Chapter 43: Care of Persons Who Are Medically Compromised

Format: Multiple Choice

Client Needs: Psychosocial Integrity

Cognitive Level: Analyze

Integrated Process: Nursing Process

Objective: 1

Page and Header: 836, Common Secondary Mental Disorders in People with Chronic Medical Illness

1. The nurse is developing a plan of care for a client experiencing severe chronic pain caused by osteoarthritis. Which assessment finding would the nurse identify as a priority?

A) Protracted grief

B) Panic disorder

C) Bulimia

D) Depression

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2. A client visits the clinic and reports experiencing chronic pain in the left leg as a result of a fall six months ago. Which intervention would be most important for the nurse to first implement when developing the client’s plan of care?

A) Acknowledge the client’s pain.

B) Identify situations that increase the pain.

C) Have the client rate the pain from 1 to 10.

D) Review the client’s current medications.

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3. The nurse is caring for a client diagnosed with cardiovascular disease (CVD). Which factor would be most important for the nurse to assess when considering the client’s psychosocial functioning?

A) Sensory impairment

B) Cognitive impairment

C) Social behaviors

D) Anxiety state

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4. A client visits the clinic and tells the nurse about experiencing chronic stress on the job for the past three months. When teaching the client about chronic stress and related depression, which comorbidity would the nurse include as a possible physiological result?

A) Lung disorders

B) Renal disorders

C) Infections

D) Thyroid disorders

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5. A client visits the emergency department after being raped in an apartment. The nurse assesses the client’s ability to adapt to the trauma by assessing the client’s social support systems and which of the following?

A) Ability to effectively activate coping strategies

B) Evidence of body image disturbance

C) Type of affect reflected in nonverbal communication

D) Degree of fear response reflected in nonverbal communication

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6. The nurse is caring for four clients who are simultaneously being treated for chronic medical conditions and psychiatric conditions. Which client would the nurse anticipate as being most resistive to taking medications for both conditions?

A) Male client who is exhibiting push of speech

B) Female client who is having difficulty sleeping

C) Male client who is convinced he is the president’s twin brother

D) Female client who cannot establish and maintain eye contact

Page and Header: 838, Nursing Interventions for Patients with Medical Illness and Secondary Mental Disorders

7. A client is being treated for depression that has occurred secondary to a chronic cardiopulmonary condition. Which antidepressant would the nurse anticipate being prescribed?

A) Trazodone

B) Bupropion

C) Fluoxetine

D) Amitriptyline

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8. A 22-year-old college student received permanent traumatic brain injury (TBI) as a consequence of an automobile accident that resulted in the death of a close friend. The client feels guilty about the friend’s death. Which assessment would be a priority for this client?

A) Risk for suicide

B) Level of depression

C) Social support systems

D) Financial status

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9. A client recovering from a major stroke, is struggling to adjust to living with the permanent disabilities and problems related to speech and mobility. The nurse is making a home visit and assesses the client closely for an increased risk for which of the following?

A) Bipolar I disorder

B) Major depressive disorder

C) Generalized anxiety disorder

D) Posttraumatic stress disorder

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10. Which of the following group of symptoms would indicate to the nurse that the client may be experiencing depression in addition to being medically ill?

A) Problems sleeping, decreased appetite, and frequent crying

B) Low self-esteem, decreased appetite, and problems sleeping

C) Feeling guilty, difficulty making decisions, and low self-esteem

D) Loss of energy, difficulty making decisions, and problems sleeping

Page and Header: 843, Barriers to Care; 845, Box 43.5

11. A group of nursing students is reviewing information about barriers to pain management. The group demonstrates the need for additional study when they identify which barrier?

A) Fear of tolerance and addiction

B) Fear of pain treatment

C) Concern for being a good client

D) Reluctance to report pain

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12. After educating a group of nursing students about the connections between mental health and medical disorders on clients and families, the instructor determines the need for additional education when the students identify which effect?

A) Increased motivation for self-care

B) Prolonged hospitalization

C) Delayed recovery

D) Increased financial strain

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13. The nurse recognizes that a client diagnosed with which medical conditions is most likely to demonstrate a secondary mental illness?

A) Chronic back pain and major depressive disorder

B) Generalized anxiety disorder and major depressive disorder

C) Substance abuse disorder and bipolar disorder

D) Panic disorder and obsessive-compulsive disorder

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14. The nurse is seeing a client who has longstanding history of osteoarthritis triggered pain. The client presents with a one-month history of low mood, loss of interest, poor appetite, and sleep disturbance. The nurse recognizes which pharmacological treatment is most appropriate for this client?

A) Sertraline

B) Phenelzine

C) Divalproex

D) Risperidone

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15. The nurse is seeing a client diagnosed with neuropathic pain secondary to type 2 diabetes and chronically low mood. The client tells the nurse in a visit about being told to consider taking a psychiatric medication. Which medication was most likely suggested for this client?

A) Duloxetine

B) Phenelzine

C) Desipramine

D) Risperidone

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16. The nurse is seeing a client with a dual diagnosis of fibromyalgia and depression. The client tells the nurse about experiencing increased stress due the demands at work. Which question should the nurse ask first?

A) “Have you ever experienced stress like this at work before?”

B) “Do you think your perception of the stress is accurate?”

C) “Have you considered increasing the dose of your pain medication?”

D) “Do you think you need to take some time off work?”

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17. A nurse is describing how pain can impact a client psychosocially. As part of the discussion, the nurse explains the pain response, identifying which substance as an excitatory amino acid being involved? Select all that apply.

A) Somatostatin

B) Substance P

C) L-glutamate

D) Serotonin

E) N-methyl-d-aspartate

F) Endorphins

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18. A client who had a myocardial infarction 2 months ago comes to the clinic for a follow-up visit. While assessing the client, the nurse would be most alert for the development of which responses? Select all that apply.

A) Personality disorder

B) Depression

C) Substance abuse disorder

D) Anxiety disorder

E) Delirium

Page and Header: 836, Common Secondary Mental Disorders in People with Chronic Medical Illness; 840, Table 43.2

19. A nurse is reviewing the medication history of a client who is now also exhibiting signs and symptoms of depression and agitation. Which medications would the nurse identify as possibly contributing to the client’s current state? Select all that apply.

A) Clonidine

B) Ibuprofen

C) Acetaminophen

D) Baclofen

E) Carvedilol

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20. A nurse is assessing a client diagnosed with neuropathic pain. Which characteristics should the nurse note upon assessment? Select all that apply.

A) Tingling

B) Cramping

C) Burning

D) Numbness

E) Aching