Mental Health Exam 2

In the video resources section of this chapter, there is information about the Ohio State prison system, where there is a model for dealing with inmates who have a serious mental illness. What is different in this model from how individuals are treated in other prisons? 1. They separate prisoners with mental illness from the general prison population. 2. They administer higher doses of medication. 3. They assure more solitary confinement. 4. They assure that inmates with mental illness are held accountable for acting out.

1. They separate prisoners with mental illness from the general prison population.

Venlafaxine

Effexor Antidepressant/ Antianxiety SNRI (blocks norepinephrine) Side Effects- sexual dysfunction, may decrease dopamine causing apathy, low libido, GI symptoms

Flooding Therapy

Exposes the patient to a large amount of undesirable stimulus in an effort to extinguish the anxiety response

The graduate nurse is applying for his first position as an RN. The nurse is mildly tense but is able to look forward to beginning the interview and learning about the position. What does this reaction demonstrate? 1. adaptive use of a defense mechanism 2. maladaptive use of a defense mechanism 3. ineffective mediation of anxiety 4. selective inattention

1. adaptive use of a defense mechanism (adaptive use of defense mechanisms allows people to lower anxiety to achieve goals in a healthy way.)

What therapeutic approach in the milieu would not be therapeutic for nurses to use when caring for adolescents being treated for impulse control disorders? 1. authoritarian, confrontational 2. keeping expressed emotion low 3. set consistent limits 4. avoid power struggles

1. authoritarian, confrontational

The nurse is caring for a patient who has been prescribed Propranol (Propranolol) (Inderal) for anxiety. What information is important for the nurse to include in medication education? 1. Decrease in heart rate 2. agitation 3. movement disorders 4. excessive salivation

1. decrease in heart rate (Beta blockers are sometimes used to treat anxiety . Beta blockers block the receptors that, when stimulated, make the heart beat faster. Beta blockers can reduce the physical manifestations of anxiety, such as blushing.)

A nursing student changes study habits to earn better grades after initially failing a test. What likely contributed to this behavioral change? 1. Normal anxiety 2. a rude awakening 3. trait anxiety 4. panic

1. normal anxiety

The nurse is assessing a client diagnosed with severe obsessive-compulsive disorder. What symptom will likely be an issue for the client's recovery? 1. sleep disturbance. 2. excessive socialization. 3. command hallucinations. 4. altered state of consciousness.

1. sleep disturbance

The parents tell the nurse that their 8-year-old child seems to "always try to be annoying and hateful." What characteristic will the nurse assess further? 1. vindictive 2. emotionally immature 3. experiencing anxiety 4. depressed

1. vindictive (Vindictiveness is defined as spiteful, malicious behavior. The person with this disorder also shows a pattern of deliberately annoying people and blaming others for his or her mistakes or misbehavior. This child may frequently be heard to say "He made me do it!" or "It's not my fault!")

Which statement by a young client who has severe and persistent mental illness would alert the nurse to the need for psycho-educational intervention? 1. "I like to watch cartoons every morning." 2. "I hear that marijuana helps calm you down." 3. "I am looking for a job washing dishes at a diner." 4. "I hate having my thoughts so messed up all the time."

2. "I hear that marijuana helps calm you down."

The community nurse is working with a client diagnosed with severe and persistent mental illness. How will the nurse best implement rehabilitation principles in the care of this client? 1. By focusing assessment on the client's problems. 2. By identifying and reinforcing the client's strengths. 3. By reviewing earlier treatment plans for errors. 4. By considering the need to lower expectations and goals for this client.

2. By identifying and reinforcing the client's strengths.

The nurse is assessing a client diagnosed with obsessive-compulsive disorder (OCD). To further understand the past history that could contribute to this psychiatric illness, what question will be important to include in the assessment? 1. Have you ever been diagnosed with Attention Deficit Disorder? 2. Do you have a sibling or other family member who has been diagnosed with OCD? 3. Have you ever been diagnosed with an eating disorder? 4. Have you ever been diagnosed with a phobia?

2. Do you have a sibling or other family member who has been diagnosed with OCD?

A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first? 1. Verify the patient's learning style 2. Lower the patient's current anxiety 3. Create outcomes and a teaching plan 4. Assess how the patient uses defense mechanisms

2. Lower the patient's current anxiety

Which therapeutic intervention can the nurse implement in on her own to help a client diagnosed with a mild anxiety disorder regain control? 1. Flooding 2. Modeling 3. Thought stopping 4. Systematic desensitization

2. Modeling (modeling calm behavior)

What information from the parents would lead the nurse to assess further for oppositional defiant disorder (ODD)? 1. Has outbursts of anger and cannot control emotions. 2. Often argues with parents and other authority figures. 3. Often initiates physical fights. 4. Rationalizes aggressive behavior.

2. Often argues with parents and other authority figures.

The nursing diagnosis for a child who has been diagnosed with an impulse control disorder is Impaired Parenting. What would be the most appropriate outcome? 1. Parents will limit communication with the client. 2. Parent participates in therapeutic program. 3. Parents develop higher academic standards for the child. 4. Parent will learn to ignore the child's rage and defiance.

2. Parent participates in therapeutic program.

A client diagnosed with a severe and persistent mental illness tells the nurse, "I think people are laughing at me behind my back. I get really upset and anxious when I have to be around others in the group home. It's better when I just stay by myself." What would be the most appropriate diagnosis for the nurse to consider? 1. Self Care Deficit 2. Social Isolation. 3. Risk for Activity Intolerance. 4. Impaired Comfort.

2. Social Isolation.

In the film, (The New Asylums, from the video resources in the chapter), solitary confinement of prisoners is discussed. What point regarding psychiatric symptoms is made about the use of solitary in the prison system? 1. Solitary confinement of a prisoner with mental illness will help to reduce agitation and psychotic symptoms. 2. Solitary confinement will usually cause the symptoms of mental illness to worsen. 3. Solitary confinement does not have an effect on the mental status of prisoners. 4. Solitary confinement will not have an effect on psychiatric symptoms if the prisoner requests this.

2. Solitary confinement will usually cause the symptoms of mental illness to worsen.

In the film, The Released, the issue that persons with serious mental illness having a high rate of returning to prison after discharge is discussed. Based on the film, what is the most important reason for this? 1. Persons with serious mental illness feel safer and better cared for in the prison system. 2. There are not enough resources for their mental health care in the community. 3. They often have a criminal side to their illness. 4. Most mental health centers will not want to treat them.

2. There are not enough resources for their mental health care in the community.

The nurse is assessing a client who is being evaluated for generalized anxiety disorder (GAD). What information from the client would support this diagnosis? 1. his symptoms started right after he was robbed at gunpoint. 2. being so worried he hasn't been able to work for the last 12 months. 3. eating in public makes him extremely uncomfortable. 4. repeatedly verbalizing his prayers helps him feel relaxed.

2. being so worried he hasn't been able to work for the last 12 months. (hint - worried)

The mother of a 6-year-old child expresses concern over the child's frequent temper outbursts. He deals with any frustration by bullying and hitting and seldom shows any remorse for his actions. What DSM 5 diagnosis will the nurse explore further? 1. social phobia 2. conduct disorder (CD) 3. oppositional defiant disorder (ODD) 4. attention deficit hyperactivity disorder (ADHD)

2. conduct disorder (CD)

The nurse identifies a short term goal for a client who has panic attacks is: "Client will gain mastery over panic episodes." What would the nurse's most therapeutic verbal intervention related to this goal? 1. "How long have you had this problem?" 2. "What is it that you would like me to do to help you?" 3. "Can you tell me what you were feeling just before your attack?" 4. "What medications usually help you?"

3. "Can you tell me what you were feeling just before your attack?"

The team determines that the client diagnosed with schizophrenia would profit from a structured environment and having simple responsibilities. Which community resource could the nurse educate the client and family about? 1. Inpatient hospitalization 2. Supportive group therapy 3. A community rehabilitation program 4. Partial hospitalization

3. A community rehabilitation program

The nurse is caring for a client who was admitted with acute symptoms of anxiety and depression. The precipitant to the admission was that the client's home was condemned due to unsanitary conditions and hoarding. The client has been barred from his home and the home will be cleaned out by the family and sanitation service. What will the nurse likely find as characteristics of this client based on knowledge of Hoarding Disorder? 1. A tendency to have violent behavior. 2. A tendency to have memory lapses. 3. A tendency to be indecisive. 4. A tendency to have somatic symptoms.

3. A tendency to be indecisive.

The nurse is caring for a client who has prescribed lorazepam (Ativan) 1 mg PO qid for 1 week. What information should the nurse emphasize to the patient? 1. Make appointments for blood levels of this medication. 2. The importance of the long-term nature of benzodiazepine therapy. 3. Do not change the dose or frequency of the medication without consulting the prescriber. 4. Use alcoholic beverages in moderation.

3. Do not change the dose or frequency of the medication without consulting the prescriber.

The nurse is developing the plan of care for a client with an anxiety disorder. Which nursing diagnosis would be most useful? 1. Spiritual Distress 2. Disturbed body image 3. Ineffective role performance 4. Disturbed personal identity

3. Ineffective role performance

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? 1. Having the client repeatedly touch "dirty" objects 2. Not allowing the client to seek reassurance from staff 3. Not allowing the client to wash hands after touching a "dirty" object 4. Telling the client that he or she must relax whenever tension mounts

3. Not allowing the client to wash hands after touching a "dirty" object

What is the group leader's responsibility in the termination phase? A. Allowing members to exchange contact information so they remain as a support for each other. B. Removing himself or herself from the group so they can function independently. C. Encouraging group members to reflect on progress made while providing group feedback. D. Encouraging group members to fill out evaluation forms so the group leader can further improve his or her therapeutic technique.

C. Encouraging group members to reflect on progress made while providing group feedback.

The focus of the clubhouse model of treatment is A. stabilizing and preventing crises. B. conducting research studies in the community. C. providing socialization, improving functioning and building independence. D. intensive treatment of severe and persistent mental illness.

C. providing socialization, improving functioning and building independence.

What response demonstrates an effective strategy to encourage a nonparticipating member to speak during a group session? A. "You are letting the group down when you fail to contribute." B. "Your opinions about what just happened are important." C. "You must be feeling safe enough to enter the discussion by now." D. "What you are thinking is very important to the group."

D. "What you are thinking is very important to the group."

Pregbalin

Lyrica Anticonvulsant to treat GAD and social anxiety

Gabapentin

Neurontin Anticonvulsant to treat GAD and social anxiety

Antidepressants used to treat

OCD, GAD, PTSD, social phobia, panic disorder by increasing serotonin and norepinephrine. Example: Buspar (Buspirone): increases serotonin.

Paroxetine

Paxil Antidepressant SSRI (blocks serotonin) Weight gain Side Effects- sexual dysfunction, may decrease dopamine causing apathy, low libido, GI symptoms

ODD (oppositional defiant disorder)

Persons diagnosed with ODD are negativistic, disobedient, and defiant toward authority figures without seriously violating the basic rights of others

Beta Blockers (lol)

Propanolol (Inderal), Atenolol (Tenormin) Social anxiety, stage fright, phobias, panic disorder Block hormone Norepinephrine, Epinephrine (Adrenalin) Slows heart rate, heart beats less forcibly, lowers B/P Side Effects: disorientation, weakness, fatigue, dizziness (anti-anxiety)

Benzodiazepines (anti-anxiety medications)

Quick onset of action good in emergency, short term use Risk of dependence- caution prescribing for individual with SA, needs to be tapered if longer use Side Effects: sedation, ataxia, decrease cognitive functioning *caution in older adults (falls), adults with dementia (increased confusion) Paradoxical effect: anxiety, agitation, talkative

Buspirone (Buspar)

Serotonin receptor partial agonist-stimulates receptor site for serotonin Does not cause dependence Takes 2 to 4 weeks to work Can be used for long term treatment Side Effects- dizziness, nausea, headache, nervousness, lightheaded, excitement Not recommended for individuals with impaired hepatic and renal function- increased plasma levels (Anti-anxiety)

Seclusion rooms are not negotiated with the patient and are often implemented against the patient's will. True or False

True

A child was placed in a foster home after being removed from abusive parents. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help the child. Which interventions should the nurse suggest? (Select all that apply.) a. Use a calm manner and low voice. b. Maintain simplicity in the environment. c. Avoid repetition in what is said to the child. d. Minimize opportunities for exercise and play. e. Explain and reinforce reality to avoid distortions.

a. Use a calm manner and low voice. b. Maintain simplicity in the environment. e. Explain and reinforce reality to avoid distortions.

A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. The initial nursing intervention of highest priority is to a. provide for the patient's safety. b. encourage clarification of feelings. c. respect the patient's personal space. d. offer an outlet for the patient's energy.

a. provide for the patient's safety.

A person speaking about a rival for a significant other's affection says in an emotional, syrupy voice, "What a lovely person. That's someone I simply adore." The individual is demonstrating a. reaction formation. b. repression. c. projection. d. denial.

a. reaction formation. (Reaction formation is an unconscious mechanism that keeps unacceptable feelings out of awareness by using the opposite behavior. Instead of expressing hatred for the other person, the individual gives praise.)

What are the benefits of being mindful? Select all that apply A)Reduces anxiety B)Weight loss C)Reduces stress D)Improves sleep E)Increases blood pressure

a. reduces anxiety c. reduces stress d. improved sleep

A patient diagnosed with a SMI died suddenly at age 52. The patient lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, "How could this happen?" Which response by the nurse accurately reflects research and addresses the family's question? a. "A certain number of people die young from undetected diseases, and it's just one of those sad things that sometimes happen." b. "Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight." c. "We will have to wait for the autopsy to know what happened. There were some medical problems, but we were not expecting death." d. "We are all surprised. The patient had been doing so well and saw the nurse every other week."

b. "Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight."

Which assessment questions would be most appropriate for the nurse to ask a patient with possible obsessive-compulsive disorder? (Select all that apply.) a. "Are there certain social situations that cause you to feel especially uncomfortable?" b. "Are there others in your family who must do things in a certain way to feel comfortable?" c. "Have you been a victim of a crime or seen someone badly injured or killed?" d. "Is it difficult to keep certain thoughts out of your awareness?" e. "Do you do certain things over and over again?"

b. "Are there others in your family who must do things in a certain way to feel comfortable?" d. "Is it difficult to keep certain thoughts out of your awareness?" e. "Do you do certain things over and over again?"

The nurse assesses a patient who complains of loneliness and episodes of anxiety. Which statement by the patient is mostly likely if this patient also has agoraphobia? a. "I'm sure I will get over not wanting to leave home soon. It takes time." b. "Being afraid to go out seems ridiculous, but I can't go out the door." c. "My family says they like it now that I stay home most of the time." d. "When I have a good incentive to go out, I can do it."

b. "Being afraid to go out seems ridiculous, but I can't go out the door."

The sibling of a patient who was diagnosed with a SMI asks why a case manager has been assigned. The nurse's reply should cite the major advantage of the use of case management as: a. "The case manager can modify traditional psychotherapy for homeless patients so that it is more flexible." b. "Case managers coordinate services and help with accessing them, making sure the patient's needs are met." c. "The case manager can focus on social skills training and esteem building in the real world where the patient lives." d. "Having a case manager has been shown to reduce hospitalizations, which prevents disruption and saves money."

b. "Case managers coordinate services and help with accessing them, making sure the patient's needs are met."

A homeless patient diagnosed with a SMI became suspicious and delusional. Depot antipsychotic medication began and housing was obtained in a local shelter. One month later, which statement by the patient indicates significant improvement? a. "They will not let me drink. They have many rules in the shelter." b. "I feel comfortable here. Nobody bothers me." c. "Those shots make my arm very sore." d. "Those people watch me a lot."

b. "I feel comfortable here. Nobody bothers me."

Many persons brought before a criminal court have mental illness, have committed minor offenses, and are off medications. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate? a. "Sometimes a little time in jail makes a person rethink what they've been doing and puts them back on the right track." b. "Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses." c. "Arresting these people helps them in the long run. Sometimes we cannot hospitalize them, but in jail they will get their medication." d. "Research suggests that special mental health courts do not make much difference so far, but outpatient commitment does seem to help."

b. "Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses."

Which behavior or action best exemplifies aggression? a. A patient at a in-patient therapy session stating they feel worthless and wants to hurt themselves, has a plan, but does not have the means to carry it out. b. A patient who flings their hands in a nurse's face, blames the nurse for dropping their medication, and stomps away. c. A patient who keeps shuffling papers and tapping their hands and legs while in a group therapy meeting. d. A patient who refuses to get lunch from the meal cart and because they "feel fat" and and say "I am not going to eat for the ret of my stay and you can't make me."

b. A patient who flings their hands in a nurse's face, blames the nurse for dropping their medication, and stomps away.

A woman is 5'7", 160 lbs. and wears a size 8 shoe. She says, "My feet are huge. I've asked three orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? a. Social anxiety disorder b. Body dysmorphic disorder c. Separation anxiety disorder d. Obsessive-compulsive disorder due to a medical condition

b. Body dysmorphic disorder

A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention? a. Offering hope allays and defuses the patient's anxiety. b. Concerns stated aloud become less overwhelming and help problem solving begin. c. Anxiety is reduced by focusing on and validating what is occurring in the environment. d. Encouraging patients to explore alternatives increases the sense of control and lessens anxiety

b. Concerns stated aloud become less overwhelming and help problem solving begin.

A person diagnosed with a SMI enters a shelter for the homeless. Which intervention should be the nurse's initial priority? a. Find supported employment. b. Develop a trusting relationship. c. Administer prescribed medication. d. Teach appropriate health care practices.

b. Develop a trusting relationship.

A nurse works with an adolescent who was placed in a residential program after multiple episodes of violence at school. Establishing rapport with this adolescent is a priority because (Select all that apply) a. it is a vital component of implementing a behavior modification program. b. a therapeutic alliance is the first step in a nurse's therapeutic use of self. c. the adolescent has demonstrated resistance to other authority figures. d. acceptance and trust convey feelings of security for the adolescent. e. adolescents usually relate better to authority figures than peers.

b. a therapeutic alliance is the first step in a nurse's therapeutic use of self. d. acceptance and trust convey feelings of security for the adolescent.

After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This patient now requires continual direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of a. side effects of antipsychotic medications. b. dependency caused by institutionalization. c. cognitive deterioration from schizophrenia. d. stress associated with acclimation to the community

b. dependency caused by institutionalization.

A patient experiences a sudden episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to give as a prn anxiolytic? a. buspirone b. lorazepam c. amitriptyline d. desipramine

b. lorazepam (Lorazepam (Ativan) is a benzodiazepine used to treat anxiety)

CD (conduct disorder)

behave in ways that do violate the rights of others and age-appropriate societal norms

A 12-year-old has engaged in bullying for several years. The parents say, "We can't believe anything our child says." Recently this child shot a dog with a pellet gun and set fire to a neighbor's trash bin. The child's behaviors support the diagnosis of a. ADHD. b. intermittent explosive disorder. c. oppositional defiant disorder (ODD). d. CD.

d. CD. (aggression against people and animals; destruction of property; deceitfulness; rule violations; and impairment in social, academic, or occupational functioning)

A 15-year-old ran away from home six times and was arrested for shoplifting. The parents told the Court, "We can't manage our teenager." The adolescent is physically abusive to the mother and defiant with the father. Which diagnosis is supported by this adolescent's behavior? a. Attention deficit hyperactivity disorder (ADHD) b. Post-traumatic stress disorder (PTSD) c. Intermittent explosive disorder d. CD

d. Conduct Disorder (CD)

A patient undergoing diagnostic tests says, "Nothing is wrong with me except a stubborn chest cold." The spouse reports the patient smokes, coughs daily, lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using? a. Displacement b. Regression c. Projection d. Denial

d. Denial

The family of a child diagnosed with an impulse control disorder needs help to function more adaptively. Which aspect of the child's plan of care will be provided by an advanced practice nurse rather than a staff nurse? a. Leading an activity group b. Providing positive feedback c. Formulating nursing diagnoses d. Dialectical behavioral therapy (DBT)

d. Dialectical behavioral therapy (DBT) (DBT is an aspect of psychotherapy.)

A family discusses the impact of a seriously mental ill member. Insurance partially covers treatment expenses, but the family spends much of their savings for care. The patient's sibling says, "My parents have no time for me." The parents are concerned that when they are older, there will be no one to care for the patient. Which response by the nurse would be most helpful? a. Acknowledge their concerns and consult with the treatment team about ways to bring the patient's symptoms under better control. b. Give them names of financial advisors that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one. c. Refer them to crisis intervention services to learn ways to manage caregiver stress and provide titles of some helpful books for families. d. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent.

d. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent.

An adolescent diagnosed with an impulse control disorder says, "I want to die. I spend my time getting even with people who hurt me." When asked about a suicide plan, the adolescent replies, "I'll jump from a bridge near my home. My father threw kittens off that bridge and they died." Rate the suicide risk. a. Absent b. Low c. Moderate d. High

d. High

A homeless individual diagnosed with SMI and a history of persistent treatment non-adherence plans to begin attending the day program at a community mental health center. Which intervention should be the team's initial focus? a. Teach appropriate health maintenance and prevention practices. b. Educate the patient about the importance of treatment adherence. c. Help the patient obtain employment in a local sheltered workshop. d. Interact regularly and supportively without trying to change the patient.

d. Interact regularly and supportively without trying to change the patient.

A hospitalized patient diagnosed with schizophrenia has a history of multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply first as the patient transitions from hospital to community? a. Administer a second-generation antipsychotic to help negative symptoms. b. Use a quick-dissolving medication formulation to reduce "cheeking." c. Prescribe a long-acting intramuscular antipsychotic medication. d. Involve the patient in decisions about which medication is best.

d. Involve the patient in decisions about which medication is best.

For a patient experiencing panic, which nursing intervention should be implemented first? a. Teach relaxation techniques. b. Administer an anxiolytic medication. c. Prepare to implement physical controls. d. Provide calm, brief, directive communication.

d. Provide calm, brief, directive communication.

A person who has been unable to leave home for more than a week because of severe anxiety says, "I know it does not make sense, but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate? a. Help the person use online video calls to provide interaction with others. b. Advise the person to accept the situation and use a companion. c. Ask the person to explain why the fear is so disabling. d. Teach the person to use positive self-talk techniques.

d. Teach the person to use positive self-talk techniques. (Positive self-talk, a form of cognitive restructuring, replaces negative thoughts such as "I can't leave my apartment" with positive thoughts such as "I can control my anxiety." This technique helps the patient gain mastery over the symptoms.)

A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counseling demonstrates principles of a. flooding. b. desensitization. c. relaxation technique. d. cognitive restructuring.

d. cognitive restructuring. (Cognitive restructuring involves the patient in testing automatic thoughts and drawing new conclusions.)

A person who feels unattractive repeatedly says, "Although I'm not beautiful, I am smart." This is an example of a. repression. b. devaluation. c. identification. d. compensation.

d. compensation.

A patient diagnosed with schizophrenia tells the community mental health nurse, "I threw away my pills because they interfere with God's voice." The nurse identifies the etiology of the patient's ineffective management of the medication regime as a. inadequate discharge planning. b. poor therapeutic alliance with clinicians. c. dislike of antipsychotic medication side effects. d. impaired reasoning secondary to the schizophrenia.

d. impaired reasoning secondary to the schizophrenia.

A student says, "Before taking a test, I feel very alert and a little restless." The nurse can correctly assess the student's experience as a. culturally influenced. b. displacement. c. trait anxiety. d. mild anxiety.

d. mild anxiety.

An outpatient diagnosed with schizophrenia tells the nurse, "I am here to save the world. I threw away the pills because they make God go away." The nurse identifies the patient's reason for medication nonadherence as a. poor alliance with clinicians. b. inadequate discharge planning. c. dislike of medication side effects. d. thought disturbances associated with the illness.

d. thought disturbances associated with the illness.

Introjection

involves intense, unconscious identification with another person.

Conversion

involves the unconscious transformation of anxiety into a physical symptom.

Splitting

is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image.

In developing the plan of care for a client with an anxiety disorder, which nursing intervention would be most helpful? 1. Express mild amusement over symptoms. 2. Arrange for client to spend time away from others. 3. Advise client to minimize exercise to conserve endorphins. 4. Reinforce use of positive self-talk to change negative assumptions.

4. Reinforce use of positive self-talk to change negative assumptions.

A community mental health nurse assesses a client with serious mental illness who is being treated with antipsychotic medication. The nurse makes the following observations listed below. Which assessed data have the least priority? 1. New-onset chewing movements 2. Resting tremors of the hands are present. 3. Muscle stiffness and rigidity are present. 4. Reports of dry mouth and eyes

4. Reports of dry mouth and eyes

Clonidine

(Catapres) anti-anxiety

Propanolol (Inderal)

(Inderal) beta blocker to treat anxiety

Atenolol

(Tenormin) beta blocker to treat anxiety

Which remark would signal to the nurse that there is a teaching need for the family of a client diagnosed with schizophrenia 1. "We always reprimand him whenever his behavior is bothersome." 2. "We watch him closely for signs of illness associated with relapse." 3. "We have taught him to use the bus so we do not have to drive him everywhere." 4. "We give positive recognition to him whenever he does even simple things well."

1. "We always reprimand him whenever his behavior is bothersome."

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." What is the nurse's most therapeutic response? 1. "What things have you done in the past that helped you feel more comfortable?" 2. "Let's try to focus on that adorable little granddaughter of yours." 3. Why don't you sit down over there and work on that jigsaw puzzle." 4. "Try not to think about the feelings and sensations you're experiencing."

1. "What things have you done in the past that helped you feel more comfortable?

Which child is demonstrating behaviors that support a diagnosis of adolescent onset conduct disorder (CD)? 1. A 12-year-old male who steals a bicycle as a gang initiation 2. A 9-year-old male who smokes half a pack of cigarettes a day 3. A 12-year-old female who regularly bullies her younger siblings 4. A 9-year-old female who engages in sexually provocative behaviors

1. A 12-year-old male who steals a bicycle as a gang initiation (adolescent onset conduct disorder (CD): symptoms do not start before age 10) (Affected adolescents tend to act out misconduct with their peer group (e.g., early onset of sexual behavior, substance abuse, risk-taking behaviors). Males are more likely to fight, steal, vandalize, and have school discipline problems, whereas girls tend to lie, be truant, run away, abuse substances, and engage in prostitution.)

The nurse is caring for a client who is experiencing a panic attack. What is the most therapeutic response of the nurse? 1. In a calm manner, tell the client to take slow, deep breaths 2. suggest that the client go to the group to get their mind off of the anxiety 3. asking the client what he means when he says "I am dying." 4. offering an explanation about why the symptoms are occurring

1. In a calm manner, tell the client to take slow, deep breaths

The nurse is assessing an adolescent who is often angry and resentful, loses her temper and is often touchy and easily annoyed. The nurse questions why the teen was diagnosed with intermittent explosive disorder rather than an oppositional defiant disorder. What information in the medical record would support the diagnosis of Intermittent explosive disorder? 1. Outbursts involve the destruction of property and physical assault against people or animals. 2. Refuses to comply with requests from authority. 3. Outbursts rarely involve the destruction of property or harm to others. 4. Outbursts are premeditated and are done to achieve some tangible objective.

1. Outbursts involve the destruction of property and physical assault against people or animals. (Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses. The aggression can be verbal or physical and targeted toward other people, animals, or property, or even themselves.)

An adult patient tells the case manager, "I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends." Where should the nurse refer the patient? (Select all that apply.) a. Psychoeducational classes b. Vocational rehabilitation c. Social skills training d. A homeless shelter e. Crisis intervention

a. Psychoeducational classes b. Vocational rehabilitation c. Social skills training

The nurse is caring for a client in the partial hospitalization program who is very troubled by chronic auditory hallucinations. The nurse seeks advice from the psychiatric clinical nurse specialist. The clinical nurse specialist would most likely suggest which of the following cognitive interventions for this client? 1. Frequently remind the client that the voices are not real. 2. Help the client to identify emotional conflicts. 3. Teach the client distracting techniques. 4. Give as-needed medication for anxiety

3. Teach the client distracting techniques.

A client diagnosed with a severe mental illness and institutionalized for most of his adult life has recently been transferred to a supervised community-based residential home that houses several other adult men. The client is refusing to go to day therapy and has begun to socially isolate if allowed. He has an apparent weight loss and has become uncooperative. What is the most likely reason for these changes? 1. This person is relapsing. 2. This person is lazy now that he is not on a regular schedule. 3. This person is having difficulty transitioning to a more independent setting. 4. This person is beginning to show signs of independence.

3. This person is having difficulty transitioning to a more independent setting.

What is the goal of a nurse working in psychiatric rehabilitation in the community? 1. To help the clients accept others making decisions about their care. 2. To help clients continue to live comfortably in a psychiatric treatment facility. 3. To help client's cope more effectively with their symptoms. 4. To help client's learn to live being dependent on others.

3. To help client's cope more effectively with their symptoms.

The nurse educator is orienting new nurses to the adolescent psychiatric unit and is discussing how to manage disruptive behavior. What techniques will be important to include in the education? 1. extensive denial of privileges 2. seclusion and restraint PRN 3. behavioral contract 4. addressing annoying behavior as such

3. behavioral contract

The nurse is caring for a young woman from Latin America who has an anxiety disorder with panic attacks. Reports from staff indicate that they find some of the patient's responses very dramatic and wonder if her anxiety is much more acute than what was reported. What observation might be considered a result of culture rather than more acute symptoms? 1. repetitive involuntary actions. 2. blushing. 3. fear of dying. 4. offensive verbalizations.

3. fear of dying.

The nurse is planning the care for a child who demonstrates hostile laughter, blames others for his behavior, is grandiose, and has difficulty establishing relationships. What would be the most appropriate nursing diagnosis? 1. fear 2. anxiety 3. impaired social interactions 4. risk for self-mutilation

3. impaired social interactions

The medical record documentation indicates that the client often relies on rationalization. What behavior of the client would the nurse most likely observe? 1. make jokes to relieve tension. 2. miss appointments. 3. justify illogical ideas and feelings. 4. behave in ways that are the opposite of his or her feelings.

3. justify illogical ideas and feelings.

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 interventions of the nurse should be based on what level of anxiety evidenced by the statement? 1. mild 2. moderate 3. severe 4. panic

3. severe

The nurse caring for a client experiencing a panic attack. After trying other interventions, the client is still very anxious. There is a list of medications ordered for the client. Which medication would be best for the immediate relief of anxiety? 1. Buspirone (Buspar) 7.5 mg 2. Trazodone (Desyrel) 50 mg 3. Melatonin 10 mg 4. Lorazepam (Ativan) 2 mg

4. Lorazepam (Ativan) 2 mg

In the film, The Released, details about the crimes committed by persons with serious mental illness are discussed. What types of crimes are most commonly associated with the incarceration of persons with serious mental illnesses? 1. Murders. 2. Violent sexual crimes 3. Major robberies. 4. Petty, nonviolent crimes.

4. Petty, nonviolent crimes.

The nurse has identified an intervention to provide an education designed to help the client access and use community supports. What will be an appropriate outcome for this intervention? 1. The client can identify stressful events. 2. The client remains medication adherent. 3. The client can discuss early signs of relapse. 4. The client arranges to attend a money management workshop.

4. The client arranges to attend a money management workshop.

When working with a client demonstrating impulse control disorders, all of the following nursing interventions have priority except 1. providing a safe environment. 2. establishing a therapeutic nurse-client relationship. 3. setting and enforcing limits and expectations. 4. confronting the client concerning disruptive behavior.

4. confronting the client concerning disruptive behavior.

Which nursing intervention will not be therapeutic for clients demonstrating impulse control disorders? 1. providing a safe environment. 2. establishing a therapeutic nurse-client relationship. 3. setting and enforcing limits and expectations. 4. confronting the client concerning the disruptive behavior.

4. confronting the client concerning the disruptive behavior.

A client is running from chair to chair in the solarium. He is wide-eyed and keeps repeating, "They are coming! They are coming!" He neither follows staff direction nor responds to verbal efforts to calm him. The nurse's interventions should be based on what level of anxiety? 1. mild 2. moderate 3. servere 4. panic

4. panic (Panic-level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety.)

What are some benefits of comfort rooms? (Select all that apply) A. Lower rates of seclusion & restraints B. Decreased assaults Client-to-client C. Patient cannot leave room until calm D. Decreased assaults Client-to-staff E. Allows for self-management

A. Lower rates of seclusion & restraints B. Decreased assaults Client-to-client D. Decreased assaults Client-to-staff E. Allows for self-management

A patient reports positive results from taking an herb to manage a migraine headache pain. The nurse confirms there are no hazardous interactions between the herb and the patient's current medications. What is the nurse's best response to the patient? A."Thanks for telling me. I'll make a note in your medical record that you're taking it." B."You are experiencing a placebo effect. When we believe something will help, it usually does." C."Self-management of health problems can be dangerous. You should have notified me sooner." D."Research studies show that herbal products actually increase migraine pain by inflaming nerve cells in the brain."

A."Thanks for telling me. I'll make a note in your medical record that you're taking it."

MAOIs (monoamine oxidase inhibitors)

Anti-depressant Tyramine-free diet

Clonidine (Catapres)

Antihypertensive, similar action as Propranolol Panic disorder, phobia, social anxiety, stage fright Slows heart rate, heart beats less forcibly, lowers B/P Inhibits brain's secretion of norepinephrine Risk when combined with beta blocker Side Effects: sexual dysfunction, headaches, dizziness, hot flashes, cold symptoms, mood swings, dry mouth. (anti-anxiety)

Buspirone

Buspar (anti-anxiety and anti-depressant: long term)

An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic. Which defense mechanism is evident? a. Rationalization b. Compensation c. Introjection d. Regression

a. Rationalization (Rationalization involves unconsciously making excuses for one's behavior, inadequacies, or feelings.)

An adolescent diagnosed with CD has aggression, impulsivity, hyperactivity, and mood symptoms. The treatment team believes this adolescent may benefit from medication. The nurse anticipates the health care provider will prescribe which type of medication? a. Second-generation antipsychotic b. Antianxiety medication c. Calcium channel blocker d. β-blocker

a. Second-generation antipsychotic (anti-anxiety meds do not treat impulse control issues; beta-blockers would help calm the individual; calcium channel blockers reduce BP.)

A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder? a. "I check where my car keys are eight times." b. "My legs often feel weak and spastic." c. "I'm embarrassed to go out in public." d. "I keep reliving a car accident."

a. "I check where my car keys are eight times."

A nurse's neighbor says, "My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions?" Select the nurse's best response. a. "NAMI offers a family education series that you might find helpful." b. "Since your sister is noncompliant, perhaps it's time for her to be changed to injectable medication." c. "You have done all you can. Now it's time to put yourself first and move on with your life." d. "You cannot help her. Would it be better for you to discontinue your relationship?"

a. "NAMI offers a family education series that you might find helpful."

Which statements most clearly indicate the speaker views mental illness with stigma? (Select all that apply.) a. "We are all a little bit crazy." b. "If people with mental illness would go to church, their problems would be solved." c. "Many mental illnesses are genetically transmitted. It's no one's fault that the illness occurs." d. "Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people." e. "People with mental illness are lazy. They get government disability checks instead of working."

a. "We are all a little bit crazy." b. "If people with mental illness would go to church, their problems would be solved." e. "People with mental illness are lazy. They get government disability checks instead of working."

Two staff nurses applied for promotion to nurse manager. The nurse not promoted initially had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurse's response? a. Altruism b. Suppression c. Intellectualization d. Reaction formation

a. Altruism (Altruism is the mechanism by which an individual deals with emotional conflict by meeting the needs of others and receiving gratification vicariously or from the responses of others.)

A patient in the emergency department shows disorganized behavior and incoherence after a friend suggested a homosexual encounter. In which room should the nurse place the patient? a. An interview room furnished with a desk and two chairs b. A small, empty storage room with no windows or furniture c. A room with an examining table, instrument cabinets, desk, and chair d. The nurse's office, furnished with chairs, files, magazines, and bookcases

a. An interview room furnished with a desk and two chairs

A nurse plans health teaching for a patient diagnosed with generalized anxiety disorder who begins a new prescription for lorazepam. What information should be included? (Select all that apply.) a. Caution in use of machinery b. Foods allowed on a tyramine-free diet c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives e. Take the medication on an empty stomach

a. Caution in use of machinery c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives

A 16-year-old diagnosed with a conduct disorder (CD) has been in a residential program for 3 months. Which outcome should occur before discharge? a. The adolescent and parents create and agree to a behavioral contract with rules, rewards, and consequences. b. The adolescent identifies friends in the home community who are a positive influence. c. Temporary placement is arranged with a foster family until the parents complete a parenting skills class. d. The adolescent experiences no anger and frustration for 1 week.

a. The adolescent and parents create and agree to a behavioral contract with rules, rewards, and consequences.

A patient diagnosed with SMI was living successfully in a group home but wanted an apartment. The prospective landlord said, "People like you have trouble getting along and paying their rent." The patient and nurse meet for a problem-solving session. Which options should the nurse endorse? (Select all that apply.) a. Coach the patient in ways to control symptoms effectively. b. Seek out landlords less affected by the stigma associated with mental illness. c. Threaten the landlord with legal action because of the discriminatory actions. d. Encourage the patient to remain in the group home until the illness is less obvious. e. Suggest that the patient list a false current address in the rental application. f. Have the case manager meet with the landlord to provide education about mental illness.

a. Coach the patient in ways to control symptoms effectively. b. Seek out landlords less affected by the stigma associated with mental illness. f. Have the case manager meet with the landlord to provide education about mental illness.

A consumer at a rehabilitative psychosocial program says to the nurse, "People are not cleaning up behind themselves in the bathrooms. The building is dirty and cluttered." How should the nurse respond? a. Encourage the consumer to discuss it at a meeting with everyone. b. Hire a professional cleaning service to clean the restrooms. c. Address the complaint at the next staff meeting. d. Tell the consumer, "That's not my problem."

a. Encourage the consumer to discuss it at a meeting with everyone.

A student says, "Before taking a test, I feel very alert and a little restless." Which nursing intervention is most appropriate to assist the student? a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects. b. Advise the student to discuss this experience with a health care provider. c. Encourage the student to begin antioxidant vitamin supplements. d. Listen attentively, using silence in a therapeutic way.

a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects.

A nurse on an adolescent psychiatric unit assesses a newly admitted 14- year-old. An impulse control disorder is suspected. Which aspects of the patient's history support the suspected diagnosis? (Select all that apply.) a. Family history of mental illness b. Allergies to multiple antibiotics c. Long history of severe facial acne d. Father with history of alcohol abuse e. History of an abusive relationship with one parent

a. Family history of mental illness d. Father with history of alcohol abuse e. History of an abusive relationship with one parent

An adolescent was arrested for prostitution and assault on a parent. The adolescent says, "I hate my parents. They focus all attention on my brother, who's perfect in their eyes." Which type of therapy might promote the greatest change in the adolescent's behavior? a. Family therapy b. Bibliotherapy c. Play therapy d. Art therapy

a. Family therapy

The nurse assesses an adult who is socially withdrawn and hoards. Which nursing diagnoses most likely apply to this individual? (Select all that apply.) a. Ineffective home maintenance b. Situational low self-esteem c. Chronic low self-esteem d. Disturbed body image e. Risk for injury

a. Ineffective home maintenance c. Chronic low self-esteem e. Risk for injury

A patient diagnosed with a SMI lives independently and attends a psychosocial rehabilitation program. The patient presents at the emergency department seeking hospitalization. The patient has no acute symptoms but says, "I have no money to pay my rent or refill my prescription." Select the nurse's best action. a. Involve the patient's case manager to provide crisis intervention. b. Send the patient to a homeless shelter until housing can be arranged. c. Arrange for a short in-patient admission and begin discharge planning. d. Explain that one must have active psychiatric symptoms to be admitted.

a. Involve the patient's case manager to provide crisis intervention.

What are the examples of predictors of violence? Select all that apply. a. Loud voice b. Silence c. Possession of a weapon d. Verbal abuse e. Irritability

a. Loud voice c. Possession of a weapon d. Verbal abuse 3. Irritability

The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal? (Select all that apply.) a. Maintain stable and consistent staff. b. Increase the length of medication education groups. c. Stress that without treatment, illnesses will worsen. d. Prescribe drugs in smaller but more frequent dosages. e. Make it easier to access prescribers and pay for drugs. f. Require adherence in order to participate in programming.

a. Maintain stable and consistent staff. e. Make it easier to access prescribers and pay for drugs.

What does a nurse healer consider when educating a patient on healing techniques? (Select all that apply) A. Massage therapy B. Prayer C. Education D. Meditation E. Employment

a. Massage therapy b. Prayer d. Meditation

Which assessment findings support a diagnosis of ODD? a. Negative, hostile, and spiteful toward parents. Blames others for misbehavior. b. Exhibits involuntary facial twitching and blinking; makes barking sounds. c. Violates others' rights; cruelty toward people or animals; steals; truancy. d. Displays poor academic performance and reports frequent nightmares.

a. Negative, hostile, and spiteful toward parents. Blames others for misbehavior. (ODD is a repeated and persistent pattern of having an angry and irritable mood in conjunction with demonstrating defiant and vindictive behavior. The distracters identify findings associated with CD, anxiety disorder, and Tourette's syndrome.)

Parents of an adolescent diagnosed with CD say, "We don't know how to respond when our child breaks the rules in our house. Is there any treatment that might help us?" Which therapy is likely to be helpful for these parents? a. Parent-child interaction therapy (PCIT) b. Behavior modification therapy c. Multi-systemic therapy (MST) d. Pharmacotherapy

a. Parent-child interaction therapy (PCIT) (In PCIT, the therapist sits behind one-way mirrors and coaches parents through an ear audio device while they interact with their children. The therapist can suggest strategies that reinforce positive behavior in the adolescent. The goal is to improve parenting strategies and thereby reduce problematic behavior.)

A person diagnosed with SMI has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse? (Select all that apply.) a. Discourage potentially stressful activities such as groups or volunteer work. b. Develop written plans that will help the patient remember what to do in a crisis. c. Help the patient identify and anticipate events that are likely to be overwhelming. d. Encourage health-promoting activities such as exercise and getting adequate rest. e. Accompany the patient to a NAMI support group.

b. Develop written plans that will help the patient remember what to do in a crisis. c. Help the patient identify and anticipate events that are likely to be overwhelming. d. Encourage health-promoting activities such as exercise and getting adequate rest. e. Accompany the patient to a NAMI support group.

A patient performs ritualistic hand washing. Which action should the nurse implement to help the patient develop more effective coping? a. Allow the patient to set a hand-washing schedule. b. Encourage the patient to participate in social activities. c. Encourage the patient to discuss hand washing routines. d. Focus on the patient's symptoms rather than on the patient

b. Encourage the patient to participate in social activities. (Look for interventions that do not focus on compulsive behavior)

A 15-year-old was placed in a residential program after truancy, running away, and an arrest for theft. At the program, the adolescent refused to join in planned activities and pushed a staff member, causing a fall. Which approach by nursing staff will be most therapeutic? a. Planned ignoring b. Establish firm limits c. Neutrally permit refusals d. Coaxing to gain compliance

b. Establish firm limits

A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety? a. Mild b. Moderate c. Severe d. Panic

b. Moderate (Moderate anxiety causes the individual to grasp less information and reduces problemsolving ability to a less-than-optimal level. Mild anxiety heightens attention and enhances problem solving. Severe anxiety causes great reduction in the perceptual field. Panic level anxiety results in disorganized behavior.)

What are the primary distinguishing factors between the behavior of persons diagnosed with ODD and those with CD? The person diagnosed with (Select all that apply) a. ODD relives traumatic events by acting them out. b. ODD tests limits and disobeys authority figures. c. ODD has difficulty separating from loved ones. d. CD uses stereotypical or repetitive language. e. CD often violates the rights of others.

b. ODD tests limits and disobeys authority figures. e. CD often violates the rights of others.

A child known as the neighborhood bully says, "Nobody can tell me what to do." After receiving a poor grade on a science project, this child secretly loaded a virus on the teacher's computer. These behaviors support a diagnosis of a. CD. b. ODD. c. intermittent explosive disorder. d. ADHD

b. ODD. (ODD is a repeated and persistent pattern of having an angry and irritable mood in conjunction with demonstrating defiant and vindictive behavior. Loading a virus is a vindictive behavior in retribution for a poor grade. Persons with CD are aggressive against people and animals; destroy property; are deceitful; violate rules; and have impaired social, academic, or occupational functioning.)

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate? a. Reassure the patient that all nurses are skilled in providing postoperative care. b. Present the information again in a calm manner using simple language. c. Tell the patient that staff is prepared to promote recovery. d. Encourage the patient to express feelings to family.

b. Present the information again in a calm manner using simple language.

A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. Which nursing diagnosis has the highest priority? a. Fear b. Risk for injury c. Self-care deficit d. Disturbed thought processes

b. Risk for injury

A patient living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the patient was prohibited from returning to the apartment. The landlord said, "You cause too much trouble." What problem is the patient experiencing? a. Grief b. Stigma c. Homelessness d. Nonadherence

b. Stigma

An 11-year-old diagnosed with ODD becomes angry over the rules at a residential treatment program and begins shouting at the nurse. What is the nurse's initial action to defuse the situation? a. Say to the child, "Tell me how you're feeling right now." b. Take the child swimming at the facility's pool. c. Establish a behavioral contract with the child. d. Administer an anxiolytic medication.

b. Take the child swimming at the facility's pool.

For patients diagnosed with SMI, what is the major advantage of case management? a. The case manager can modify traditional psychotherapy. b. With one coordinator of services, resources can be more efficiently used. c. The case manager can focus on social skills training and esteem building. d. Case managers bring groups of patients together to discuss common problems.

b. With one coordinator of services, resources can be more efficiently used.

SMI is characterized as a. any mental illness of more than 2 weeks' duration. b. a major long-term mental illness marked by significant functional impairments. c. a mental illness accompanied by physical impairment and severe social problems. d. a major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities.

b. a major long-term mental illness marked by significant functional impairments.

An outpatient diagnosed with schizophrenia attends programming at a community mental health center. The patient says, "I threw away the pills because they keep me from hearing God." Which response by the nurse would most likely to benefit this patient? a. "You need your medicine. Your schizophrenia will get worse without it." b. "Do you want to be hospitalized again? You must take your medication." c. "I would like you to come to the medication education group every Thursday." d. "I noticed that when you take the medicine, you are able to keep the job you wanted."

d. "I noticed that when you take the medicine, you are able to keep the job you wanted."

A person diagnosed with a SMI living in the community was punched, pushed to the ground, and robbed of $7 during the day on a public street. Which statements about violence and SMI in general are accurate? (Select all that apply.) a. Persons with SMI are more likely to be violent. b. SMI persons are more likely to commit crimes than to be the victims of crime. c. Impaired judgment and social skills can provoke hostile or assaultive behavior. d. Lower incomes force SMI persons to live in high-crime areas, increasing risk. e. SMI persons experience higher rates of sexual assault and victimization than others. f. Criminals may believe SMI persons are less likely to resist or testify against them

c. Impaired judgment and social skills can provoke hostile or assaultive behavior. d. Lower incomes force SMI persons to live in high-crime areas, increasing risk. e. SMI persons experience higher rates of sexual assault and victimization than others. f. Criminals may believe SMI persons are less likely to resist or testify against them

Where is the vestibular sensory organ located? A)Frontal Lobe B)Spine C)Inner Ear D)Eyes

c. Inner Ear

An adolescent acts out in disruptive ways. When this adolescent threatens to throw a heavy pool ball at another adolescent, which comment by the nurse would set appropriate limits? a. "Attention everyone: we are all going to the craft room." b. "You will be taken to seclusion if you throw that ball." c. "Do not throw the ball. Put it back on the pool table." d. "Please do not lose control of your emotions."

c. "Do not throw the ball. Put it back on the pool table."

A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be: a. "What would you like me to do to help you?" b. "Why do you suppose you are feeling anxious?" c. "I'm not sure I understand. Give me an example." d. "You must get your feelings under control before we can continue."

c. "I'm not sure I understand. Give me an example."

An adolescent was recently diagnosed with ODD. The parents say to the nurse, "Isn't there some medication that will help with this problem?" Select the nurse's best response. a. "There are no medications to treat this problem. This diagnosis is behavioral in nature." b. "It's a common misconception that there is a medication available to treat every health problem." c. "Medication is usually not prescribed for this problem. Let's discuss some behavioral strategies you can use." d. "There are many medications that will help your child manage aggression and destructiveness. The health care provider will discuss them with you."

c. "Medication is usually not prescribed for this problem. Let's discuss some behavioral strategies you can use."

A cruel and abusive person often uses rationalization to explain the behavior. Which comment demonstrates use of this defense mechanism? a. "I don't know why I do mean things." b. "I have always had poor impulse control." c. "That person should not have provoked me." d. "I'm really a coward who is afraid of being hurt."

c. "That person should not have provoked me."

Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with SMI? a. Clubhouse model b. Cognitive-behavioral therapy (CBT) c. Assertive community treatment (ACT) d. Cognitive enhancement therapy (CET)

c. Assertive community treatment (ACT)

Which nursing diagnosis is likely to apply to an individual diagnosed with a SMI who is homeless? a. Insomnia b. Substance abuse c. Chronic low self-esteem d. Impaired environmental interpretation syndrome

c. Chronic low self-esteem

The nurse wants to enroll a patient with poor social skills in a training program for patients diagnosed with schizophrenia. Which description accurately describes social skills training? a. Patients learn to improve their attention and concentration. b. Group leaders provide support without challenging patients to change. c. Complex interpersonal skills are taught by breaking them into simpler behaviors. d. Patients learn social skills by practicing them in a supported employment setting.

c. Complex interpersonal skills are taught by breaking them into simpler behaviors.

Shortly after the parents announced that they were divorcing, a 15-year old became truant from school and assaulted a friend. The adolescent told the school nurse, "I'd rather stay in my room and listen to music. It's easier than thinking about what is happening in my family." Which nursing diagnosis is most applicable? a. Chronic low self-esteem related to role within the family b. Decisional conflict related to compliance with school requirements c. Defensive coping related to adjustment to changes in family relationships d. Disturbed personal identity related to self perceptions of changing family dynamics

c. Defensive coping related to adjustment to changes in family relationships

An adolescent was arrested for prostitution and assault on a parent. The adolescent says, "I hate my parents. They focus all attention on my brother, who's perfect in their eyes." Which nursing diagnosis is most applicable? a. Disturbed personal identity related to acting out as evidenced by prostitution b. Hopelessness related to achievement of role identity as evidenced by feeling unloved by parents c. Defensive coping related to inappropriate methods of seeking parental attention as evidenced by acting out d. Impaired parenting related to inequitable feelings toward children as evidenced by showing preference for one child over another

c. Defensive coping related to inappropriate methods of seeking parental attention as evidenced by acting out

Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, "The nurse manager had a headache the day I was interviewed." Which defense mechanism is evident? a. Introjection b. Conversion c. Projection d. Splitting

c. Projection (Projection is the hallmark of blaming, scapegoating, prejudicial thinking, and stigmatizing others.)

An adolescent diagnosed with a CD stole and wrecked a neighbor's motorcycle. Afterward, the adolescent was confronted about the behavior but expressed no remorse. Which variation in the central nervous system best explains the adolescent's reaction? a. Serotonin dysregulation and increased testosterone activity impair one's capacity for remorse. b. Increased neuron destruction in the hippocampus results in decreased abilities to conform to social rules. c. Reduced gray matter in the cortex and dysfunction of the amygdala results in decreased feelings of empathy. d. Disturbances in the occipital lobe reduce sensations that help an individual clearly visualize the consequences of behavior.

c. Reduced gray matter in the cortex and dysfunction of the amygdala results in decreased feelings of empathy. (This reduction may be related to aggressive behavior and deficits of empathy. The less gray matter in these regions of the brain, the less likely adolescents are to feel remorse for their actions or victims.)

A person has minor physical injuries after an auto accident. The person is unable to focus and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is the person's level of anxiety? a. Mild b. Moderate c. Severe d. Panic

c. Severe

An 11-year-old diagnosed with ODD becomes angry over the rules at a residential treatment program and begins cursing at the nurse. Select the best method for the nurse to defuse the situation. a. Ignore the child's behavior. b. Send the child to time-out for 2 hours. c. Take the child to the gym and engage in an activity. d. Role-play a more appropriate behavior with the child.

c. Take the child to the gym and engage in an activity.

A patient experiencing panic suddenly began running and shouting, "I'm going to explode!" Select the nurse's best action. a. Ask, "I'm not sure what you mean. Give me an example." b. Capture the patient in a basket-hold to increase feelings of control. c. Tell the patient, "Stop running and take a deep breath. I will help you." d. Assemble several staff members and say, "We will take you to seclusion to help you regain control."

c. Tell the patient, "Stop running and take a deep breath. I will help you."

An adult diagnosed with a serious mental illness (SMI) says, "I do not need help with money management. I have excellent ideas about investments." This patient usually does not have money to buy groceries by the middle of the month. The nurse assesses the patient as demonstrating a. rationalization. b. identification. c. anosognosia. d. projection.

c. anosognosia. (the inability to recognize one's deficits due to one's illness)

When alprazolam is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to a. report drowsiness. b. eat a tyramine-free diet. c. avoid alcoholic beverages. d. adjust dose and frequency based on anxiety level.

c. avoid alcoholic beverages

A patient diagnosed with obsessive-compulsive disorder has this nursing diagnosis: Anxiety related to __________ as evidenced by inability to control compulsive cleaning. Which phrase correctly completes the etiological portion of the diagnosis? a. feelings of responsibility for the health of family members b. approval-seeking behavior from friends and family c. persistent thoughts about bacteria, germs, and dirt d. needs to avoid interactions with others

c. persistent thoughts about bacteria, germs, and dirt

A patient tells a nurse, "My best friend is a perfect person. She is kind, considerate, good-looking, and successful with every task. I could have been like her if I had the opportunities, luck, and money she's had." This patient is demonstrating a. denial. b. projection. c. rationalization. d. compensation.

c. rationalization. (Rationalization consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy the teller as well as the listener)

A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask? a. "Have you been a victim of a crime or seen someone badly injured or killed?" b. "Do you feel especially uncomfortable in social situations involving people?" c. "Do you repeatedly do certain things over and over again?" d. "Do you find it difficult to control your worrying?"

d. "Do you find it difficult to control your worrying?" (Generalized anxiety = excessive worry)

The parent of a seriously mentally ill adult asks the nurse, "Why are you making a referral to a vocational rehabilitation program? My child won't ever be able to hold a job." Which is the nurse's best reply? a. "We make this referral to continue eligibility for federal funding." b. "Are you concerned that we're trying to make your child too independent?" c. "If you think the program would be detrimental, we can postpone it for a time." d. "Most patients are capable of employment at some level, competitive or supported."

d. "Most patients are capable of employment at some level, competitive or supported."

anti-anxiety drugs (benzodiazepines)

potentiate GABA short term effectiveness, acute episodes of anxiety