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An adult diagnosed with attention-deficit/hyperactivity disorder (ADHD) says, 'I've always been stupid. I never had friends when I was a child. My parents often punished me because I made mistakes. Now, I can't keep a job.' The nurse managing care should consider suggesting what intervention?
- A. Aversive therapy to extinguish negative behaviors.
- B. Cognitive therapy to help address internalized beliefs.
- C. Group therapy to allow comparison of feelings with others.
- D. Vocational counseling to identify needed occupational skills.
Correct Answer: B
Rationale: Cognitive therapy and knowledge of ADHD will make it possible for the patient to reframe the past and present in a more positive and realistic light and to challenge internalized false beliefs about self this improving self-image. Aversive therapy would not be useful for the patient. Group therapy may be valuable later to allow for the testing of new coping behaviors in a safe environment. Vocational counseling can help the patient explore suitable career options while pursuing treatment.
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An adult says, 'When I was a child, I took medication because I couldn't follow my teachers' directions. I stopped taking it when I was about 13. I still have trouble getting organized, which causes difficulty at my job.' Which disorder is most likely?
- A. Stress intolerance disorder
- B. Generalized anxiety disorder (GAD)
- C. Borderline personality disorder
- D. Adult attention-deficit/hyperactivity disorder (ADHD)
Correct Answer: D
Rationale: Adult ADHD is usually diagnosed in early life and treated until adolescence. Treatment is often stopped because professionals think the disorder resolves itself because the hyperactive impulsive behaviors may diminish; the inattentive and disorganized behaviors tend to persist, however. Stress intolerance disorder is not found in the DSM-5. The scenario description is inconsistent with generalized anxiety disorder and borderline personality disorder.
Which economic factors are most critical to the success of discharge planning for a patient diagnosed with severe and persistent mental illness?
- A. Access to housing
- B. Individual psychotherapy
- C. Income to meet basic needs
- D. Availability of health insurance
- E. Ongoing interdisciplinary evaluation
Correct Answer: A,C,D
Rationale: The success of discharge planning requires careful attention to the patient's economic status. Access to housing is the first priority of the seriously mentally ill, and lack of income and health insurance is a barrier to effective treatment and rehabilitation. Although important aspects of ongoing care of the seriously mentally ill patient, ongoing interdisciplinary evaluation and individual psychotherapy are not economic factors.
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.
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.
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.