Mental health chapters 13-22 (exam 3)

A patient diagnosed with a dissociative disorder should also be assessed regularly for which of the following? Select all that apply. A. Substance abuse B. Mood disorders C. Post traumatic stress disorder D. Personality disorders E. Social engagement disorder

A, B, C, D Persons with dissociative disorders may also have comorbid substance abuse, mood disorders, personality disorders, or PTSD.

Which agent would a nurse likely expect to administer as a first-line medication to a patient experiencing mild panic disorder? Select all that apply A. Fluoxetine B. Sertraline C. Paroxetine D. Alprazolam

A, B, and C. Fluoxetine, sertraline, and paroxetine are SSRIs and are used to treat panic disorder. Alprazolam is a benzodiazepine used, in combination with SSRIs, to treat a severely distressed patient.

A nurse is engaged in case finding. Which activity would be involved? A. Identifying those at risk B. Assessing for suicidal ideation C. Ascertaining for a suicide plan D. Determining the severity of the intent

A. Case finding involves identifying people at who are at risk for suicide to initiate proper treatment. Identifying suicidal ideation, ascertaining a suicidal plan, and determining the severity of the intent are activities involved in risk assessment.

Which of the following would the nurse assess as part of the biologic domain for a patient experiencing crisis? A. Changes in health practices B. Emotions C. Coping strengths D. Individual's ability to respond

A. Changes in health practices The nurse would assess changes in health practices as part of the biologic domain. Assessing emotions and coping strengths are part of the emotional and behavioral responses. Assessing an individual's ability to respond would be part of the social functioning and support.

A patient with PTSD startles easily and reacts irritably to small annoyances. The nurse interprets this as which of the following? A. Hyperarousal B. Intrusion C. Avoidance D. Numbing

A. Hyperarousal Hyperarousal is manifested by being hypervigilant for signs of danger, becoming easily startled, reacting irritably to small annoyances and sleeping poorly. Intrusion refers to the individual continually experiencing the event through flashbacks and nightmares. Avoidance and numbing reflect complete powerlessness by the individual.

Which of the following reflects a biologic theory of aggression and violence? A. Monoamine oxidase A gene affects neurotransmitters B. Person and situation factors are involved in an ongoing social interaction C. Aggression is a learned response to a stimulus D. Expression of aggression is rewarded

A. Monoamine oxidase A gene affects neurotransmitters An aggression-related gene (monoamine oxidase A) that affects norepinephrine, serotonin, and dopamine reflects a biologic theory for aggression and violence. Person and situation factors, aggression as a learned response, and rewarding of aggression expression reflect psychological theories for aggression and violence.

The psychiatric-mental health nurse is assessing a new client who was just admitted to the inpatient psychiatric unit in a manic episode. Which assessment should the nurse prioritize? A. Possible past history of antidepressant use B. Family history of psychiatric disorders C. Dates of any prior hospitalizations D. Identify the possible trigger for this episode

A. Possible past history of antidepressant use Many are treated in the primary care setting initially and are misdiagnosed as being depressed. The use of antidepressants can precipitate a manic episode. The nurse should determine if the client has taken any antidepressants first so proper treatment can be initiated. The other choices should be assessed as the nurse continues the complete assessment.

The psychiatric mental-health nurse is preparing a care plan for a patient who is being discharged from the hospital after a bout of severe depression. Which individual should the nurse ensure is included in the interprofessional team for this individual? A. Primary care provider B. Insurance representative C. Psychiatrist on call D. The staff nurse

A. Primary care provider Depression is often treated by the PCP with medication. Any care plan should include the PCP to ensure the interprofessional team is providing the best care possible for this individual. The insurance representative, psychiatrist on call, and staff nurse would not be included in the outpatient treatment for this individual.

The nurse is working with a 29-year-old female who is a victim of IPV. Which factor must the nurse prioritize when providing care to this patient? A. Remain nonjudgmental throughout the process B. Convince the individual to make changes C. Refuse to continue working with the survivor D. Press charges against the abuser

A. Remain nonjudgmental throughout the process It's vitally important for the nurse to always remain nonjudgmental throughout the process, especially if the survivor is an adult and competent. The other choices are not within the scope of practice for the nurse. Insisting the survivor makes changes she does not want to is removing autonomy from her, which is also illegal. Refusing to continue working with the survivor would be unethical. It would not be legal for the nurse to press charges against the abuser, however, the nurse must report to the appropriate authorities the suspicion of abuse and they will make the determination of pressing charges.

Which type of crime is rape considered? A. Violence B. Intimidation C. Power D. Anger

A. Violence Rape is considered a crime of violence. Stalking is a crime of intimidation. Power and anger may be involved with rape, but they are not considered a crime.

Which characteristic would the nurse anticipate observing in a person with type B personality? A. Aggressiveness B. Easygoing C. Introverted D. Pessimistic

B. A person with a type B personality is relaxed and easygoing. A person with a type A personality is aggressive and competitive. A person with a type C personality is introverted. A person with a type D personality is pessimistic.

Which intervention reflects the psychological domain when providing care to a patient who has attempted suicide? A. Providing care for the self-inflicted injury B. Challenging the patient's suicidal mindset C. Providing social skills training D. Administering medications

B. Challenging the patient's suicidal mindset would be an intervention addressing the patient's psychological domain. Providing care for the self-inflicted injury and administering medications reflect the biologic domain. Providing social skills training reflects the social domain.

The PMHRN is assessing a new patient. Which finding would cause the nurse to suspect the patient has OCD? A. Running every morning for at least 30 minutes B. Insists the house be clean and spotless before going to bed at night C. Spends 15 to 30 minutes each day reading a best-seller book D. Uses mega-doses of vitamin supplements

B. Insists the house be clean and spotless before going to bed at night Rituals, such as excessive cleaning is a sign of an obsession and should be investigated further in the assessment. Actions which take longer than an hour are considered obsessions. Spending 30 minutes running each day and reading a best seller book would be healthy activities. Medication is not considered a factor to cause obsessions.

Which factor should a nurse prioritize assessing in a survivor of violence? A. Social support B. Lethality C. Mental status D. Dependency in the relationship

B. Lethality The priority assessment for a survivor of violence is a lethality assessment to ascertain if the survivor is in danger for his or her life. If so, then the nurse must take immediate steps to ensure the survivor's safety. Social support, mental status, and dependency in the relationship would be assessed after the individual's safety is ensured.

Which agent would most commonly be prescribed for a patient with bipolar I disorder? A. Lamotrigine B. Lithium C. Carbamazepine D. Divalproex

B. Lithium Although divalproex, carbamazepine, and lamotrigine may be used as mood stabilizers, lithium is the most widely used mood stabilizer.

When applying the stages of the bereavement process, which response would most likely be witnessed by the nurse in the conservation stage? A. Separation anxiety B. Social withdrawal C. Disbelief D. Acceptance of the loss

B. Social withdrawal During the conservation-withdrawal phase, social withdrawal occurs. Disbelief occurs during the shock stage. Acceptance of the loss occurs during healing. Separation anxiety predominates in the awareness of loss stage.

The PMHRN is assessing a new patient who has recently been admitted to the inpatient psychiatric unit. Which factor should alert the nurse to the possibility this patient has experienced chronic stress? A. Decreased WBC count B. Apparent inactive HPA axis C. History of multiple infections D. Decreased hormone levels

C. History of multiple infections Chronic stress will suppress the immune system, which will increase the possibility of the patient developing multiple infections, with some being of a chronic nature, such as Epstein--Barr. Chronic stress increases hormone secretion, especially cortisol; increases the activity of the HPA axis; and will lead to the elevation of WBC counts.

Various theories have been formulated to explain suicide. Which theory uses the three basic factors of hopelessness, helplessness, and worthlessness to explain why suicide happens? A. Three-step theory B. Emotional factor theory C. Biological theory D. Cognitive theory

D. The cognitive theory presents the cognitive triad of helplessness, hopelessness, and worthlessness as the basis for suicide. The Three-Step theory is a psychological theory which stresses: (1) emotional pain, (2) thoughts of suicide, (3) actual attempt. The emotional factor theory is also a psychological theory which indicates factors such as shame, guilt, despair, emotion-focused coping, loss, grief, and emotional distress are responsible for suicide. Biologic theories point out that various chemical malfunctions and genetics play a part in suicide.

When applying the ABCs of psychological first aid, the nurse addresses which action with cognition? A. Decreasing excitement B. Providing for safety C. Assisting to function more effectively D. Providing reality testing

D. Providing reality testing When applying the "C" of the ABCs, the nurse would perform reality testing and provide clear information. Decreasing excitement occurs with "A," arousal. Providing for safety and assisting the person to function more effectively occurs with "B," behavior.

Which of the following would the nurse be alert for in a patient receiving fluoxetine? A. Hypertensive crisis B. Sedation C. Weight gain D. Seretonin Syndrome

D. Serotonin syndrome Fluoxetine is an SSRI and may lead to the development of serotonin syndrome. Tricyclic antidepressants are commonly associated with sedation and weight gain. Hypertensive crisis occurs with MAOIs if they are coadministered with food or other substances containing tyramine.