A 9-year-old child has been admitted to the hospital after 'huffing' lighter fluid and is in a high euphoric state. For what should the nurse assess?
- A. Depressed respirations
- B. Severe vomiting
- C. Frightening hallucinations
- D. Elevation of temperature
Correct Answer: A
Rationale: Inhaling hydrocarbons depresses the central nervous system, including respiratory rate and general sensorium.
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The nurse is assessing a 16-year-old female for characteristics of anorexia nervosa. Which assessment finding(s) would lead the nurse to suspect the possibility of this diagnosis? (Select all that apply.)
- A. Amenorrhea
- B. Severe weight loss
- C. Oily skin
- D. Hypertension
- E. Lanugo on back
Correct Answer: A,B,E
Rationale: Primary symptoms of anorexia nervosa include severe weight loss, amenorrhea, and lanugo hair over the back and extremities.
When the nurse is collecting a nursing history, an adolescent states that she has tried speed. For what does the nurse recognize this as the street name?
- A. Barbiturates
- B. Cocaine
- C. Methamphetamine
- D. Marijuana
Correct Answer: C
Rationale: Speed' is the street name for methamphetamine.
How does the nurse describe a person who is bulimic?
- A. Severely underweight
- B. Alternates binge eating with purging
- C. Introverted perfectionist
- D. Has extremely close family relationships
Correct Answer: B
Rationale: Bulimia is characterized by alternating binge eating and purge behavior.
A nurse is hired to work in a psychiatric facility on a unit specializing in obsessive-compulsive disorders (OCD). Which diagnoses might the nurse expect to encounter? (Select all that apply.)
- A. Trichotillomania
- B. Hoarding disorder
- C. Excoriation disorder
- D. Body dysmorphic disorder
- E. Oppositional defiant disorder
Correct Answer: A,B,C,D
Rationale: Trichotillomania, hoarding disorder, excoriation disorder, and body dysmorphic disorder are forms of OCD, while oppositional defiant disorder is not.
What role has the child of an alcoholic assumed if he tries to do everything perfectly?
- A. Perfect child
- B. Super coper
- C. Flight
- D. Helper
Correct Answer: B
Rationale: The super coper is a child of an alcoholic who tries to do everything perfectly and feels overly responsible.
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