”
Determine the type of abortion requested in the case above. Justify your answer.
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List the different types of abortion.
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3-Clarify the role of physicians in cases of legal abortion.
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PLEASE HELP ME 🙂
A client has ill-fitting dentures and limited intake of high-fiber foods. Based on this information, which of these potential problems may the patient experience?
Constipation.
Inadequate caloric intake.
Malabsorption of nutrients.
Dehydration.
2. When evaluating the effects of heat application on a body part, which of these outcome criteria should a nurse expect the heat to accomplish?
Increased venous congestion on the area of application.
Reduction of blood flow to tissues around the affected area.
Construction of peripheral blood vessels surrounding the area.
Increase supply of oxygen and nutrition to the area.
3. When turning a client to the side-lying position, which actions should a nurse take?
Put a footboard against the bottom of the client’s feet.
Place a small pillow under the client’s lumbar spine.
Place a rolled pillow parallel to the client’s back.
Put a small pillow under the client’s ankles.
4. A nurse is caring for a client with vaso-occlusive sickle cell crisis. What is the major purpose of administering intravenous fluids to patients with this condition?
To prevent atrophic changes in the spleen.
To prevent hemolysis of the sickled red blood cells.
To promote intravascular hemodilution.
To hydrate the sickled red blood cells.
5. What is the purpose of the placement of a nasogastric tube for a client who is in the immediate postoperative phase following an appendectomy?
To prevent paralytic ileus.
To monitor the amount of the client’s gastric secretions.
To monitor the pH of the client’s gastric secretions.
To prevent abdominal distention.
6. The nurse is to record the intake and output of a 2-year-old client. The client is not toilet trained. Which measure would be most appropriate to include in the patient’s plan of care?
Obtaining an order to have an indwelling urinary catheter inserted.
Sitting the client on the bedpan at least every two hours.
Applying a pediatric urine collection device over the patient’s urinary meatus
Weighing the client’s wet diapers prior to discarding them 7. The nurse reviews the medical prescription for preparation of a client for cesarean delivery. Which medical order should the nurse question?
Do an abdominal shave and prep.
Catheterize client with a straight catheter.
Obtain a blood type and cross match.
Initiate intravenous infusion using an 18-gauge catheter.
8. A woman has determined that she would like to bottle feed her infant. The nurse should provide which of the following instructions regarding this feeding method?
Expect a 2-week-old newborn to drink approximately 90-150 mL of formula at each feeding time.
Microwave refrigerated formula for about 2 minutes before feeding the newborn.
Water must be sterilized by boiling, then cooled and mixed with formula powder or concentrate.
Check the nipple before feeding to ensure that it allows passage of formula in a slow stream.
9. Which statement made by a client with a gastric ulcer demonstrates a need for further dietary instructions?
“I can eat pretzels for a snack.”
“I can have yogurt between meals.”
“I can eat bran cereal for breakfast with toast and jelly.”
“I can drink coffee with meals and between meals.”
10. Which measure should the nurse include while caring for a client who has been diaphoretic for the past six hours?
Changing the bed linens frequently.
Providing oral care every four hours.
Keeping an emesis basin near the bedside.
Offering the client a bedpan every six hours.
11. Which assignment, delegated to unlicensed assistive personnel (UAP) by a nurse, is appropriate?
The UAP is assigned to assess a client’s lung sounds
The UAP is assigned to measure a client’s intake and output.
The UAP is assigned to teach a client about diet restrictions
The UAP is assigned to change a client’s postoperative wound dressing
12. Each of these clients has impaired mobility related to knee surgery. Which clients should a nurse assess first?
A 70-year-old who has bilateral cataracts.
A 20-year-old who has a sports-related injury.
A 59-year-old who has a history of hypertension.
A 37-year-old who reports limited mobility.
13. Which factor should a nurse consider when delegating tasks to unlicensed assistive personnel (UAP)?
The UAP’s willingness to perform tasks.
The UAP’s duration of employment on the unit.
The UAP’s previous experiences on the unit.
The UAP’s relationship with clients.
14. The nurse charts on all assigned clients at 2:00 P.M. The nurse then remembers something that happened to a client at 9:00 A.M. that was not charted. Which action would the nurse take?
Draw a line through the previous charting with “error” and then re-record everything, including the new information.
Puth the information in the margin and indicate the accurate time placement by drawing an arrow.
Include the 9:00 A.M. scenario in the shift report.
Enter the scenario after the original 2:00 P.M. charting and mark it as a “late entry.”
15. Which statement by the client would the nurse recognize as suggestive of hypothyroidism?
“I feel cold and tired all the time.”
“My hands shake whenever I reach for anything.”
“I sweat whenever I walk more than one block.”
“My head aches each evening.”
16. Which action would the nurse include to enhance the effectiveness of client teaching sessions?
Include all clients on the unit in the sessions.
Initially demonstrate and explain the procedure to the client.
Avoid repetition of content.
Include all content in one session so as not to overwhelm the patient.
17. Which task should the licensed practical nurse (LPN) delegate to the nursing assistant?
Measuring the pulse oximetry level for a client that has status asthmaticus.
Ambulating a client that had hip replacement surgery three days ago.
Changing the dressing for a client that had would debridement last week.
Checking the A.M. blood sugar for a client that has ketoacidosis.
Picture
18. All of the following tasks need to be accomplished. Considering client safety, which task should be delegated to the nurse rather than delegating it to unlicensed personnel?
“Re-positioning a client that had a stroke one week ago.”
“Using an electric razor to shave a client that is on anticoagulant therapy.”
“Emptying all of the unit urinary collection bags and tabulating shift outputs.”
“Feeding a client who has dysphagia.”
19. Which of these nursing actions is an example of malpractice?
Injuring a back muscle while lifting a client up in bed.
Incorrectly informing a family member that they need to wear a mask when visiting a client.
Yelling at a client who has been ringing the call bell constantly for two hours.
Neglecting to report a decrease in blood pressure in a client who then develops shock.
20. The nurse administers a client’s morning dose of furosemide at 8 PM. The client gets up several times during the night to urine. The nurse’s action is an example of?
Negligence, since the nurse was careless when reading the order.
Allowable nursing practice, since the medication was administered on the correct day.
Malpractice, since the client’s sleep was disturbed.
A medication error, since the medication was administered at the wrong time.
21. Which of these employees demonstrates the competency of commitment to work ethic as expected by employers?
An employee who documents relevant data observations of clients.
An employee who applies theory into clinical practice.
An employee who volunteers to work overtime frequently.
An employee who arrives on time and takes only the allowed breaks.
22. Which of these actions, if taken by the nurse, indicates a correct application of the principles of delegation to unlicensed assistive personnel?
The nurse assigns the task of taking vital signs for all clients in the ICU.
The nurse delegates the task of interpreting data to the unlicensed assistive personnel.
The nurse delegates the task of evaluating treatment effectiveness.
The nurse assesses each client prior to delegating tasks to the unlicensed assistive personnel.
23. Which of these topics should the nurse include in the teaching plan for the parents of a child who has asthma?
The use of the stethoscope to monitor the child’s breath sounds.
The identification of the early symptoms of an asthmatic attack.
The importance of activity restrictions to prevent attacks.
The accurate counting of the respirations per minute.
24. The nurse gives instructions to a client that is receiving high dose of nonsteroidal anti-inflammatory drugs. Which of these statements, if made by the client, would indicate to the nurse that the client understands the instruction?
“I should call my doctor when I have frequent urination.”
“I’ll stop the medication if I get loose stools.”
“I will expect the medicine to give ne constipation.”
“I’ll notify the doctor if I experience epigastric pain.”
25. Which of the following actions would the nurse recognize as potential risk for causing a medication error?
Questioning the doctor about a dosage that is greater than usual.
Administering the medication and looking up information about the medication afterward.
Checking with the pharmacist when multiple tablets are needed for a single dose.
Removing the unit dose wrapper from the medication at the medication room.
26. Which of these clients is at risk for osteoporosis due to inadequate calcium intake?
A nursing mother who eats yogurt with each meal.
An elderly female who eats cottage cheese for breakfast and lunch
A thin female who limits dairy products because of lactose intolerance
An obese adolescent who eats ice cream daily after exercising.
28 When assessing a client’s abdomen, the nurse should perform which of these techniques first?
Percussion
Inspection
Auscultation
Palpation

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1. On your schedule for today is a 51-year-old African American male patient diagnosed three months ago with hypertension. The patient was started on chlorthalidone 25mg and educated on the DASH diet. At his one month follow up his chlorthalidone was increased to 50mg a day. He is I for his three month follow up. His BP today is 162/108. You review his home BP log and find todays reading aligns with most of the readings he documented from home monitoring. Witch the following is the most appropriate addition to his treatment plan?
A. Add Ramipril 2.5 mg
b. Change from Chlorthalidone to HCTZ
c. Add Carvedilol 12.5 mg
d. Add 5 mg of amlodipine
2. You have calculated the 10-Year risk of cardiac disease and stroke for your Type2 diabetic patient and find their values place in the pharmacologic treatment benefit range. The patient is averse to taking a statin but agrees to a trial of niacin. Patient education needs to include which of the following instructions?
a. Avoid Prolonged Sun exposure.
b. Decrease daily fluid intake
c. Reduce frequency of blood glucose monitoring.
d. Monitor for signs of orthostatic hypotension.
3. A 77-year-old patient with a history of hypertension comes in newly diagnosed with heart failure. Understanding the treatment guidelines for heart failure which of the following would you anticipate the patient to have been initially prescribed for NYHA class I/AHA stage A heart failure?
A. Diuretic
B. Calcium Channel Blocker
C. ACE inhibitor
D. Beta Blocker
4. You are seeing an 88-year-old female patient in follow up for her long-standing hypertension. Her hypertension. Her hypertension is well managed on 80 mg of Diovan (valsartan) for several years. Understanding the mechanism of action of the ARBs you know it works to lower blood pressure by which of the following?
a. Facilitates the release of aldosterone
b. Inhibits calcium influx into smooth muscle
c. Enhances prostaglandin synthesis
d. Blocks the action of angiotensin II
5. Ms. Y is a 74-year-old African American female in for her annual health evaluation. She denies any health problems or concerns. She is not on any routine medications and reports to taking melatonin 5mg occasionally at night to sleep. Her BP on intake for the visit is 147/88. Based on the JNC 8 guidelines which of the following interventions should be included in the treatment plan for her?
o Prescribe 12.5 mg chlorthalidone daily
o Prescribe 5 mg amlodipine daily
o Prescribe no medication
o Prescribe 10mg lisinopril daily
6. One of your office colleagues’ patients is on your schedule today. When asking for a same day appointment reported to the front office staff, they were feeling extremely fatigued and noted that their urine was “very dark”. Upon interviewing the patient, you learn that for the last 6 weeks the patient has been on lovastatin (Mevacor) 80 mg a day with dinner due to his last lipid panel with a total cholesterol level of 329.The patient denies any muscle pain or stiffness. You have the patient give you a urine specimen and inspection reveal it looks like “cola cola”. The treatment plan for today’s visit includes ordering labs and deciding on how to manage the Mevacor. Which of the following is most appropriate for today’s treatment plan?
a. Order a liver panel, a CK level, a lipid panel with no change in Mevacor.
b. Order a liver panel, a CK level, a lipid panel and half the Mevacor dose
c. Order a liver panel, a CK level, a lipid panel and dose of Mevacor every other day
d. Order a liver panel, a CK level, a lipid panel and discontinue the Mevacor
7. You are evaluating lipid panel results of a 44-year-old male. Results are as follow: total cholesterol of 256, HDL 32, LDL 159, and triglycerides 95. Based on these findings which of the following should you do?
o Refer him to a cardiologist
o Recommend regular aerobic activity
o Calculate 10-year risk of heart disease/stroke
o Prescribe a low dose statin
8. Two weeks ago, you diagnosed a 39-year-old nonsmoking patient with hypertension. The patient returns to the office today with a complaint of a dry cough within a week of starting on the BP medication. With knowledge of the side effects of hypertensive medications the advanced practice nurse suspects the new onset cough is likely a side effect of which of the following?
a. Thiazide Diuretic
b. ACE inhibitor
c. Beta Blocker
d. Calcium channel blocker
9. You have a patient who is under the care of their cardiologist for atrial fibrillation. The patient’s current management regimen includes amiodarone. Which of the following is not an adverse event associated with the amiodarone?
A. Tachycardia
B. Blue-gray skin
C. Hypothyroidism
D. Pulmonary fibrosis
10. 71-year-old patient comes in asking if they needed to be treated for their high blood pressure. Her current medications include citalopram 20 mg daily for depression. Were you to do due diligence in evaluating the patients’ blood pressure readings and determine that treatment is appropriate, which of the following medication classes should be avoided in this patient?
A. ACE inhibitors
b. Calcium channel blockers
c. Beta Blockers
d. Angiotensin receptor blockers
11. Your type 2 diabetic patient with co morbid hypertension comes in for a follow up related to hypertension management. They report home BP monitoring readings in the range of 140s- 150s systolic and 90s diastolic. In the office today the patients BP is 151/94. Based on the JNC 8 guidelines you know that for optimum management of this patient’s hypertension the BP needs to be in which of the following ranges?
12. Your 51-year-old female patient has just been diagnosed with stage II hypertension. She has a history of migraine headaches. As a part of your evaluation today you get an EKG and a CXR. Her CXR is negative, and her EKG shows a second-degree heart block. With this patient’s health history and today’s findings which of the following antihypertensive agents is best avoided for this patient?
a. Angiotensin receptor blockers
b. Calcium channel blockers
c. ACE inhibitors
d. Diuretics
13. Which of the following is an appropriate blood pressure for a 65-year-old male with no co-morbidities?
o SBC <135, DBP <85 o SBC <130, DBP ><80 o SBC ><150, DBP ><90 o SBC ><140, DBP ><130, DBP <80 o SBC <130, DBP ><80 o SBC ><150, DBP ><90 o SBC ><140, DBP ><150, DBP <90 o SBC <130, DBP ><80 o SBC ><150, DBP ><90 o SBC ><140, DBP ><140, DBP <90 15. Your 68-year-old patient with COPD and HF comes in for a visit prompted by his wife who says, "he does not want to eat and is just not feeling good". Current medications include Lasix (furosemide) 20 mg daily, Calan SR (verapamil hydrochloride) 180 mg daily, Digoxin 0.25 mg daily, symbicort 160/4.5(budesonide/formoterol) 2 inhales BID, and Theolair SR 200 mg (extended-release theophylline) BID. His BP is 162/98, Pulse 80, Respirations 22. You did 12 lead EKG and find he is in sinus rhythm with frequent premature atrial contractions. Which of the following interventions do you want to do next? a. Increase the patient's Calan SR dose. b. Refer the patient to a cardiologist c. Order digoxin, theophylline, and potassium levels d. Refer the patient to a Pulmonologist 16. You have just diagnosed a 67-year-old patient with type 2 diabetes. Which of the following drugs is recommended as the treatment of choice for treating hypertension in diabetic patients? o ACE inhibitor o Beta blocker o Diuretic o Calcium channel blocker 17. A long-standing patient comes in at 8:30am asking you to evaluate 'palpitations' that she has been having periodically. They usually occur at night and last only a few minutes. Since she was having them this morning, she decided to come in. On assessment you note an irregularly, irregular pulse with a rate in the 90s and her BP is 130/82. You suspect she is in atrial fibrillation and likely has been having intermittent episodes. You call her husband and ask him to transport her to a facility that can work her up appropriately. With your assessment that the patient has been experiencing intermittent episodes of atrial fibrillation which of the following regimens do you anticipate your patient will be on when you see her next? o Adenosine and heparin o Beta blocker and warfarin o ACE inhibitor and warfarin o Beta blocker and heparin 18. A patient comes to your office as a walk-in appointment with a complaint of a nagging 2- 3/10 chest pain for about the last 2 hours at work. He works in a manufacturing plant where he breaks down diesel part using a 20-pound sledgehammer. His coworkers noted his usual work rhythm was off and told him he needed to get checked out. He reports BP 100/56. You call an ACLS transport ambulance to take the patient to an emergency room. Which of the following pharmacologic interventions would you do while waiting for the ambulance to arrive? o Administer 20mg morphine IVP o Administer 75mg of Plavix (clopidogrel) o Administer 80mg of Lasix IVP o Administer 0.3mg nitroglycerin SL 19. A 45-year-old female is coming in today with a complaint of palpitations. She reports that for the last few weeks she has been plagued by sudden onset of feelings of palpitations that she also describes as 'feels like my heart is racing'. You ask if she has taken her pulse during any of these episodes and she says she didn't think about order an event monitor for the patient and find that episodes the patient is describing are periods where she is in PSVT (paroxysmal supraventricular tachycardia) addition to proceeding with a workup to evaluate the possible causes for PSVT in this patient, the advanced practice nurse would anticipate initiation of which of these? o Alprazolam (Xanax) 0.5mg PRN for anxiety o Verapamil hydrochloride (Calan SR) 180mg a day o Citalopram (Celexa) 20mg daily o Losartan (Cozaar) 50mg a day 20 You are seeing a patient with NYHA class III heart failure. Understanding pharmacologic management strategies which of the following agents would you not expect to see your patient on? a. Alpha blocker b. Hydralazine c. ACE inhibitor d. Diuretic

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1. A patient who was admitted yesterday with an adjustment disorder and depressed mood has not left his or her room. The psychiatric-mental health nurse’s most appropriate approach at meal time today is to respond:
a, “I will bring your tray to your room, if it will make you more comfortable.”
b, “I will walk with you to the dining room and sit with you while you eat.”
c, “Where would you like to eat your meal this noon?”
d, “You will feel better if you go to the dining room and eat with the others.”
2. A 17-year-old, female patient with anorexia nervosa has just been released from the hospital. To facilitate recovery at home, the psychiatric-mental health nurse instructs the family to:
a, discourage the patient from sneaking food between meals, by unobtrusively reducing her access to the kitchen.
b, encourage the patient’s interest in menu planning, food magazines, and cooking lessons, by leaving information and materials around the house.
c, permit the patient to eat her meals privately in her bedroom to discourage family preoccupation with meals.
d, recommend that the patient joins in routine family meals and clears the dishes after dinner, even if she does not eat.

3. A supervisor observes inconsistency in the psychiatric-mental health nurse’s behavior toward a patient; the nurse is unreasonably concerned, overly kind, or irrationally hostile. The most appropriate explanation is that the nurse is displaying:
a, countertransference.
b, empathic resonance.
c, splitting behavior.
d, transference.
4. The first step in the treatment of incest is to:
a, believe the child who reports the activity.
b, notify the proper authorities.
c, objectively confront the accused family member.
d, remove the child from the home.

5. A couple in counseling reports fighting with their son when they are angry with each other. This behavior typifies:
a, coalition.
b, indirect communication.
c, transference.
d, triangulation.

6. The severe feeling of restlessness produced by some psychotropic medications, which is often misinterpreted by patients as anxiety or a recurrence of psychiatric symptoms, is known as:
a, akathisia.
b, akinesia.
c, bradykinesia.
d, dystonia.

7. During an initial patient interview, the psychiatric and mental health nurse begins by asking the patient to describe his or her:
a,current situation.
b, feelings about the current situation.
c, personal history.
d, thoughts about the current situation.

8. A female patient reports an intense, overwhelming fear of driving a car. The fear has disrupted all elements of the patient’s life. The patient does not go to the grocery store unless someone transports her, has relinquished her job, and has few social contacts. The patient’s treatment plan includes:
a, assertiveness training.
b, biofeedback.
c, stress management assistance.
d, systematic desensitization.

9. A short-term goal for a patient with Alzheimer’s disease is:
a, improved functioning in the least restrictive environment.
b, improved problem solving in activities of daily living.
c, increased self-esteem and improved self-concept.
b, regained sensory perception and cognitive function.

10. Older adults have reached Erikson’s developmental stage of ego integrity when they:
a, acknowledge that one cannot get everything one wants in life.
b, assess their lives and identify actions that had value and purpose.
c, express a wish that life could be relived differently.
d, feel that they are being punished for things they did not do.

11. A patient states that unit staff members have been avoiding him or her since an attempt to self-mutilate. The psychiatric-mental health nurse’s most appropriate response is to:
a,apologize for the staff’s behavior.
b,explain that feelings of rejection are typical after self-mutilation.
c,listen, redirect the patient to his or her feelings, and explore the issue with the staff.
d, report the matter to the nurse manager.

12. When planning inpatient psychotherapeutic activities for a patient who has antisocial personality disorder, the psychiatric-mental health nurse:
a, focuses on group, rather than individual, therapy.
b, provides a permissive atmosphere, so the patient feels a sense of control.
c, provides an organized, structured environment.
d, recognizes that the disorder is characterized by social withdrawal.

13. Accompanied by many family members, a 16-year-old Chinese-American female patient is admitted to the unit with reports of sadness and suicidal ideation. The patient and her family emigrated from mainland China five years ago. Regarding the family, the psychiatric and mental health nurse:
a,encourages the patient to communicate her need for privacy to her family.
b, gently asks the family members to leave the room.
c, privately asks the mother for her assistance in clearing the room.
d,provides care for the patient while the family members are present.

14. According to family systems theory, removing the “identified patient” from the environment most likely causes the:
a, patient to decompensate, due to the loss of his or her support system.
b, patient to significantly improve, often with minimal or no additional therapy.
c, remaining family members to decompensate, as evidenced by new dysfunctional behavior.
d, remaining family members to lose motivation and withdraw from therapy.

15. A psychiatric-mental health nurse, who is teaching a couple how to use positive reinforcement techniques with their child, recommends:
a,agreeing with the child’s statements, whether negative or positive, and simply restating the child’s statements without other comment.
b,controlling the child’s behavior, so there is no chance of negative behavior.
c,removing adverse consequences to produce positive results.
d, rewarding positive behaviors to promote their recurrence.
16. Which of the following is NOT true about the epidemiology and risk factors of violent behavior?
a. More than 50% of people who commit criminal homicides and who engage in assaultive behavior have imbibed significant amounts of alcohol immediately beforehand.
b. For aggression classified as homicide, battery, assault with a weapon, or rape, the frequency among males clearly exceeds that among females.
c. Most adults with and without mental disorders who commit aggressive acts do so against people they do not know, that is, strangers.
d. For domestic violence, in which one partner hurts another, the frequency among men and women is about equal.
17. Your client is a 14-year-old girl brought in by her parents for evaluation because of episodes of defiance over curfews and of staying out late with friends. Your initial approach to her situation is which of the following?
a. You meet with the family and tell the parents that such separation-individuation behavior is healthy and normal.
b. You meet with the girl alone and explain that her behavior is exposing her to many high-risk behaviors, including substance abuse, delinquency, unprotected sex, pregnancy, and sexually transmitted diseases.
c. You arrange for a separate therapist for the girl, a separate therapist for the parents, and yourself as the family counselor.
d. You assess the family situation, assess the level of communication in the family, and attempt to identify specific stressors or situations that could be aggravating a normal development stage in order to address them.

18. You are working in a substance-abuse treatment clinic where the clients are subject to random, mandatory drug screening as a part of their probation for substance abuse-related offenses. If your client has a negative urine test result, you can be confident that the client has not abused any of the following drugs in the past 2 to 3 days EXCEPT:
a. Heroin
b. Toluene
c. Cocaine
d. Marijuana
19. Your client is a 34-year-old Hispanic-American farm worker who was diagnosed last year with bipolar disorder and who has been prescribed lithium carbonate. He came to the United States from Nicaragua 18 months ago. You are meeting him for the first time, after he has had 4 hospitalizations for his disorder and during which his lithium levels ranged from “undetectable” to 2.1 mEq/liter. What is the first step that you would take to assess his “health literacy” concerning his disorder?
a. Determine whether he speaks English well enough to understand explanations and directions in English or whether he needs a translator.
b. Ask him whether he was given information on bipolar disorder during and after his hospitalizations.
c. Ask him to describe in his own words what his illness is and what he must do to manage it.
d. Find out how much formal schooling he has had.
120. A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Recent Life Changes Questionnaire. How should
the nurse evaluate this client data?

. a,The client is experiencing severe distress and is at risk for physical and psychological illness.

b, A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of
stress-related illness.

c,Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of
coping resources and available supports.
d,The client may view these losses as challenges and perceive them as opportunities.
21. A common nursing diagnosis for a patient with antisocial personality disorder is:
a, chronic low self-esteem, related to poor self-image and excessive fear of failure.
b, disturbed thought processes, related to sensory-perceptual alterations.
c, impaired social interaction, related to manipulative behaviors.
d, social isolation, related to anxiety in social situations.

22.When screening families for post-traumatic stress disorder following a major natural disaster, psychiatric-mental health nurses are practicing which type of disease prevention?
a, Primary.
b, Secondary.
c,Tertiary.
d, Universal.

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*** the patient is —
PATIENT FOR Concept map
HISTORY OF PRESENT PROBLEM:
Patient is Joan Walker; she is 84 years old. She has had a productive cough which is green in color for the past 4 days. Her PCP (primary care provider) started her on Prednisone 40 mg daily and Azithromycin (Zithromax) 250 mg PO for 5 days which she started 3 days ago. She has had intermittent chills, a fever last night of 102F/38.9C and has increased shortness of breath especially in the evening and during the night. She is using her albuterol inhaler about every 1-2 hours which does not seem to be working. She called 911 and is now in your ER and you are the nurse responsible for her care.
PERSONAL/SOCIAL HISTORY:
Joan is a widow for the past 6 months, after being married for 64 years and is currently living in a SNF (skilled nursing facility). Taught as anelementary school teacher for over 30 years in the local community. She is active in her church and called her pastor who can with her to the ER. You walked in as the pastor asked Joan if she would like to pray. Joan replied to the pastor “yes please I feel that this may be the beginning of the end for me”
Current vital signs T: 103.2F/39.6, P 110 regular, R 30 labored and using accessory muscles, BP 178/96, O2 sat 86% on 6 liters of oxygen via nasal cannula, P-Q-R-S-T Pain Assessment Provoking: deep and shallow breathing, Quality: ache, Radiation: generalized pain over right side of chest no radiation, Severity: 3/10, Timing: Intermittent last a few seconds
CURRENT ASSESSMENT:
General Appearance: appears anxious and in distress, barrel chest observed
Respiratory: Dyspnea with use of accessory muscles, breath sounds very diminished bilaterally anterior and posterior with scattered expiratory wheezing
Cardiac: Pale hot and dry, no edema, heart sounds regular S1 S2 pulse strong equal with palpation at radial/pedal/post-tibial landmarks
Neuro: Alert and orientated to person, place, time, and situation (x4)
GI: Abdomen soft nontender bowel sounds audible per auscultation in all 4 quadrants
GU: Voiding without difficulty, urine clear
Skin: intact turgor elastic and no tenting visible
Fluid and Electrolytes/Lab/ Diagnostic results
Chest x-ray: left lower lobe infiltrate with hypoventilation present in both lung fields
Lab: WBC (4.5-11.0) hers: current is 14.5 prior was 8.2
Hgb (12-16g/dL) current 13.3 prior was 12.8
Platelets (150-450×103/ul) current 217 prior was 298
Neutrophil % (42-72) current 92 prior was 75
Band for (3-5%) current 5 prior was 1
Here is more lab data:
Basic Metabolic Pane. (BMP):
Sodium (135-145 mEq/L) current 138 prior 142
Potassium (3.5-mEq/L5) current 3.9 prior 3.8
CO2 (Bicarb) (21-31mmol/L) current 35 prior 31
Glucose (70-110 mg/dL) current 112 prior 102
BUN (7-25 mg/dL) current 32 prior 28
Creatinine (0.6-1.2) current 1.2 prior 1.0
Lactate (0.5-2.2 mmol/L) current 3.2 prior NA
ARTERIAL BLOOD GAS (ABG):
pH (7.35-7.45) current 7.25
pCO2 (35-45) current 68
pO2 (80-100) current 52
HCO3 (bicarb) (18-26) current 36
O2 sat (>92%) current 84%
What is the ABG interpretation?
HERE IS THE PATIENT’S MEDICATION
Lorazepam 2.5 mg every 6 hours as needed for anxiety
Atorvastatin 600 mg twice a day
Enalapril 10 mg daily
Albuterol MDI 2 puffs every 4 hours PRN
Salmeterol/fluticasone Diskus (Advair) 1 puff every 12 hours
Triamterene-HCTA (Dyazide) 1 tablet daily
Reflection what did I learn from this? ****
*DIRECTIONS ****
Preparing the assignment
Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions.
1. Choose an individual for whom you have cared in the clinical setting.2. Create a concept map based on the complete physical assessment you performed while providing care using the provided power point template. a. Components of the concept mapi. Individual’s information (10 points/10%)1. Age2. Medical diagnosis3. Brief review of underlying pathophysiology
*List what functional changes are happening
*List process that initiated and maintained disorder or disease
ii. Assessment Data (15 points; 15%)1. Include all assessment data, not simply information that supports the selected nursing diagnoses
Inspect
Palpation
Percussion
Auscultate
Neurological Exam
iii. Nursing Diagnoses (15 points/ 15%)1. Select three nursing diagnoses to addressesa. One must be an actual problemb. One must address a psychosocial needc. The final must be a high priority for the individualiv. Linkages Within and Between Diagnoses (5 points/5%)1. Concept map demonstrates relationship within and between the nursing diagnoses.v. Planning (15 points/15%)1. Prioritize diagnoses to reflect needs of the individual2. Set realistic outcome measurement3. At least two (2) scholarly, primary sources from the last 5 years, excluding the textbook, are providedvi. Implementation (15 points/15%)1. Interventions are individualized for patient-provide rationale2. Interventions support achievement of selected outcome measurements-provide rationale
vii. Evaluation of Outcomes (5 points/15%)1. Determine if outcomes were met.2. Provide evidence that supports that determination.3. Describe what changes, if any, are needed to promote expected outcomes in the future.viii. Safety-Communication-Infection Control 16 points/16%)a. specific elements of communication used when providing care,b. safety concerns related to the individual for whom you cared, andc. infection control practices followed while caring for this patient.ix. APA Citations and Writing (4 points/4%)a. References are submitted with assignment.b. Uses appropriate APA format and is free of errors.c. Grammar is free of errors.d. Spelling is free of errors.
viii. Safety-Communication-Infection Control 16 points/16%)a. specific elements of communication used when providing care,b. safety concerns related to the individual for whom you cared, andc. infection control practices followed while caring for this patient.
ix. APA Citations and Writing (4 points/4%)
Safety
Communication
Infection Control
Image transcription text
4 Student 4:24 PM Fri Jan 21 uandfcidei l0
Medical Diagnoses Pathophysiclogy review
Assessment Data Patient initials:… Show more
Please fill the map off the patient information… thanks
And a reference page… make it Apa format

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Practice guidelines for complex trauma and dissociative identity disorder caution that which of the following may limit one’s ability to heal. A . Somatic approaches B . Talk therapies focused on cognitive understanding C . EMDR D . A and C Which of the following is consistent with a Common Elements approach? A . Common Elements involves use of individual treatment approaches that are part of many manualized treatment B . Evidenced-based strategy is viewed in light of the actual intervention as well as diagnostic category. C . The Common Elements method is seen as a transdiagnostic approach to treat a variety of common mental health issues. D . Is Common Elements method should not be used with child/adolescents with PTSD. Which of the following is not an underlying assumption that differentiates child therapies from adult psychotherapy? A . Family inclusion B . The concept of Recovery C . The concept of Resiliency D . Developmental considerations The person-centered therapist who is genuine and authentic during the therapy session is exhibiting which psychological condition? A . Congruence B . Actualizing tendency C . Belief of human nature D . Accurate empathic understanding Review of child specific Evidence Based Practices (EBP) demonstrate progress in some treatment areas however there is still much work to be done particularly in use of EBPs guided by diagnostic criteria in children with which of the following disorders? A . ADHD B . Anxiety C . Bipolar Disorder D . Adolescent Depression The advanced practice psychiatric nurse notices in working with a patient with a dissociative disorder that the person appears to be doing worse after significant gains are made. The advanced practice psychiatric nurse explains the reason for this is likely which of the following? A . This indicates the change(s) really did not take B . The patient is unconsciously sabotaging the therapy. C . This indicates process is trying to force a change too fast. D . As positive changes occur they may be followed by a temporary increase in sadness, anger, or anxiety because even positive change may be experienced as a loss. The use of medications is indicated in combination with psychosocial interventions in several child and adolescent severe emotional disorders (SED) including which of the following? A . Pediatric bipolar disorder B . Mild ADHD C . Antisocial personality disorder D . All of the above Research suggests that psychodynamic therapeutic approaches are effective for some children, particularly those with which of the following disorders? A . Conduct Disorders B . Anxiety and Depression C . Depression and Psychosis D . Attention Deficit-Hyperactivity Disorders Evidence-based therapeutic modalities for treating older adults with anxiety include which of the following: A . Cognitive Behavioral Therapy, Relaxation training, Biofeedback B . Dialectical Behavior Therapy, Reminiscence Therapy, Biofeedback C . Guided Imagery, Music Therapy, Yoga D . A and C The advanced practice psychiatric nurse is working with the patient on maintaining treatment outcomes and developing a guide for surviving difficult times. These strategies are consistent with which phase in the CBT process? A . Introductory phase B . Middle phase C . Late middle phase D . Termination Which of the following is true about Complementary and Alternative Medicine (CAM) Therapies and Older Adults? A . CAM therapies are a good alternative to conventional medicine B . CAM therapies can be used in conjunction with psychotherapy to provide effective, evidence-based treatments to older adults with psychiatric disorder. C . Evidence is unclear whether CAM therapies improve quality of life or wellness in older adults. D . Most middle age and older adults are reluctant to use CAM therapies for management of mental health concerns. The advanced practice psychiatric nurse realizes a basic assumption of Dialectical Behavior Therapy (DBT) is that therapists treating the difficult patient need support. This support includes which of the following? A . The support is provided through case management B . The support is designed to focus on clinical issues of the patient C . The DBT therapist in solo practice does not need a consultation group for support. D . The support includes a consultation group to treat the therapist by using the same skills the patient is asked to use. During the middle phase of CBT with an older adult the advanced practice psychiatric nurse notices that homework is not getting done and suggest that the homework be done during the therapy session. This indicates which of the following? A . The patient is not vested in the therapy. B . Clearly the advanced practice psychiatric nurse needs more training in CBT. C . The advanced practice psychiatric nurse is enabling the patient and thus undermining the therapy. D . The advanced practice psychiatric nurse is suggesting an acceptable modification to facilitate the therapy process. Research support that children with serious emotional disorders (SED) are likely to have which of the following? A . Children with SEDs are likely to be severely impaired B Children with SEDs are likely to have many community agencies involved in their . care and support. C . Children with SEDs are likely to have a comorbid disorder. D . A and C The role of the therapist during Stage 4 of the Dialectical Behavior Therapy procession model includes which of the following? A . Prepare the patient to safely let go of therapy. B . Maintain calmness without over-reacting to the patient’s behavior. C . Reassure the patient that extinction bursts are reasonable and normal. D . ONLY A and B In working with an older female patient, the advanced practice psychiatric nurse notices the patient seems to respond superficially reminding the advanced practice psychiatric nurse of her own mother and finds herself looking forward to their sessions, which recently have been going longer than scheduled. The advanced practice psychiatric nurse recognizes this as A . Gerotransference B . Transcendence C . Countertransference D . A sign of a close therapeutic relationship The Gestalt therapist notices the patient is fidgeting with fingers, legs are shaking and asks the patient “What are you experiencing right now in your body?” This is a type of creative experimentation known as which of the following? A . Focusing B . Body awareness C . Language of responsibility D . Empty-chair dialogue Which of the following is a biologically based psychotherapy methodology used to treat patients who have experienced trauma? A . Trauma Resiliency Model B . Cognitive Behavioral Therapy C . Psychodynamic Psychotherapy D . Existential Psychotherapy Functional status refers to A . A person’s capacity to manage activities of daily living independently B . A person’s positive perspective on their own capabilities C . A person’s expected increase in dependency as one ages D . A person’s expected decrease in independence as one ages Which of the following is not consistent with the Principles of Effective Treatment for Addiction according to the NIH? A . Treatment needs to be readily accessible. B . Psychotropic medication should be stopped prior to treatment. C . Treatment does not need to be voluntary to be effective. D . Drug use during treatment must be monitored continuously as lapses may occur during treatment. The purpose of Mindfulness-Based Stress Reduction in the older adult is A . To avoid using psychotropic medications B . To escape from stressful situations and relationships C . To learn to be present in the moment nonjudgmentally. D . To avoid stigma of traditional psychotherapy Critical goals in addiction treatment include improving impulse control, reducing craving, and promoting and adaptive social environment. Evidenced based skills that can best impact these goals include: A . Life Review Therapy B . Contingency Management C . Motivational Interviewing D . Interpersonal Psychotherapy E . B and C In working with a patient with borderline personality disorder, the Dialectical Behavior Therapy (DBT) therapist emphasizes suicidal and self-harming behaviors are problems to be solved and are the highest priority for treatment. Which of the following would be inconsistent with DBT therapy? A . The patient must agree to reduce self-harming behaviors as a goal for therapy. B . The patient must agree to work with the therapist before acting on self-harming urges. C . If the patient engages in the self-harming behavior and is admitted to the hospital the therapist can continue to support the patient through scheduled telephone or inperson sessions. D . If the patient engages in the self-harming behavior and is admitted to the hospital the therapist suspends direct consultation with the patient until 24 hours after the patient is discharged from the hospital. In following the rules for the Dialectical Behavior Therapy (DBT) therapist, the therapist would not do which of the following? A . Recognize the therapist is human and fallible. B . Make every reasonable effort to provide competent treatment for the patient. C . Share the rules for the DBT therapist with the patient during orientation to the therapy. D . The therapist agrees to use consultation and allow the patient to view this directly if desired.

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hello dear writer please help to make my case study. it is based on management of clients with renal and urologic disorders. the case scenario is based on Mr. Mr.. M. a 79-year-old man who was admitted today to your unit for a urinary tract infection and urosepsis. Based on what you have learned this week about management of clients with renal and urologic disorders answer the following questions:
What else would you do in this situation with Mr. M?
What other options or alternatives would you explore and why for Mr. M?
What referrals might you make for Mr. M at this time?
Who else on the interprofessional team would you involve in Mr. M’s care? everything related to this case study i will post here please you add information according it and at the end i will post a sample similar to this case study for your guidance. The required (necessary) readings for this week are:
Lewis , S., Heitkemper, M., Dirksen, S., Barry, M., Goldsworthy, S., & Goodridge, D. (2014) Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems, (3rd Edition). Reed Elsevier Canada, Ltd. Toronto, Canada. Chapters: 47-49 THIS IS THE BOOK RECOMMNDED BY MY TEACHER TO GET ONFO REGARDING UROLOGICAL AND RENAL SYSYTEM. NOW I AM SHARING ONFO REGARDING MR,M
..Name: Mr. M
Age: 79
Diagnosis: Urinary Tract Infection and Urosepsis
VS q4h
Ambulate with assistance prn
I&O q8h
IV Lactated Ringers 100 ml/hr
Bathroom privileges with assistance
Diet: soft as tolerated
Routine meds: Acetamenophen 500 mg tabs i po q4h for temperature greater than 38 degrees celcius; Ceftriaxone 1 g IVPB qAM as orderedIt is now 0730. As you enter his room you notice he is restless and seems disoriented. You are planning your initial care activities for Mr. M. Using the list below, think about how you would prioritize the five nursing interventions as you would do them to initially take care of Mr. M.
INSERT A NUMBER BOX FOR THIS ACTIVITY
Assess for call bell and bed safety features
Take vital signs
Gather urinary output data
Assess mental status
Perform a body systmes physical assessment
NEED FEEDBACK/ANSWERS WITH RATIONALES – TO DOWNLOAD FROM PUBLISHER WEBSITE
As you provide morning care to Mr. M you note the following signs and symptoms:
VS: T 38.5 C, P 98, R 22, BP 120/76, pulse oximetry 94%
Fine crackles audible on auscultation in the bilateral lower lung fields
Crackles audible throughout the bilateral lung fields
He is sleepy, lethargic
He is incontinent of a scant (small) amount of urine
Based on your nursing assessment and critical thinking select the nursing diagnosis that is a high priority at this time. You should have a rationale for your selection.
Answers – Week 8
Week 8 – Mr M
Nursing Assessment
It is now 0730. As you enter his room you notice he is restless and seems disoriented. You are planning your initial care activities for Ms. M. Using the list below, think about how you would prioritize the five nursing interventions as you would do them to initially take care of Mr. M.
5 – Assess for call bell and bed safety features
Minimize fall or injury to patient
1 – Take vital signs
Reassess, especially temperature
4 – Gather urinary output data
Assess amount, color and voiding pattern
3 – Assess mental status
Assess delirium and manage confusion
2 – Perform a body systems physical assessment
Establish baseline; assess bladder; patient may have a full bladder; which may contribute to his restlessness
Follow-up Action Plan
As you take his 12:00 noon vital signs you note the following signs and symptoms: lethargic, skin very warm and flushed, VS T 39.1 C, P 130, R 28, BP 90/5484, pulse oximetry 88%. Based on this new information what are your next steps? What do you think is going on with Mr. M? What would you identify as the PRIORITY PROBLEM? Now prioritize the following nursing interventions for this situation and identify your follow up action plan for Mr. M.
1. Check pulse oximetry: attach probe to ear, nose or forehead preferably
4. Take vital signs q5min
6. Notify physician
2. Prepare to start oxygen
5. Document findings
3. Prepare to insert indwelling urinary catheter
Priority Problem: Signs and symptoms of septic shock
New action plan: Monitor vital signs and oxygenation; prepare to transfer to intensive care unitFeedback – Week 8
Points to consider for Mr M:
At 0600 Temp was 38
There is no documentation that Tylenol was given
Restlessness
Agitated and restless all night – why?
What are your thoughts about why this is happening?
Sepsis
Urinary retention
Fever
Dehydration
What should you be considering?
Geriatric patient
What should you be assessing?
Initiate neuro checks
At 0730
Temp was 38.5
Did you give Tylenol?
P has gone from 78 to 98
BP has dropped from 146/88 to 120/76
Fine crackles audible
Sleepy and lethargic
All night was agitated and restless
Scant amount of urine
Complete a physical assessment as baseline has been deviated from
What should you be considering as this is an elderly patient?
You should be concerned for this patient
Notify physician of change in status
At 1200 Temp was 39.1
P – 130
R – 28
BP – 90/54
Lethargic, skin warm and flushed
Oximetry 88%
What is happening?
If Tylenol had been given would this situation have developed?
Prepare for transfer to ICU
ALL ABOVE DATA PLEASE USE TO MAKE MY CASE STUDY.
NOW I AM SHARE ONE OF MY CASE STUDY WHICH WAS RELATED TO ANOTHER SYSYTEM U CAN USE IT AS SAMPLE
Case Study on Mr. L.
Peripheral vascular disorder (PVD) is an infection and complication affecting organs in the body, including the brain, kidney, limbs, and the digestive system (Fanari & Weintraub, 2015). PVD results from blockage of veins and arteries. Cholesterol in the body causes the blood vessels to narrow, leading to the inadequate blood supply to the other organs. As noted by Zoccali and London (2017), nursing practitioners’ management of peripheral vascular and lymphatic disorders involves coming up with ways to help patients alleviate the condition. Also, management consists of referring the patient to other healthcare practitioners for necessary assistance. If a nurse cannot manage to deal with the patient’s condition on their own, it would be logical for them to involve other medical practitioners within the institution to develop strategies to help the patient.
In addition to identifying that Mr. L is suffering from the peripheral vascular disorder, I would come up with patient care strategies focusing on the needs of the client, their beliefs, and personal decisions. As indicated by Zoccali and London (2017), just like all other patients, Mr. L has his own specific needs and preferences. As a result, all the PVD management approaches may not be essential for his situation. In coming up with the management plan for Mr. L, I would also consider the environment he is living in to ensure that the strategies are beneficial in his case. Since Mr. L stays alone, my PVD management strategies will find this to ensure that the treatment procedures give the best outcomes. Also, in planning for his medication, I would ensure that I prescribe medicines that can work for a patient who is a smoker to avoid adverse side effects.
Under Fanari and Weintraub (2017), I would also consider lifestyle and home care remedies for his condition besides treatment alternatives for MR. L. Life changes and home remedies are essential in mitigating the symptoms of PVD. Some of the lifestyle changes that I would recommend for Mr. L includes advising that he quits smoking. Smoking tobacco increases the chances of constriction of arteries, which makes PVD worse. Also, smoke may affect the efficacy of the medication, meant to help manage the diseases. Since Mr. L is suffering from tobacco addiction, I suggest that he receives cessation medication to help him quit the habit. Also, I would recommend that he takes regular exercise, which increases blood supply to body organs, which aids in the treatment of PVD.
Since Mr. L’s condition is far worse, and some of the management strategies might not work, I would refer Mr. L to a physiotherapist, a foot care nurse, and a cardiologist. The physiotherapist will help Mr. L exercise to ensure that there is enough blood flow to his limbs. The foot care nurse will ensure that the dressing on the wounds on his feet is appropriate to avoid cases of infections. Al illustrated by Fanari and Weintraub (2017), the cardiologist will check for any arterial and venous blockages on his left femoral-popliteal that contribute to the legs’ inadequate blood flow leading to the darkening of toes. On the interprofessional team, I would like to involve community health volunteers to help in ensuring that MR. L focuses on his recovery outside the hospital.
Conclusively, patient management is essential in ensuring that PVD patients get the necessary assistance o to enhance their recovery. Also, control ensures that nurses have a plan in place that supports the needs of their patients. Also, nursing practitioners have to make sure that their patients will stick to the treatment protocols outside the institution. In this case, the community health volunteer will be essential in the daily dressing of the wounds, and ensuring patients who stay alone take their medication on time.

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Introduction to mental health
List 3 social factors that may act as a risk factor for mental illness.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
List 3 psychological factors that may act as a protective factor for mental illness
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
List 3 cognitive changes that may occur as a result of mental illness
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
List 3physical factors that may increase a person’s risk for mental illness
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Define mental illness
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Name 3 mental health settings where an enrolled nurse could work in your local council.
1_________________________________________________________________________________2_________________________________________________________________________________3_________________________________________________________________________________
Name 2 services in your local area, other than hospital, where a person with mental illness may access support.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Describe 3 things that a consumer consultant may do as part of their role.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Provide 1 reason why homelessness is more common for people with mental illness than the general population?
____________________________________________________________________________________________________________________________________________________________________

“The vision of the World Health Organisation action plan (2013-2020) is a world in which mental health is valued, promoted and protected, mental disorders are prevented and persons affected by these disorders are able to exercise the full range of human rights and to access high quality, culturally-appropriate health and social care in a timely way to promote recovery, in order to attain the highest possible level of health and participate fully in society and at work, free from stigmatization and discrimination” (WHO 2013).
Describe 2 things you will do as a nurse to implement this plan.
1_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
List 2 ways you could gain a better understanding of the consumer’s perspective or their mental illness
1________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Responding to Distress
What are 4 requirements for a therapeutic relationship?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Describe 4 components of active listening.
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Give 2 examples of body language that may make a patient think you are not interested in communicating with them.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Give an example of a crisis situation that may occur on an inpatient ward that may require an enrolled nurse to seek assistance from colleagues
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Choose two of the following anxiety reduction techniques- progressive muscle relaxation, controlled or abdominal breathing, calming response, visualisation and imagery, grounding. Explain what it is using the same language you would use with a patient.
1_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________2_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What does the P stand for in the acronym SPIKES?
__________________________________________________________________________________
What app could you suggest a patient use to practice mindfulness?
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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1. Jeanne is a 48-year-old with dissociative identity disorder who was admitted to the crisis unit for a short-term stay after a suicide threat. On the unit, she has repeated the statement that she will kill herself to get rid of “all the others,” meaning her alters.
a. How do you think that staff reacts to working with patients such as Jeanne?
b. What do you believe needs to be done to protect Jeanne?
2. John, a 24-year-old, returned from the Iraq War last month. Since then he has become increasingly irritable, isolated, and depressed. His wife says he does not want to go anywhere and won’t leave his home for days at a time. In the interview with the nurse at the clinic, he indicates that he feels helpless and anxious and jumpy.
a. Identify priorities in providing care for this patient.
b. What type of medication would you anticipate being ordered for John?
Chapter 17:
1. A patient with suspected somatic symptom disorder has been admitted to the medical-surgical unit after an episode of chest pain with possible electrocardiographic changes. While on the unit, she frequently complains of palpitations, asks the nurse to check her vital signs, and begs staff to stay with her. Some nurses take her pulse and blood pressure when she asks. Others evade her requests. Most of the staff tries to avoid spending time with her.
a. Consider why staff wish to avoid her. How would you feel as a nurse in this situation?
b. Design interventions to cope with the patient’s behaviors. Give rationales for your interventions.
Chapter 18
1. Logan, a 19-year-old male model, has experienced a rapid decrease in weight over the past 4 months after his agent told him he would have to lose some weight or lose a coveted account. Logan is 6 feet 2 inches tall and weighs 132 pounds, down from his usual 176 pounds. He is brought to the emergency department with a pulse of 40 beats per minute and severe arrhythmias. His laboratory workup reveals severe hypokalemia. He has become extremely depressed, saying, “I’m too fat… I don’t want anything to eat… If I gain weight, my life will be ruined. There is nothing to live for if I can’t model.” Logan’s parents are startled and confused, and his best friend is worried and feels powerless to help Logan. “I tell Logan he needs to eat or he will die… I tell him he is a skeleton, but he refuses to listen to me. I don’t know what to do.”
a. Which physical and psychiatric criteria suggest that Logan should be immediately hospitalized?
b. What are some of the questions you would eventually ask Logan when evaluating his biopsychosocial functioning?
c. What are your feelings toward someone with anorexia? Can you make a distinction between your thoughts and feelings toward women with anorexia and toward men with anorexia?
d. What are some things you could do for Logan’s parents and friend in terms of offering them information, support, and referrals? Identify specific referrals.
e. Identify at least five criteria that, if met, would indicate that Logan was improving.
Chapter 19:
1- Anthony is a 46-year-old who complains of waking frequently at night. Consequently, he is tired all day and knows that he has not been functioning as well as he should. Whenever he can manage it, he goes out to his car at lunchtime to take a 60-minute nap, because he has fallen asleep at his desk and been given a disciplinary warning. He is drinking 2 to 3 cups of coffee in the afternoon so that he does not feel sleepy while driving home.
a. What questions would you ask to determine if Anthony might have a sleep disorder?
b. What recommendations will you make to improve his sleep hygiene?
c. What instructions and education should you give this patient regarding personal and community safety?
2. Your patient, Vivian, has been using temazepam (Restoril) for several years to treat insomnia. She has been reading that long-term use of hypnotics is not healthy or productive and wants to quit taking them. However, she is focused on needing 9 hours of sleep each night and is extremely worried about what will happen when she discontinues the temazepam.
a. What instructions would you provide to Vivian regarding stimulus control, sleep restriction, and cognitive restructuring of her sleep complaint?
b. Identify alternative pharmacological therapies.
Chapter 20:
1. As a nurse on an adolescent psychiatric-mental health nursing unit, you often encounter teenagers who are misinformed about growth and development, as well as sexuality. What information would you include in a series of teaching sessions that would help these adolescents acquire a greater understanding of the developmental changes they are going through?
2. To understand your own beliefs, answer these questions:
a. Are you comfortable with your own sexuality? With that of others?
b. Are you judgmental?
c. Could you be helpful to someone who has a sexual disorder?
d. What factors have influenced your beliefs and values regarding sexuality?
e. What do you think is the impact of sexually explicit television, music videos, and movies on your sexual attitudes, values, and beliefs?
Chapter 21:
1. Jacob is a 14-year-old adolescent who has been diagnosed with conduct disorder.
a. Explain to one of your classmates his probable behaviors in terms of (1) aggression toward others, (2) destruction of property, (3) deceitfulness, and (4) violation of rules.
b. What are the outcomes for this disorder?
c. List at least seven ways you could support Jacob’s parents. What are some community referrals you could give them in your own locale?
2. Mallory is a 17-year-old female being admitted to the adolescent psychiatric unit after several weeks of impulsive behaviors such as extensive cutting and running away from home.
a. Put the following areas of assessment in order of priority and provide the rationale for your choices:
1. Suicide risk
2. Current coping skills
3. Skin integrity/risk for infection
4. Childhood development
5. Current family relationships
b. Identify at least three appropriate nursing diagnoses for Mallory based on the previously provided information.
c. Name three nursing interventions to support the nursing diagnosis of ineffective coping.
Chapter 22:
1. Write a paragraph describing your possible reactions to a drug-dependent patient to whom you are assigned.
a. Would your response be different depending on the substance (e.g., alcohol versus heroin or marijuana versus cocaine)? Give reasons for your answers.
b. Would your response be different if the substance-dependent person were a professional colleague? How?
2. Rosetta Seymour is a 15-year-old who has started using heroin nasally.
a. Briefly discuss the trend in heroin use among teenagers.
b. When Ms. Seymour asks you why she needs to take more and more to get “high,” how would you explain to her the concept of tolerance?
c. If she had just taken heroin, what would you find on assessment of physical and behavioral-psychological signs and symptoms?
d. If she came into the emergency department with an overdose of heroin, what would be the emergency care? What might be effective long-term care?
Chapter 23:
1. Mrs. Kendel is an 82-year-old woman who has Alzheimer’s disease. She lives with her husband, who has been trying to care for her in their home. Mrs. Kendel is having trouble dressing. She has put her blouse on backward and sometimes puts her bra on over her blouse. She often forgets where things are. She makes an effort to cook but has recently attempted to “put out” the electric burners of the stove with pitchers of water. Once in a while, she cannot find the bathroom in time, often mistaking it for a closet. At times, she cries because she is aware that she is losing her sense of her place in the world. She and her husband have always been close loving companions, and he wants to keep her at home as long as possible.
a. Assist Mr. Kendel by writing out a list of suggestions that he can try at home that might help facilitate (a) communication, (b) activities of daily living, and (c) maintenance of a safe home environment.
b. Identify at least three interventions appropriate to this situation for each of the areas previously cited.
c. Identify resources available for maintaining Mrs. Kendel in her home for as long as possible. Provide the name of a self-help group that you would urge Mr. Kendel to join.
Chapter 24:

1. Cherie is brought to the emergency department after slashing her wrist with a razor. She has previously been in the emergency department for drug overdose and has a history of addictions. Cherie can be sarcastic, belittling, and aggressive to those who try to care for her. When the psychiatric triage nurse comes in to see her, Cherie is initially adoring and compliant, telling him, “You are the best nurse I’ve ever had, and I truly want to change.” But when he refuses to support her request for diazepam (Valium) and meperidine (Demerol) for “pain,” she yells at him, “You are a stupid excuse for a nurse. I want to see the doctor immediately.” Cherie has borderline personality disorder.
a. What defense mechanism is Cherie using?
b. How could the nurse handle this situation while setting limits and demonstrating concern?

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Assignment :
BIMI Case Study and Instructions.
Assignment Instructions:
After reading Brief Integrated Motivational Intervention (BIMI), use the following case study to complete a BIMI. Use the provided worksheets required to complete a BIMI with a volunteer you find to roleplay as “Keira”. If you cannot find a volunteer, you can roleplay “Keira” yourself.
You are an addictions counselor working at SUNDANCE RESIDENTIAL MENTAL HEALTH AND ADDICTIONS RECOVERY CENTRE. You are often asked to meet with clients who enter the facility due to a mental health crisis. At times some of these clients have substance abuse issues, but they have not entered the treatment center due to these issues. This is the case with Keira Keys.
KEIRA KEYS is a 27- year – old female who has entered the Sundance Mental Health & Addictions Recovery Centre. Keira came to the Centre after several days in the hospital after a serious suicide attempt. This was Keira’s 3rd attempt at suicide in the past 2 years.
Keira has been at the Sundance Recovery Centre for 2 weeks now and has been actively participating in therapy. Keira has disclosed to her therapist that prior to being hospitalized she had been drinking hard and using cocaine a lot more than usual. Keira has also indicated to her therapist that she is feeling very tired of her life. She has lost many of her old friends due to her lifestyle and while still in contact with her family, they are threatening to disown her.
The therapist had some details to pass on to you regarding some background information on Keira as well as some information about Keira’s substance use.
Keira lived in a very chaotic home with her parents and 3 siblings.Keira was the oldest and was expected to help look after her siblings from a very young age, while both her parents worked. Keira did not have a good relationship with her parents as she felt like she was their babysitter, not their daughter. Keira’s mom was very critical of Keira and her father was typically very quiet and would often go spend his free time in the garage ‘fixing things’. Keira learned later that her father went to the garage to drink. Keira never considered her father an alcoholic as he never appeared drunk and went to work every day. At the age of 17 Keira developed a relationship with a boy from school. Her new boyfriend expected Keira to spend time with him and so Keira began to rebel against her babysitting duties. Her parents weren’t happy and Keira left home before her 18th birthday. She lived with her boyfriend’s family for a few months until that relationship ended. Since that time, Keira has been struggling to support herself, but she does have her own basement apartment. She works in bars as a waitress and her tips, which is around $60.00 per night, help to keep her afloat. Due to her work environment, Keira stays for drinks with her peers after the bar closes every night. Keira has anywhere from 3 to 6 drinks depending on when the manager closes up. Keira never has to pay for drinks at the bar as the manager lets them drink for free. A year ago, she went to a party with a friend from work and she tried cocaine for her first time. For quite some time, Keira only used cocaine at parties when it was offered to her. However, over the past 3 months Keira has started buying her own. Keira is finding now that she is using her ‘tip’ money to buy cocaine, and she has less money for her living expenses. Last month, Keira was not able to make rent and her landlord threatened to evict her. It was after this news that Keira attempted to take her life by trying to overdose on alcohol and prescription meds (the therapist does not know where Keira got these). Lucky for Keira, a friend from work came by Keira’s apartment and found Keira.
The therapist has asked Keira if she would be willing to speak with you about substance use and Keira has agreed, although is not thrilled with the idea. She states she is willing to have a quick meeting with you, but she is not willing to go into another type of counseling or therapy session. BIMI Case Study and Instructions You see this as a good opportunity to use Brief Integrated Motivational Intervention with Keira and set up a time to sit down with her.
Below is a short guideline for you to follow. Please ensure you read your book for the complete information on how to complete a BIMI.
Step 1: Engagement and Brief Assessment (Chapter 2)
Session 1
Purpose: Build relationship and open environment in which substance use can be discussed. Complete worksheets: •
BIMI Brief Assessment Sheet •
AUDIT and/or SDS •
PHQ-9 •
GAD-7 •
You are at your first meeting with Keira. During this meeting you are building trust and a relationship. In a conversational style you must complete the Worksheet: BIMI Brief Assessment. Depending on Keira’s answers, there will be other questionnaires to complete with her. You must choose which worksheets to complete. As an example, if Keira is not misusing alcohol, then you would not complete an AUDIT. •
This first session may be a bit longer than the recommended 15 to 30 minutes due to the need to complete the questionnaires with your client.
Session 2
Purpose: Provide client with feedback from Session 1. Answer client questions, provide educational information to take away.
Complete worksheet *(before you meet with Kiera again): BIMI Assessment Feedback-Your Results
• To properly complete this worksheet, you will need to do some research. Be sure that any research and stats are CANADIAN.
• Be prepared to answer any questions the client may have in relation to their substance misuse and how it affects their specific mental health issues.
• During this session you will go over the results of the Feedback with your client and discuss how your client feels about the information you have presented.
Step 2: Making Decisions About Change (Chapter 3)
(Will take more than one session)
Purpose: Help client begin to consider benefits and costs associated with use.
Complete (your choice) Worksheet 1 or 2: What I enjoy about using/What keeps me using? Complete Worksheet 3: How does my use sometimes affect me?
• Complete Worksheet 1 or 2(these are the same worksheets but in different format): What I enjoy about Using/ What keeps me using?
• After discussing Worksheet 1/2; move on to Worksheet #3: How does my use sometimes affect me?
Step 3: Change Plans and Social Support (Chapter 4)
(Will take more than 1 session)
Purpose: Help build client confidence that change is possible. Identify small achievable substance related or personal goal.
Complete Worksheet 4: Taking steps toward my goals.
BIMI Case Study and Instructions
• Help client identify who is their circle of healthy supports.
• Discuss with client their personal goals. Then complete Worksheet 4: Taking steps toward my goals. You may need to use a larger sheet to complete worksheet 4. Assist your client in identifying things that might get in the way of success. Then work with your client to come up with strategies to deal with those possible setbacks should they occur.
Work Sheets
Image transcription text
BIMI-Brief Assessment Sheet Crack Cocaine
|Legal Illicit Alcohol Cannabis Cocaine
Powder | Highs | Heroin Method… Show more
Image transcription text
Crack Cocaine | Lego Illicit Alcohol Cannabis
Cocaine Powder Highs | Heroin Methodone |
Amphetamine Other What route… Show more
Image transcription text
Questions 1 2 3 4 Score 1 How often do you
have a drink Never Monthly 2-4 2-3 4+ times
containing alcohol? or less times… Show more
Image transcription text
SDS Tell your client: “Please think of
your use of during a recent period of
usingwhen you answer these qu… Show more
Image transcription text
MOODPHQ- 9 Name Date Over the lost 2
weeks, how often have you been Not Several
More Nearly bothered by any of … Show more
Image transcription text
GAD-7 Over the last 2 weeks, how often have
you been Not At Several More than Nearly
bothered by the following proble… Show more
Image transcription text
BIMI ASSESSMENT FEEDBACK-YOUR
RESULTS VENTION Diagnosis: Substance of
choice: Part 1 ALCOHOL DRUG… Show more
Image transcription text
Worksheet 1: What Do I Enjoy About Using or
What Keeps Me Using? What I enjoy about
using _(insert name of substanc… Show more
Image transcription text
Difficulties my use may be causing? 1. 2. 3. 4.
When I look over my list I feel Looking at it,
does it make me think differently… Show more
Image transcription text
Worksheet 2: What I Enjoy About Using or
What Keeps Me Using (Table) insert name of
substance] WORKSHEETS AND… Show more
Image transcription text
– Worksheet 3: How Does My Use Sometimes
Affect Me? MyTRIGGERS The EFFECT on me
What I THINK Later_qu’ Straight … Show more
Image transcription text
Worksheet 4: Taking Steps Toward My Goal
Now Goal Step 1: Step 2: Step 3: Step 4:
WORKSHEETS AND HANDOUT… Show more

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