1. In the table below complete the personal development plan, setting goals and personal objectives that will enable you to improve on your own work practice / nursing career.
You can review the following example[1] to assist with this task
Personal Development Plan
Strengths Areas for further development
Opportunities What is stopping you
Setting Goals – discuss a minimum of three (3)
What do I want to learn?
What do I have to do?
What support and resources do I need?
How will I measure success?
Target date for review
Personal objectives
Short term goals (next 12 months)
Medium term goals (next 1 – 3 yrs.)
2. Discuss how you can measure the progress of this plan and the importance of measuring the progress. (Word Count Range: 50-100 words, reference)
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3. Once you have completed your personal development plan, undertake a self-evaluation of the plan by discussing it with a colleague you work with or one of your peers, then answer the following question.
Write a short self-evaluation of your personal development plan including any feedback you have received from your discussion of this plan with others (Word Count Range: 100-150 words)
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4a. Identify a time when you received feedback from an employer, peer or facilitator on vocational placement and discuss how the conversation went – show a 2-way open conversation about feedback, explain if the feedback was descriptive or evaluative and give a rationale (Word Count Range: 100-150 words, reference)
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4b. Now that you have discussed your personal plan, obtained feedback and completed a self-evaluation, outline at least two (2) areas that you feel could be improved upon. (Word Count Range: 50-100 words)
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5. Provide a short reflection on the feedback you have actively sought and received so far from your clinical placements, either from your facilitators or staff where you did placement. (Word Count Range: 50-100)
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6. Outline two (2) ways that you can regularly participate in the review processes at a place of employment that will show your commitment to upgrading your skills and knowledge (Word Count Range: 50-100 words, reference)
(Please note that this can relate to any employment that you are currently in or have been in)
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7. As you progress as a nurse there will be many opportunities to enhance your learning development. Outline three (3) ways you can seek specialist advice or further training (Word Count Range: 50-100 words, reference)
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[1] https://www.managers.org.uk/~/media/Files/Checklists/Personal-Development-Plan-Example-Guide.pdf

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During active labor, there is a gush of clear fluid and the fetal heart rate drops to 100 bpm. A vaginal examination reveals a loop of umbilical cord in the vagina. The nurse places the client in which position?
A) Trendelenburg
B) Lithotomy
C) Hands and knees
D) Left-side lying
2. A client at 8 weeks’ gestation comes to the clinic with vaginal bleeding and cramps. An ultrasound examination shows the cervix is dilated. What is the client experiencing?
A) Inevitable abortion
B) Threatened abortion
C) Missed abortion
D) Complete abortion
3. The nurses assesses a neonate born at 36 weeks’ gestation. The neonate is grunting, has nasal flaring, and subcostal retractions. Respiratory rate is 82 breaths/min, and on auscultations there are crackles in the lungs. What is the nurse’s assessment of the neonate’s condition?
A) Transient tachypnea
B) Surfactant deficiency
C) Persistent pulmonary hypertension
D) Apnea
4. A client at 38 weeks’ gestation is admitted to labor and delivery with vaginal bleeding after sustaining abdominal trauma. Which laboratory values are a priority in determining the plan of care for this client? Select all that apply.
A) Fibrinogen
B) Fibrin degradation products
C) Prothrombin time
D) Red blood cell count
E) Bleeding time
5. Why are newborns born to diabetic mothers prone to hypoglycemia?
A) Excess subcutaneous fat reduces blood flow to the tissues
B) Increased metabolic stress due to the stress on mother’s body
C) Elevated insulin production metabolized glucose faster
D) Liver is immature and cannot convert glycogen to glucose
6. A new mother is alarmed because her newborn has lost 10 ounces in weight since being born 2 days ago. She believes that she has been breastfeeding properly. Which information would the nurse include as a likely cause of this phenomenon? Select all that apply.
A) Absence of salt- and fluid-retaining maternal hormones
B) The infant’s voiding and passing stool
C) Low calorie content of colostrum
D) A congenital digestive disorder
E) An increase in fetal metabolism
F) Failure of mother to bond with newborn
7. A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant?
A) 6 months
B) 3 months
C) 9 months
D) 12 months
8. A woman with systemic lupus erythematosus is interested in preconception counseling to discuss her desire to get pregnant. The nurse explains that it would be best if she is symptom-free or in remission for how long before getting pregnant?
A) Schedule induction of labor today.
B) Allow her to continue without plans for delivery.
C) Schedule cesarean delivery at 39 weeks.
D) Prepare for assessment of fetal lung maturity.
9. The nurse determines that a fetal nonstress test is nonreactive for over 20 minutes. The nurse interprets this result as suggesting which situation? Select all that apply.
A) The patient is sleeping.
B) The patient is hypoglycemic.
C) The patient is using an illicit drug.
D) The patient is exercising too much.
E) The patient is smoking while pregnant.
10. A young mother gives birth to twin boys who shared the same placenta. What serious complication are they at risk for?
A) Twin-to-twin transfusion syndrome (TTTS)
B) HELLP syndrome
C) TORCH syndrome
D) ABO incompatibility
11. A patient in labor and delivery has just been diagnosed with pre-eclampsia. Which signs and symptom should the nurse prioritize when assessing this client? Select all that apply.
A) BP 140/90 mm Hg
B) slow reflexes
C) glucose in urine
D) edema of face
E) headache
12. A nurse is caring for a client who is at 36 weeks of gestation and who has a suspected placenta previa. Which of the following findings support this diagnosis?
A. Painless red vaginal bleeding
B. Increasing abdominal pain with a nonrelaxed uterus
C. Abdominal pain with scant red vaginal bleeding
D. Intermittent abdominal pain following passage of bloody mucus
13. A nurse is caring for a newborn immediately following birth. After assuring a patent airway, what is the priority nursing action?
A. Administer vitamin K.
B. Dry the skin.
C. Administer eye prophylaxis.
D. Place an identification bracelet.
14. A nurse in a prenatal clinic is caring for a client who is at 7 weeks of gestation. The client reports urinary frequency and asks if this will continue until delivery. Which of the following responses should the nurse make?
A. “It’s a minor inconvenience, which you should ignore.”
B. “In most cases it only lasts until the 12th week, but it will continue if you have poor bladder tone.”
C. “There is no way to predict how long it will last in each individual client.”
D. “It occurs during the first trimester and near the end of the pregnancy.”
15. A nurse is caring for a client who just delivered a newborn. Following the delivery, which nursing action should be done first to care for the newborn?
A. Clear the respiratory tract.
B. Dry the infant off and cover the head.
C. Stimulate the infant to cry.
D. Cut the umbilical cord.
16. A nurse in labor and delivery is caring for a client. Following delivery of the placenta, the nurse examines the umbilical cord. Which of the following vessels should the nurse expect to observe in the umbilical cord?
A. Two veins and one artery
B. One artery and one vein
C. Two arteries and one vein
D. Two arteries and two veins
17. A nurse in a prenatal clinic is caring for a client who is suspected of having a hydatidiform mole. Which of the following findings should the nurse expect to observe in this client?
A. Rapid decline in human chorionic gonadotropin (hCG) levels
B. Profuse, clear vaginal discharge
C. Irregular fetal heart rate
D. Excessive uterine enlargement
18. A nurse is caring for a new mother who is concerned that her newborn’s eyes cross. Which of the following statements is a therapeutic response by the nurse?
A. “I will call your primary care provider to report your concerns.”
B. “I will take your baby to the nursery for further examination.”
C. “This occurs because newborns lack muscle control to regulate eye movement.”
D. “This is a concern, but strabismus is easily treated with patching.”
19. A nurse is caring for a client who is having a nonstress test performed. The fetal heart rate (FHR) is 130 to 150/min, but there has been no fetal movement for 15 min. Which of the following actions should the nurse perform?
A. Immediately report the situation to the client’s provider and prepare the client for induction of labor.
B. Encourage the client to walk around without the monitoring unit for 10 min, then resume monitoring.
C. Offer the client a snack of orange juice and crackers.
D. Turn the client onto her left side.
20. A nurse on a labor unit is admitting a client who reports painful contractions. The nurse determines that the contractions have a duration of 1 min and a frequency of 3 min. The nurse obtains the following vital signs: fetal heart rate 130/min, maternal heart rate 128/min and maternal blood pressure 92/54 mm Hg. Which of the following is the priority action for the nurse to take?
A. Notify the provider of the findings.
B. Position the client with one hip elevated.
C. Ask the client if she needs pain medication.
D. Have the client void.
21. A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is “not
really sure if she is in labor or not.” Which of the following should the nurse recognize as a sign of true labor?
A. Rupture of the membranes
B. Changes in the cervix
C. Station of the presenting part
D. Pattern of contractions
22. A nurse is caring for a client who is at 40 weeks of gestation and is in labor. The client’s ultrasound examination indicates that the fetus is small for gestational age (SGA). Which of the following interventions should be included in the newborn’s plan of care?
A. Observe for meconium in respiratory secretions.
B. Monitor for hyperglycemia.
C. Identify manifestations of anemia.
D. Monitor for hyperthermia.
23. A nurse is instructing a woman who is contemplating pregnancy about nutritional needs. To reduce the risk of giving birth to a newborn who has a neural tube defect, which of the following information should the nurse include in the teaching?
A. Limit alcohol consumption.
B. Increase intake of iron-rich foods.
C. Consume foods fortified with folic acid.’
D. Avoid foods containing aspartame.
24. A nurse in the ambulatory surgery center is providing discharge teaching to a client who had a dilation and curettage (D&C) following a spontaneous miscarriage. Which of the following should be included in the teaching?
A. Vaginal intercourse can be resumed after 2 weeks.
B. Products of conception will be present in vaginal bleeding.
C. Increased intake of zinc-rich foods is recommended.
D. Aspirin may be taken for cramps.
25. A nurse is preparing to assess a newborn who is postmature. Which of the following findings should the nurse expect? (Select all that apply.)
A. Cracked, peeling skin
B. Positive Moro reflex
C. Short, soft fingernails
D. Abundant lanugo
E. Vernix in the folds and creases
26. A nurse is caring for a client who is in the first stage of labor. The nurse observes the umbilical cord protruding from the vagina. Which of the following actions should the nurse perform first?
A. Cover the cord with a sterile, moist saline dressing.
B. Prepare the client for an immediate birth.
C. Place the client in knee-chest position.
D. Insert a gloved hand into the vagina to relieve pressure on the cord.

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Mr. Y is a 78-year old man who was born in Korea and moved to the US with his wife 50 years ago. Together, the couple opened a floral shop and ran the business for 40 years. Mrs. Y enjoyed watching her husband’s talent and love of nature come out in his flower arrangements.
When Mr. Y was in his late 60’s, he started having difficulty making his favorite flower arrangements. Their son also noticed Mr. Y misplacing tools, losing paper orders, and forgetting important pick-up times. At home, Mrs. Y noticed her husband having problems remembering recent events, and waking up at odd hours in the night thinking it was time to open the shop. Mr. Y was becoming irritable at home and at the shop.
When Mr. Y was 70 years old, the family decided to sell the business. Their healthcare providers confirmed that Mr. Y was presenting with early stage Alzheimer’s disease. The family decided that Mrs. Y would be appointed as her husband’s Power of Attorney for personal care and property. She continued to care for her husband at home.
When Mr. Y turned 75-years old, he was having increased difficulty remembering where things were in the house. He often woke his wife at odd hours of the night thinking it was time to get up and ready. When Mrs. Y reoriented her husband that it was still night-time, he would get confused an easily upset. Mr. Y was also becoming more physically weak, but did not perceive his limitations. He was home, forgetting where he had to go and which house was his.
Their son recognized that his mother was as happy as she used to be. She was constantly worrying about her husband’s increasing care needs, and could not enjoy activities she used to do. She was stressed and was not sleeping properly. With support from their healthcare providers the family decided that a long-term care setting would benefit Mr. Y and Mrs. Y’s well-being.
Admission to long-term care
At the admission conference, the long term care home’s social worker and charge nurse met Mr. Y and his family, and learned more about his history and preferences. His medical diagnosis includes moderate Alzheimer’s disease and osteoarthritis, with a history of urinary tract infections. Mr. Y hears well, uses reading glasses, and wears upper and lower dentures. Mr. Y also requires reminders to use his walker properly. Mrs. Y always prompted her husband for toileting, as well as when to eat and take medications. Mr. Y requires limited assistance from his wife during activities of daily living, such as dressing or transfers. As for his preferences, Mr. Y loves homemade Korean food, pastries, and warm drinks. He had always enjoyed baths in the evenings.
Mr. Y’s first week
During the first week in LTC, the staff noticed Mr. Y pacing the hallways, pushing locked doors, entering other residents’ rooms. When approached by the nursing staff, he had repetitive questions: “Who are you?”, “What do I do?”, “Where do I go?” Mr. Y required frequent reminders that this was his new home. During meals, Mr. Y ate little despite encouragement and staff offering assistance. During personal care such as changing, toileting and showering, Mr. Y kicked, scratched, grabbed and screamed at the staff. Two staff were required during these care activities.
Socially, Mr. Y actively participated in group craft activities and exercise classes when the therapists and staff coached him. During the times with no scheduled activities, Mr. Y paced the hallways and asked staff: “What do I do?”, “Where do I go?”
Mr. Y’s second week
At the end of the second week in the LTC, Mr. Y was no longer pacing the halls. He was often found napping in his room during the days. One afternoon, a staff nurse went into Mr. Y’s room and found him sleeping. She tried to gently wake Mr. Y, but he was not easy to arouse. She tried a second time and asked very loudly, “Mr. Y, it’s lunch time, are you ready to go?” Mr. Y slowly opened his eyes. The staff nurse repeated the question, and Mr. Y replied slowly, “Oh, I ate last week.” The staff nurse then asked “I know you had breakfast this morning, now it’s lunch time. Are you hungry?” Mr. Y paused and closed his eye. The staff nurse gently woke him again by rubbing his arm and repeated her question. Mr. Y slowly replied, “Yes, my wife is cooking, I will eat.” Together, they walked slowly to dining room.
In the dining room, Mr. Y stared out the window and did not answer the staff nurse when they asked him for his lunch preference. When approached a third time, Mr. Y rambled slowly in English and in Korean to the staff nurse. He continued to speak Korean to the staff nurse as they tried to assist him with his lunch, but he was unfocused and inattentive. He was unable to finish his meal because of his behavior. The staff were worried that he was not eating or drinking enough since admission.
When there were group activities, the therapists found it harder to encourage Mr. Y to attend and participate like he had been doing before. It took a lot of encouragement and assistance to have him attend. During the activity, he did not participate or sometimes fell asleep in the middle of the exercise or social program.
A few nights in a row, he was found wandering outside his bedroom without his walker. One time, he told the staff nurse, “Someone is looking for me.” The PSW reassured him that he is safe, and tried to direct him back to his room. But Mr. Y walked past the staff nurse and said, “I have to go to the bus stop.” After a few attempts, the staff nurse was able to direct Mr. Y to his room to sleep, and reoriented him to the use of the call bell. This behavior continued with increasing disorientation. The sleep disturbances resulted in Mr. Y being too drowsy in the mornings, and not able to eat any breakfast.
Although Mrs. Y was kept informed of her husband’s condition since admission to long-term care, it was not until her first visit during Mr. Y’s third week in long-term care when she realized how much her husband had changed. She was alarmed and asked the staff, “What is happening? What will be done for him? How can I help?”
Behavioral and psychological symptoms of dementia is a term used to describe the way a person with dementia expresses their unmet needs and presents symptoms of dementia. It is important to explore what is going on for the person. Looking at Mr. Y’s first week in long-term care:
He is wandering a lot, and staff has to re-orient him many times. What do you think is happening and why might he be reacting this way?
Mr. Y’s Alzheimer’s has progressed to Middle-stage Alzheimer’s which makes him forgetful of events or personal history, confused about where he is or what day it is, and shows an increased tendency to wander and become lost.
In Middle-stage Alzheimer’s Mr. Y starts to demonstrate personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior. He may get frustrated or angry and act in unexpected ways, such as refusing to bathe.
I would assess their pain, infections, electrolyte imbalances or metabolic disorders, urinary retention, constipation, cerumen, and others.
During Mr. Y’s personal care, what might be happening for him and why might he be reacting this way?
What other things can you do to explore underlying causes of a person’s behavioral and psychological symptoms of dementia?
A range of non-pharmacological approaches to care have been found to be effective at managing behavioral and psychological symptoms of dementia, but not all approaches are effective or appropriate for everyone. It is important to tailor a care plan to meet the person’s needs and preferences. What non-pharmacological approaches have you used to manage behavioral and psychological symptoms of dementia? Would you want to use these for Mr. Y?
Caring for people with dementia requires effective communication skills. Which strategies might work for Mr. Y? What are some communication strategies that have worked for you in the past?
There are several strategies to preserve Mr. Y’s abilities and promote living well with dementia.
What are some activities that long-term care staff can offer that you think Mr. Y will enjoy? Think of what he liked to do at home.
How can we promote Mr. Y’s social life?
It is important to promote a healthy lifestyle. How can we support Mr. Y’s nutrition?
How can we improve his quality of sleep?
Are there any issues surrounding Mr. Y’s safety? What can we do to make the environment safer?

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) Which of the following would be a developmental red flag that would trigger further
assessment for a 2-year-old?
A.
Cannot jump; cannot throw object overhand.
B.
Cannot use a three-word sentence; speech only 50% understandable
C.
Cannot use a meaningful two-word phrase; lack of empathy (looking sad
if a child cries)
D.
Never imitates adult activities; cannot do parallel play.
)Which of the following are included in the clinical features of anxiety illness disorder? Check all
that apply.
A.
Persons maintain they have a particular disease or as time progresses their belief
may transfer to another disease.
B.
Lab results, lack of progression of the disease, and appropriate reassurances from the
provider are helpful treatments for the person with the disease.
C.
Preoccupation with illness may or may not interfere with their interaction with family,
friends, and co-workers.
D.
They are often addicted to internet search about their feared illness, inferring the
worst from the information.
) A dementia which usually occurs in the sixth decade of life, characterized by gradual onset
and progressive decline without focal neurological deficits is known as which of the
following?
A.
HIV dementia
B.
Vascular dementia
C.
Lewy-body dementia
D.
Alzheimer’s type dementia
(DAT)
) Which of the following is true about impulses? Check all that apply.
A.
Impulses are acted upon with the expectation of receiving
pleasure
B.
Impulses are usually ego-dystonic.
C.
Impulsive behaviors are characterized by their repetitive
nature.
D.
The repeated acting out of impulses leads to psychological
impairment.
) Which of the following is consistent with dementia in HIV?
A.
The individual’s decline is very slow and may take years to progress.
B.
The individual’s decline is progressive in nature with motoric and behavioral
abnormalities.
C.
The individual’s decline is in a stepwise fashion with motoric and behavioral
abnormalities.
D.
The individual’s decline has marked variability and fluctuating motoric and behavioral
abnormalities.
70) Somatoform disorders represent which type of clinical problem in psychosomatic Medicine?
A.
Co-occurring medical and psychiatric conditions.
B.
Psychiatric complications of medical conditions and
treatments.
C.
Psychiatric symptoms secondary to a medical
condition.
D.
Psychological factors precipitating medical
symptoms.
) A type of delirium characterized by psychomotor retardation and apathy is known as which
of the following?
A.
Mixed delirium
B.
Medical delirium
C.
Hypoactive
delirium
D.
Hyperactive
delirium
A child 0-3 months would be expected to be able to do which of the following?
A.
Develop social smile
B.
React and turn toward
sounds
C.
Watch faces, follows
objects
D.
All the above
The ARNP is meeting with a person who reports a fascination with fire, along with recurrent
deliberate and purposeful setting of fires. The ARNP realizes that these behaviors are
consistent with which of the following disorders?
A.
Pyromania
B Obsessive-compulsive
. disorder
C.
Intermittent explosive
disorder
D.
Pyrophobia
Which of the following supports a good prognosis for a person with a conversion disorder?
A.
Insidious onset
B.
Clearly identifiable stressors at time
of onset
C.
Average intelligence
D.
B and C
Which of the following medications are FDA-approved medications for the treatment of
delirium?
A.
Donepezil
B.
Galantamine
C.
Rivastigmine
D.
None of the
above
Depression secondary to interferon treatments represents which of the following clinical
problems in psychosomatic medicine?
A.
Psychiatric complications of medical conditions and
treatments.
B.
Psychiatric symptoms secondary to a medical condition.
C.
Psychological factors precipitating medical symptoms.
D.
Psychiatric symptoms as a reaction to medical condition or
treatments.
Which of the following is a common visceral symptom of conversion disorder?
A.
Seizures
B.
Diarrhea
C.
Paralysis
D.
Mid-line
anesthesia
Which of the following are common disorders that must be differentiated from dissociative
identity disorder? Check all that apply.
A.
Perimenstrual disorders
B.
Posttraumatic stress
disorder
C.
Obsessive-compulsive
disorder
D.
B and C only
In treating a patient with dementia and a co-occurring depression, which of the following
symptoms should be treated first?
A.
Insomnia
B.
Irritability
C.
Loss of
appetite
D.
Depressed
mood
Which of the following is consistent with normal range gross motor developmental
milestones for a 4 year old?
A.
Walks down stairs, jumps backwards
B.
Balances on one foot for 4 seconds, can broad
jump 1 foot
C.
Writes part of name; copies a square.
D.
Eats independently, unbuttons items
Which of the following social interactions indicates progression into the normal range,
meeting developmental milestones for a 5-year-old?
A.
Shares on own
B.
Engages in imaginative play
C.
Group play; has a preferred friend
D.
Has a group of friends, apologizes
for errors
Visual hallucinations are associated with impairment in which of the following regions of the
brain?
A.
Occipital
B.
Temporal
C.
Left parietal
D.
Frontal,
prefrontal
The ARNP is doing a physical exam on a patient that has a paralyzed hand of unknown
etiology in which the patient’s hand is raised and dropped into the patient’s face. Which of
the following patient responses support the finding of a conversion disorder?
A.
The patient’s hand drops onto the patient’s face.
B.
The patient’s hand falls next to the patient’s face.
C.
The patient’s hand stays in the air when dropped.
D.This would not be an appropriate test for conversion
disorder.
Which of the following are included in the five different milestone skill areas that should be
evaluated?
A.
Social/emotional skills
B.
Gross/fine motor skills
C.
Speech and language
skills
D.
All the above
Which of the following approaches/treatments are recommended in working with patients
with a conversion disorder?
A.
After a very thorough evaluation to r/o any medical cause, tell the patient that the
symptoms are imaginary.
B.
Recommend psychotherapy to focus on issues of stress and coping.
C.
Recommend psychoanalysis to explore intrapsychic conflicts.
D.
B and C only
hich of the following adaptive skills are consist with normal range developmental milestone
of an 18-month-old?
A.
Bite, chews cookie; looks for
fallen item
B.
Finger feeds items; takes off a
hat.
C.
Gets onto a chair; removes
garment
D.
Opens doorknobs; pulls off pants.
N-Methyl D-aspartate glutamate receptor antagonists are used to treat dementia by doing
which of the following?
A.
Stall the neurodegenerative processes
B.
Promotes synaptic plasticity
C.
Prevent over excitation of glutamate
receptors
D.
All of the above
Which of the following is NOT consistent with what is known about intermittent explosive
disorder across the lifespan?
A.
Intermittent explosive disorder may appear at any stage of life.
B.
Intermittent explosive disorder usually appears between late adolescence and
early adulthood.
C.
Intermittent explosive disorder typically increases in severity with the onset of
middle age.
D.
The onset of intermittent explosive disorder may be acute or insidious.
Which of the following is not consistent with what is known about the epidemiology of
dissociative fugue?
A.
It is usually described in adults.
B.
It is commonly described in men
C.
It is more common in women than in men.
D.
It is more common during natural disasters, war time, or times of major social
dislocations and violence.
A cognitive assessment should include which of the following?
A.
Baseline cognitive
functioning
B.
Changes from baseline
functioning
C Speed of onset of cognitive
. changes
D.
All of the above
The ARNP notices that a patient with a conversion disorder unable to walk has an
inappropriately cavalier attitude toward what seems to be a major impairment and
recognizes this an associated psychological symptom known as which of the following?
A.
Identification
B.
Primary gain
C.
Secondary gain
D.
La belle
indifference
Which of the following speech and language skills are consistent with normal developmental
milestones of a 3-year-old?
A.
Uses three-word sentences; names body
parts.
B.
Uses two-word sentences; understands me
and you
C.
Follows three-step request; tells stories
D.
Responds to “why?”; likes rhyming words
A patient presents with persistent feelings of detachment from one’s self, like watching
one’s self in a movie. The ARNP recognizes this as which of the following?
A.
Derealization
B.
Depersonalization
C.
Generalized amnesia
D.
Dissociative identity
disorder
Schizophrenia in a patient with end-stage renal disease is an example of which type of
clinical problem in psychosomatic medicine?
A.
Co-occurring medical and psychiatric conditions
B.
Psychiatric symptoms secondary to a medical
condition
C.
Psychiatric symptoms as a reaction to a medical
condition
D.
Psychiatric complications of medical conditions and
treatments
A person erroneously believes they sustained an emotional or physical trauma in early life is
known as which of the following?
A.
Ganser syndrome
B.
False memory syndrome
C.
Factitious dissociative identity
disorder
D.
Imitative dissociative identity
disorder
MRI findings in patients with intermittent explosive disorder may reveal changes to which
area of the brain that is associated with loss of impulse control?
A.
Cerebellum
B.
Prefrontal
cortex
C.
Temporal lobe
D.
Parietal lobe
The ARNP evaluates a 4-year-old who cannot balance on one foot for 3 seconds, cannot copy
a circle and realizes which of the following?
A.
This is normal for a 4-year-old.
B.
This is a developmental red flag for a 4-year-old that should trigger a specialized
assessment.
C.
This is a developmental red flag for a 5-year-old so do nothing at this point.
D.
This is a minor concern, the APRN advises to enroll the child in gymnastics for
balance and an art class to learn to draw better.
Which of the following is consistent with what is known about treating individuals with
kleptomania?
A.
Insight-oriented psychotherapy has been shown to be effective regardless of
motivation level of the individual.
B.
Psychoanalysis is the treatment of choice.
C.
Behavior therapy including aversion therapy has been reported to be successful with
highly motivated individuals.
D.
A combination of aversive conditioning and alter social contingencies has been
reported successful even when self-motivation was lacking

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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

*** 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? —This is my patient information—- *** attached is the different student sample on different patient*** that you could get clue
Image transcription text
Nursing Diagnosis related to –. Nursing
Diagnosis related to –. as evidence by–
Nursing Diagnosis related to –. a… Show more

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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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