50 Question RN Quiz - MH

The nurse would identify which medication as a high-potency medication used to treat schizophrenia? a. Loxapine b. Thioridazine c. Fluphenazine d. Perphenazine

c. Fluphenazine Fluphenazine is a high-potency medication used for schizophrenia. Loxapine and perphenazine are medium-potency medications used to treat schizophrenia. Thioridazine is a low-potency medication used to treat schizophrenia.

An older adult client reports flashbacks related to his experiences in Vietnam; he exhibits startle reactions and poor concentration. Which mental health disorder is associated with these symptoms ? a. Schizophrenia b. Bipolar disorder c. Post-traumatic stress disorder (PTSD) d. Obsessive-compulsive disorder (OCD)

c. Post-traumatic stress disorder (PTSD) PTSD is a syndrome characterized by the development of symptoms after an extremely traumatic event. Symptoms include helplessness, flashbacks, intrusive thoughts, memories, images, emotional numbing, loss of interest, avoidance of any place that reminds the affected person of the traumatic event, poor concentration, irritability, startle reactions, jumpiness, and hypervigilance.

Which intervention would the nurse include when developing a plan of care for an older client with dementia? a. Explain to the client the details of the regimen. b. Demonstrate interest in the client's various likes and dislikes. c. Be firm when dealing with the client's attitudes and behaviors. d. Provide consistency in carrying out nursing activities for the client.

d. Provide consistency in carrying out nursing activities for the client. The nurse would include providing consistency in carrying out nursing activities for the client. Familiarity with situations and continuity add to the client's sense of security and foster trust in the relationship. Detailed explanations will be forgotten; instructions should be simple and to the point and given when needed for clients with dementia.

Which explanation is true for childhood depression? a. May appear as acting-out behavior b. Looks almost identical to adult depression c. Does not respond to conventional treatment d. Is short in duration and has an early resolution

a. May appear as acting-out behavior Children have difficulty verbally expressing their feelings; acting-out behaviors, such as temper tantrums, may indicate an underlying depression. Adult and childhood depression may be manifested in different ways. Many conventional therapies for adults with depression, including medication, are effective for children with depression. Childhood depression is not necessarily short- term and requires treatment.

Which statement by the nurse indicates understanding of DSM-5 criteria for post-traumatic stress disorder (PTSD)? Select all that apply. One, some, or all responses may be correct. a. 'Feelings of self-worth remain high.' b. 'PTSD does not occur in children younger than 6 years of age.' c. 'Clients will remember all details of the event.' d. 'A person directly witnessed a traumatic event.' e. 'Flashbacks must last for longer than 1 month.' f. 'Derealization means feeling detached from your body.'

e. 'Flashbacks must last for longer than 1 month.' To meet the DSM-5 criteria for PTSD, the duration of intrusive symptoms (disturbing dreams, flashbacks, negative mood, and alterations in reactivity) must occur for more than 1 month. Clients with PTSD frequently demonstrate persistent negative beliefs about themselves. PTSD can occur in clients of any age, though the DSM-5 criteria are modified for children younger than 6 years of age. Clients frequently cannot remember important aspects of the traumatic event. Exposure to an actual or threatened event can cause PTSD. Derealization is a persistent experience of unreality; depersonalization means feeling detached from your body.

Based on the given table, which post-traumatic client is in need of counseling after a traumatic event? A - Have difficulty recalling the event. B - Have difficulty sleeping one month after the event C - Reporting "feeling numb" 1 week after the event D - Feeling exhausted due to a heavy workload

Client B - Having difficulty sleeping one month after the event A huge traumatic event may lead to the development of post-traumatic stress disorder (PTSD) in some survivors. Survivors such as client B who have difficulty sleeping 2 weeks or more after a disaster are at risk for PTSD and require counseling to reduce the risk of PTSD. Survivors of a traumatic event often report vivid memories or flashbacks of the event; inability to remember the event is not typical of clients at risk for PTSD. Therefore, client A would not likely require counseling. Survivors with PTSD report feeling numb for 2 weeks or more. Therefore, client C who reports feeling numb 1 week after the event may not require counseling. Feeling exhausted is not a risk factor for PTSD; therefore, client D may not require counseling.

The nurse is performing a mental health depression screen to determine an adolescent's risk of suicide. Which statement by the adolescent would most concern the nurse? a. 'I have a plan for taking my life.' b. 'Lately I have felt down and sad.' c. 'I don't have any close friends at school.' d. 'Several people in my family have been depressed.'

a. 'I have a plan for taking my life.' The nurse will be most concerned if a client reports having a plan for committing suicide. In this situation, the nurse seeks immediate intervention . When obtaining a health history, the nurse will assess a client for reports of feeling down, having no close friends, and a family history of depression. These factors will be further assessed to determine a client's risk for committing suicide, but do not represent immediate danger.

Which feeling would the nurse anticipate a manic client with bipolar 1 disorder is likely experiencing? a. Guilt b. Grandeur c. Worthlessness d. Self-deprecation

b. Grandeur The nurse would anticipate the client would experience feelings of grandeur. During a manic episode a client has an inflated self-esteem. Feelings of guilt worthlessness, and self-deprecation are not associated with bipolar disorder, manic episode; these occur during the depressive phase.

A mood-stabilizing medication is prescribed for a client's bipolar disorder. After the nurse completes a teaching session about the medication, which client comment indicates to the nurse that further teaching is needed? a. 'I know I won't have to stay on this medication for too long.' b.'I understand that I'll need to keep in touch with my primary health care provider.' c. 'Taking medication without using other forms of therapy may not be as effective.' d. 'Taking the medication is better than experiencing the highs and lows I've been having.'

a. 'I know I won't have to stay on this medication for too long.' The comment, 'I know I won't have to stay on this medication for too long', reveals that the client does not understand that the medication is necessary to prevent mood swings; long-term adherence to the pharmacological regimen is important in managing bipolar disorder. Regular medical visits are needed to ensure the best management of the illness. Various cognitive and behavioral therapies provide support in coping with life's stressors. Adherence to the medication regimen should eliminate mood swings for most people with bipolar disorder.

The CAGE questionnaire is used to screen the client's use of which substance? a. Alcohol b. Barbiturates c. Hallucinogens d. Multiple drugs

a. Alcohol The CAGE questionnaire is one of the simplest and most reliable screening tools for alcohol abuse. CAGE is an acronym for the key words (Cut down, Annoyed, Guilty, and Eye-opener) in the four questions asked of people suspected of abusing alcohol. The CAGE questionnaire is not designed to screen clients for barbiturate, hallucinogen, or multiple drug abuse.

Which signs and symptoms are the 'four A's' of Alzheimer disease? a. Amnesia, apraxia, agnosia, aphasia b. Avoidance, aloofness, asocial, asexual c. Autism, loose association, apathy, affect d. Aggressive, amoral, ambivalent, attractive

a. Amnesia, apraxia, agnosia, aphasia Neurofibrillary tangles in the hippocampus cause recent memory loss (amnesia) temporoparietal deterioration causes cognitive deficiencies in speech (aphasia), purposeful movements (apraxia), and comprehension of visual, auditory, and other sensations (agnosia). Avoidance, aloofness, asocial, and asexual are characteristics of the schizoid personality. Autism, loose association, apathy, and flat affect are characteristics of schizophrenia. Aggressive, amoral, ambivalent and attractive are characteristics of an antisocial personality.

For a client with obsessive-compulsive disorder, which reaction is most likely to occur when the performance of a ritual is interrupted? a. Anxiety b. Hostility c. Aggression d. Withdrawal

a. Anxiety Because the compulsive ritual is used to control anxiety, any attempt to prevent the action will increase anxiety. Underlying hostility is considered part of the disorder itself, not a reaction to an interruption of the ritual. Aggression is possible only if the anxiety reaches a panic level and causes the person to express anger overtly. Withdrawal is not a pattern of behavior associated with obsessive compulsive disorder.

Which signs and symptoms would the nurse find in a client who is in the depressive phase of bipolar I disorder? Select all that apply. One, some, or all responses may be correct. a. Apathy b. Hyperactivity c. Flight of ideas d. Loss of appetite e. Sleep disturbances

a. Apathy d. Loss of appetite e. Sleep disturbances The nurse would find apathy, loss of appetite, and sleep disturbances. When a client is depressed, the mood is sad or flat, which is manifested by apathy. Depressed people do not have an appetite or the energy to eat. Difficulty initiating or maintaining sleep or excessive sleepiness is associated with depression. Hyperactivity is a sign of the manic phase of bipolar disorder. Flight of ideas is a sign of the manic phase of a bipolar disorder.

A physically ill client is being verbally aggressive to the nursing staff. Which is the correct nursing response? a. Ask the client to tell me why he or she is upset. b. Explore the situation with the client. c. Withdraw from contact with the client. d. Tell the client the reason for the staff's actions.

a. Ask the client to tell me why he or she is upset. At this time the client is using this behavior as a defense mechanism. Using an open-ended question regarding the client's verbal aggression can be an effective interpersonal technique because it is nonjudgmental and allows the client to elaborate on feelings at the time. During periods of overt hostility, perceptions are altered, making it difficult for the client to evaluate the situation rationally. Withdrawal signifies non acceptance and rejection. The staff may be the target of a broad array of emotions; by focusing only on behaviors that affect the staff, the full scope of the client's feelings is not considered.

The mother of an adolescent complains of strange behavior such as sitting alone in a room, being inactive, having a sad facial expression, and withdrawing from previously enjoyed activities. On inquiry, the nurse finds that the adolescent's parents were recently divorced. Which condition does the client likely have? a. Depression b. Alcohol abuse c. Narcotic abuse d. Substance withdrawal

a. Depression The symptoms, such as sitting alone in a room, being inactive, having a sad facial expression, and withdrawal from previously enjoyed activities suggest that the adolescent is in a state of depression due to the interpersonal problems with his or her parents. Alcohol and narcotic abuse do not cause depressive symptoms. Substance withdrawal may cause agitation or nausea and vomiting.

During the initial assessment phase, which parameter would the nurse focus on for a client with panic disorder and agoraphobia? a. Easing the client's anxiety so further interviewing may be done b. Learning about the client's home life to facilitate the planning of future care c. Suggesting that the client rest for a while before taking the health history d. Helping the client identify the source of anxiety so the source may be avoided

a. Easing the client's anxiety so further interviewing may be done The nurse would focus on easing the client's anxiety so further interviewing may be done. The client will be unable to concentrate or focus on the interview if anxiety is not reduced. Learning about the client's home life to facilitate the planning of care is not the priority at this time; anxiety must be reduced and the client's level of comfort increased. The client will not rest until anxiety is reduced. Helping the client identify the source of anxiety so the source can be avoided is not the priority at this time; anxiety must be reduced and the client's level of comfort increased.

Which approach would the nurse use to help a client with bipolar disorder who is aggressive and disruptive in group and social settings develop social skills? a. Facilitating one-on-one interactions b. Encouraging self-care with support c. Developing guidelines for seclusion d. Helping the client decrease activity level

a. Facilitating one-on-one interactions The nurse would facilitate one-on-one interactions. A client who is aggressive in groups must begin socialization in one-on-one interactions that are less stimulating and distracting. Promoting self-care avoids addressing behaviors in group and social situations. Seclusion is always a last resort; the nurse does not want that to be the focus of the treatment. The client may not be able to decrease the activity at this time, and therefore it must be channeled appropriately.

Which reason would be likely for a client's anger and acting out when the nurse interrupts the hand-washing ritual of a client with obsessive-compulsive disorder? a. Has overwhelming feelings of anxiety b. Resents the nurse's authoritarian manner c. Is clashing with the nurse's personality d. Reflects an aggressive characteristic

a. Has overwhelming feelings of anxiety The client has overwhelming feelings of anxiety. The ritual reduces anxiety when not permitted to complete the ritual, a client with an obsessive-compulsive disorder will experience increased anxiety, frustration, and anger, and he or she may act out. The client is experiencing anxiety not related to the nurse's manner, personality clash, or an aggressive characteristic.

The nurse recognizes which atypical antipsychotics as being approved for long-term use to prevent the recurrence of mood episodes in clients with bipolar disease?Select all that apply. One, some, or all responses may be correct. a. Olanzapine b. Quetiapine c. Ziprasidone d. Risperidone e. Aripiprazole

a. Olanzapine c. Ziprasidone e. Aripiprazole Olanzapine, ziprasidone, and aripiprazole are atypical antipsychotics approved for long-term use to prevent recurrence of mood episodes. Quetiapine and risperidone are atypical antipsychotics approved for use in bipolar disease but are not approved for long -term use to prevent the recurrence of mood episodes.

Which term describes a display of anger that is socially unacceptable? a. Abuse b. Battery c. Aggression d. Defensiveness

c. Aggression Experiencing and demonstrating anger is a normal human reaction; however aggression is manifest when behaviors are socially and emotionally unacceptable. Abuse is a general term that infers physical, sexual, emotional, or verbal mistreatment of another individual. Battery involves harmful or offensive touching or physical contact. Defensiveness is protection of oneself against a real or perceived threat.

Which primary objective of nursing interventions would the nurse maintain for clients with dementia, delirium, and other neurocognitive disorders? a. Safety within the environment b. Enhancement of psychological faculties c. Participation in educational activities d. Face-to-face contact with other clients

a. Safety within the environment Safety within the environment is the primary objective of nursing interventions. Clients with neurocognitive disorders need an environment that will keep them safe, because their own abilities to interpret and respond appropriately are diminished. People with dementia, delirium, and other neurocognitive disorders usually have a declining level of function in all areas. Maintaining psychological function is often not possible. The primary objective is not to participate in education activities or have face-to-face contact with other clients. People with dementia, delirium, and other neurocognitive disorders have a limited ability to participate in educational activities and may also have a limited ability to interact socially with other clients.

which medications are used as the first-line treatment for post-traumatic stress disorder (PTSD)? Select all that apply. One, some, or all responses may be correct. a. Sertraline b. Paroxetine c. Phenelzine d. Venlafaxine e. Amitriptyline

a. Sertraline b. Paroxetine Sertraline and paroxetine are selective serotonin reuptake inhibitors that are approved by the US Food and Drug Administration as a first-line treatment for PTSD. If these medications are ineffective, the use of phenelzine, venlafaxine, or amitriptyline is indicated.

Which characteristic of a therapeutic milieu would the nurse consider important for a confused older adult with socially aggressive behavior? a. Sets limits b. Has variety c. Is grouped oriented d. Allows freedom of expression

a. Sets limits The therapeutic milieu characteristic would be to set limits. Because clients with socially aggressive behavior have poor control, these individuals require a therapeutic environment in which appropriate limits for behavior are set for them. Variety will increase anxiety. The daily routine should be structured and repetitive. A group-oriented environment is too stimulating for a person with socially aggressive behavior. Freedom of expression may result in injury to the client or others, because the client may be unable to control impulses.

Which of these questions is included on the CAGE screening test for alcoholism? a. 'Do you feel that you are a normal drinker?' b. 'Have you ever felt bad or guilty about your drinking?' c. 'Are you always able to stop drinking when you want to?' d. 'How often did you have a drink containing alcohol in the past year?'

b. 'Have you ever felt bad or guilty about your drinking?' The CAGE screening test for alcoholism contains four questions corresponding to the letters CAGE: Have you ever felt you ought to Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning (as an Eye-opener) to steady your nerves or get rid of a hangover? Do you feel that you are a normal drinker?' and 'Are you always able to stop drinking when you want to?' are two of the 26 questions on the Michigan Alcohol Screening Test ( MAST). 'How often did you have a drink containing alcohol in the past year?' is one of the 10 questions on the Alcohol Use Disorders Identification Test (AUDIT).

Which approach would the nurse use when managing the care of a client diagnosed with generalized anxiety disorder (GAD)? a. Creating an anxiety-free environment for the client b. Assisting the client with the development of healthy, adaptive coping mechanisms c. Avoiding triggers that produce anxiety in the client d. Providing reinforcement that the client's anxiety issues can be eliminated

b. Assisting the client with the development of healthy, adaptive coping mechanisms The nurse would assist the client with the development of healthy, adaptive coping mechanisms. GAD is characterized by the maladaptive use of worrying as a coping mechanism. The ultimate goal is for the nurse to help the client replace the ineffective worrying with effective, healthy coping mechanisms. It is not possible or even desirable to create an anxiety-free environment; the goal is to help the client learn to deal with anxiety in a healthy manner. Although identifying triggers is an appropriate outcome, avoiding the triggers is usually not possible. It is not appropriate to falsely reassure the client that anxiety issues can be eliminated; all individuals experience anxiety and must appropriately learn to cope with those anxieties.

Which approach would the nurse use for a client with an obsessive-compulsive disorder to decrease the use of ritualistic behavior? a. Providing repetitive activities that require little thought b. Attempting to limit situations that will worsen the anxiety c. Getting the client involved in activities that will provide distraction d. Suggesting that the client perform menial tasks to hide feelings of guilt

b. Attempting to limit situations that will worsen the anxiety The nurse would attempt to limit situations that will worsen the anxiety. People with high anxiety develop various behaviors to relieve the anxiety; when anxiety is reduced, the need for these obsessive-compulsive actions is reduced. Simple repetitive activities will not be therapeutic for this client and may increase anxiety. Getting the client involved in distracting activities is a temporary action that does not address the feelings that cause anxiety or how to effectively cope. The client should be assisted to learn how to deal with various emotions; therefore, hiding feelings is nontherapeutic .

Neuroleptic malignant syndrome is a potentially fatal reaction to antipsychotic therapy. Which signs and symptoms of this syndrome will the nurse identify? Select all that apply. One, some, or all responses may be correct. a. Jaundice b. Diaphoresis c. Hyperrigidity d. Hyperthermia e. Photosensitivity

b. Diaphoresis c. Hyperrigidity d. Hyperthermia Diaphoresis, hyperrigidity, hyperthermia occur with neuroleptic malignant syndrome as a result of dopamine blockade in the hypothalamus. Jaundice and photosensitivity are not associated with neuroleptic malignant syndrome.

As the nurse approaches a client who has schizophrenia, he unexpectedly shouts , 'Get out of here before I hit you! Go away!' Which rationale best explains the client's behavior? a. Hallucinations cause aggression. b. He feels threatened by the nurse. c. He is afraid of harming the nurse. d. The nurse is a phobic object.

b. He feels threatened by the nurse. Clients acutely ill with schizophrenia frequently do not trust others; fear and feeling threatened can cause them to lash out. Hallucinations can cause fear and anxiety, and a client's act of self-protection could appear aggressive, but an experienced nurse will intervene before the hallucinations produce high levels of anxiety. Clients acutely ill with schizophrenia usually are more concerned with what is happening to them and are not able to be concerned about others. The nurse could be a phobic object , but if so, the client's fear reaction should be anticipated and nursing action should be adjusted accordingly (e.g., ask for permission to approach).

A client with dementia is trying to open the door and says, 'I want to leave now.' Which intervention would the nurse use? a. Ask the client where she or he is going and how she or he plans to get there. b. Invite the client to attend an activity program that she or he enjoys. c. Allow the client to leave; she or he has the right to refuse treatment. d. Explain that the family and doctor want her or him to stay for safety.

b. Invite the client to attend an activity program that she or he enjoys. The nurse would use distraction to direct the client away from the door. This intervention provides safety without confrontation. The nurse would assess the plans of cognitively intact clients who want to leave against medical advice. For safety, clients with dementia would not be allowed to leave without supervision. For clients with mild dementia, brief and simple explanations might help, but if the client is too confused to understand, explanations will increase anxiety.

The nurse is assessing a client with a history of aggression and inappropriate anger issues. Which findings indicate the client is escalating and requires immediate intervention to prevent harm to others? Select all that apply. One, some, or all responses may be correct. a. Feeling depressed b. Mumbling to oneself c. Pacing back and forth d. Discussing issues with staff e. Maintaining strong eye contact

b. Mumbling to oneself c. Pacing back and forth e. Maintaining strong eye contact Behaviors that would require the nurse to intervene include the client mumbling to him- or herself, pacing back and forth, and maintaining strong eye contact. These are signs that precede violence. Feeling depressed may be a precursor to suicide. Discussing issues with the staff would not indicate aggressive behavior that warrants immediate intervention.

Which interventions would be included in the plan of care for a client with bipolar I disorder? Select all that apply. One, some, or all responses may be correct. a. Touch the client to provide reassurance. b. Provide a structured environment for the client. c. Ensure that the client's nutritional needs are met. d. Engage the client in conversation about current affairs. e. Design activities that require the client to maintain short-term memory.

b. Provide a structured environment for the client. c. Ensure that the client's nutritional needs are met. The nurse would include the following interventions in the plan of care: Provide a structured environment for the client and ensure that the client's nutritional needs are met. Structure tends to decrease agitation and anxiety and to increase the client's feelings of security. Whether the individual is experiencing mania or depression, nutritional needs must be met. The hyperactivity associated with mania interferes with the ability to sit still long enough to eat; hyperactivity requires an increase in the intake of calories for the energy expended. If the client is in the depressive phase, the client may overeat or undereat. Touching can be threatening for many clients and should not be used indiscriminately. Conversations should be kept simple. The client with bipolar disorder, either depressed or manic phase, may have difficulty following involved conversations about current affairs. Clients with bipolar disorder do not have problems with short-term memory.

Which characteristic unique to bulimia nervosa differentiates this disorder from anorexia nervosa? a. The client is obese and always tries different or extreme diets. b. The client has near-ideal weight and behavior can seem normal. c. The client has a distorted body image and thinks of self as fat. d. The client is struggling with dependence vs. independence.

b. The client has near-ideal weight and behavior can seem normal. Bulimic clients hide much of their bingeing and purging behaviors and, unlike clients with anorexia, may have near-ideal body weights. Clients with bulimia nervosa are usually not obese. Clients with anorexia are more likely to try extreme weight loss diets. Distorted body image and conflict of dependence versus independence are associated with both anorexic and bulimic clients.

Which statements by the nursing student indicate a need for further teaching about disaster management on how to cope effectively after a disaster event? Select all that apply. One, some, or all responses may be correct. a. 'I will support coworkers.' b. 'I will eat snacks for energy.' c. 'I will work for 15 hours per day.' d. 'I will monitor stress levels of colleagues.' e. 'I will talk about my feelings with my family.'

c. 'I will work for 15 hours per day.' e. 'I will talk about my feelings with my family.' Without intervention during or after an emergency, health care professionals who have worked in a disaster event may develop post-traumatic stress disorder (PTSD). To prevent this, they should not work more than 12 hours per day. They should share their feelings with the staff and managers who worked along with them. These health care professionals should support their coworkers and eat healthy snacks for energy. Stress levels should also be monitored to prevent PTSD.

In which time interval do the most serious life-threatening effects of alcohol withdrawal occur? a. 8 to 12 hours b. 12 to 24 hours c. 24 to 72 hours d. 72 to 96 hours

c. 24 to 72 hours Alcohol withdrawal delirium is a life-threatening central nervous system response to alcohol withdrawal; it occurs in 24 to 72 hours, when the blood alcohol level drops as alcohol is detoxified and excreted. Jitteriness, nervousness, and insomnia may occur 8 to 12 hours after withdrawal; these are not life-threatening issues. Nervousness, insomnia, nausea, vomiting, and increased blood pressure and pulse may occur after 12 to 24 hours; these are not life-threatening problems. Withdrawal symptoms will begin to subside after 72 to 96 hours, and the risk for complications is diminished.

Which signs and symptoms are typical for anorexia nervosa? a. Slow pulse rate, mild weight loss, and alopecia b. Compulsive behaviors, excessive fears, and nausea c. Amenorrhea, excessive weight loss, and abdominal distention d. Excessive activity, memory lapses, and an increase in the pulse rate

c. Amenorrhea, excessive weight loss, and abdominal distention In anorexia nervosa, weight loss is excessive (15% of expected weight); nutritional deficiencies result in amenorrhea and a distended abdomen. Although pulse irregularities and alopecia are associated with anorexia, weight loss is excessive, not mild. Although compulsive behaviors are common, excessive fears and nausea are not associated with anorexia nervosa. Memory lapses are not associated with anorexia nervosa; excessive exercising and pulse irregularities are.

The primary health care provider is concerned that a client receiving haloperidol may be developing neuroleptic malignant syndrome. When assessing for this syndrome, for which clinical manifestations would the nurse monitor the client? a. Jaundice and malaise b. Tremors and seizures c. Diaphoresis and hyperpyrexia d. Dry skin and hyperbilirubinemia

c. Diaphoresis and hyperpyrexia Diaphoresis and hyperpyrexia are the classic signs of neuroleptic malignant syndrome, which is caused by neuroleptic-induced blockage of dopamine receptors. Jaundice, malaise, tremors, seizures, dry skin, and hyperbilirubinemia are side effects of haloperidol, not neuroleptic malignant syndrome.

Why would lactulose be prescribed for a client with a history of cirrhosis of the liver? a. The desire to drink alcohol is decreased. b. Diarrhea is controlled and prevented. c. Elevated ammonia levels are lowered. d. Abdominal distension secondary to ascites is decreased.

c. Elevated ammonia levels are lowered. Lactulose is an ammonia detoxicant. It decreases serum ammonia concentration by preventing reabsorption of ammonia. Lactulose has been used to lower blood ammonia content in clients with portal hypertension and hepatic encephalopathy secondary to chronic liver disease . Lactulose has no effect on the craving for alcohol or reduction of ascites or abdominal distension. Lactulose is also used as a hyperosmotic laxative; therefore it will not relieve diarrhea.

A client with a history of alcoholism develops Wernicke encephalopathy associated with Korsakoff syndrome. Which medication therapy is indicated for management of this condition? a. Traditional phenothiazine b. Judicious use of antipsychotics c. Intramuscular injections of thiamine d. Oral administration of chlorpromazine

c. Intramuscular injections of thiamine Thiamine is a coenzyme necessary for the production of energy from glucose. If thiamine is not present in adequate amounts, nerve activity is diminished and damage or degeneration of myelin sheaths occurs. A traditional phenothiazine is a neuroleptic antipsychotic that should not be prescribed because it is hepatotoxic. Antipsychotics must be avoided; their use has a higher risk of toxic side effects in older or debilitated persons. Chlorpromazine, a neuroleptic, cannot be used because it is severely toxic to the liver.

Which signs and symptoms would the nurse observe in a client with schizophrenia? a. Traumatic flashbacks and hypervigilance b. Depression and psychomotor retardation c. Loosened associations and hallucinations d. Ritualistic behavior and obsessive thinking

c. Loosened associations and hallucinations Loosened associations and hallucinations are the primary behaviors associated with a thought disorder such as schizophrenia. Traumatic flashbacks and hypervigilance are more common in post-traumatic stress disorder than in schizophrenia. Depression and psychomotor retardation are not characteristic of schizophrenia but are characteristic of depression. Ritualistic behavior and obsessive thinking are generally associated with obsessive-compulsive disorders, not schizophrenia.

A client has been diagnosed with generalized anxiety disorder (GAD). Which behavior would the nurse expect to observe? a. Making huge efforts to avoid 'any kind of bug or spider' b. Experiencing flashbacks to an event that involved a sexual attack c. Spending hours each day worrying about something 'bad happening' d. Becoming suddenly tachycardic and diaphoretic for no apparent reason

c. Spending hours each day worrying about something 'bad happening' Using worrying as a coping mechanism is a behavior characteristic of GAD. Avoiding bugs and spiders would indicate a phobia. Flashbacks to traumatic events are characteristic of PTSD. Experiencing an accelerated HR and perfuse sweating for no apparent reason is consistent with a panic attack.

A client's serum lithium level is 0.2 mEq/L (0.2 mmol/L). Which interpretation is correct? a. Toxic level b. Borderline toxic level c. Subtherapeutic level d. Borderline therapeutic level

c. Subtherapeutic level The therapeutic range of serum lithium is 0.5 to 1.5 mEq/L (o.5-1.5 mmol/L). A serum lithium level of 0.2 mEq/L (0.2 mmol/L) is below the therapeutic range (subtherapeutic). The signs and symptoms of lithium toxicity usually occur when the serum lithium level exceeds 2.0 mEq/L (2.0 mmol/L).

Which behaviors are commonly exhibited by clients who are diagnosed with schizophrenia? a. Disorientation, forgetfulness, and anxiety b. Grandiosity, arrogance, and distractibility c. Withdrawal, regressed behavior, and lack of social skills d. Slumped posture, pessimism, and cognitive retardation

c. Withdrawal, regressed behavior, and lack of social skills Withdrawal, regressed behavior, and lack of social skills are classic behaviors exhibited by clients with a diagnosis of schizophrenia. Disorientation, forgetfulness, and anxiety are more commonly associated with dementia. Grandiosity, arrogance, and distractibility are more commonly associated with bipolar disorder, manic phase. Slumped posture, pessimistic outlook, and flight of ideas are more commonly associated with depression.

A client has newly diagnosed, rapid-cycling bipolar disorder. Which classification of medication is used to manage this condition? a. Antianxiety medication b. Antiparkinson medication c. Antidepressant medication d. Anticonvulsant medication

d. Anticonvulsant medication Anticonvulsant medications are therapeutic for clients with rapid-cycling bipolar disorder. Antianxiety medications are not primarily used for rapid-cycling bipolar disorder. Antianxiety medications may be helpful for clients with treatment resistant mania. Antiparkinson medications are not used for rapid-cycling bipolar disorder. An antidepressant medication is not used unless the client also is taking an antipsychotic medication.

Based on Maslow's hierarchy of needs, which client is demonstrating characteristics of self-actualization? a. Client is competent and is esteemed by others for accomplishing work goals. b. Client maintains a stable, loving, same-sex partnership for several years c. Client learns to sublimate aggressive impulses using physical exercises d. Client has an accurate perception of reality and is accepting of self and others

d. Client has an accurate perception of reality and is accepting of self and others According to Maslow, a self-actualized person has an accurate perception of reality and is accepting of self and others. This person is fair-minded, independent, spontaneous, and creative; he or she takes pleasure in being alone but is also socially active. Accomplishing work goals is meeting self-esteem needs. Being in a stable, loving relationship is evidence of having love and belonging needs met. Sublimating aggressive impulses demonstrates that safety needs are being met.

Which action would the nurse take before conducting an admission interview for a client with schizophrenia who has been violent in the past? a. Move to the client's side and sit down. b. Alert the assault response team about the client's history. c. Have two other staff members present when talking with the client. d. Enter the room with another staff member while remaining between the client and the door.

d. Enter the room with another staff member while remaining between the client and the door. The nurse would enter the room with another staff member while remaining between the client and the door. Making sure to stay between the client and the door provides safety for the nurse and the other staff member, because it will enable them to make a rapid exit. Moving to the client and sitting down invades the client's territory and may precipitate an aggressive client response. Alerting the assault response team is premature; the team is alerted when a client is out of control, harming self or others, and cannot be managed by the staff on the unit. Having two other staff members present may be viewed by the client as confrontational and may precipitate an aggressive response.

Which clinical findings would the nurse observe in a client with bipolar disorder, manic episode? Select all that apply. One, some, or all responses may be correct. a. Passivity b. Fatigue c. Anhedonia d. Grandiosity e. Talkativeness f. Distractibility

d. Grandiosity e. Talkativeness f. Distractibility The nurse would observe grandiosity, talkativeness, and distractibility. Grandiosity, manifested by extravagant, pompous, flamboyant beliefs about the self, frequently occurs during the manic phase of bipolar disorder. As mania increases, the client's rate of speech increases, and speech is delivered with urgency (pressured speech). Clients experiencing manic episodes have difficulty blocking out incoming stimuli, which results in distractibility and responses to irrelevant stimuli. Passiveness is exhibited when clients turn anger inward and show little emotion. It frequently occurs during the depressive stage of bipolar disorder. Fatigue is associated with the depressive stage of bipolar disorder. Anhedonia, an inability to feel pleasure, is associated with the depressive stage of bipolar disorder.

Which drug would the nurse ask the client about using when presenting to the emergency department with increased energy, irritability, hypertension, and hyperthermia? a. Alcohol b. Heroin c. Oxycodone d. Methamphetamine

d. Methamphetamine Methamphetamine is a stimulant that increases the temperature and blood pressure. It can cause increased energy, irritability, convulsions, and death. Alcohol is a central nervous system (CNS) depressant. Overdose of alcohol leads to decreased level of consciousness, hypotension, hypothermia, and respiratory depression. Heroin, an opioid, leads to euphoria, sedation, confusion, and slowed breathing. Oxycodone is an opioid and CNS depressant, leading to psychomotor retardation, drowsiness, slurred speech, and pupillary constriction.

Which action would the nurse take for a client who paces back and forth across the floor, speaks incoherently, and continually talks to and verbally fights with people who are not present? a. Set limits on the client's verbal aggression. b. Isolate the client to decrease the aggressive behavior. c. Establish a relationship to reduce the client's loneliness. d. Provide emotional support while demonstrating acceptance of the client.

d. Provide emotional support while demonstrating acceptance of the client. The nurse would provide emotional support while demonstrating acceptance of the client. Clients who have lost contact with reality can be helped to reestablish contact with reality when the nurse demonstrates respect and focuses on the client; this distracts the client's attention from the hallucinations. Setting limits on verbal aggression is not the intervention for the nurse to take. This client is responding to hallucinating voices aggressively; the client is not verbally aggressive to real people. The client presents no immediate threat to the self or others; isolating the client will decrease contact with reality and will probably worsen the hallucinations, and it is illegal. Although establishing a relationship is appropriate, this relationship would be therapeutic, not to reduce the client's loneliness.

A client with a bipolar disorder, depressed episode, displays an increase in depression over the past month. Which behavior is expected? a. Elated affect b. Loose associations c. Physical exhaustion d. Slowed thought processes

d. Slowed thought processes As depression increases, thought processes become slower and verbal expression decreases due to lack of emotional energy. Elation is associated with bipolar disorder, manic episode; the affect of a depressed person is usually one of sadness, or it may be blank. Loose associations are related to schizophrenia, not depression. Physical exhaustion is associated with bipolar disorder, manic episode; decreased physical activity does not produce physical exhaustion.

To prevent or minimize client outbursts during group therapy, the nurse would understand that which emotion precedes anger and aggression? a. Elation b. Isolation c. Depression d. Vulnerability

d. Vulnerability Vulnerability precedes anger and aggression. Anger and aggression are often preceded by feelings of vulnerability, especially when someone is in new and unfamiliar surroundings, such as an inpatient unit. Feelings of elation do not typically result in displays of anger or aggressive behavior. Some individuals may feel isolation or depression, but these are not the primary factors leading to anger and aggression.