Mental Health Chapters 11-19 pre and post tests and NCLEX questions

Which disorder is characterized by the client's misinterpretation of physical sensations or feelings? -Somatic disorder -Conversion disorder -Factitious disorder -Illness anxiety disorder

-Illness anxiety disorder -Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. Illness anxiety can be quite obsessive, because thoughts about illness may be intrusive and difficult to dismiss, even when the patient recognizes that his or her fears are unrealistic. This is not an accurate description of any of the other options.

A client diagnosed with post-traumatic stress disorder (PTSD) shows little symptom improvement after being prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse expects that which medication will be prescribed next? -Topiramate -Amitriptyline -Imipramine -Citalopram

-Imipramine -The tricyclic antidepressant imipramine may be prescribed if SSRIs or SNRIs are not tolerated or do not work. None of the other options would be the next consideration since all are atypical antipsychotic medications that lack research supported evidence of their effectiveness in the treatment of PTSD

Which nursing diagnosis should be investigated for clients with somatoform disorders? -Self-care deficit -Deficient fluid volume -Ineffective coping -Delayed growth and development

-Ineffective coping -Soma is the Greek word for "body," and somatization is the expression of psychological stress through physical symptoms. This information supports that clients generally demonstrate ineffecting coping of anxiety, loneliness, and risk of suicide. None of the other options are associated with somatoform disorders.

The record mentions states that the client habitually relies on rationalization. The nurse might expect the client to present with what behavior? -Behaves in ways that are the opposite of his or her feelings. -Misses appointments. -Justifies illogical ideas and feelings. -Makes jokes to relieve tension.

-Justifies illogical ideas and feelings. -Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener. None of the other options present with this behavior.

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response? -Discounting positive attributes -Catatonia -Learned helplessness -Self-blame

-Learned helplessness -Learned helplessness results in depression when the client feels no control over the outcome of a situation. None of the other options demonstrate these feelings.

Empathic listening is therapeutic because it focuses on what form of action? -Encouraging resilience -Enhancing self-esteem -Reducing anxiety -Lessening feelings of isolation

-Lessening feelings of isolation -Empathic listening can be healing because it can help minimize feelings of isolation. Empathic listening is not focused on any of the other factors suggested by the other options.

What is the first-line drug used to treat mania? -Carbamazepine -Clonazepam -Lithium carbonate -Lamotrigine

-Lithium carbonate -Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder. The other options are prescribed to manage other related symptoms of bipolar disorder.

Selective inattention is first noted when experiencing which level of anxiety? -Mild -Panic -Severe -Moderate

-Moderate -When moderate anxiety is present, the individual's perceptual field is reduced and the client is not able to see the entire picture of events. This is not an initial characteristic of any of the other levels of anxiety.

Beck's cognitive theory suggests that the etiology of depression is related to what factor? -Serotonin circuit dysfunction -Sleep abnormalities -Negative processing of information -Belief that one has no control over outcomes

-Negative processing of information -Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, self-deprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue. None of the other options are related to this theory.

When the clinician mentions that a client has anhedonia, the nurse can expect that the client will demonstrate what behavior? -Difficulty with tasks requiring fine motor skills -A weight loss from anorexia -No pleasure from previously enjoyed activities -Poor retention of recent events

-No pleasure from previously enjoyed activities -Anhedonia is the term used to suggest the lack of the ability to experience pleasure. The remaining options are not reflective of the term.

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? -Telling the client that he or she must relax whenever tension mounts -Not allowing the client to seek reassurance from staff -Having the client repeatedly touch "dirty" objects -Not allowing the client to wash hands after touching a "dirty" object

-Not allowing the client to wash hands after touching a "dirty" object -Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval. None of the other options reflect accurate information regarding this form of therapy.

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? -They tend to be more effective for men. -They often cause the client to have diurnal variation. -Recent memory impairment is commonly observed. -Onset of action is from 1 to 3 weeks or longer.

-Onset of action is from 1 to 3 weeks or longer. -A drawback of antidepressant drugs is that improvement in mood may take 1 to 3 weeks or longer. None of the other options provide correct information regarding antidepressant medications.

Inability to leave one's home because of avoidance of severe anxiety suggests the existence of which anxiety disorder? -Panic attacks with agoraphobia -Posttraumatic stress response -Obsessive-compulsive disorder -Generalized anxiety disorder

-Panic attacks with agoraphobia -Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred. None of the other options are associated with this form of anxiety.

Delusionary thinking is a characteristic of which form of anxiety? -Chronic anxiety -Panic level anxiety -Severe anxiety -Acute anxiety

-Panic level anxiety -Panic level anxiety is the most extreme level and results in markedly disturbed thinking greater than in any of the other options.

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with which term? -Psychomotor agitation -Senile dementia -Central serotonin syndrome -Hypertensive crisis

-Psychomotor agitation -These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression. None of the other options are associated so directly with these behaviors.

When a client experiences four or more mood episodes in a 12-month period, which term is used to describe this behavior? -Incongruent -Cyclothymic -Dyssynchronous -Rapid cycling

-Rapid cycling -Rapid cycling implies four or more mood episodes in a 12-month period, as well as more severe symptomatology. None of the other options are associated with this characteristic behavior.

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating which ego defense mechanism? -Projection -Reaction formation -Rationalization -Undoing

-Reaction formation -Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion. This behavior is not associated with any of the other options.

The most common course of schizophrenia is an initial episode followed by what course of events? -Recurrent acute exacerbations and deterioration -Continuous deterioration -Recurrent acute exacerbations -Complete recovery

-Recurrent acute exacerbations and deterioration -Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. -With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

Dissociative identity disorder is characterized by what event? -Sudden, unexpected travel away from home and inability to remember the past -Recurring feelings of detachment from one's body or mental processes -The inability to recall important information -The existence of two or more subpersonalities, each with its own patterns of thinking

-Recurring feelings of detachment from one's body or mental processes -Dissociation is an unconscious defense mechanism that protects the individual against overwhelming anxiety through an emotional separation. However, this separation results in disturbances in memory, consciousness, self-identity, and perception. None of the other options accurately characterizes this form of mental dysfunction.

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. Which ego defense mechanism is in use? -Projection -Repression -Displacement -Reaction formation

-Repression -Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness. This is not the outcome of any of the other options.

Which factor can reduce the vulnerability of a child to etiological influences predisposing to the development of psychopathology? -child abuse -malnutrition -resilience -having a depressed parent

-Resilience -Resilience refers to developing and using certain characteristics that help a child to handle the stresses of a difficult childhood without developing mental problems. Resilient children can adapt to changes in the environment, form nurturing relationships with adults other than their parents, distance themselves from the emotional chaos of the family, and have social intelligence and the ability to use problem-solving skills.

An individual who is able to regain mental stability after a traumatic event is said to be demonstrating what trait? -Autonomy -Maturity -Resilience -Independence

-Resilience -The term resilience refers to positive adaptation, or the ability to maintain or regain mental health despite adversity. None of the other terms suggest such an ability.

What is the priority nursing diagnosis for a hyperactive manic client during the acute phase of treatment? -Impaired verbal communication -Risk for injury/suicide -Ineffective role performance -Risk for other-directed violence

-Risk for injury/suicide -Risk for injury is high, related to the client's hyperactivity and poor judgment. Safety is always the priority when considering client care.

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal what characteristic? -Sexual preoccupation -Good memory and concentration -Delusions of persecution -Self-deprecating ideation

-Self-deprecating ideation -Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world. This characteristic is not associated with any of the other options.

When a hyperactive manic client expresses the intent to strike another client, what is the initial nursing intervention? -Question the client's motive -Initiate physical confrontation -Prepare the client for seclusion -Set verbal limits

-Set verbal limits -Verbal limit setting should always precede more restrictive measures. -Questioning motives does not address the safety issue that exists.

A client has reached the maintenance phase of schizophrenia. What is the appropriate clinical planning focus for this client? -Safety and crisis intervention -Acute symptom stabilization -Social, vocational, and self-care skills -Stress and vulnerability assessment

-Social, vocational, and self-care skills -During the maintenance phase of schizophrenia, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community. All the other options should have been handled previously.

When discussing somatic disorders from a cultural perspective, which statement is true? -Somatic disorders are rarely observed in males. -Secondary gain is seldom a factor in somatic disorders. -Underdeveloped countries rarely tolerate somatic disorders. -Somatic symptoms vary widely from culture to culture.

-Somatic symptoms vary widely from culture to culture. -The type and frequency of somatic symptoms vary across cultures. Currently, none of the other options have been supported by research.

A 5-year-old who consistently omits the sound for 'r' and 's' when speaking is demonstrating which type of disorder? -speech -specific learning -social communication -language

-Speech -Speech disorders are marked by problems in making sounds. Children may have trouble making certain sounds, or they may distort, add, or omit sounds. Such patterns are not associated with any of the other options.

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress would include what behavior? -Report both nausea and vomiting -Exhibit stoic behavior -Suddenly tremble severely -Laugh inappropriately

-Sudden tremble severely -Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity. None of the other options are associated with this cultural response to stress.

Which side effect of antipsychotic medication is generally nonreversible? -Pseudoparkinsonism -Tardive dyskinesia -Dystonic reaction -Anticholinergic effects

-Tardive dyskinesia -Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The other side effects often appear early in therapy and can be minimized with treatment.

Which nursing intervention is designed to help a schizophrenic client minimize the occurrence of a relapse? -Schedule the client to attend group therapy that includes those who have relapsed -Teach the client and family about behaviors associated with relapse -Remind the client of the need to return for periodic blood draws to minimize the risk for Relapse -Help the client and family adapt to the stigma of chronic mental illness ad periodic relapses

-Teach the client and family about behaviors associated with relapse -By knowing what behaviors signal impending relapse, interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted. None of the other options are effective interventions when considering relapse prevention.

When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing what characteristic? -cultural assimilation -resilience -vulnerability -temperament

-Temperament -Temperament is the behavior the child habitually uses to cope with the environment. It is a constitutional factor thought to be genetically determined. It may be modified by the parent-child relationship. None of the other options would reflect this characteristic.

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client at what level of anxiety? -mild. -panic. -moderate. -severe.

-severe -Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. Mild and moderate levels of anxiety do not demonstrate these feels while panic is even more intense than the scenario implies.

When a client is prescribed lorazepam 1 mg po four times a day (qid) for 1 week for generalized anxiety disorder, the nurse should which intervention as the priority? -question the physician's order because the dose is excessive. -explain the long-term nature of benzodiazepine therapy. -teach the client to limit caffeine intake. -tell the client to expect mild insomnia.

-teach the client to limit caffeine intake. -Caffeine is an antagonist of antianxiety medication. None of the other options present accurate information regarding lorazepam.

The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that includes with characteristics? -Ill-fitted and ragged -Dark colored and modest -Colorful and inappropriate -Compulsively neat and clean

-Colorful and inappropriate -Manic clients often manage to dress and apply makeup in ways that create a colorful, inappropriate, even bizarre, appearance. None of the remaining options meet that criteria.

Which mental health disorder is an example of a somatoform disorder? -Conversion disorder -Depersonalization -Dissociative identity disorder -Dissociative fugue

-Conversion disorder -Somatic disorders include conversion disorders that are functional neurological disorders. None of the other options are associated with this classification of mental health disorders.

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." How should the nurse respond to this statement? -"Depression is seen in people of all ages, from childhood to old age." -"Depression is most often seen among the middle adult age group." -"The age of onset for most depressive episodes is given as 18 years." -"That is a good observation. Depression does mostly strike people older than 50 years."

-"Depression is seen in people of all ages, from childhood to old age." -Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) is reprimanded for taking the nurse's pen without asking first. He responds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding with which statement? -"I do like you, but I don't like it when you grab my pen." -"You must ask for permission before taking someone else's things." -"Liking you has nothing to do with whether I will loan you my pen." -"It sounds as though you are feeling helpless and insecure."

-"I do like you, but I don't like it when you grab my pen." -This reply shows positive regard for the child while describing the behavior as undesirable. Feedback such as this helps the child feel accepted while making her aware of the effect her behavior has on others. None of the other options provide the necessary degree of positive regard.

A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. Which response should the nurse provide to this client statement? -"You are safe here in the hospital; nothing bad will happen to you" -"These voices are wrong about the hospital food. It is not contaminated." -"I understand that the voices are very real yo you, but I do not hear them." -"Other people are eating the food, and nothing is happening to them."

-"I understand that the voices are very real yo you, but I do not hear them." -This reply acknowledges the client's reality but offers the nurse's perception that he or she is not experiencing the same thing. This is the only option that provides such support.

Which statement would best show acceptance of a depressed, mute client? -"It is important for you to share your thoughts with someone who can help you evaluate your thinking." -"I would like to sit with you for 15 minutes now and again this afternoon." -Each day we will depend time together to talk about things that are bothering you." -"I will be spending time with you each day to try to improve your mood."

-"I would like to sit with you for 15 minutes now and again this afternoon." -Spending time with the client without making demands is a good way to show acceptance. While not inappropriate, the other options are less accepting.

When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," what would be an appropriate response for the nurse to make? -"I do not believe I understand the word volmers, Tell me more about them." -"Why do you think someone, or something is going to harm you?" -"It must be frightening to think something is going to harm you." -"You are safe here. This is a locked unit, and no one can get in."

-"It must be frightening to think something is going to harm you." -This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience. Option A gives global reassurance. Option B encourages elaboration about the delusion. Option C asks for information that the client will likely be unable to answer.

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response? -"Is this part of the reason you think no one likes you?" -"Let's look at what you just said that you can 'Never do anything right."' -"Tell me what things you think you are not able to do correctly." -"That is the most unrealistic thing I have ever heard."

-"Let's look at what you just said that you can 'Never do anything right."' -Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate. None of the other options examines the underlying cause of the feeling.

When discussing the symptoms of post-traumatic stress disorder (PTSD), the nurse should make which statement? -"When experiencing a flashback, the client generally experiences a slowing of responses." -"PTSD causes agitation and hypervigilance but rarely chronic depression." -"The symptoms can neither occur almost immediately or even take years to manifest." -"PTSD is an emotional response that does not cause significant changes in brain chemistry."

-"The symptoms can neither occur almost immediately or even take years to manifest." -The onset of PTSD symptoms can occur as early as a month after exposure, but a delay of months or years is not uncommon. None of the other statements correctly describe the symptoms of PTSD.

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." Which response should the nurse make initially? -"Try not to think about the feelings and sensations you're experiencing." -"Let's try to focus on that adorable little granddaughter of yours." -"Why don't you sit down over there and work on that jigsaw puzzle?" -"What things have you done in the past that helped you feel more comfortable?"

-"What things have you done in the past that helped you feel more comfortable?" -Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. While distraction may be helpful in some situations, it is not the initial intervention.

Which child is at greatest risk for developing attachment problems as a result of a neurobiological development? -A 10-year-old female -A 4-year-old female -A 13-year-old male -A 7-year-old male

-A 4-year-old female -The developing brain is particularly vulnerable to adverse events because the most rapid brain development occurs in the first five years of life. The right hemisphere is involved in processing social-emotional information, promoting attachment functions, regulating body functions, and in supporting the individual in survival and in coping with stress. Since the right brain develops first and is involved with developing templates for relationships and regulation of emotion and bodily function, early attachment relationships are particularly important for healthy development and life-long health.

Currently what is understood to be the causation of schizophrenia? -A combination of inherited and nongenetic factors -Deficient amounts of the neurotransmitter dopamine -Excessive amounts of the neurotransmitter serotonin -Stress related and ineffective stress management skills

-A combination of inherited and nongenetic factors -Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme nongenetic factors (e.g., viral infection, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain.

What symptom can the nurse expect a client diagnosed with depersonalization disorder to manifest? -A feeling of detachment from one's body or mental processes -Worry about having a serious disease based on symptom misinterpretation -Aimless wandering with confusion and disorientation -Existence of two or more personalities that take control of behavior

-A feeling of detachment from one's body or mental processes -Depersonalization is characterized by a sense of unreality or self-estrangement. None of the other options present an expected characteristic of depersonalization disorder.

A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as what? -Blocking -A delusion -A neologism -Clang association

-A neologism -A neologism is a newly coined word that has meaning only for the client. -None of the other options fit this description.

An obsession is defined as what? -Thinking of an action and immediately taking the action -An intense irrational fear of an object or situation -A recurrent behavior performed in the same manner -A recurrent, persistent thought or impulse

-A recurrent, persistent thought or impulse -Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind. None of the remaining statements are accurate when defining the term obsession.

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of which classification of medications? -Anticholinergic medication. -Standard antipsychotic medication. -A short-acting benzodiazepine medication. -Tricyclic antidepressant medication.

-A short-acting benzodiazepine medication. -A short-acting benzodiazepine is the only type of medication listed that would lessen the client's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.

Which room placement would be best for a client experiencing a manic episode? -A shared room with a client with dementia -A single room near the nurses' station -A shared room away from the unit entrance -A single room near the unit activities area

-A single room near the nurses' station -The room placement that provides a non-stimulating environment is best. Nearness to the nurses' station means close supervision can be provided. None of the other options provide low stimulation.

Working to help the client view an occurrence in a more positive light is referred to by which term? -Flooding -Cognitive restructuring -Desensitization -Response prevention

-Cognitive restructuring -The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive. This is not necessarily true of any of the other options.

The family of a child diagnosed with attention deficit hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What is the focus of child's evaluation? (Select all that apply.) -Physical growth -ADLs -Personal perception -Academic performance -Social relationships

-ADLs -Personal perception -Academic performance -Social relationships -For the family and child with ADHD, evaluation will focus on the symptom patterns and severity. For those with ADHD, inattentive type, the focus of evaluation will be academic performance, activities of daily living, social relationships, and personal perception. For those with ADHD, hyperactive-impulsive type or combined type, the focus will be on both academic and behavioral responses.

What is a desired outcome for the maintenance phase of treatment for a manic client? -Adhere to follow-up medical appointments -Take medication more than 50% of the time -Use alcohol to moderate occasional, mood "highs". -Exhibit optimistic, energetic, playful behavior.

-Adhere to follow-up medical appointments -The client would be living in the community during the maintenance phase. Keeping follow-up appointments is highly desirable. None of the other options are accurate.

What defense mechanisms can only be used in healthy ways? -Idealization and splitting -Suppression and humor -Altruism and sublimation -Reaction formation and denial

-Altruism and sublimation -Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses. This statement is not true of the other options.

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal what common assessment data? (Select all that apply.) -An eating disorder -A previous suicide attempt -A history of sexual abuse -A history of childhood trauma -A sibling with the disorder

-An eating disorder -A history of sexual abuse -A history of childhood trauma -A sibling with the disorder -Sexual and physical abuse in childhood or trauma increases the risk of this disorder. Genetics are strongly associated with this disorder. First-degree relatives have twice the risk. OCD tends to occur along with anxiety disorders 76% of the time. Other comorbid conditions include major depressive disorder, bipolar disorder, and eating disorders. Suicide while a concern is not among the most common issues for the client diagnosed with OCD.

Which of the following would be assessed as a negative symptom of schizophrenia? -Anhedonia -Hostility -Agitation -Hallucinations

-Anhedonia -Negative symptoms refer to deficits that characterize schizophrenia. They include the crippling symptoms of affective blunting (lack of facial expression), anergia (lack of energy), anhedonia (inability to experience happiness), avolition (lack of motivation), poverty of content of speech, poverty of speech, and thought blocking.

A client, who has been prescribed clozapine 6 weeks ago, reports flulike symptoms including a fever and a very sore throat, the nurse should initiate which nursing intervention? -Arrange for the client to have blood drawn for a white blood cell count -Advise the physician that the client should be admitted to the hospital -Suggest that the client take something for the fever and get extra rest -Consider recommending a change of antipsychotic medication

-Arrange for the client to have blood drawn for a white blood cell count -Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms.

Dysthymia cannot be diagnosed unless it has existed for what period of time? -At least 6 months -At least 1 year -At least 3 months -At least 2 years

-At least 2 years -Dysthymia is a chronic condition that by definition has to have existed for longer than 2 years. None of the other options present a sufficient time period.

A 7-year-old, who is described as impulsive and hyperactive, tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with which diagnosis? -Attention deficit disorder -Conduct disorder -Autism -Attention deficit hyperactivity disorder

-Attention deficit hyperactivity disorder -The data are most consistent with attention deficit hyperactivity disorder (ADHD) as described in the DSM-5. The other options present with characteristics and behaviors that differ from those in the scenario.

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports which information? -Repeated verbalizing prayers results in a relaxed feeling. -Being unable to work for the last 12 months. -Eating in public makes the client extremely uncomfortable. -Symptoms started right after being robbed at gunpoint.

-Being unable to work for the last 12 months. -GAD is characterized by symptomatology that lasts 6 months or longer. None of the other descriptions would support the diagnosis.

Which social behavior is often a result of a child having been exposed to some form of abuse? -speech disorders -bulling others -eating disorders -delayed motor skills

-Bullying others -Children who have experienced abuse are at risk for identifying with their aggressor and may act out, bully others, become abusers, or develop dysfunctional interpersonal relationships in adulthood. None of the remaining options are as directly associated with abuse as bullying.

A child who was physically and sexually abused is at great risk for demonstrating which characteristic? -Depression -Suicide attempts -Bullying, abusive behavior -Becoming active in a gang

-Bullying, abusive behavior -Children who have been abused are at risk for abusing others, as well as for developing dysfunctional patterns in close interpersonal relationships. While the other characteristics may occur, none are as characteristic as the correct option.

Studies have shown a correlation between mental disorders and which medical condition? -Chronic renal failure -Psoriasis -Asthma -Cardiovascular disease

-Cardiovascular disease -Studies in recent years have contributed to the growing body of evidence indicating a link between mental disorders and medical conditions such as cardiovascular disease and cancer. No such correlation has been proven between medical and any suggest psychiatric conditions.

What is a possible outcome criterion for a client diagnosed with anxiety disorder? -Client reports reduced hallucinations. -Client demonstrates persistent avoidance behaviors. -Client reports feelings of tension and fatigue. -Client demonstrates effective coping strategies.

-Client demonstrates effective coping strategies. -Option 1 is the only desirable outcome listed for this diagnosis.

What therapeutic intervention should be prescribed for a client diagnosed with a somatoform disorder? -Conveying an interest in the client rather than in the symptoms -Encouraging the client to use benzodiazepines liberally -Encouraging the client to rely on the nurse to meet the client's needs -Steering conversation away from the client's feelings

-Conveying an interest in the client rather than in the symptoms -When the nurse focuses on the client rather than on the symptoms, the client's self-worth and coping skills are enhanced. The discussion related to client feelings is a major focus of therapy. Neither of the remaining options serves to help the client identify the causes of the illness and so would not serve as effective interventions.

When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her." The nurse should plan to provide which intervention? -Educate the father regarding signs that the child is being physically abused -Encourage the mother to consider attending parenting classes -Counsel the mother regarding ways to better bond with her child -Suggest that the child's father become her primary caregiver

-Counsel the mother regarding ways to better bond with her child -All people have temperaments, and the fit between the child and parent's temperament is critical to the child's development. The caregiver's role in shaping that relationship is of primary importance, and the nurse can intervene to teach parents ways to modify their behaviors to improve the interaction.

What term is used to identify the condition demonstrated by a person who has numerous hypomanic and dysthymic episodes over a two-year period? -Cyclothymia -Bipolar II disorder -Bipolar I disorder -Seasonal affective disorder

-Cyclothymia -Cyclothymia refers to mood swings involving hypomania and dysthymia of 2 years duration. The mood swings are not severe enough to prompt hospitalization. None of the other options meet that criteria.

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of which ego defense mechanism? -Denial -Undoing -Suppression -Altruism

-Denial -Denial involves escaping unpleasant reality by ignoring its existence. This is not the outcome of any of the other options.

The symptoms of an adjustment disorder can include which characteristics? (Select all that apply.) -Depression -Guilt -Anger -Social withdrawal -Overachieving

-Depression -Guilt -Anger -Social withdrawal -In contrast to acute stress disorder responses, which are quite severe and include anxiety and fear, symptoms of an adjustment disorder can run the gamut of all forms of distress including guilt, depression, and anger. These feelings may be combined with other manifestations of distress, including physical complaints, social withdrawal, or work or academic inhibition. The behaviors associated with overachieving are not seen in individuals diagnosed with an adjustment disorder.

What statement about the comorbidity of depression is accurate? -Substance abuse and depression are seldom seen as comorbid disorders -Depression most often exists in an individual as a single entity -Depression is commonly seen in individuals with medical disorders -Depression may coexist with other disorders but is rarely seen with schizophrenia

-Depression is commonly seen in individuals with medical disorders -Depression commonly accompanies medical disorders especially those that result in chronic pain. The other options are false statements.

What can be said about the comorbidity of anxiety disorders? -Substance abuse disorders rarely coexist with anxiety disorders. -Anxiety disorders virtually never coexist with mood disorders. -Depression may occur prior to onset of anxiety. -Anxiety disorders generally exist alone.

-Depression may occur prior to onset of anxiety. -In many instances, major depression may occur prior to the onset of panic disorder or may occur at the same time. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.

Schizophrenia is best characterized as presenting which personality trait? -Multiple -Deteriorating -Split -Ambivalent

-Deteriorating -The course of schizophrenia is marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

A Gulf War veteran is entering treatment for post-traumatic stress disorder. What assessment is of greatest importance to this particular client? -Find out if the client uses acting-out behavior. -Establish whether the client has chronic hypertension related to high anxiety. -Ascertain how long ago the trauma occurred. -Determine the use of chemical substances for anxiety relief.

-Determine the use of chemical substances for anxiety relief. -Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms.

What information should the nurse give to the family of a client who has had a dissociative episode? -Ways to intervene to prevent self-mutilation and suicide attempts. -Dissociation is a method for coping with severe stress. -Dissociation suggests the possibility of early dementia. -Brief periods of psychotic behavior may occur.

-Dissociation is a method for coping with severe stress. -Childhood physical, sexual, or emotional abuse and other traumatic events are associated with adults experiencing dissociative symptoms. None of the other options are true.

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." What is the best initial approach to managing this behavior? -Enforcing consequences by responding, "Let's walk down to the seclusion room." -Reprimand the client by standing, "What an offensive thing to suggest." -Clarifying the nurse-client relationship by stating, "I don't have sex with clients -Distracting the client by suggesting, "It's time to work on your art project."

-Distracting the client by suggesting, "It's time to work on your art project." -Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the client. This intervention is both therapeutic and less restrictive.

Which behavior best supports the diagnosis of posttraumatic stress disorder (PTSD) in a 4-year-old child? -Overeating -Hypervigilance -Passivity -A drive to be perfect

-Hypervigilance -PTSD in preschool children may manifest as irritability, aggressive or self-destructive behavior, sleep disturbances, problems concentrating, and hypervigilance. None of the other options are characteristic of PTSD in a young child.

A client experiencing a panic attack keeps repeating, "I'm dying, I can't breathe.". What action by the nurse should be most therapeutic initially? -Asking the client what he means when he says, "I am dying." -Encouraging the client to take slow, deep breaths -Offering an explanation about why the symptoms are occurring -Verbalizing mild disapproval of the anxious behavior

-Encouraging the client to take slow, deep breaths -Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. The client needs help to regain composure and stabilize vital signs; the only option that addresses these issues is the correct option.

A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. What information should the nurse provide the client regarding this practice? -Explain the high possibility of an adverse reaction. -Agreeing that this will help the client to remember the medications. -Caution the client to drink several glasses of water daily. -Suggest that the client also use a sun lamp daily.

-Explain the high possibility of an adverse reaction. -Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants. None of the other options are relevant to the situation.

A primary health provider describes a client as "malingering." The nurse knows this means that the client is demonstrating which behavior? -Experiencing symptoms that cannot be explained medically. -Falsely claiming to have symptoms. -Experiencing symptoms that have a physiological basis. -Seeking medication to ease pain of psychological origin.

-Falsely claiming to have symptoms. -Malingering is a consciously motivated act to deceive based on the desire for material gain. The symptoms described are nonexisting and so none of the other options are correct statements of behavior.

What is the major distinction between fear and anxiety? -Fear enables constructive action; anxiety is dysfunctional. -Fear is a universal experience; anxiety is neurotic. -Fear is a response to a specific danger; anxiety is a response to an unknown danger. -Fear is a psychological experience; anxiety is a physiological experience.

-Fear is a response to a specific danger; anxiety is a response to an unknown danger. -ear is a response to an objective danger; anxiety is a response to a subjective danger. This information helps identify the correct option.

Panic attacks in Latin American individuals often involve demonstration of which behavior? Blushing Repetitive involuntary actions Offensive verbalizations Fear of dying

-Fear of dying -Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear of dying. This information directs you to the correct options.

A symptom commonly associated with panic attacks? -Apathy -Obsessions -Fear of impending doom -Fever

-Fear of impending doom -The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur. None of the other symptoms are associated with a panic attack.

Which side effects of lithium can be expected at therapeutic levels? -Coarse hand tremor and gastrointestinal upset -Nausea and thirst -Ataxia and hypotension -Fine hand tremor and ployuria

-Fine hand tremor and ployuria -The fact that fine hand tremor and polyuria are present at therapeutic levels is quite annoying to some clients. These and other side effects are factors in noncompliance.

Which behavior is most indicative of a 4-year-old child diagnosed with Tourette's syndrome? -Humming while performing activities that require concentration -Difficulty in social relationships -Difficulty in completing tasks on time -Frequent eye blinking

-Frequent eye blinking -Persistent motor or vocal ticking is characteristic of Tourette's syndrome. Dysfunctional social relationship is an inconclusive symptom, especially for a 4-year-old. Humming can be a normal response of a child at play. Ineffective time management is usually associated with a child who demonstrates ADHD, not Tourette's syndrome.

A client prescribed a monoamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, what can the client safely eat? -Kielbasa and sauerkraut -Avocado salad plate -Fruit and cottage cheese plate -Liver and onion sandwich

-Fruit and cottage cheese plate -Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat, contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, a hypertensive crisis, and eventually a cerebrovascular accident. This information makes the other options incorrect.

A client diagnosed with disorganized schizophrenia would have greatest difficulty with the nursing intervention? -Providing nutritional supplements -Giving multistep directions -Using concrete language -Interacting with a neutral attitude

-Giving multistep directions -The thought processes of the client with disorganized schizophrenia are severely disordered, and severe perceptual problems are present, making it extremely difficult for the client to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times. Ineffective organizational skills would not be a primary factor considering the other options.

Which behavior would be characteristic of a client during a manic episode? -Going rapidly from one activity to another -Being unwilling to leave home to see other people -Taking frequent rest periods and naps during the day -Watching other intently and talking little

-Going rapidly from one activity to another -Hyperactivity and distractibility are basic to manic episodes. None of the other options demonstrate such characteristics.

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." What term should the nurse use to identify this behavior? -Limit testing -Flight of ideas -Grandiosity -Distractibility

-Grandiosity -Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity. None of the other options are associated with this behavior.

Parents express concern when their 5-year-old child, who is receiving treatment for cancer, keeps referring to an imaginary friend, Candy. Which response should the nurse provide to best address the parent's concerns? -Children of this age usually have imaginary friends. -The child needs more of their one-on-one attention. -The imaginary friend is a coping mechanism the child is using. -It is nothing to worry about unless the child starts to socially isolate.

-The imaginary friend is a coping mechanism the child is using. -Often traumatized children feel responsible for what happened to them and are frightened by flashbacks, amnesia, or hallucinations that may be due to trauma. For example, a child may use imaginary friends as a coping mechanism. This option addresses the parents' concern most effectively.

When the partner of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on which information? -Much depends on the socioeconomic class of the individuals -Highly creative people tend toward development of the disorder -No research exists to suggests genetic transmission -The rate of bipolar disorder is higher in relatives of people with bipolar disorder

-The rate of bipolar disorder is higher in relatives of people with bipolar disorder -This understanding will allow the nurse to directly address the question. Responses based on the other statements would be tangential or untrue.

Generally, which statement regarding ego defense mechanisms is true? -They seldom make the person more comfortable. -They often involve some degree of self-deception. -They are usually effective in resolving conflicts. -They are rarely used by mentally healthy people.

-They often involve some degree of self-deception. -Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception. This information helps eliminate the other options as the correct statement.

A 10-year-old who is frequently disruptive in the classroom begins to fidget in her chair and then moves on to disruptive behavior. What is the most appropriate initial technique for managing this sort of disruptive behavior? -Therapeutic holding -Quiet room -Seclusion -Touch control

-Touch control -The appropriate adult can move closer to the child and place a hand on her arm or an arm around her shoulder for a calming effect when the fidgeting is first noted. The closeness signals the child to use self-control. It is the least restrictive treatment approach and should be tried initially.

Which statement about structural dissociation of the personality is true? -Trauma is the basis for this type of disorder. -This disorder results in a split in the personality causing a lack of integration. -No known link exists between this disorder and early childhood loss or trauma. -Nurses perceive clients with this disorder as easy to care for.

-Trauma is the basis for this type of disorder. -The theory of structural dissociation of the personality proposes that patients with complex trauma have different parts of their personality, the apparently normal part and the emotional part, that are not fully integrated with each other. Each part has its own responses, feelings, thoughts, perceptions, physical sensations, and behaviors. These different parts may not be aware of each other, with only one dominant personality operating depending on the situation and circumstance of the moment. None of the other options are accurate statements regarding this disorder.

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention? -Prompting the client if the reply is slow -Reviewing the client's medical record to support the client's response -Repeating the question if the client does not answer promptly -Waiting quietly for the client to reply

-Waiting quietly for the client to reply -Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply.

When a client reports that lithium causes an upset stomach, the nurse should make which suggestion associated with taking the medication? -2 hours after meals -With an antacid -30 minutes before meals -With meals

-With meals -Many clients find that taking lithium with or shortly after meals minimizes gastric distress. None of the other options present accurate information.

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? -Advise the client to curtail salt intake for 24 hours -Continue to administer medication as ordered -Advise the client to limit fluids for 12 hours -Withhold medication and notify the physician

-Withhold medication and notify the physician -The client's lithium level has exceeded desirable limits. Additional doses of the medication should be withheld, and the physician notified. None of the other options are accurate interventions.

An acute phase nursing intervention aimed at reducing hyperactivity is demonstrated by which intervention? -Directing unit activities -Orienting a new client to the unit -Writing a diary -Exercising in the gym

-Writing in a diary -Manic clients often respond well to the invitation to write. They will fill reams of paper. While writing they are less physically active. None of the remaining options presents this opportunity to reduce physical activity.

A child diagnosed with autism will demonstrate impaired development in which area? -playing with other children -swallowing and chewing -adhering to routines -eye-hand coordination

-playing with other children -Autism affects the normal development of the brain in social interaction and communication skills. Symptoms associated with autism spectrum disorders include significant deficits in social relatedness, including communication, nonverbal behavior, and age-appropriate interaction. Other behaviors include stereotypical repetitive speech, obsessive focus on specific objects, over adherence to routines or rituals, hyper- or hypo-reactivity to sensory input, and extreme resistance to change. None of the other options are characteristically associated with autism.

What nursing diagnosis should be considered for a child with attention deficit hyperactivity disorder ADHD? -defensive coping -impaired verbal communication -anxiety -risk for injury

-risk for injury -The child's marked hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, and so forth.