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Psychiatric Mental Health Nursing 4th Edition Frisch Test Bank

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Psychiatric Mental Health Nursing 4th Edition Frisch Test Bank

ISBN-13: 978-1435400771

ISBN-10: 1435400771

 

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Psychiatric Mental Health Nursing 4th Edition Frisch Test Bank

ISBN-13: 978-1435400771

ISBN-10: 1435400771

 

 

 

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Free Nursing Test Questions:

CHAPTER 20 THE CLIENT WITH DISORDERS OF SELF-REGULATION: SLEEP DISORDERS, EATING DISORDERS, SEXUAL DISORDERS

 

TRUE/FALSE

 

  1. Rapid eye movement (REM) sleep is found in stage 1 sleep.

 

ANS:  F                    PTS:   1

 

  1. Sleep latency is a term that refers to the time it takes to fall asleep.

 

ANS:  T                    PTS:   1

 

  1. Treatment for anorexia is more effective than treatment for bulimia.

 

ANS:  F                    PTS:   1

 

  1. A person with a diagnosis of hypoactive sexual disorder is almost always elderly and suffering from hormonal abnormalities.

 

ANS:  F                    PTS:   1

 

COMPLETION

 

  1. The period of sleep characterized by vivid dreams and fast brain wave patterns similar to the awake state occurs during stage ____________________.

 

ANS:

5

five

 

PTS:   1

 

  1. The sleep disorder described as a condition in which a person falls asleep and stays asleep for several hours but does not feel rested when awakening is called ____________________.

 

ANS:  primary insomnia

 

PTS:   1

 

  1. Abnormalities in sleep patterns are called ____________________.

 

ANS:  dyssomnia

 

PTS:   1

 

  1. Severe daytime sleepiness for which there is no physiologic explanation or external cause is called ____________________.

 

ANS:  primary hypersomnia

 

PTS:   1

 

  1. The term that defines the learned expression of maleness and femaleness is called ____________________.

 

ANS:  gender role

 

PTS:   1

 

  1. A person’s internal sense of being a male or a female is called ____________________.

 

ANS:  gender identity

 

PTS:   1

 

  1. The human sexual response is composed of four stages, including desire, excitement, orgasm, and ____________________.

 

ANS:  resolution

 

PTS:   1

 

MULTIPLE CHOICE

 

  1. How many hours of sleep a night do most adults require?
a. 3 to 4
b. 5 to 6
c. 7 to 9
d. 10 to 12

 

 

ANS:  C

Most adults need the traditional 7 to 9 hours of sleep a night, but some adults are “short sleepers” and function well on only 3 or 4 hours. Persons who function well despite little sleep are not diagnosed with primary insomnia.

 

PTS:   1                    DIF:    Comprehension                               REF:   Sleep Disorders| Insomnia

 

  1. The nurse is working with a young adult who has a history of “irresistible urges for sleep, nodding off frequently at the most inconvenient times,” and being confused when “coming out of it.” The client describes feeling sleepy and then falling to the floor but not losing consciousness in the middle of laughing at a colleague’s story at work. This client is MOST likely suffering from which of the following disorders?
a. parasomnia
b. hypersomnia
c. insomnia
d. narcolepsy

 

 

ANS:  D

The client is most likely suffering from narcolepsy, a primary sleep disorder in which individuals frequently have three different and quite striking sleep-related symptoms. First, they have the frequent recurrence of an irresistible need for brief episodes of sleep. They awake from these feeling remarkably refreshed and rarely report daytime sleepiness except immediately prior to one of these episodes. Second, narcoleptic persons often have vivid dreamlike states as they are falling asleep or waking up. Third, they may have episodes of cataplexy.

 

PTS:   1                    DIF:    Analysis         REF:   Sleep Disorders| Daytime Sleepiness

 

  1. You are teaching a client about his diagnosis of narcolepsy. The client asks about the cause of this disorder. You would explain that this disorder:
a. has as its cause childhood sexual fears
b. is caused by the bite of a particular fly
c. is due to giving up too much sleep as a child
d. seems relatively common among close relatives

 

 

ANS:  D

The nurse should explain that there is strong evidence that narcolepsy has a hereditary predisposition. Narcolepsy is relatively common among close relatives of affected individuals.

 

PTS:   1                    DIF:    Application    REF:   Sleep Disorders| Daytime Sleepiness

 

  1. You are working with a client who has many of the symptoms of cataplexy. Which of the following questions would you ask this client about her experience, which she describes as a “collapsing spell,” to determine if it was cataplexy?
a. “Did you stop breathing?”
b. “Were you aware of your surroundings?”
c. “Would you describe it as a blackout?”
d. “Did other people witness the event?”

 

 

ANS:  B

To determine if the client has cataplexy, the nurse should ask the client if he or she was aware of his or her surroundings during one of the collapsing spells. Cataplexy is defined as the sudden loss of muscle power at times of sudden emotion, often laughter or fear. These persons may drop things or even fall to the ground, but unlike a simple faint, they never lose consciousness during a cataleptic episode.

 

PTS:   1                    DIF:    Application    REF:   Sleep Disorders| Daytime Sleepiness

 

  1. People who suffer from sleep terrors:
a. fear going to sleep
b. fear waking up
c. have no recall of the event
d. have vivid memories of nightmares

 

 

ANS:  C

Sleep terrors are related parasomnia in which there is no recall of the sleep-related event. Individuals experiencing sleep terrors rouse suddenly from sleep with a cry or scream. They typically sit up in bed in apparent terror; sweaty, pupils dilated, tachypneic, and tachycardic.

 

PTS:   1                    DIF:    Comprehension

REF:   Sleep Disorders| Parasomnias

 

  1. You are the nurse working with a client who complains of not sleeping well, waking up several times during the night, and not feeling rested in the morning. You will likely write a nursing diagnosis of:
a. Sleep-Pattern Disturbance
b. Intermittent Sleep Pattern
c. Restless Sleep Pattern
d. Impoverished Sleep Pattern

 

 

ANS:  A

Because the client complains of not sleeping well, waking up several times during the night, and not feeling rested in the morning, a nursing diagnosis of Sleep Pattern Disturbance would be used.

 

PTS:   1                    DIF:    Analysis         REF:   Nursing Diagnosis

 

  1. Which of the following nursing interventions is MOST common when working with a client who has a problem getting to sleep or waking during the night?
a. instructing the client to eat a meal or snack just before bedtime
b. watching television in the bedroom until falling asleep
c. drinking two glasses of wine just before bedtime
d. no food except warm milk within 3 to 4 hours of going to bed

 

 

ANS:  D

The most common intervention when working with a client who has a problem getting to sleep or waking during the night is to instruct the client that no food except warm milk should be consumed within 3 to 4 hours of going to bed. While a light snack may help, a heavy meal will not if gastroesophageal reflux (an occasional physical cause of insomnia) has been diagnosed in individuals who consume large meals within 3 hours of sleeping.

 

PTS:   1                    DIF:    Application    REF:   Techniques of Sleep Hygiene

 

  1. A client who has been taking prescription medication to treat insomnia for an agreed-upon trial period asks about remaining on the medication long-term for treatment of chronic insomnia. Your answer is MOST accurately based on which of the following?
a. Long-term use of medications is the only proven effective treatment for insomnia.
b. All medications prescribed to treat insomnia are studied over several years’ continuous use.
c. There is little data supporting the use of medications long-term for treatment of insomnia.
d. The Food and Drug Administration (FDA) does not approve medications unless they are safe for long-term use.

 

 

ANS:  C

There is little evidence supporting the long-term use of prescription medications in insomnia. However, persons receiving benzodiazepines reported more daytime sleepiness and dizziness than those given a placebo in one research study. Zolpidem and zaleplon may have somewhat fewer side effects, but there is still little evidence for long-term use.

 

PTS:   1                    DIF:    Application    REF:   Sleep Disorders| Treatment of Insomnia

 

  1. A nurse practitioner is treating a client for uncomplicated adult primary insomnia on an outpatient basis. After ruling out correctable medical causes for the insomnia, the nurse practitioner formulates a plan of care to provide primary care cognitive therapy to treat the insomnia. Whether or not this plan of care is appropriate depends on the knowledge that cognitive therapy developed for use by a primary care provider:
a. is not effective because cognitive therapy can be performed only by a cognitive behavioral therapy specialist
b. appears to have a good short-term efficacy for managing uncomplicated adult primary insomnia
c. contradicts the results of multiple studies that show no significant benefit from cognitive behavioral therapy for the treatment of insomnia
d. results in the same efficacy and side-effect profile as placebo therapy

 

 

ANS:  B

A “primary therapy” cognitive therapy appears to have good short-term efficacy for managing uncomplicated adult primary insomnia in outpatient practice. Cognitive behavioral therapy is likely to have fewer side effects and may have lower long-term costs than the use of prescription medications.

 

PTS:   1                    DIF:    Application    REF:   Sleep Disorders| Treatment of Insomnia

 

  1. A psychiatric nurse obtains an initial comprehensive history from a client during a psychiatric admission intake. The nurse notes the following positive findings: chronic fatigue and sense of nonrestful sleep, daytime sleepiness, hypertension, multiple awakenings throughout the night, and snoring. The nurse knows that this constellation of findings is MOST consistent with:
a. secondary insomnia
b. nocturnal seizures
c. obstructive sleep apnea
d. uncomplicated adult primary insomnia

 

 

ANS:  C

The client exhibiting chronic fatigue and a sense of nonrestful sleep, daytime sleepiness, hypertension, multiple awakenings throughout the night, and snoring is most like experiencing obstructive sleep apnea. In this condition the tissues of the upper airway relax so profoundly during deep sleep that they collapse and obstruct the flow of air into the lungs. When obstruction is only partial, snoring results, but when complete the client often arouses from sleep. Obstructive sleep apnea may increase a person’s risk of developing hypertension, heart disease, and depression.

 

PTS:   1                    DIF:    Analysis

REF:   Sleep Disorders| Daytime Sleepiness| Breathing-Related Sleep Disorders

 

  1. During a group conference, the topic of eating disorders is discussed. One of your classmates is caring for a teenager who is emaciated but continues to refuse to eat enough and engages in jogging daily. This client likely has the diagnosis of:
a. anorexia nervosa
b. bulimia nervosa
c. binge eating disorder
d. histrionic personality disorder

 

 

ANS:  A

The client would most likely have the diagnosis of anorexia nervosa. Anorexia nervosa is a medical-psychological condition characterized by profound disturbance in body image. Persons with this disorder view themselves as undesirably fat even when they become clinically emaciated. These individuals do not lose their appetite for food but actively starve themselves in an effort to keep from gaining weight. They also engage in exercises that will cause weight loss.

 

PTS:   1                    DIF:    Analysis         REF:   Eating Disorders| Anorexia Nervosa

 

  1. In planning care for a client with anorexia nervosa, which nursing diagnosis is the highest priority?
a. Altered Nutrition: Less than Body Requirements
b. Body Image Disturbance
c. Fluid and Electrolyte Imbalance
d. Self-Esteem Disturbance

 

 

ANS:  C

Fluid and electrolyte imbalance is the highest priority when planning care for someone with anorexia nervosa. Fluid and electrolyte imbalances can lead to cardiac rhythm abnormalities and risk of death. The first priority in treating a client diagnosed with anorexia nervosa is adequate nutrition to stop starvation.

 

PTS:   1                    DIF:    Analysis         REF:   Eating Disorders| Anorexia Nervosa

 

  1. The three major aspects of bulimia nervosa are BEST represented by which of the following clusters of behaviors?
a. fasting, bingeing, and purging
b. dieting, running, and controlling
c. cutting self, refusing to eat, and anger
d. isolating, many food dislikes, and nervousness

 

 

ANS:  A

Fasting, binging, and purging are the three behaviors that represent the main aspects of bulimia nervosa. There are estimates that this disorder affects 1% to 3% of all adolescent females, with a significantly lower number of adolescent males affected. There are grave physiological and psychological consequences from engaging in bulimia nervosa. Typically, those engaging in bulimia nervosa hide their activities and face a risk of being discovered by parents or other family members.

 

PTS:   1                    DIF:    Comprehension

REF:   Eating Disorders| Bulimia Nervosa

 

  1. A psychiatric diagnosis that often complicates bulimia is:
a. anxiety
b. depression
c. mania
d. psychosis

 

 

ANS:  B

Depression is a diagnosis that often complicates bulimia. The depression can also lead to suicide attempts or completed suicides. Other disorders that may be associated with bulimia are anorexia-nervosa, substance abuse, obsessive-compulsive disorder, and borderline personality disorder.

 

PTS:   1                    DIF:    Comprehension

REF:   Eating Disorders| Bulimia Nervosa| Body Image and Self-Worth

 

  1. You are working with a hospitalized client whose primary diagnosis is a medical diagnosis. This client also has a diagnosis of bulimia nervosa. Which of the following nursing actions would be your top priority?
a. Secure all the laxatives the client brought with her.
b. Assess for any self-harm ideation and means for suicide.
c. Orient the client to the unit rules and regulation.
d. Obtain a baseline set of vital signs and the client’s weight.

 

 

ANS:  B

When working with a hospitalized client who also has a diagnosis for bulimia nervosa, the top priority would be to assess for any self-harm ideation and means for suicide. Both major depressive disorder and borderline personality disorder are often diagnosed with people who have bulimia nervosa. Major depressive disorder and borderline personality disorder are both illnesses with a high risk of attempted and completed suicide.

 

PTS:   1                    DIF:    Application

REF:   Eating Disorders| Bulimia Nervosa| Body Image and Self-Worth

 

  1. You suspect that the client you are assigned has bulimia nervosa. Which of the following assessment findings would provide the strongest clue?
a. elevated vital signs
b. weight gain
c. erosion of dental enamel and salivary gland enlargement
d. skin lesions on upper arms and enlargement of the liver

 

 

ANS:  C

Erosion of dental enamel and salivary gland enlargement would be the strongest clue that the client has bulimia nervosa. Vomiting is the most common method of purging among people who are bulimic (although laxatives are also used). Frequent vomiting erodes the enamel on teeth and accelerates tooth decay. Also, enlargement of the salivary gland is common. Additionally, frequent vomiting and weight loss can disturb the electrolyte balance and also lead to heart arrhythmias.

 

PTS:   1                    DIF:    Analysis

REF:   Eating Disorders| Bulimia Nervosa| Body Image and Self-Worth

 

  1. In screening people for bulimia nervosa, the nurse would question the person about:
a. satisfaction with eating patterns and eating in secret
b. relationships with others and eating with others
c. childhood experiences with food and eating
d. feelings about food and nourishing the body

 

 

ANS:  A

The nurse would question individuals about whether they are satisfied with their eating habits and whether they find themselves eating in secret. A study found that whereas only 10% of all nonbulimic people are unsatisfied with their eating habits, fully 100% of all people who were bulimic were unsatisfied with their eating habits.

 

PTS:   1                    DIF:    Application

REF:   Eating Disorders| Bulimia Nervosa| Body Image and Self-Worth

 

  1. The inability of people with anorexia nervosa to process interoceptive stimuli has suggested to some researchers that anorexia might be caused by:
a. neurological or endocrine abnormalities
b. attempts to gain control of life
c. abnormal brain anatomy
d. brain pathway abnormalities

 

 

ANS:  A

Neurological or endocrine abnormalities may be responsible for that inability of people with anorexia to process interoceptive stimuli. This inability to process interoceptive stimuli results in being unable to tell when one is hungry or full. Some have posited an organic cause for these abnormalities. However, it is unknown whether these neurological and endocrine abnormalities are the cause or result of anorexia nervosa.

 

PTS:   1                    DIF:    Comprehension

REF:   Eating Disorders| Anorexia Nervosa| The Perceived Need for Weight Control

 

  1. The first step in the treatment of the client who is anorexic is:
a. nutritional rehabilitation
b. psychotherapy to enhance self-esteem
c. group therapy to share experiences
d. developing internal strategies

 

 

ANS:  A

The first step in treatment of a client who is anorexic is nutritional rehabilitation. Adequate nutrition to stop starvation must be the top priority. In some cases,  force-feeding may be necessary. Once adequate nutrition has been established, psychotherapy, maintenance, and finally, follow-up care can proceed.

 

PTS:   1                    DIF:    Application    REF:   Planning/Interventions

 

  1. Which of the following treatments has had some success in the treatment of anorexia?
a. gastric motility enhancers
b. hormonal therapy
c. intensive psychoanalysis
d. cognitive-behavioral therapy

 

 

ANS:  D

Cognitive-behavioral therapy (CBT) has had some success with clients who are anorexic. It has been more effective with clients who are bulimic. However, when a client who is anorexic is extremely emaciated, CBT and other psychotherapies lose priority over regaining nutritional balance for the client. In some cases, with profoundly emaciated clients who are anorexic, CBT is combined with force-feeding.

 

PTS:   1                    DIF:    Comprehension

REF:   Eating Disorders| Anorexia Nervosa| Treatment

 

  1. What is an indicator of high risk for acute mortality in anorexia?
a. early age of onset
b. comorbidity with depression
c. gender distinctions, male
d. weight 61% below ideal

 

 

ANS:  D

Weight 61% below ideal (a client weighing less than 40 percent of his or her ideal bodyweight) is an indicator for high risk of mortality among clients who are anorexic. In such cases severe electrolyte imbalances and cardiac rhythm abnormalities are most likely present. Force-feeding may be necessary when clients are unwilling (or due to physical deterioration, unable) to feed themselves.

 

PTS:   1                    DIF:    Comprehension

REF:   Eating Disorders| Anorexia Nervosa

 

  1. In caring for the client with anorexia who feels so out of control, the nurse can provide:
a. unlimited choices
b. rigorous intake requirements
c. rational limit setting
d. stress-reduction techniques

 

 

ANS:  C

The nurse can provide rational limit setting for clients with anorexia nervosa. In some cases, a client’s eating patterns may be so distorted that the client needs the nurse to help him or her relearn healthy eating practices. This, along with flexibility and empathy, can be very helpful for someone who is out of control with eating habits, but wishes to regain control. The nurse can role-model healthy eating and exercise behaviors, as well as provide emotional and psychological support.

 

PTS:   1                    DIF:    Application    REF:   Eating Disorders| Anorexia Nervosa

 

  1. The common psychological characteristic shared by individuals with eating disorders is:
a. noncompliance
b. protracted grieving
c. self-concept disturbance
d. self-care deficit

 

 

ANS:  C

Self-concept disturbance is the most common psychological characteristic shared by both clients who are anorexic and clients who are bulimic. Specifically, both clients who are anorexic and clients who are bulimic have a distorted body image. In the case of clients who are anorexic, this distorted body image may cause an individual to see him- or herself as being fat, regardless of how thin or emaciated the client becomes as a result of the disorder.

 

PTS:   1                    DIF:    Comprehension                               REF:   Eating Disorders

 

  1. The client with bulimia differs from the client with anorexia in that the person with bulimia:
a. usually is of normal weight
b. shows evidence of lanugo
c. has a distorted body image
d. has more rigid thinking

 

 

ANS:  A

Clients with bulimia tend to be of a normal weight. On the other hand, clients with anorexia can become so emaciated as a result of starvation that there is a great risk of death. In such cases, force-feeding may be required because the client is unwilling, or physically unable, to feed him- or herself.

 

PTS:   1                    DIF:    Comprehension

REF:   Eating Disorders| Anorexia Nervosa

 

  1. A client with bulimia asks you about using medication to treat her bulimia. Your response is based on the knowledge of which of the following?
a. Since bulimia is a behavioral problem, treating bulimia with medications is not an effective strategy.
b. Of the available selective serotonin reuptake inhibitors (SSRIs) medications, only the use of fluoxetine (Prozac) is supported by strong evidence.
c. The most effective medications are the benzodiazepine anxiolytics used to reduce panic attacks that trigger episodes of bulimia.
d. Pharmacological treatment of bulimia usually includes regularly scheduled antiemetics to prevent vomiting of stomach contents.

 

 

ANS:  B

Among the SSRIs, only fluoxetine (Prozac) was shown to be effective in managing bulimia. In addition to SSRIs, forms of psychotherapy have been used to treat bulimia. Cognitive behavioral therapy specifically was shown in one study to be more effective than antidepressants alone. CBT has been shown to reduce both the frequency and the severity of bulimic symptoms.

 

PTS:   1                    DIF:    Application    REF:   Eating Disorders| Bulimia Nervosa| Treatment

 

  1. You are a nurse working in a community hospital emergency department. A 19-year-old female is brought in to the ED with a fractured jaw and pelvis, sustained when the car she was driving was rear-ended by another vehicle going 10 mph as she sat at a red light. You become concerned that this client may engage in either anorexic or bulimic behaviors, because uncontrolled engagement in these behaviors over time:
a. often results in osteoporosis
b. is associated with increased suicidal behavior
c. will alter this client’s response to narcotic analgesics
d. interferes with the person’s ability to safely operate a motor vehicle

 

 

ANS:  A

Uncontrolled bulimic and anorexic behaviors can result in early onset osteoporosis. A lack of nutrients consumed in food results in a weakening in the bone structure. Additionally, bradycardia is almost always seen in people who are anorexic, due to both starvation and excessive exercise. Fractures in young women, especially after relatively minor trauma, is cause for suspicion of anorexia and bulimia.

 

PTS:   1                    DIF:    Application    REF:   Eating Disorders| Anorexia Nervosa

 

  1. The nurse working in a provider’s office would find most often that clients coming for annual checkups who have sexual problems:
a. readily volunteer information about sexual functioning without prompting
b. offer a primary complaint of sexual problems
c. open up about sexual problems only when the nurse asks questions
d. rarely describe any medical problems, but talk only about sexual problems

 

 

ANS:  C

Most clients only discuss sexual problems with their nurse when the nurse asks questions. Many people are uncomfortable talking about sexual matters with others, even health care professionals. Additionally, sexual problems are also the source of shame and embarrassment to those afflicted with them.

 

PTS:   1                    DIF:    Application    REF:   Sexual Disorders

 

  1. Paraphilias can be defined as sexual disorders of:
a. anatomy and physiology
b. generalized functioning
c. arousal
d. thoughts and behaviors

 

 

ANS:  D

Paraphilias are sexual disorders of arousal. They are disorders of sexual thought, fantasy, or behavior. This includes, but is not limited to, exhibitionism, transvestic fetishism, sadism, masochism, and pedophilia

 

PTS:   1                    DIF:    Knowledge    REF:   Sexual Disorders| Specific Sexual Disorders

 

  1. A psychiatric nurse practitioner takes a sexual history from a new client. To determine that the client’s sexual response pattern meets the criteria for disorder of sexual functioning, the nurse:
a. instructs the client to keep a detailed record of all sexual activity for a month
b. orders hormone-level laboratory testing at each stage of the client’s sexual response
c. asks if the observed problem is causing significant discomfort or distress to the client
d. rules out all possible physical causes of the sexual performance difficulty

 

 

ANS:  C

For a sexual response pattern to meet the criteria for a disorder of sexual functioning, the problem must cause significant discomfort and distress to the client. In many casesRemember,me sexual response patterns that could be considered “difficulties” are able to be comfortably integrated into the individual’s or couple’s life without discomfort or distress. In other cases, the “difficulties” may in fact be causing discomfort and problems in the individual’s or couple’s lives, yet they are using denial mechanisms to avoid acknowledging the issue as a problem.

 

PTS:   1                    DIF:    Application    REF:   Sexual Disorders| Disorders of Sexual Functioning

 

  1. Pedophilia is a paraphilia that is BEST described as:
a. extreme arousal by looking at feet
b. sexual interest directed at children
c. sexual turn-on by being in chains
d. cross-dressing to get aroused

 

 

ANS:  B

Pedophilia is sexual interest directed at children. Although such a disorder is commonly associated with illegal actions such as possession of child pornography and child molestation, in many cases an individual with tendencies toward pedophilia does not take any actions toward these desires beyond fantasizing about them. There are studies that show that a history of childhood sexual abuse may increase the risk of pedophilia among individuals.

 

PTS:   1                    DIF:    Knowledge    REF:   Sexual Disorders| Paraphilias

 

  1. Individuals with the paraphilia of transvestic fetishism are MOST commonly:
a. heterosexual females
b. heterosexual males
c. homosexual males
d. lesbian females

 

 

ANS:  B

Heterosexual males make up the majority of individuals with transvestic fetishism. Also, transvestic fetishism does not imply gender identity disorder. In other words, simply because an individual gains gratification from wearing the cloths of the opposite gender does not imply that that person wishes to become the opposite gender.

 

PTS:   1                    DIF:    Comprehension

REF:   Sexual Disorders| Paraphilias| Transvestic Fetishism

 

  1. The MOST frequently employed nursing intervention for a diagnosis of altered sexuality patterns requires the nurse to have developed skill in performing:
a. referrals to a sex therapist
b. cognitive behavioral therapy
c. sex education
d. active listening

 

 

ANS:  D

Nurses need to develop the skill of performing active listening as part of an intervention for a diagnosis of altered sexuality patterns. Using nursing theories that promote unconditional acceptance and support can be the most useful as a guide for planning care. In most cases complete trust is required before sexual issues can be discussed between a client and nurse.

 

PTS:   1                    DIF:    Application    REF:   Nursing Process| Planning/Interventions

 

  1. A male client being followed for premature ejaculation is prescribed the SSRI sertraline to be taken 4 to 8 hours prior to planned sexual intercourse. The client reads the client education leaflet for this medication and then asks you how taking an antidepressant medication will “fix” his problem with premature ejaculation when he isn’t depressed. Your explanation is based on the knowledge that sertraline is being used:
a. “off label” primarily for its side effect of delayed ejaculation
b. to treat a masked depression to resolve his sexual performance disorder
c. as a placebo to convince the client that the problem has been medically “fixed”
d. for its anxiolytic effect to reduce sexual performance anxiety

 

 

ANS:  A

SSRIs are primarily used to treat premature ejaculation due to the common side effect these medications have in delaying ejaculation. Whereas when prescribed to treat depression, such a side effect may be considered negative, it has proven beneficial in helping men who are not suffering from depression, but are suffering from premature ejaculation.

 

PTS:   1                    DIF:    Application

REF:   Sexual Disorders| Erectile Dysfunction, Male Menopause, and the “Medicalization” of Sexual Dysfunction: Premature Ejaculation

 

  1. An engaged couple seek premarital counseling. A priority when assessing factors that might complicate their adjustment to marital sexual activity with each other would be:
a. history of previous sexual activity
b. attitude toward engaging in psychotherapy
c. cultural or religious differences
d. age difference between 5 and 10 years

 

 

ANS:  C

Cultural and religious differences are an area that may complicate adjustment to marital sexual activities between an engaged couple. Because different cultures and religions have differing views on what constitutes normal sexual activity between two people, a couple who come from differing cultures may have very different expectations on what their sex life will be like. Cultural differences regarding what sexual acts are considered normal and what are considered taboo, norms on birth control methods and practices, even the amount of sexual activity one of the partners may have had before marriage may cause challenges during the marriage if not addressed beforehand.

 

PTS:   1                    DIF:    Application    REF:   Sexual Disorders

 

  1. When assessing a client for sleep disturbances, the associated fatigue and mood disturbances have been linked to all EXCEPT which of the following?
a. a pattern of daily naps and rest periods
b. medications, herbal remedies, other chemical use and exposure
c. which hours during the day or night the client usually works
d. chronic sleep shortage or deprivation

 

 

ANS:  A

A pattern of daily naps and rest periods are not associated with fatigue and mood disturbances. While naps may hamper an individual’s night sleep, establishing a pattern of naps and rest periods does not, in and of itself, create additional fatigue and mood disturbance. Medications, the hours a client works, and shortage of sleep can help create fatigue and mood disturbances. These issues affect both the amount of sleep received nightly and the quality of sleep received.

 

PTS:   1                    DIF:    Comprehension                               REF:   Sleep Disorders

 

  1. A psychiatric nurse is obtaining a comprehensive history from a 32-year-old male client who has engaged in bulimic behaviors over the past 17 years. When dealing with bulimia, the nurse knows that failure to improve may be associated with all EXCEPT which of the following?
a. comorbid substance abuse
b. the use of structured cognitive behavioral therapy
c. borderline, narcissistic, and antisocial personality disorders
d. a long-term duration of symptoms before initial diagnosis and treatment

 

 

ANS:  B

Failure to improve is not associated with structured cognitive behavioral therapy. In fact, cognitive behavioral therapy has been shown to be more effective in treating bulimia than antidepressants alone. Impulsivity and depression in addition to the other mentioned issues may also be associated with failure to improve.

 

PTS:   1                    DIF:    Application    REF:   Eating Disorders| Bulimia Nervosa| Treatment

 

  1. Which paraphilia is defined as the act of exposing one’s genitalia to a stranger?
a. exhibitionism
b. frotteurism
c. masochism
d. voyeurism

 

 

ANS:  A

Exhibitionism is a paraphilia dealing with a person who gains sexual gratification from exposing his or her genitalia to others. Some exhibitionists gain gratification from shocking their victims. For others, the gratification comes from fantasizing that their exposure will result in sexual interest in them on behalf of their victims. Very rarely do exhibitionists pursue their sexual overtures beyond exposing themselves, toward more aggressive action.

 

PTS:   1                    DIF:    Comprehension

REF:   Sexual Disorders| Paraphilias

 

  1. Which paraphilia is defined as sexual excitement from observing others’ bodies or others engaging in sexual activities?
a. sadism
b. fetishism
c. masochism
d. voyeurism

 

 

ANS:  D

Voyeurism is a paraphilia in which sexual excitement is derived from observing the bodies of others or observing others engaging in sexual activities. Oftentimes, for individuals with strong voyeuristic urges, they gain more excitement from watching others’ bodies or watching others engage in sexual activities than they do engaging in sexual activities themselves.

 

PTS:   1                    DIF:    Knowledge    REF:   Sexual Disorders| Paraphilias

 

  1. Which paraphilia is defined as sexual excitement from contact with a nonliving object?
a. fetishism
b. pedophilia
c. sadism
d. transvestic fetishism

 

 

ANS:  A

The definition of fetishism is sexual excitement from contact with a nonliving object. The types of objects are varied depending on the particular desires of the individual. In many cases, such individuals are unable to achieve sexual excitement or climax without the presence of such objects.

 

PTS:   1                    DIF:    Knowledge    REF:   Sexual Disorders| Paraphilia

 

  1. A couple arrives at a mental health clinic because the wife is concerned about some of her husband’s behavior. She relates to the nurse, “I have found him several times looking across the courtyard with binoculars and snooping on neighbors while they were having sex. I don’t understand, because he never wants to have sex with me.” The nurse’s assessment would MOST likely reveal which sexual disorder?
a. homosexuality
b. transvestism
c. voyeurism
d. fetishism

 

 

ANS:  C

The nurse recognize that this behavior is an example of voyeurism. Voyeurs derive sexual excitement from observing the bodies of others or observing others engaging in sexual activities. Oftentimes, for individuals with strong voyeuristic urges, they gain more excitement from watching others’ bodies or watching others engage in sexual activities than they do from engaging in sexual activities themselves.

 

PTS:   1                    DIF:    Application    REF:   Sexual Disorders| Paraphilias

 

  1. The nurse is assigned to provide care for a client admitted with anorexia nervosa. If the goal is to extinguish such habits as purging, hiding food, dieting, and using laxatives in order to increase proper nutritional habits and positive self-affirmations, nursing interventions would MOST likely be based on which form of therapy?
a. psychoanalytic
b. electroconvulsive therapy
c. behavioral therapy
d. reminiscent therapy

 

 

ANS:  C

Nursing interventions would most likely be based on behavioral therapy. This form of therapy is based on providing consequences for behavior. Loss of privileges may be a negative consequence and increased privileges and positive feedback are used as positive consequences of behavior.

 

PTS:   1                    DIF:    Application    REF:   Planning/Interventions

 

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