Nokea
A nurse prepares for an initial interview with a patient with suspected adult attention-deficit/hyperactivity disorder (ADHD). Questions should be focused to elicit information about which problem?
- A. Headaches
- B. Inattention
- C. Sexual impulses
- D. Trichotillomania
Correct Answer: B
Rationale: Inattention usually persists from childhood into adult ADHD, although hyperactivity, impulsivity, and social impairments may also be present. Headaches would not be expected. Sexual impulses may be affected by adult ADHD, but this area is assessed later. Trichotillomania refers to pulling out one's hair as a tension-relieving behavior.
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The father of a child diagnosed with schizophrenia says, 'I lost my job, so we have no health insurance.' The mother says, 'I must watch this child all the time. Without supervision, our child becomes violent and destructive.' A sibling says, 'My parents don't pay attention to me.' These comments signify what related stress?
- A. Life-cycle stressors
- B. Psychobiological issues
- C. Family burden of mental illness
- D. Stigma associated with mental illness
Correct Answer: C
Rationale: Family burden refers to the meaning that the experience of living with a person who is mentally ill has for families. The stressors mentioned are not related to live-cycle issues. The stressors described are psychosocial. Stigma refers to shame and ridicule associated with mental illness.
A man tells the nurse, 'All my life, I have felt and acted like a woman while living in a man's body. For the past year, I have lived and dressed as a woman. I changed jobs to protect my new identity.' Which request is the patient likely to make to the health care provider?
- A. Can you refer me for psychological testing?'
- B. Will you prescribe hormonal therapy?'
- C. Will you alter my medical records?'
- D. What should I tell my parents?'
Correct Answer: B
Rationale: Before sexual reassignment surgery, the step that follows living as a member of the other sex is hormone therapy. The patient's decision to live as a woman makes this a natural request. Psychological testing occurs before sexual reassignment surgery, often after hormone therapy has begun. The patient has likely told his parents by this point.
Which nursing action should occur first when preparing to work with a patient who has a problem of sexual functioning?
- A. Acquire knowledge of the patient's sexual roles and preferences.
- B. Develop an understanding of human sexual responses.
- C. Assess the patient's sexual functioning.
- D. Clarify the nurse's own personal values.
Correct Answer: D
Rationale: Before a nurse can be helpful to patients with sexual dysfunction, he or she must be aware of and comfortable with his or her own feelings about sex and sexuality. Nurses must be comfortable with the idea that patients have a right to their own values and must avoid criticism and censure.
An adult has been feeling significant tension since losing a home through foreclosure. This person goes to park, feeds the birds, and then impulsively exposes himself to a group of parents and children. Which term applies to this behavior?
- A. Voyeurism
- B. Frotteurism
- C. Exhibitionism
- D. Sexual masochism
Correct Answer: C
Rationale: Exhibitionism is obtaining sexual pleasure from exposing one's genitalia to unsuspecting strangers. Voyeurism refers to obtaining sexual pleasure from observing people who are naked. Frotteurism is associated with obtaining sexual arousal by rubbing one's genitals against an unsuspecting person. Sexual masochism refers to deriving sexual pleasure from being humiliated, beaten, or otherwise made to suffer.
Which nursing diagnosis is likely to apply to the plan of care for a homeless individual diagnosed with severe and persistent mental illness?
- A. Insomnia
- B. Substance abuse
- C. Chronic low self-esteem
- D. Impaired environmental interpretation syndrome
Correct Answer: C
Rationale: Many individuals with severe mental illness do not live with their families and are homeless. Life on the street or in a shelter has a negative influence on the individual's self-esteem, making this nursing diagnosis one that should be considered. Insomnia may be noted in some patients but is not a universal problem. While substance abuse may be a comorbid problem, it is not an approved North American Nursing Diagnosis Association International (NANDA-I) diagnosis. Impaired environmental interpretation syndrome refers to persistent disorientation, which is not observed in a majority of the homeless population.