Mental Health Exam 3 EAQs

The suicide rate is highest for what demographic group? A) White males 65 and older B) Black males 65 and older C) Black females 65 and older D) White females 65 and older

White males 65 and older White males aged 65 years and older have the highest rate of suicide. Black males, black females, and white females age 65 years or older have lower suicide rates. p. 444

Which drug was the first antipsychotic to be used therapeutically? A) Fluoxetine B) Chlorpromazine C) Chlordiazepoxide D) Ziprasidone

Chlorpromazine Chlorpromazine was the first antipsychotic drug, introduced in the early 1950s. Fluoxetine is an antidepressant. Chlordiazepoxide is a benzodiazepine. Ziprasidone is used to treat manic symptoms. p. 53

Which nursing intervention should be implemented during a suicidal client's crisis period? A) Arranging for the client to stay with family or friends B) Establishing frequent rapport with the client C) Activating links to community social support D) Identifying situations that trigger suicidal thoughts

Establishing frequent rapport with the client Establishing a frequent rapport with the client is a nursing intervention appropriate during the client's crisis period. Arranging for the client to stay with family or friends and activating links to community social support are more appropriate immediately following the crisis period. Identifying situations that trigger suicidal thoughts can be done during follow-up. p. 369

Which neurobiological factor is the greatest predictor of suicide? A) Dizygotic twins B) Low levels of 5-hydroxyindoleacetic C) Underactivity of the noradrenergic system D) Normal hypothalamic-pituitary-adrenal axis

Low levels of 5-hydroxyindoleacetic Low levels of 5-hydroxyindoleacetic in cerebral spinal fluid are associated with impulsive suicide-like violence. Low levels of 5-hydroxyindoleacetic can predict future attempts and future completed suicides. A dizygotic twin is a genetic factor with lower suicide concordance rates. Overactivity of the noradrenergic system is associated with higher suicidal risk. Abnormalities of the hypothalamic-pituitary-adrenal axis are associated with major depression and suicide victims. p. 364

Which principles related to crisis resolution direct the care provided by a crisis intervention nurse? Select all that apply. A) The client employs previously used problem-solving methods to regain pre-crisis function. B) The goal of crisis intervention is for the client to regain pre-crisis level functioning. C) During a crisis, people often are more receptive than usual to outside intervention. D) Early intervention probably increases the chances for coping that is effective. E) The nurse must be willing to take a passive and nondirective role in the care.

B, C, D The goal of crisis intervention is to return the client to at least the pre-crisis level of functioning. During a crisis, people often are more receptive than usual to outside intervention. With intervention, the client can learn different adaptive means of problem solving to correct inadequate solutions. The nurse must be willing to take an active, even directive, role in intervention. Early intervention probably increases the chances for a good prognosis. p. 325

After a sexual assault, a college student was treated in the emergency department, diagnosed with acute stress disorder, and referred for counseling. Which is the most likely approach to counseling for this client? A) Psychoanalysis B) Aversion therapy C) Stress-reduction therapy D) Cognitive behavioral therapy

Cognitive behavioral therapy Cognitive behavioral therapy uses a range of strategies such as psychoeducation, behavior modification, cognitive therapy, exposure therapy, and stress management to help the victim manage behavior and change maladaptive beliefs and thoughts resulting from the traumatic experience. Psychoanalysis is long-term therapy that focuses on early life development of pathology. Aversion therapy uses unpleasant conditioning or reinforcement, so it is not appropriate in this scenario. Stress-reduction therapy is one component of cognitive-behavioral therapy. p. 126

What is the term used for the emotional pain or cost of working with traumatized persons that may result in a stress response for a nurse? A) Grief B) Burnout C) Compassion D) Compassion fatigue

Compassion fatigue Compassion fatigue is the emotional pain or cost of working with traumatized persons that may result in a stress response for a nurse. Grief is incorrect, because it is defined as the individualized response to a loss that is perceived, real, or anticipated. Burnout is incorrect, because it is defined as decreased work performance due to negative behaviors and thoughts. Compassion is incorrect, because it is defined as the ability to be with someone who is suffering. p. 395

The nurse is managing the care of an older adult diagnosed with bipolar disorder who is in a manic phase. The nurse closely monitors the client for risks to safety. Which factor most indicates this intervention for this client? A) Mania can result in irresponsible and physically risky behaviors. B) The manic phase will be followed by a phase of severe depression. C) This client is an easy target for abuse from other aggressive clients. D) Older adults experience physical conditions that greatly increase the potential for injury.

Mania can result in irresponsible and physically risky behaviors. Clients in the manic phase of bipolar disorder may have misperceptions about their power and importance and involve themselves in senseless, irresponsible, and risky activities that can result in physical harm. It is true that depression generally follows mania, that manic individuals are at risk for injury caused by others who are affected by or who misunderstand the behavior, and that older adults are at risk for injury related to both acute and chronic illness. However, the primary risk to this client comes from the manic behavior itself. p. 229

A 12-year-old female finds herself feeling anxious and overwhelmed and seeks out the school nurse to report that "Everything is changing; my body, the way the boys who were my friends are treating me, everything is so different." It is likely the child is describing what disorder? A) Personal identity disorder B) A maturational crisis C) Suicidal ideations D) Mild neurosis

A maturational crisis The maturational crisis of moving from childhood into adolescence may be difficult because many new coping skills are necessary. The child's description does not indicate a personal identity disorder, suicidal ideation, or neurosis. p. 326

Which child should be assessed for possible posttraumatic stress disorder (PTSD) as a result of exposure to major trauma in his or her life? Select all that apply. A) A 5-year-old child who lives with grandparents since his or her single parent was deployed by the military 10 months ago. B) An 8-year-old child who has a medical history that includes several broken bones and a dislocated shoulder. C) A 4-year-old who was hospitalized for 2 months after being injured in an automobile accident. D) A 12-year-old who has been in cancer remission for 3 years since finishing both chemotherapy and radiation treatments. E) A 3-year-old whose older sibling was born with both physical and cognitive impairments.

B, C, D Tragically, children are exposed to many traumatic events without the strength or coping skills to adequately defend themselves. Children who have been abused are at great risk for developing emotional, intellectual, and social handicaps as a result of their traumatic experiences. Other traumatic events for children include invasive medical procedures and critical life-threatening illnesses. It is thought that the younger the child, the more seriously ill, and the more invasive the procedure, the more likely the child will develop PTSD. Research has found that those children who have survived cancer have four times the risk of developing PTSD than their siblings. Although being separated from parents and having siblings with major physical and emotional problems can be stressful, the risk to the child depends in large part on the support and care the child receives. p. 406

Which documentation in the medical record of a client diagnosed with bipolar disorder demonstrates achievement of outcomes for the continuation phase of recovery? Select all that apply. A) The client slept for 3 uninterrupted hours. B) The client is demonstrating new problem-solving skills. C) The client is able to identify three early signs of relapse. D) The client acknowledges the need to be medication-compliant. E) The client states an understanding of the cyclic nature of the disorder.

B, C, D, E Although the overall outcome of the continuation phase is relapse prevention, many other outcomes must be accomplished to maintain relapse prevention. These outcomes include demonstrating communication and new problem-solving skills, knowledge of early signs and symptoms of relapse, adherence to the drug therapy, and an understanding of the cyclical nature of the disease. Symptom stabilization, such as addressing poor sleeping habits, is appropriate for the acute phase of recovery. pp. 237-238

Which behavior of the nurse is most appropriate when caring for a client experiencing acute mania? A) Judging the values of the client as incorrect B) Giving long, detailed explanations to the client C) Using a soft and gentle approach with the client D) Redirecting the client's energy into alternate channels

Redirection the client's energy into alternate channels. The best way for the nurse to manage a client experiencing acute mania is to firmly redirect the client's energy into more constructive channels. This intervention helps the client utilize the elevated energy levels associated with acute mania for useful activities. The nurse should avoid judging the client's values, because this could provoke the client to argue and may exaggerate the mania. In acute mania, the client has a short attention span; therefore, the nurse should give short and precise explanations. The nurse should use a firm and calm approach when interacting with a client experiencing acute mania. p. 232

When preparing a client for electroconvulsive therapy (ECT), what does the nurse discuss with the client? A) Maintenance treatments are seldom required. B) The initial course of therapy requires 6 to 12 treatments. C) This form of therapy is particularly successful for positive symptoms of schizophrenia. D) The initial therapy involves an ECT treatment repeated once a week for a prescribed time period.

The initial course of therapy requires 6 to 12 treatments A usual course of ECT is 6 to 12 treatments. Maintenance ECT usually involves weekly treatments for the first month after remission, with gradual tapering to monthly ECT treatments. ECT is not typically used in the treatment of schizophrenia. Treatments are typically given two to three times per week p. 218

A nurse conducts an initial interview with a combat veteran. The veteran says, "The war was years ago, but I still remember my friends who were killed. I don't know why I lived and they died." What is the nurse's priority response? A) "Are you having any thoughts of harming yourself?" B) "It's important to think about how good your life is now." C) "Are you saying you have some guilt about being a survivor?" D) "The outcomes of war are tragic and stay with us for many years."

"Are you having any thoughts of harming yourself?" The incidence of suicide is high among war veterans. The nurse's highest priority is to assess the risk for suicide or self-harm. Giving advice and false reassurance are nontherapeutic communication techniques. Using reflection is therapeutic, but assessing the risk of suicide is a higher priority. p. 125

Which statement does the nurse know exemplifies suicidal ideation? A) "My neighbor killed himself." B) "I overdosed on medicine, but it wasn't enough to kill me." C) "I plan to kill myself by slitting my wrists." D) "I have a terminal illness and have found a doctor who will help me end my life peacefully."

"I plan to kill myself by slitting my wrists." Suicidal ideation refers to the process of thinking about killing oneself, exemplified in the statement about planning to kill oneself by slitting the wrists. Suicide is the act of intentionally ending one's own life exemplified by the statement that a neighbor has killed himself. Suicide attempt includes all willful, self-inflicted, life-threatening attempts that have not lead to death, exemplified by overdosing but unsuccessfully committing suicide. Physician-assisted suicide is when a physician aids in assisting the terminally ill patient to self-administer a lethal does of medication exemplified by the the statement from a client who has a terminal illness. p. 363

A nurse is interviewing a client who lost her husband. Which statement made by the client would indicate to the nurse that the client is suffering from persistent complex bereavement disorder? A) "I have had several dreams in the past week and my husband has been in all of them." B) "I haven't been able to get a full night's sleep since my husband passed away 2 weeks ago." C) "It's been over a year. There are days when I want to die so I can be with him again. I can't do this anymore." D) "I know it's only been a week, but I should have made him go to the doctor and maybe this wouldn't have happened."

"It's been over a year. THere are days when I want to die so I can be with him again. I can't do this anymore." Suicidal thoughts are an example of persistent complex bereavement disorder; the client's husband passed away over a year ago and the bereaved wife wants to die in order to rejoin their loved one. Dreaming about the deceased spouse is part of the process of uncomplicated grief. Insomnia is a normal reaction that is a part of uncomplicated grief. Feelings of guilt are normal reactions that are part of uncomplicated grief. p. 390

A community mental health nurse counsels a group of clients about the upcoming flu season. What instruction does the nurse provide for clients who are prescribed lithium? A) "The flu is contagious. Isolate yourself if you get the flu so that you avoid exposing others to it." B) "Remember that lithium reduces your immunity, so you are more vulnerable to catching the flu." C) "Stop taking your medicine, and contact me if you develop nausea, vomiting, and/or diarrhea." D) "Because you take lithium, you may have flu symptoms that are not typically experienced by others."

"Stop taking your medicine, and contact me if you develop nausea, vomiting, and/or diarrhea." Nausea, vomiting, and diarrhea can all be early signs of lithium toxicity, so the nurse should advise clients to contact him or her if this occurs. Clients taking lithium are not more likely to experience unique symptoms from the flu. Clients taking lithium are not more vulnerable to catching the flu. Because the flu is contagious, anyone who develops it should be isolated from others. pp. 235-236

When an individual in the second stage of crisis is unable to resolve the situation by using his or her usual coping strategies, the individual is likely to implement which coping strategy? A) Becomes disorganized and uses trial-and-error problem solving. B) Withdraws and acts as though the problem does not exist. C) Develops severe personality disorganization. D) Resorts to planning suicide.

Becomes disorganized and uses trial-and-error problem solving. Becoming disorganized and using trial-and-error problem solving is characteristic of the second stage of crisis, according to accepted crisis theory. Withdrawing and acting as though the problem does not exist, developing severe personality disorganization, and planning suicide are not associated with the second stage of crisis. p. 327

Which body system is most at risk for decompensation during the acute phase of a severe manic episode? A) Renal B) Cardiac C) Endocrine D) Pulmonary

Cardiac A primary consideration for a client in acute mania is the prevention of exhaustion and death from cardiac collapse. Because exhaustion due to mania is life-threatening, a careful cardiac assessment takes priority over renal, endocrine, and pulmonary systems. p. 230

Which statement about clients diagnosed with personality disorders is accurate? A) Clients readily recognize their problems and seek professional assistance. B) Extended hospitalization is the best intervention and is commonly needed for stabilization. C) Characteristics of these disorders are most evident in social and interpersonal interactions. D) Research has produced multiple medications that effectively manage symptoms of personality disorders.

Characteristics of these disorders are most evident in social and interpersonal interactions. The presence of a personality disorder interferes with or complicates social and interpersonal functioning. Individuals who meet criteria for personality disorders have problems with empathy or intimacy within their relationships. People diagnosed with personality disorders tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them. While short-term hospitalization may sometimes be necessary when acute problems occur, extended hospitalizations tend to be counterproductive for this population. In the United States, there are no Federal Drug Administration-approved medications specifically for treating personality disorders; however, some health care providers prescribe selected psychotropic medications for off-label use. p. 166, p. 172

In the United States, which agency has overall responsibility to coordinate responses to disasters? A) World Health Organization (WHO) B) Department of Homeland Security (DHS) C) Federal Emergency Management Agency (FEMA) D) National Incident Management System (NIMS)

Department of Homeland Security (DHS) The DHS has ultimate government responsibility for the safety of United States citizens and territories while assuring adequate preparedness, response, and recovery protocols are immediately available. WHO serves the global community. DHS oversees operations of FEMA. NIMS helps first responders from different disciplines and areas to work together effectively when a community has exhausted its available resources in addressing a large-scale occurrence. p. 327

A client diagnosed with borderline personality disorder has suicidal intentions. The nurse plans to teach mindfulness and emotion regulation to improve the client's interpersonal effectiveness skills and support which type of therapy? A) Family therapy B) Schema-focused therapy C) Dialectical behavior therapy D) Supportive psychotherapy

Dialectical behavior therapy Dialectical behavior therapy is an advanced practice intervention used in clients with borderline personality disorder who have chronic suicidal intentions. This therapy includes cognitive and behavioral techniques like mindfulness and emotion regulation to improve interpersonal effectiveness skills in clients. In family therapy, the family members of the client are taught how to assist the client in handling stress. Family therapy helps the family learn how to function better as a unit. Schema-focused therapy helps clients change their views of themselves by evaluating the behavior of people in stressful conditions. In supportive psychotherapy, the therapist encourages the client to participate in activities to enhance the client's ability to cope with stressors. p. 176

A client who is bipolar tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those television concerts are going to retire because they can't compete with me." What does the nurse document? A) Flight of ideas B) Distractibility C) Limit testing D) Grandiosity

Grandiosity Exaggerated beliefs in one's own importance, identity, or capabilities is considered grandiosity. Flight of ideas is a nearly continuous flow of accelerated speech with abrupt changes among topics. Distractibility describes attention being too easily drawn to unimportant or irrelevant external stimuli. Limit testing describes a person's pushing the limits of what behavior is acceptable. p. 229

What is the most common method of inpatient suicide? A) Drowning B) Self-inflicted gunshot C) Hanging D) Cutting wrists

Hanging The most common method of inpatient suicide is hanging. Drowning is unlikely in the health care setting. Clients are searched for weapons such as knives or firearms upon entry into the organization, so suicide by gunshot or cutting wrists is unlikely. p. 56

A nurse notices that a client behaves in a melodramatic way and acts flirtatiously. With which personality disorder does the nurse expect the client to be diagnosed? A) Paranoid personality disorder B) Schizoid personality disorder C) Histrionic personality disorder D) Narcissistic personality disorder

Histrionic personality disorder People diagnosed with histrionic personality disorder have emotional, attention-seeking behaviors. They are often melodramatic and act flirtatiously. People diagnosed with paranoid personality disorder are extremely suspicious and often believe others will harm them. People diagnosed with schizoid personality disorder exhibit emotional detachment and are viewed as loners. People diagnosed with narcissistic personality disorder are arrogant and need constant admiration. p. 170

A client who had a stroke three days ago tearfully tells the nurse, "What's the use in living? I'm no good to anybody like this." What should be the nurse's priority action? A) Implement the institutional protocol for suicide risk. B) Educate the client about the success of stroke rehabilitation. C) Support the client in clarifying and expressing feelings of grief. D) Offer the client an opportunity to confer with the pastoral counselor.

Implement the institutional protocol for suicide risk. The client's comment suggests hopelessness, helplessness, and worthlessness. Physical illnesses play a role in increasing suicide risk. Suicide precautions should be initiated. This action takes priority over discussion of stroke rehabilitation, grief, and the client's preference for meeting with the pastoral counselor because it poses an immediate risk to the client's life. pp. 363, 366

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" What does this cognitive distortion represent? A) Self-blame B) Catatonia C) Learned helplessness D) Discounting positive attributes

Learned hopelessness Learned helplessness results in depression when the client feels no control over the outcome of a situation. Self-blame is an example of negative self-appraisal wherein the client believes that everything is his or her fault. Catatonia is abnormal physical movement. Discounting positive attributes occurs when clients are unable to recognize what they do well. p. 200

Which event can lead to the development of a situational crisis in clients? A) Physical assault B) Natural disaster C) Birth of a child D) Loss of a job

Loss of a job A situational crisis arises from external events such as loss of a job or an abortion. An adventitious crisis results from accidental events that are unplanned, which may be human-made or caused by nature. This crisis arises from situations such as physical assaults and natural disasters like floods and earthquakes. A maturational crisis arises from developmental changes in a person's life such as the birth of a child or death of parents. p. 326

Which provision should the nurse include in a client's no-suicide contract? A) Never to attempt suicide. B) To alert someone if an attempt is planned. C) To discuss why the client feels suicidal D) Not to attempt suicide in the next 24 hours.

Not to attempt suicide in the next 24 hours. A no-suicide contract is quite straightforward in seeking a client's promise not to attempt to harm oneself within a specified period. When that time expires, a new contract is negotiated. The contract does not involve the promises of never attempting suicide, alerting someone if an attempt is planned, and discussing why the client feels suicidal. p. 369

A client with a history of psychosis is admitted after a suicide attempt. During the initial assessment the client states, "The voices are still telling me to kill myself. Which is the priority nursing intervention for this patient? A) Place the client on suicide precautions. B) Obtain an order for a psychiatric consult. C) Get the client to sign a suicide contract. D) Ask a family member or friend to stay with the client.

Place the client on suicide precautions. People who are psychotic, especially those who experience command hallucinations, are at a high risk for suicide. A client admitted for a suicide attempt should be immediately placed on suicide precautions. An order for a psychiatric consult should be obtained but is not the priority. Getting the client to sign a suicide contract and asking a family member or friend to stay with the client are interventions when the patient is at moderate to low risk for suicide or receiving outpatient treatment. p. 366

What is the highest priority of care for a client in emotional crisis? A) Reduction of anxiety B) Development of new coping skills C) Prevention of boundary blurring D) Promoting client safety

Promoting client safety The nurse's initial task is to promote safety by assessing the client's potential for suicide or homicide. Reduction of anxiety, development of new coping skills, and prevention of boundary blurring are all important components of the care plan, but safety of the client takes the highest priority. p. 330

Depression is the most common and treatable psychiatric condition in the older client. What is the first choice of treatment for depression in this age group? A) Antidepressants B) Social support groups C) Assisted living placement D) Electroconvulsive therapy (ECT)

Social support groups Social support groups are the recommended treatment for depression in the elderly, because the cause is usually related to social isolation. Antidepressants may be tried after increasing the client's social network. Assisted living placement is not a treatment and may not address the depression. ECT is reserved for severe depression. p. 443

A nurse planning continuing education programs for nursing staff members at a multipurpose senior center will plan programs based on the knowledge that one of the most common mental health problems among the elderly is A) Schizophrenia B) Agoraphobia C) Obsessive-compulsive disorder D) Suicidal ideation

Suicidal ideation In the United States, the suicide rate among the elderly is the highest for any age group. Suicide is one of the top 10 causes of death among the aged. Although schizophrenia, agoraphobia, and obsessive-compulsive disorder may exist among this population, they are not common. p. 444

What is the major reason for hospitalization of depressed clients? A) Inability to go to work B) Suicidal ideations C) Loss of appetite D) Psychomotor agitation

Suicidal ideation Suicidal thoughts are a major reason for hospitalization of clients with major depression. It is imperative to intervene with such clients to keep them safe from self-harm. Inability to go to work, loss of appetite, and psychomotor agitation describe symptoms of major depression but are not by themselves the major reason for hospitalization. p. 363

A nurse is caring for a client who was recently sexually assaulted. During the assessment, the client appears calm and rational but with periods of confusion and agitation. How should this nurse interpret this behavior? A) The client needs intense psychological counseling. B) The client is experiencing posttraumatic stress disorder. C) The client is overreacting in relation to the description of the sexual assault. D) The client's behavior is consistent with that expected during the acute phase of crisis.

The client's behavior is consistent with that expected during the acute phase of crisis. In the acute phase, after a crisis, a person may appear self-contained and calm with periods of crying, restlessness, or agitation. Psychological counseling would be suggested as long-term therapy. Posttraumatic stress disorder is the long-term consequence of sexual assault. Every client has a unique response to crisis; therefore, over-reacting is not an appropriate interpretation. p. 354

Which assumption serves as a foundation for the use of crisis intervention? A) The individual is mentally healthy but in a state of disequilibrium. B) Long-term dysfunctional adjustment can be addressed by crisis intervention. C) An anxious person is unlikely to be willing to try new problem-solving strategies. D) Crisis intervention nurses need to remain passive as the client deals with the crisis.

The individual is mentally healthy but in a state of disequilibrium. The individual is mentally healthy but in a state of disequilibrium is the only true statement. Crisis intervention cannot address long-term dysfunctional adjustment. An anxious person is not likely to try new strategies. Crisis intervention nurses take an active role in working with the client. p. 325

A client who is treated with lithium carbonate shows no improvement and often gets agitated and depressed. Which drug would the nurse expect the primary health care provider to prescribe to the client? A) Phenobarbital B) Valproate C) Gabapentin D) Phenytoin

Valporate Anticonvulsants are used when the client is not responding to lithium therapy. They are also used in dysphoric mania characterized by mixed state, or when the client often gets agitated and depressed. Valproate, carbamazepine, and lamotrigine are the three anticonvulsants that can be used in treating bipolar disorder. Other anticonvulsants such as phenobarbital, gabapentin, and phenytoin are not indicated in bipolar disorders, because they may worsen the client's condition. p. 237

A 27-year-old male client is unable to sleep after the loss of a parent. The client denies a history of or current issues with any physical or psychological illness. The client denies using either alcohol or tobacco but does report having, "no one to talk to about my problems." According to the SAD PERSONS scale, what is the score of this client? A) 2 B) 3 C) 4 D) 5

3 According to the SAD PERSONS scale, there are 10 risk factors for suicide. These include sex, age, depression, previous suicide attempt, alcohol use, lack of social support, organized plan for suicide, lack of spouse, and illness. Each factor is marked as 1 if it is present in a client. Therefore, according to this scale this client scores 3. One point each is given sex, age, lack of social support, and lack of partner. If a person scores 3 to 4, he or she should be either hospitalized or sent to a psychiatrist for consultation. If the person has a score of 0 to 2, the client should be sent home and called for follow-up. If the score is 5 to 6, the client should be strongly considered for hospitalization. p. 365

A 30-year-old divorced male with a history of alcohol abuse is admitted with a diagnosis of depression with suicidal ideation with a detailed plan. According to the SAD PERSONS scale, what score will the client earn? A) 3 B) 6 C) 7 D) 10

6 A male (1), aged 30 (1), history of depression (1), ethanol use (1), organized, lethal plan (1), and divorced (1) = 6 points. The other options are too high or too low according to the point assignments. p. 365

Which individual has the highest risk for experiencing major depression? A) A teenaged male who failed to make the football team B) A young adult female who recently gave birth to her first child C) An older adult female who retired after 25 years of factory work D) A middle-aged male who is a self-employed small business owner

A young adult female who recently gave birth to her first child A young adult female who recently gave birth to her first child has the highest risk. The lifetime risk for major depression is 7% to 12% for men and 20% to 30% for women. Among women, rates peak between adolescence and early adulthood. It is particularly important to screen for depression among women of reproductive age, especially those who have children or plan to become pregnant. The teenaged male and the retired female do present with some risk for depression. The middle-aged male's risk for major depression is relatively small. p. 197

What question should be asked during a critical incident debriefing that involved the restraining of a violent client? Select all that apply. A) Could the situation have been avoided? B) Did the response demonstrate teamwork? C) How do the staff members feel about the client? D) Do the staff members individually agree with unit policies? E) How does each staff member feel about his or her personal response?

A, B, C, E Immediately after the seclusion or restraint episode, the staff must debrief with each other. Critical incident debriefing is crucial for a number of reasons. First, a review is necessary to ensure that quality care was provided to the client. Staff members need to critically examine their response to the client. Questions to be answered include the following: Could we have done anything that would have prevented the violence? Did the staff respond as a team? How do staff members feel about this client? How do staff members feel about their personal responses? The focus of this discussion is not staff feelings about unit policies. p. 383

Which assessment questions does the nurse know focus on the characteristic behaviors of a client diagnosed with borderline personality disorder? Select all that apply. A) Does your mood shift dramatically over a few hours? B) Have you ever been told you are sarcastic? C) Do you experience visual or auditory hallucinations? D) How would you describe your romantic relationships? E) How would you describe your romantic relationships?

A, B, D, E Areas of assessment related to borderline personality disorder typically include history of mood shifts; tendencies toward sarcasm and anger; intense, unstable romantic relationships; and suicidal behaviors. Hallucinations are not characteristic of this disorder. pp. 169-170

The nurse manager is working on a unit support process to prevent compassion fatigue for a busy oncology unit. Which characteristics should be included in the program goals? Select all that apply. A) Reduce medication errors B) Develop self-care skills. C) Add more sick days off. D) Identify signs of depression. E) Discuss healthy work relationships. F) Develop a professional support team.

A, B, D, E, F Methods to prevent compassion fatigue can be provided with a program to reduce medication errors, develop self-care skills, identify signs of depression, discuss healthy work relationships, and develop a professional support team. More sick days are a sign of compassion fatigue and will not provide the unit with a supportive staff. p. 127

Which symptoms should the nurse assess to identify borderline personality disorder when interviewing clients? Select all that apply. A) Tendency toward intense anxiety B) Inclination toward group activities C) Feelings of emptiness D) Extent of happiness E) Frequency of mood shifts

A, C, E, The nurse can assess borderline personality disorder by evaluating the tendency toward anxiety, anger, and irritability in the client. The nurse should assess feelings of emptiness and loneliness. A client with borderline personality disorder also experiences frequent extreme mood shifts. Clients with borderline personality do not engage in group activities due to anxiety. Extent of happiness doesn't help in identifying borderline personality disorder, because the client has mood swings. pp. 169-170

A pregnant woman seeks counseling after losing a parent. She informs the nurse that she has lost her job a few days ago and is aware of her responsibility for her family. Which factors put her at greater risk of suicide? Select all that apply. A) Being pregnant B) Losing a job C) The death of her parent D) Accessing health care E) Being responsible for her family

B, C The nurse should know about the risk factors of suicide. Unemployment and death of a loved one are two of the risk factors. However, pregnancy, access to health care, and a sense of responsibility for the family are protective factors for suicide. p. 364

What assessment data are primary risk factors for depression? Select all that apply. A) Male gender B) History of physical abuse as a child C) Middle-class socioeconomic status D) History of alcohol abuse E) Married

B, D Primary risk factors of depression include early childhood trauma and history of alcohol or other substance abuse. Female gender, low socioeconomic class, and unmarried are other primary risk factors. p. 198

The nurse is conducting crisis intervention for a client in a flood-affected area. What appropriate actions should the nurse take? Select all that apply. A) Ask the client to describe previous problems. B) Anticipate that the client would be less receptive than usual. C) Encourage the client to set realistic goals. D) Focus on the present problems of the client. E) Assume that the client has a chronic psychiatric disorder.

C, D

Which assessment finding regarding communication is likely in a client experiencing acute mania? A) Mutism B) Poverty of ideas C) Clang associations D) Psychomotor retardation

Clang association Clang associations are the stringing together of words because of their rhyming sounds, without regard to their meaning. This communication style occurs commonly in clients experiencing mania. Mutism, poverty of ideas, and psychomotor retardation are assessment findings usually associated with depression rather than mania. p. 226

A client was admitted to a mental health unit after expressing a desire to commit suicide. The nurse reviews documentation regarding the client's care. Which information supports attention to the QSEN competency related to teamwork and collaboration? A) Client accepts offer to take a walk with the staff B) Client agreed to contract for safety with the staff C) Client escorted by staff to group session facilitated by art therapist D) Client denied any homicidal or suicidal ideations when assessed by the staff

Client escorted by staff to group session facilitated by art therapist Care being provided by members of various health care specialties, such as art therapy, would support the QSEN competency of teamwork and collaboration. The client accepting an offer to take a walk with the staff, agreeing to contract for safety with the staff, and denying any homicidal or suicidal ideations when assessed by the staff demonstrate attention to the QSEN safety competency. p. 5

Which antianxiety medication should the nurse expect will be prescribed to clients with acute mania? A) Clonazepam B) Citalopram C) Labetalol D) Propranolol

Clonazepam Antianxiety medications are prescribed to clients with acute mania who are resistant to lithium therapy to reduce psychomotor agitation in the clients. Clonazepam is a benzodiazepine class of drug and usually is prescribed to clients with mania due to its efficacy and fewer side effects. Citralopram belongs to the class of medications known as selective serotonin reuptake inhibitors. These medications produce side effects like nervousness and agitation and therefore should not be prescribed for mania. Labetalol is a beta blocker medication that is usually prescribed to reduce blood pressure. Propranolol is a beta blocker used for the treatment of hypertension in clients with anxiety. It is not prescribed for clients with acute mania. p. 237

A community nurse is assessing the risk factors for suicide among a group of people. What are the factors that are associated with high risk of suicide? A) Pregnancy in women B) Religious values and beliefs C) Family history of suicide D) Responsibility to the family

Family history of suicide It is important for the nurse to be aware of factors associated with a high risk of suicide. A family history of suicide makes an individual highly susceptible to suicide. However, pregnancy, religious values and beliefs, and a sense of responsibility to the family are protective factors. These factors often make a client rethink the decision to commit suicide. p. 364

An 85-year old man has been sad and crying frequently, not attending to hygiene, eating less, and sleeping much of the day. Which principle will apply to the initial nursing assessment and intervention for this person? A) Older male clients have the highest rate of suicide. B) Loss and depression are an expected part of the aging process. C) Older male clients are the most resilient part of the population. D) Tricylic antidepressants are front-line treatment for this age group.

Older male clients have the highest rate of suicide. The risk of suicide for men increases with age, particularly for white men age 65+, whose risk is seven times that of females of the same age. A myth associated with aging is that loss and depression are part of the aging process. Older male clients are not the most resilient part of the population. Selective serotonin reuptake inhibitors (SSRIs) are front-line treatment for geriatric depression. p. 444

What assessment of the thought processes of a client diagnosed with depression is most likely to reveal? A) Good memory and concentration B) Delusions of persecution C) Self-deprecatory ideation D) Sexual preoccupation

Self-deprecatory ideation Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world. Memory and concentration may be negatively affected in a depressed individual. Delusions of persecution are symptomatic of schizophrenia. Sexual preoccupation is unlikely in depressed clients, who are more likely to suffer from low libido. p. 200

Which states have legalized physician assisted suicide (PAS)/physician aid in dying (PAD)? Select all that apply. A) Florida B) Oregon C) Vermont D) Michigan E) California F) Washington

B, C, E, F In the United States, as of February 2016, only four states have legalized PAS/PAD. These states include Oregon, Vermont, California, and Washington. Florida and Michigan have not legalized PAS/PAD. p. 363

The nurse is assessing a client diagnosed with narcissistic personality disorder. Which behavior is the nurse most likely to find in this client? A) Aggression toward others B) Exploitation of others C) Hypervigilance of others D) Submission to others

Exploitation of others People diagnosed with narcissistic personality disorder are arrogant and need constant admiration. They lack social empathy and may exploit others for their own benefit. People diagnosed with borderline personality disorder and antisocial personality disorder are often aggressive toward others. People diagnosed with paranoid personality disorder view others with suspicion and may be hypervigilant of them. People diagnosed with dependent personality disorders feel insecure and may be submissive to others. p. 170

The nurse is creating a plan of care for a client who is reporting increased stress related to a new position at work. What nursing intervention can address the short-term effects that the stress has on the hypothalamus-pituitary-adrenal cortex? A) Maintain adequate fluid intake B) Monitor blood pressure C) Implement an exercise routine D) Screen the client for depression

Maintain adequate fluid intake Effects of stress on the hypothalamus-pituitary-adrenal cortex can cause dehydration. Maintaining adequate fluid intake during this time can prevent dehydration. Elevated blood pressure, obesity, and depression may develop due to the long-term effects of stress. p. 122

A nurse tries to communicate with a depressive client who is mute and avoids interaction. How should the nurse approach the client? A) The nurse should leave the client alone. B) The nurse should ask the client about their family members. C) The nurse should talk to the client about the weather. D) The nurse should tell the client everything will be fine and he or she shouldn't be upset.

The nurse should talk to the client about the weather. Depressed clients often avoid interacting with others. In such cases, the client's attention must be drawn towards the surrounding environment. This helps the client to focus on reality. Leaving the client alone may make the client feel lonely and cause withdrawal. Asking repeated questions to the client about his or her personal life can make the client feel aggressive and anxious. Making a remark or statement on the client's condition can make the client feel guilty. p. 207

Which change in behavior is important to include when teaching the client and the family to recognize possible signs of impending mania? A) Decreased sleep B) Increased appetite C) Decreased social interaction D) Increased attention to bodily functions

Decreased sleep Changes in sleep patterns are especially important, because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. Increased appetite, decreased social interaction, and increased attention to bodily functions do not indicate impending mania. p. 238

The nurse counseling a client at a crisis center identifies that the client is demonstrating behaviors that suggest an adventitious crisis. Which client response supports the nurse's findings? A) "Terrorists brutally killed all the passengers; I somehow managed to escape." B) "I love my parents. Why did they leave me alone?" C) "I have lost my job; I want to put an end to my life." D) "I have nothing to do and feel worthless."

"Terrorists bruitally killed all the passengers; I somehow managed to escape." The client is experiencing an adventitious crisis, because the client has been exposed to a national disaster, in which terrorists killed all the passengers of an aircraft. National disasters such as acts of terrorism may cause adventitious crises in clients. Adventitious crisis is not a part of daily life. It develops due to events like natural disasters, national disasters such as terrorist attacks, and crime. Situational crisis is caused when the client feels abandoned or when a loved one passes away. It can also be caused by exposure to severe physical and mental illness, assaults, and abuse. Maturational crisis is caused by events such as leaving home for education, retirement, and the death of a parent. p. 326

A young parent is experiencing posttraumatic stress disorder (PTSD) after the death of two children in a motor vehicle accident. How would the cardinal signs of PTSD show up in this client? Select all that apply. A) Flashbacks and distressing memories B) Avoidance of friends with young children C) Persistent fear and guilt D) Ability to relax but not fall asleep E) Meaningful relationships at work and home F) Tolerating an exercise program

A, B, C The cardinal signs of PTSD could show up in this client as flashbacks and distressing memories, avoidance of friends with young children, and persistent fear and guilt. Sleep difficulties with ability to relax, meaningful relationships at work and home, and tolerance of an exercise program are measures to reduce stress. p. 123

The nurse assessing a client who survived a terrorist attack finds that the client is demonstrating impaired thinking and severe anxiety. Which strategy should the nurse implement while conducting crisis intervention for the client? Select all that apply. A) The nurse focuses on the present situation of the client. B) The nurse assures the client that he or she will be fine within 2 days. C) The nurse encourages the client to express feelings in a nondestructive manner. D) The nurse encourages the client to focus on multiple implications at a time. E) The nurse assists the client to identify past coping skills.

A, C, E While conducting the crisis intervention, the nurse should focus on the present situation of the client. It helps to plan an effective treatment plan. The nurse should encourage the client to express feelings in a nondestructive manner. It helps to ensure safety of others and the client. The nurse should assist the client to identify past coping skills. It helps the client to develop problem-solving and decision-making skills. The nurse should not give false assurance that the client will be fine within 2 days. It usually takes 4 to 6 weeks for the client to recover from a crisis. The nurse should encourage the client to focus on one implication at a time to avoid stress and confusion. p. 325

A depressive client is prescribed tricyclic antidepressants. What appropriate advice does the nurse give to the client's family? A) Do not give full dose to the client at bedtime. B) Double the dose if the client forgets to take the bedtime dose. C) Advise the client to be cautious while driving. D) Stop the medication if hypotension occurs.

Advise the client to be cautious while driving. Tricyclic antidepressants (TCAs) cause side effects such as drowsiness or dizziness. The client must be advised to be cautious while crossing the road, driving, or working with machines. The client must take a full dose at bedtime, so that the side effects are less during the day. If the client forgets to take the dose, the next dose should be taken at the scheduled time. A double dose should be avoided. The medication should not be stopped if there is reduction in blood pressure, because medication cessation can cause nausea, altered heartbeat, cold sweats, and nightmares. p. 215

A client was admitted to a health care facility following a suicide attempt resulting from family violence. After the crisis is resolved, what intervention should be given the highest priority? A) Give the client an outpatient referral. B) Refer the client to an inpatient psychiatric unit. C) Identify the perpetrator and have him or her arrested. D) Ask the client if they have suicidal ideations.

Ask the client if they have suicidal ideations. The first step after the crisis resolution is to know about the lethality of the situation. For this, the nurse needs to carefully question the client. If the client is looking forward to the future and has no further suicidal plans, a referral to outpatient care can be done. If the client is still suicidal, then a referral to a psychiatric unit can be done. The client's safety is the main concern. The nurse should not be judgmental about the perpetrator. p. 343

According to Roberts, which is an example of the first priority of the seven-stage model of crisis intervention? A) Actively listening to the client's feelings B) Assessing the client for life-threatening injuries C) Ensuring that the client has a safe place to go following treatment D) Following up with the client to evaluate his or her well-being following the crisis

Assessing the client for life-threatening injuries The base level of Roberts's seven-stage model of crisis intervention represents the first priority, which is planning and conducting a crisis assessment; this would include assessing the client for any immediately life-threatening injuries. Actively listening to the client's feelings is an example of dealing with feelings and emotions, the fourth priority in the model. Developing a safety plan for when the client leaves treatment is part of the sixth priority, developing and formulating an action plan. Following up with the client for evaluation is the last priority. . p. 325

When a client complains of being "stressed out," the nurse understands that this label may include what experiences? Select all that apply. A) Sleeping through the night B) Excessive appetite C) Loss of interest in favorite activities D) Headaches and back pain E) Difficulty concentrating

B, C, D, E Feeling "stressed out" is commonly associated with changes in appetite, loss of interest in favorite activities, headaches and back pain, difficulty concentrating, and difficulty sleeping. p. 120

What statement accurately describes a maturational crisis? Select all that apply. A) Such crises occur once adulthood has been reached. B) Physical changes may result in conflict or crisis. C) This form of crisis represents both vulnerability and potential. D) New coping skills must be learned because old ones are ineffective. E) Retirement can result in a maturational crisis for some individuals.

B, C, D, E Maturational crises are associated with maturation, a process that occurs across the life cycle. Each maturational stage represents a time where physical, cognitive, instinctual, and sexual changes prompt an internal conflict or crisis, which results in either psychosocial growth or regression that represents increased vulnerability, and at the same time, heightened potential. When a person arrives at a new stage, formerly used coping styles are no longer effective, and new coping mechanisms have yet to be developed and must be learned. Examples of events that can precipitate a maturational crisis include leaving home during late adolescence, marriage, birth of a child, retirement, and the death of a parent. One does not need to be an adult to experience a maturational crisis. p. 330

The nurse manager instructed the nurse to conduct crisis intervention for a client whose parents died in an accident. How should the nurse start the crisis intervention for the client? A) By establishing rapport with the client B) By understanding the feelings of the client C) By planning interventions for the client D) By teaching mindfulness to the client

By establishing rapport with the client. According to Robert's seven-stage model of crisis intervention, developing a relationship with the client is the initial step in managing a crisis. The nurse should establish rapport with the client to develop trust and a healthy relationship. Once the client is comfortable with the nurse, the client will be able to express feelings freely with the nurse. The nurse can understand the client's feelings after the client starts interacting with the nurse. Based on the assessments of the problems and coping skills of the client, the nurse can plan the intervention to help the client cope with stress. Once the planning of the interventions is done, the nurse can implement the teaching of various coping strategies such as mindfulness to the client. p. 325

A group of teenagers was exposed to a violent shooting of two of their friends after being held captive for several hours. What physiological changes may occur within their brains? Select all that apply. A) Reduced amygdala size B) Reversible brain damage C) Increased metabolic activity in the limbic regions D) Altered release of neurotransmitters E) Reduced hippocampal volume

C, D, E The teenagers are likely to have posttraumatic stress disorder, which is associated with increased metabolic activity in the limbic region, altered release of neurotransmitters, and reduced hippocampal volume. There is no correlation with a reduction in the size of the amygdala. Brain damage is permanent. p. 125

What is the prevalence rate over a 12-month period for major depressive disorder? A) Lower than the prevalence rate for schizophrenia B) Lower than the prevalence rate for panic disorders C) Equal to the prevalence rate for schizophrenia disorders D) Greater than the prevalence rate for bipolar affective disorder

Greater than the prevalence rate for bipolar affective disorder Statistics show that the prevalence rate over a 12-month period for major depressive disorder is 6.7%, and the lifetime prevalence rate for bipolar affective disorder is 2.6%, so this answer is correct. The prevalence rate for schizophrenia is lower than that of major depressive disorder so the responses indicating major depressive disorder is lower than or equal to the rate of schizophrenia are incorrect. The rate of major depressive disorder is higher than that of panic disorders, so the response indicating it is lower is incorrect. p. 12

The nurse is assessing a client diagnosed with anxiety who is a victim of intimate partner abuse. Which nursing intervention will help in reducing the anxiety levels of the client? A) Suggest a plan for resolving the issue. B) Encourage the use of trial-and-error method for problem solving. C) Advise the client to avoid interacting with the partner. D) Provide knowledge of problem-solving techniques.

Provide knowledge of problem-solving techniques. According to Caplan there are four phases of a crisis. In phase I the client has increased feelings of anxiety owing to the difficulty in solving the problem. The nurse takes an initial step by providing knowledge of problem-solving techniques. The intervention can be emphasized by providing moral support, which helps in reducing the anxiety levels and developing confidence. The nurse should not suggest a plan to the client. The nurse should encourage the client to develop problem-solving skills to resolve the issue. In the second phase of crisis, clients tend to use the trial-and-error method of solving problems and coping with the crisis. The nurse should avoid giving premature advice to the client to avoid making the client feel rejected. p. 327

A family's home and possessions are lost when a massive forest fire burns out of control. Afterward, the family unites to apply for emergency assistance and rebuilds in the same location. Which concept is this family demonstrating? A) Resilience B) Socialization C) Family dynamics D) Family management

Resilience Resilience means the family has the hardiness and flexibility to adapt and cope successfully with this devastating loss. Socialization refers to the ways a family teaches its members to develop an ability to function in society as adults. Family dynamics refers to a family's patterns of behavior and function on a maturity continuum. Family management refers to the decisions regarding issues of power, resource allocation, rule making, and the provision of financial support that contribute to adaptive family functioning. p. 12

A client reports not sleeping well as well as experiencing anxiety and excessive crying. These symptoms began shortly after losing both his or her home and job after a tornado devastated the town in which the client lives. Which of the following statements regarding crisis accurately describes the individual's situation? A) The client is experiencing low self-esteem from the job loss, as well as anger because of the loss of his or her home. B) The client is experiencing both a situational and an adventitious crisis. C) The client is experiencing ineffective coping and should be hospitalized for intensive therapy. The client is experiencing a situational crisis with the added stress of financial burden.

The client is experiencing both a situational and an adventitious crisis. It is possible to experience more than one type of crisis situation simultaneously, and as expected, the presence of more than one crisis further taxes individual coping skills. The client lost his or her job (situational crisis) and also experienced the devastating effects of a tornado (adventitious crisis). The client may be experiencing low self-esteem, but this doesn't accurately describe the crisis criteria. There is nothing in the scenario suggesting the client needs acute hospitalization at this time. The client is experiencing not only a situational crisis, but an adventitious one as well, which makes coping more difficult. p. 336

An adult recently diagnosed with multiple sclerosis says, "I'm worried I won't be able to support my family or send my children to college." This person begins drinking alcohol heavily and omitting prescribed medications. What is the likely cause of the client's behavior? A) The client is in a state of situational crisis. B) The client is in a state of equilibrium. C) The client is reflecting on the situational event. D) The client is perceiving the event in a distorted way.

The client is in a state of situational crisis The client is experiencing a stressful event and using inadequate coping mechanisms. As disequilibrium continues, a crisis situation develops. A situational crisis occurs when a specific external event disturbs an individual's psychologic equilibrium. This client is not in a state of equilibrium, which refers to a state of emotional balance. This client has passed the stage of reflecting on the situational event. The client is not distorting the situation but is using maladaptive coping mechanisms. p. 326

The nurse is assessing four psychiatric clients in the emergency department. Which client needs crisis intervention? A) The client complaining of inability to sleep for the past 2 days B) The client who has been taking a new antidepressant for 1 week C) The client with new onset hallucinations D) The client who recently experienced the death of a spouse

The client with new onset hallucinations Crisis care is appropriate for clients with acute psychosis, such as new onset hallucinations. A client complaining of inability to sleep may be having anxiety or depression. Crisis intervention in this situation is not warranted but further assessment is required. It will take approximately 3 to 4 weeks for antidepressant medications to become therapeutic for the client with depression. A client who recently experienced the death of a spouse may be grieving, but there is no indication crisis intervention is needed. p. 56

Which anticonvulsant mood stabilizer often prescribed for bipolar disorder carries a black box warning that includes pancreatitis? A) Ramelteon B) Lamotrigine C) Valproic acid D) Carbamazepine

Valproic acid Valproic acid (Depakene) is helpful in bipolar patients unresponsive to lithium. Black box warnings for valproic acid include hepatotoxicity, tetratogenicity, and pancreatitis. Ramelteon is a melatonin receptor agonist that works as a hypnotic. The use of lamotrigine may trigger a severe allergic skin reaction called Stephens-Johnson syndrome (SJS). The use of carbamazepine warrants a periodic complete blood count due to rare, but serious blood dyscrasias (e.g., aplastic anemia and agranulocytosis). p. 46

How much time does it usually take for a crisis to self-resolve? A) 1 to 10 days B) 1 to 3 weeks C) 4 to 6 weeks D) 3 to 4 months

4-6 weeks At 4 to 6 weeks, the individual is making accommodations and adjustments to relieve anxiety, and the crisis is no longer a crisis. These adjustments usually cannot be made in less time, but taking 3 to 4 months would not be tolerable. p. 325

Which statement by a client indicates understanding of the client education provided about a prescribed selective serotonin reuptake inhibitors (SSRI)? A) "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." B) "I will not take any over-the-counter medication while on this medication. C) "I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." D) "I will report increased thirst and urination to my health care provider."

"I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." High fever, fast heartbeat, and abdominal pain describe symptoms of serotonin syndrome, a life-threatening complication of SSRI medication. The other options are incorrect because the client should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the health care provider, and would not have been educated to report increased thirst and urination as a side effect of SSRI. p. 216

A psychiatric client admitted with suicidal ideations asks the nurse, "How long will I be staying here for treatment." How does the nurse respond? A) "The average length of stay for clients is 4 days." B) "The average length of stay for clients is 8 days." C) "The average length of stay for clients is 10 days." D) "The average length of stay for clients is 14 days."

"The average length of stay for clients is 8 days." Nationwide, the average length of stay for mental health disorders is 8 days, and the average length of stay for substance abusers is 4.8 days. Lengths of stay of greater than 8 days are not within the national reported average. p. 56

The nurse responsible for the safety of a 10-year-old client diagnosed with impulse control disorder is most concerned about which of the following? A) The child stating that he or she wishes to die. B) The child's preoccupation with violent television programs. C) A notation in the child's medical history describing a previous suicide attempt. D) The father's report that the child is clumsy and is always hurting him- or herself.

A notation in the child's medical history describing a previous suicide attempt. The number one predictor of suicidal risk is a past suicide attempt. Although the child expressing a wish to die, being preoccupied with violent television programs, or always hurting him or herself may be considered, they do not have the predictive ability of a previous attempt. p. 365

Which assessment data support the suspicion that a depressed client is demonstrating self-directed anger? Select all that apply. A) Hospitalized for alcohol detoxification B) Diagnosed as being morbidly obese C) Three-pack-a-day cigarette smoker D) Multiple failed marriages E) Declared bankruptcy twice

A, B, C Anger in depression may be directed toward the self in the form of suicidal or otherwise self-destructive behaviors (e.g., alcohol abuse, substance abuse, overeating, smoking, etc.). Multiple marriages and financial problems are not characteristic examples of self-directed anger. p. 205

Which factors are considered when determining a client is at high risk for suicide? Select all that apply. A) Attempted suicide two years ago B) Father committed suicide at age 45 C) Consistently did poorly in school D) Reports excessive reliance upon alcohol E) Currently living with family members

A, B, D Factors that increase this client's risk for suicide include a past suicide attempt, family member who successfully committed suicide, and abuse of alcohol. Poor academics and living with family are not strong predictors of suicidal behavior. p. 366

Which child or teenager is demonstrating classic depression-related behavior? Select all that apply. A) A 4-year-old cries frequently for no apparent physical reason. B) A 6-year-old demands to sleep with one parent when the other is away. C) An 8-year-old consistently declines offers to play with schoolmates. D) An 11-year-old cries when a beloved family pet runs away. E) A 15-year-old becomes verbally abusive to siblings.

A, C, E As children grow and develop, they may display a wide range of moods and behaviors, making it easy to overlook signs of depression. For example, a very young child may cry, a school-age child might withdraw from schoolmates, and a teenager may become irritable with siblings in response to feeling sad or hopeless. The 6-year-old who demands to sleep with one parent when the other is away and an 11-year-old who cries when a beloved family pet runs away are examples of acute grief or anxiety rather that depression. p. 197

A client arrested for an assault in which the client savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with which personality disorder? A) Antisocial B) Borderline C) Schizotypal D) Narcissistic

Antisocial Clients diagnosed with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts. This lack of remorse for such behavior is not typical of borderline, schizotypal, or narcissistic personality disorders. P. 169

A client diagnosed with schizophrenia says, "I hear the voices every day. They always say bad things about me." Which nursing action is the priority? A) Assess the client for suicidal thinking and plans. B) Review the client's medication regime and compliance. C) Educate the client about symptoms associated with schizophrenia. D) Suggest distracters for the client to use when auditory hallucinations occur.

Assess the client for suicidal thinking and plans. Auditory hallucinations can be dangerous for clients, particularly if they develop into command hallucinations; therefore, the nurse should assess the client for suicidal thinking and plans before anything else. The nurse should ultimately review the client's medication regime and compliance, educate the client about symptoms associated with schizophrenia, and suggest distractors for the client to use when auditory hallucinations occur as well, but each of these should come after an initial assessment for suicidal thinking and plans. pp. 249-250

An elderly client in the terminal stages of lung cancer reports pain. The client tells the nurse, "I wish I could just die." What does the nurse do? Select all that apply. A) Ignore the statement B) Listen to the client's feelings C) Document the statement D) Report to the health care provider E) Ask the client to express more

B, C, D, E A terminally ill client may feel hopeless and depressed. It is important for the nurse to provide support and actively listen to a client who makes a statement such as "I wish I could just die." The statement may indicate suicidal ideations. It is also important to document such statements and report them to the health care provider. The nurse should try to explore more about the feelings of the client by asking him or her to tell more about how he or she feels. The nurse should never ignore such statements, because such clients may be suicidal. p. 445

Because depression may present differently in children than it does in adults, what is a possible indicator of depression in a child? Select all that apply. A) Hyperactivity and inattention B) Anger and isolation C) Changes in clothing style D) Changes in friendships E) Changes in music tastes F) Selective mutism

B, C, D, E Depression can present differently in children and adolescents. They may display anger and isolation, a change in dress (dark clothing, hair covering the face or eyes, poor grooming), a change in friends, listening to music with sad or violent themes, and other behaviors not typically seen in adults with depression. Hyperactivity and inattention are indicators of attention deficit-hyperactivity disorder (ADHD). Selective mutism is an anxiety disorder. p. 410

A client diagnosed with major depression successfully committed suicide while hospitalized. What appropriate action should the nurse manager take regarding the unit's staff? Select all that apply. A) Reprimand the staff for not taking proper care of the client. B) Review the events for the possible overlooked client clues. C) Provide adequate emotional support to the staff of the unit. D) Recommend not sharing information with the client's family until after the investigation is complete. E) Recommend conducting a psychological postmortem.

B, C, E The staff may experience posttraumatic stress disorder if a client commits suicide at the hospital under their watch. A review of the events must be done to find the overlooked clues in the client's behavior. This helps to avoid future mistakes and improve the quality of treatment. The nurse should support the staff to help them cope with the event. A thorough psychological postmortem should be done to determine any faulty judgment of the staff and to improve the treatment protocol. The staff should not be suspended. The client's family must be informed immediately. p. 371

A client has a long history of bipolar disorder with frequent episodes of mania secondary to stopping prescribed medications. The client says, "I will use my whole check next month to buy lottery tickets. Winning will solve my money problems." Which is the nurse's most appropriate action? A) Educate the client about the low odds of winning the lottery. B) Present reality by saying to the client, "That is not good use of your money." C) Confer with the treatment team about appointing a legal guardian for the client. D) Tell the client, "If you buy lottery tickets, your money will run out before the end of the month."

Confer with the treatment team about appointing a legal guardian for the client. Because the client is at risk for damaging his or her financial situation and is unable to manage the mania without medications, the nurse should confer with the treatment team about appointing a legal guardian for the client. Educating the client about the odds of winning the lottery will not prevent the client from purchasing lottery tickets and is therefore not the best action. Counseling about the best use of money is not the best action because it ultimately doesn't help prevent the client from spending all his or her money on lottery tickets. Reasoning that the client will run out of money if he or she purchases lottery tickets will also not prevent the client from making the purchase and is therefore not the best action. pp. 224, 226

The client treated with lithium carbonate repeatedly requests water to drink and has slurred speech. What is the priority nursing action in this case? A) Provide food to the patient. B) Administer mannitol to the patient. C) Evaluate the client's blood lithium level. D) Report to the primary health care provider.

Evaluate the client's blood lithium level. Excessive thirst, slurred speech, and polyuria are early signs of lithium toxicity. The nurse should frequently check the client's lithium level. Food does not help prevent lithium toxicity. Mannitol can be administered to eliminate the drug if severe toxicity is determined, but it must be diagnosed first. The nurse can report to the primary health care provider after checking the lithium levels in the blood. p. 236

How often should the nurse chart the whereabouts and record mood, verbatim statements, and behavior of a client assessed for being at a very high risk for self-harm? A) Three times a day B) Every 15 minutes C) Every 60 minutes D) Every other day

Every 15 minutes When clients are at high risk of suicide and assessment shows that they may follow a plan of self-harm, the nurse should keep them under 24-hour surveillance. The nurse should chart the client's whereabouts and record his or her mood, verbatim statements, and behavior every 15 minutes. The clients may cause self-harm if the interval between two checks is large, such as three times a day, every 60 minutes, or every other day. p. 369

A Native American adult is hospitalized. The emergency department assessment indicates auditory and visual hallucinations. The client states, "My dead father told me to kill myself to save me from the bad spirits." What would be an appropriate nursing intervention for the nursing care plan? A) Initiate a consultation between the hospital chaplain and the client. B) Provide the client with frequent periods alone for meditation and prayer. C) Assign only Native American staff members to provide this client's care. D) Consult the family, with the client's consent, for a spiritual healer from the client's tribe.

Initiate a consultation between the hospital chaplain and the client. Culturally competent care is a holistic approach that addresses the mind-body-spiritual aspect of individuals. Consulting with a spiritual leader may help address the client's spiritual concerns. It is unsafe to leave a potentially suicidal client alone. It may not be possible to only assign Native American staff members to care for this client, and all staff members should be culturally respectful and knowledgeable. The client is not mentally well enough to provide consent to allow the nurse to speak to the client's family. p. 100

Which behavior is most characteristic of a client diagnosed with antisocial personality disorder? A) Justifying taking another client's dessert by stating, "I deserve two desserts." B) Throwing a book when asked to turn down the volume on the television. C) Insisting that it is necessary to eat only green foods on Thursdays. D) Repeatedly accusing the staff of favoring another client.

Justifying taking another client's dessert by stating, "I deserve two desserts." An entitled attitude is a characteristic demonstrated by clients diagnosed with antisocial personality disorder. Poor impulse control as demonstrated by throwing a book is a hallmark of borderline personality disorder. Schizotypal personality disorder is associated with eccentric behavior while intense jealousy is characteristic of paranoid personality disorder. P. 169

A nurse working in the county jail assesses four new inmates. The nurse should direct guards to place an inmate charged with which crime under suicide watch? A) Breaking and entering B) Criminal solicitation (prostitution) C) Lewd and lascivious act on a minor D) Assault and battery on an elderly person

Lewd and lascivious act on a minor Individuals accused of sexual offenses involving children often face considerable shame and hostility, putting them at an especially high risk of suicide within the first 24 to 48 hours of incarceration. Breaking and entering, criminal solicitation, and assault and battery are not associated with higher suicide risk. p. 428

A nurse observes that a client behaves rudely to the staff and refuses treatment. On inquiry, the nurse learns that The client says to the nurse, "I think that all staff members are planning to harm and deceive me." Which diagnosis does the nurse expect to see in the client's medical record? A) Schizoid personality disorder B) Paranoid personality disorder C) Narcissistic personality disorder D) Obsessive-compulsive personality disorder

Paranoid personality disorder Clients diagnosed with paranoid personality disorder are suspicious and believe that others want to exploit, harm, and deceive them. They develop a defense system and try to counterattack the other person and reject the treatment, often behaving rudely. Clients diagnosed with schizoid personality disorder have reduced emotional attachment and depression. In narcissistic personality disorder, clients are extremely worried about their prestige; they feel intense shame and fear of abandonment by others. Clients diagnosed with obsessive-compulsive personality disorder exhibit repetitive behaviors. pp. 168-169

A client diagnosed with major depressive disorder tells the community mental health nurse, "I usually spend all day watching television. If there's nothing good to watch, I just sleep or think about my problems." What is the nurse's most appropriate action? A) Suggest that the client instead call some friends. B) Refer the client for counseling with a recreation therapist. C) Refer the client for counseling with an occupational therapist. D) Tell the client that watching television and thinking about problems worsens depression.

Refer the client for counseling with a recreation therapist. A recreation therapist can help the client find activities to do during free time that may better improve emotional, physical, cognitive, and social well-being. Suggesting that the client call friends could make the client feel worse if this is not possible given the client's support system or level of motivation for social engagement. Occupational therapists work with clients to develop the practical and necessary skills of daily independent living. Advising the client that watching television and thinking about problems will only make depression worse conveys judgment without helping the client find better health-promoting activities. p. 55

Three months after the death of his wife, an 86-year-old man begins having difficulty with concentration and sleep. Family members must provide reminders and encouragement for him to bathe, take prescribed medications, and eat regularly. Which nursing action is most appropriate? A) Assist the family to place this client in a skilled care facility. B) Refer this client for further evaluation and treatment of suspected depression. C) Educate the family and support persons regarding the progression of dementia. D) Confer with the primary care provider about prescribing a hypnotic medication to improve the client's sleep.

Refer this client for further evaluation and treatment of suspected depression. This client experienced a serious loss; signs of depression are evident. Further evaluation and treatment is needed. Depression in the older adult is frequently confused with dementia. The scenario does not suggest that the client has dementia or needs placement in a skilled care facility. A hypnotic medication is likely to increase this client's confusion. p. 273

What is the leading cause of premature death in clients diagnosed with schizophrenia? A) HIV B) Obesity C) Substance abuse D) Suicide

Suicide Suicide is the leading cause of death in the population diagnosed with schizophrenia. HIV is double the rate of the general population and contributes to the morbidity and mortality of the clients diagnosed with schizophrenia. Obesity and substance use disorder are also higher in the schizophrenic population and most certainly contribute to the comorbidities and mortality. p. 245

A nurse interacts with a depressive client. The client says, "Can you get me a sharp knife?" What conclusion is most appropriate for the nurse to make from the client's response? A) The client is socially withdrawn. B) The client has delusions. C) The client is at higher risk of suicide. D) The client can cause harm to others.

The client is at higher risk of suicide. The nurse should appropriately evaluate the client's suicide plan. Clients with definite intention and time are at high risk. Based on the method of lethality, clients can be classified as higher risk and lower risk. Carbon monoxide poisoning, using a gun, jumping off a high place, or car crash indicate high risk. Depressive clients normally feel rejected and avoid social gatherings. The statement by the nurse does not indicate that the client is socially withdrawn. Although delusions do not indicate a high risk of suicide, they can result in suicide. The client does not have manifestations of delusions. The client is depressed and sad but not aggressive, so there is less risk for harm to others. pp. 366-367

The nurse is caring for a client diagnosed with borderline personality disorder. Which behavior does the nurse expect find in the client? A) The client is always calm and depressed. B) The client shows extreme fluctuating emotions. C) The client abuses peers and hospital staff. D) The client feels uncomfortable with the nurse's attention.

The client shows extreme fluctuating emotions Clients diagnosed with borderline personality disorder have unstable moods. Such clients exhibit rapid emotional shifts. They may be extremely aggressive and suddenly become extremely calm. While this client may have calm or depressed periods, he or she will not remain that way. A diagnosed with borderline personality disorder will not necessarily be abusive to other clients or staff. A client diagnosed with borderline personality disorder craves attention and would not be uncomfortable with it. pp. 169-170

A nurse is managing the care of an individual diagnosed with avoidant personality disorder. What is the appropriate outcome for this client? A) The client will refrain from aggressive behavior toward others within 5 days. B) The client will demonstrate use of assertive communication within 3 months. C) The client will establish an intimate relationship with another adult within 2 weeks. D) The client will make a permanent commitment never to self-mutilate within 1 week.

The client will demonstrate use of assertive communication within 3 months. A person diagnosed with avoidant personality disorder is excessively anxious in social situations and hypersensitive to negative evaluation but desires social interaction. Assertiveness training is intended to assist this person in self-expression. Outcome achievement for any of the personality disorders is slow because personality is a deeply ingrained characteristic. It is likely to take months or years to achieve desired outcomes, not just 5 days or 2 weeks. Clients diagnosed with avoidant personality disorder do not typically self-mutilate. p. 171

When questioned by the nurse, a client admitted to a mental health facility after an unsuccessful suicide attempt states: "I wasn't attempting to kill myself, it was just an accidental overdose." Which would the nurse determine that this statement best reflects? A) The client's public self B) The client's private self C) The client's desired self-image D) The client's self-awareness

The clients private self Spoken words are symbols that represent the public self. Verbal statements can be true or meant to distort, conceal, or deny true feelings. The private self is not available from conversation alone and can include nonverbal behaviors. This statement does not characterize either desired self-image or self-awareness. p. 94

Which statement is descriptive of clients diagnosed with personality disorders? A) They are resistant to behavioral change. B) They have an ability to tolerate frustration and pain. C) They usually seek help to change maladaptive behaviors. D) They are able to form satisfying and intimate relationships.

They are resistant to behavioral change. Personality disorders are deeply ingrained and pervasive. Clients diagnosed with personality disorders find it very difficult, if not impossible, to change. Because they are so resistant to change, these clients do not often seek help. This makes a client easily frustrated and intolerant of pain. They have difficulty establishing and maintaining intimate relationships that are satisfying. p. 167

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." What should the nurse be prepared to do? A) Wait quietly for the client to reply. B) Prompt the client if the reply is slow. C) Repeat the question if the client does not answer promptly. D) Review the client's medical record to support the client's response.

Wait 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. The nurse should not rush or pressure the client by prompting the client to reply or repeating the question. There is no need to confirm the client's response with information in the medical record. p. 207

The high school nurse meets with small groups of students the day after a school bus accident resulted in the death of five students. Which comment should the nurse use to begin the session? A) "Sometimes life is not fair. Yesterday's tragedy is an example of just how unfair it can be." B) "We're grateful that you are safe. Our discussion is to talk about feelings associated with yesterday's tragedy." C) "Thank you for coming today. As school leaders, we know it is very important to respond to yesterday's tragedy." D) "We've had a terrible loss. I also feel your pain. You need to talk about your feelings associated with the event."

"We're grateful that you are safe. Our discussion is to talk about feelings associated with yesterday's tragedy." By indicating that the nurse leading the session and the school are glad the students are safe and that the meeting's purpose is to talk about feelings associated with the tragedy, the nurse is beginning the introductory phase of the critical incident stress debriefing process, so this is the correct answer. Claiming that life is not fair does nothing to establish a safe environment and clarify the goals of the debriefing, so this is an incorrect response. Indicating that the students would need to respond to the tragedy fails to begin the meeting by establishing a safe place or a clear objective for the meeting, so this is not the correct way to begin the meeting. Beginning with feelings about the loss and the nurse's own pain doesn't start the session in a way that creates safety and clarity, so this is not the correct response. p. 330

To assess the client's perception of the event precipitating a crisis, what question should the nurse initially ask? A) "What was happening just before you began feeling this way?" B) "During difficult times in the past, what has helped you?" C) "Can you give me the name of someone you trust?" D) "Who is available to help you?"

"What was happening just before you began feeling this way?" Asking the client what was happening to him or her before the crisis is the only query that is directed at the client's perception of the precipitating event. "During difficult times in the past, what has helped you?" "Can you give me the name of someone you trust?" and "Who is available to help you?" ask important questions but are not related to perception of the precipitating event. p. 327

A nurse is discharging a client who sought treatment after experiencing a sexual assault. What information is given priority when providing the client with discharge instructions? A) Information regarding options to prevent an unwanted pregnancy B) The phone number to the local police department C) Scheduled a follow-up appointment with a rape crisis counselor D) A written list of common physical, social, and emotional reactions following sexual assault

A written list of common physical, social, and emotional reactions following sexual assault. Crisis counseling should always be available to any person who has been sexually assaulted. Discharge instructions should include information on clinics, rape crisis counselors, and support groups. Having a follow-up appointment with a rape crisis counselor should be done before the client leaves the Emergency Department. Emergency contraception should be offered at the time of the visit, subject to informed consent and consistent with the current treatment guidelines. Phone numbers for the local police department may be included but are not a priority at this time. A written list of common physical social, and emotional reactions should be included in the discharge instructions. p. 358

Which client statements support the existence of a comorbid condition characteristically associated with posttraumatic stress disorder (PTSD)? Select all that apply. A) "I don't have any really good friends, just acquaintances." B) "Marriage doesn't work for me; I've been divorced three times." C) "My partner is always upset because I can't seem to keep a job." D) "Controlling my anger is a big problem for me." E) "I wish my parents were still alive; they loved and cared about me."

A, B, C, D Difficulty with interpersonal, social, or occupational relationships nearly always accompanies PTSD, and trust is a common issue of concern. Common presenting symptoms include difficulty controlling one's anger. Communicating the sadness of losing loved ones is not necessarily associated with PTSD. p. 124

Which statements are true regarding tertiary crisis care? Select all that apply. A) The care may be provided on an outpatient basis. B) A goal is to have the client regain optimum function. C) A goal is the prevention of further crisis-related emotional disruption. D) Sheltered workshops are not designed to provide tertiary crisis care. E) Care focuses on recovery from a disabling mental state resulting from a crisis.

A, B, C, E Tertiary care provides support for those who have experienced a severe crisis and are now recovering from a disabling mental state. Social and community facilities that offer tertiary intervention include rehabilitation centers, sheltered workshops, day hospitals, and outpatient clinics. Primary goals are to facilitate optimal levels of functioning and prevent further emotional disruptions. p. 330

Which mental health diagnosis is considered to be within the government's severe and persistent mental illness (SPMI) and serious mental illness (SMI) classifications? Select all that apply. A) Obsessive-compulsive disorder B) Narcissistic personality disorder C) Bipolar disorder D) Schizophrenia E) Panic disorder

A, C, D, E The federal government's classifications of SPMI and SMI apply to those who are affected most deeply by psychiatric disorders. Disorders that fall into this category include severe forms of depression, panic disorder, and obsessive-compulsive disorder, as well as schizophrenia, schizoaffective disorder, and bipolar disorder. Narcissistic personality disorder is not classified among the SPMI or SMI disorders. pp. 418-419

The nurse is performing crisis intervention for a client who has been sexually assaulted. What action should the nurse take first? A) Ask the client what happened. B) Assess the client for any suicidal intentions. C) Learn the client's perception of the situation. D) Assess the coping skills of the client.

Assess the client for any suicidal intentions. A client experiencing crisis can develop suicidal behavior to escape from the situation. The nurse should first asses the suicidal intentions of the client to promote the safety of the client. Aside from asking details that pertain only to the client's health and safety, the nurse's priority intervention should not be to ask the client what happened since this could unnecessarily retraumatize the client. The client's perception of the situation and coping skills are assessed after assessing the suicidal intentions of the client, because the safety of the client is of greater importance. p. 329-330

What is the priority concern for the crisis intervention nurse? A) Client safety B) Setting up future contacts C) Brainstorming possible solutions D) Working through termination issues

Client safety Client safety is always the priority concern in crisis intervention therapy. The disequilibrium of crisis predisposes the client to suicidal thinking. Setting up contacts, brainstorming solutions, and working through termination issues are all concerns of crisis intervention, but they are secondary to safety. p. 330

Which side effects of lithium can be expected when the medication is at therapeutic levels? A) Nausea and thirst B) Ataxia and hypotension C) Fine hand tremors and polyuria D) Coarse hand tremors and gastrointestinal upset

Fine hand tremors and polyuria Fine hand tremors and polyuria are present at therapeutic levels of lithium treatment. Nausea and thirst are early signs of toxicity. Ataxia, hypotension, coarse hand tremors and gastrointestinal upset are advanced signs of toxicity. p. 236

A client admitted with acute mania tells the staff and the other clients that he is on a secret mission given to him by the President of the United States to monitor citizens for terrorist activity. The client states "I am the only one he trusts, because I am the best!" For documentation purposes, which term describes this behavior? A) Unpredictability B) Rapid cycling C) Grandiosity D) Flight of ideas

Grandiosity Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although patients with mania are unpredictable, this scenario does not describe unpredictability. Rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which involves a continuous flow of speech with abrupt topic changes. p. 229

What information concerning electroconvulsive therapy (ECT) treatment and its effectiveness for clients diagnosed with bipolar disorder is true? A) It is appropriate for all cases of manic behavior. B) It is promising for clients with a history of rapid cycling. C) Treatment is contraindicated for patients during depressive episodes. D) Treatment shows little effectiveness for patients experiencing paranoid tendencies.

It is promising for clients with a history of rapid cycling. ECT is used to subdue severe manic behavior, especially in clients with treatment-resistant mania and clients with rapid cycling. It is not necessarily useful for all cases of mania. Depressive episodes, particularly those with severe, catatonic, or treatment-resistant depression, are an indication, not contraindication, for this treatment. ECT is effective for clients with bipolar disorder who have rapid cycling, and for those with paranoid-destructive features. p. 237

A depressed client is noted to pace very often, pull at his or her clothes, and wring his or her hands. What do these behaviors indicate? A) Senile dementia B) Hypertensive crisis C) Psychomotor agitation D) Serotonin syndrome

Psychomotor agitation These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression. Senile dementia is a loss of cognitive function seen in older adults. Hypertensive crisis is extremely high blood pressure. Symptoms of serotonin syndrome, which is a medication side effect, include abdominal pain, diarrhea, sweating, fever, tachycardia, elevated blood pressure, altered mental state (delirium), myoclonus (muscle spasms), increased motor activity, irritability, hostility, and mood change. p. 205

A client diagnosed with major depressive disorder has vegetative symptoms. Which nursing diagnosis is most applicable to these symptoms? A) Self-care deficit B) Spiritual distress C) Disturbed thought processes D) Risk for self-directed violence

Self-care deficit Vegetative signs of depression include grooming and hygiene deficiencies, significantly reduced appetite, and changes in sleeping, eating, elimination, and sexual patterns. Spiritual distress, disturbed thought processes, and risk for self-directed violence relate to assessment findings in depression associated with other symptoms. p. 205

The client is being admitted for short-term effects of a stress event. What is the nurse likely to find during the assessment? A) Tachycardia B) High blood lipid levels C) Depression D) Heart disease

Tachycardia Tachycardia is a short-term effect of a stressor. High blood pressure, depression, and heart disease are long-term effects of stress. p. 121

What is the purpose of standardized rating scales for depression? A) To identify stressors and coping mechanisms B) To evaluate current cognitive processes C) To differentiate physical- and somatic-based symptoms D) To evaluate and monitor severity of symptoms

To evaluate and monitor severity of symptoms A number of standardized rating scales are used to evaluate and monitor the severity of depression. Identification of stressors and coping mechanisms occurs during the psychosocial assessment. Evaluating current cognitive processes is the main purpose of the mental status evaluation (MSE). Thorough physical and psychological health evaluations will differentiate physical- and somatic-based symptoms. p. 81

A client says to the nurse, "I once enjoyed going to parks and museums with my family but that is not fun anymore." How would the nurse document this complaint? A) Anergia B) Euthymia C) Anhedonia D) Self-deprecation

Anhedonia Anhedonia means that there is no pleasure or joy in life. It is a common finding with depression. Anergia refers to a lack of energy or physical passivity. Euthymia refers to a mood state that is normal and moderate, with neither depression nor mania. Self-deprecation refers to negative statements about self. p. 199

The expected outcome at the conclusion of crisis intervention therapy is that the client will function A) At a higher level than before the crisis. B) At the pre-crisis level. C) Only marginally below the pre-crisis level. D) Without aid from identified support systems.

At pre-crisis level The intent of crisis intervention is to return the individual to the pre-crisis level of functioning. A crisis would not provide the necessary teaching factors to result in the functioning at a higher level. The goal is not to lose function. Not all crises require help from a support system. p. 325

Which question is the most appropriate to ask when assessing a patient for supportive signs and symptoms for a potential diagnosis of posttraumatic stress disorder (PTSD) related to a sexual assault? A) "Are you hearing voices?" B) "Do you experience flashbacks of the rape?" C) "What are you doing to cope with your anxiety?" D) "Have you developed any compulsive behaviors since being assaulted?"

"Do you experience flashbacks of the rape?" Intrusive re-experiencing of the initial trauma such as flashbacks is one of the four cardinal symptoms of PTSD. Neither compulsions nor auditory hallucinations are considered to be cardinal symptoms of PTSD. Coping strategies are not related to supporting the diagnosis. p. 123

A 35-year-old army combat veteran is being treated for migraines and hypertension. The nurse is particularly interested in the individual's response to which mental health-focused question? A) "Are you worried about anything in particular? B) "Is there any history of suicide in your family?" C) "Have you ever experienced a hallucination?" D) "How would you describe posttraumatic stress disorder?"

"How would you describe posttraumatic stress disorder?" The behaviors associated with posttraumatic stress disorder (PTSD) are becoming more commonly observed in combat veterans. Hypertension and migraines are often seen as comorbid medical conditions of PTSD. "Are you worried about anything in particular?" is a generalized question that is not specific to this client. The question about a family history of suicide is more focused on depression than possible PTSD. The question about hallucinations is more focused on psychosis than possible PTSD. p. 125

Which complaint regarding sleep would the nurse expect from a client diagnosed with major depression? A) "I usually take a nap for about 30 minutes in the afternoon." B) "It takes me about 15 minutes to fall asleep. I often have vivid dreams." C) "I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." D) "I often fall asleep in the middle of an activity. When I wake up, I feel better."

"I wake up about 4 AM and cannot go back to sleep. I feel tired all the time." Change in sleep patterns is a cardinal sign of depression. Often, people experience insomnia, wake frequently, and have a total reduction in sleep, especially deep-stage sleep. One of the hallmark symptoms of depression is waking at 3 or 4 AM and then staying awake or sleeping for only short periods. Napping and vivid dreams are normal sleep variations. Falling asleep in the middle of an activity is indicative of narcolepsy. p. 205

A client has just lost a close friend. Which client statement best supports the nurse's assessment that the client has demonstrated resiliency? A) "Losing a parent is a natural part of life." B) "I know I'm not the first person to lose a loved one." C) I've learned from experiencing other losses that I'll be alright." D) "Losing my friend is the hardest thing I've ever experienced."

"I've learned from experiencing other losses that I'll be alright." Resiliency is the ability to recover from or adjust successfully to trauma or change. Being resilient does not mean that people are unaffected by stressors. Rather than becoming paralyzed by the negative emotions, resilient people recognize the feelings, readily deal with them, and learn from the experience. A successful transition through a crisis builds resiliency for the next difficult trial. Statements that loss is a natural part of life, that the client knows he or she is not the first to experience loss, and that the loss is the hardest thing he or she has experienced represent healthy ways of coping, but they do not demonstrate resilience. p. 12

A family's home and possessions are lost when a massive forest fire burns out of control. What type of crisis has occurred? A) Situational B) Adventitious C) Maturational D) Developmental

Adventitious An adventitious crisis is not a part of everyday life. It results from events that are unplanned and may be accidental, caused by nature, or human-made. This type of crisis results from a natural disaster, a national disaster, or a crime of violence. A situational crisis arises from events that are extraordinary, external, and often unanticipated. A situational crisis may occur after the loss or change of a job, the death of a loved one, an abortion, change in financial status, divorce, or severe illness. A maturational crisis may be associated with leaving home during late adolescence, marriage, birth of a child, retirement, or death of a parent. Each developmental stage represents a maturational crisis that is a critical period of increased vulnerability, and at the same time, heightened potential. p. 326

The goal of crisis intervention has been met when a mother who lost her job demonstrates which behavior? A) Ability to begin a search for a new job. B) Is no longer angry with her employer. C) Describes her new job as being better than the old one. D) Accepts a new job that requires a move to another state.

Describes her new job as being better than the old one. The goal of crisis intervention is to have the client return to a pre-crisis level of function. Finding a job that is fulfilling is an example of such an achievement. Being able to begin a search for a new job, no longer being angry with her employer, and accepting a new job that requires a move to another state are all positive actions but do not demonstrate a return to pre-crisis function. p. 330

Which action should the nurse take when managing a hospitalized client experiencing acute mania? A) Encouraging frequent naps B) Advising the client to avoid frequent toilet visits C) Giving the client well-cooked three-course meals D) Allowing the client to dress and groom unassisted

Encourage frequent naps The client experiencing acute mania is at risk for inadequate rest. The nurse should encourage the client to take frequent naps and sleep during the day. The nurse should encourage the client to frequently visit the toilet to reduce the risk of fecal impaction. Clients experiencing acute mania find it difficult to sit and eat an entire meal. The nurse should provide high-calorie, high-protein finger foods that the client can consume easily. To protect the client's dignity while in a manic state, the nurse may need to encourage good grooming habits and conservative dress. Without assistance, the client may be too distracted to finish grooming, and his or her appearance may attract unwanted attention or ridicule. p. 230

Following an assessment, the nurse concludes that the client is in phase 2 crisis. What signs and symptoms support this conclusion? A) Suicidal intentions B) Intention to harm others C) Feelings of extreme discomfort D) Severe panic

Feelings of extreme discomfort Crisis is categorized into four distinct phases based on the behavior of the client. A client in phase 2 crisis has feelings of extreme discomfort, threat, and anxiety. Patients in phase 4 have suicidal ideation and/or intention to harm others. Patients who exhibit severe panic and withdrawal are included in phase 3. p. 327

Which outcome indicates that the individual is demonstrating a commonly observed but negative coping strategy after a crisis event? A) Scheduling spiritual counseling sessions three times a week B) Gaining 10 lb over a 6-week period of time C) Losing one's driver's license for driving drunk D) Offering numerous excuses for not socializing E) Running 5 miles daily

Gaining 10 lb over a 6-week period of time Common coping mechanisms may be overeating, drinking, smoking, withdrawing, yelling or fighting. Counseling and reasonable exercise would not be considered negative coping strategies. p. 328

A pregnant client is diagnosed with seasonal affective disorder. What appropriate action does the nurse include in the client's treatment plan? A) Administer St. John's wort (Hypericum perforatum) regularly. B) Administer selective serotonin reuptake inhibitors regularly. C) Advise the client to rest and avoid exercising. D) Instruct the client to get exposed to a light source for 30 to 45 minutes daily.

Instruct the client to get exposed to a light source for 30 to 45 minutes daily. Light therapy is the best treatment for seasonal affective disorder. It increases the melatonin secretion by the pineal gland. It is ideal to expose the client to a light source for 30 to 45 minutes. St. John's wort (Hypericum perforatum) should not be given to pregnant clients, because it may not be safe. Selective serotonin reuptake inhibitors must not be used in pregnant clients, because they may have teratogenic effects on the fetus. Exercise enhances mood, so the nurse should not discourage the client from exercising. p. 219

A nurse, managing a client diagnosed with depression, should expect to introduce the client to which form of short-term therapy? A) Erikson's ego theory B) Psychodynamic therapy C) Interpersonal psychotherapy D) Freud's psychoanalytical theory

Interpersonal psychotherapy Interpersonal psychotherapy is effective short-term therapy that helps in reducing psychiatric symptoms by improving interpersonal relationships, which can be the main cause for depression. Erikson's ego theory gives a developmental model that is more useful for assessment to identify age-appropriate normal skills. Psychodynamic therapy is more suitable for relatively healthy people and is usually considered long-term with a number of sessions. Freud's psychoanalytical theory presents a human developmental process throughout childhood and its relation to human personality. pp. 20, 22-23

A client is experiencing stress at work. What is an example of a physical stressor in the workplace? A) Staff cliques B) Guilt C) Low pay D) Loud noises

Loud noises Loud noises are an example of a physical stressor in the workplace. Staff cliques and low pay are psychosocial stressors. Guilt is a psychological stressor. p. 120

What quality may explain why some individuals tend to survive traumas and stressors more successfully than others? A) Intimacy B) Adversity C) Resiliency D) Impulsivity

Resiliency Individuals with resiliency tend to survive traumas or stressors more successfully. Resiliency is developed through the successful transition through a previous crisis, often with the guidance of parents and other supportive figures. Individuals who are resilient may also have better resources and parenting, and may be neurologically less vulnerable to stress. Most children can develop resiliency if provided with the necessary support. Intimacy is an important quality to establishing close social relationships. Adversity describes traumas and stressors that challenge a person's well-being. Impulsivity is a risky quality that involves acting without evaluating possible consequences. p. 405

The nurse has developed a plan for a client with a severe sleep pattern disturbance to spend 20 minutes in the gym exercising each afternoon. Which intervention should be scheduled upon returning to the unit? <p>The nurse has developed a plan for a client with a severe sleep pattern disturbance to spend 20 minutes in the gym exercising each afternoon. Which intervention should be scheduled upon returning to the unit?</p> Rest Group therapy Protein-based snack Unstructured private time

Rest A depressed client usually has little energy. After even a short exercise period, the client may feel exhausted and need rest. Group therapy could be counterproductive to this need, while a protein-based snack and unstructured private time may not directly address it. p. 209

A nurse is caring for a client diagnosed with schizophrenia. Which type of intervention should the nurse plan to ensure the safety of the client? A) Primary intervention B) Tertiary intervention C) Secondary intervention D) Critical incident stress debriefing

Secondary intervention Secondary intervention includes coping strategies from acute crisis and prolonged anxiety levels. The prime theme of secondary intervention is to ensure the safety of the client. It includes the assessment systems, support systems, and coping strategies. Primary interventions include psychotherapeutic crisis interventions. Tertiary interventions include coping for clients with a disabling mental state. Critical incident stress debriefing is a form of tertiary intervention. p. 330

Which statement is true of the relationship between bipolar disorder and suicide? A) Clients with bipolar disorder are not considered to be at a high risk for suicide. B) Clients need to be monitored only in the depressed phase, because this is when suicides occur. C) Suicide is a serious risk, because nearly 20% of those diagnosed with bipolar disorder commit suicide. D) As long as clients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.

Suicide is a serious risk, because nearly 20% of those diagnosed with bipolar disorder commit suicide. Mortality rates for bipolar disorder are severe because 25% to 50% of individuals with bipolar disorder will make a suicide attempt at least once in their lifetimes, and the suicide rate of bipolar individuals is 15% to 20%. Suicides occur in both the depressed and the manic phases. Bipolar clients are always considered high risk for suicide because of their impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only clients who stop medications commit suicide. p. 224

A nurse conducting crisis intervention for a client has identified that the client demonstrates impaired social interaction. Which symptom supports this conclusion? A) The client is overwhelmed. B) The client has exaggerated startle response. C) The client avoids using social support. D) The client has difficulty with interpersonal relationships.

The client has difficulty with interpersonal relationships. An assessment of the signs and symptoms of stress in a client in crisis is the initial step for formulating an effective crisis management plan. If the client has difficulty with interpersonal relationships, then the nursing diagnosis for the client would be impaired social interaction. If the client is in an overwhelmed state, then the diagnosis of the client would be disturbed personal identity. Startle response is a symptom of anxiety, and decreased use of social support would come under the diagnosis of ineffective coping. p. 329

A nurse is planning crisis intervention for a client who has been diagnosed with acute stress and panic episodes. Which nursing intervention does the nurse implement while giving primary care to the client? A) The nurse assesses coping styles of the client. B) The nurse assesses the support systems of the client. C) The nurse teaches relaxation techniques to the client. D) The nurse suggests the client join a rehabilitation center.

The nurse teaches relaxation techniques to the client. Crisis interventions consist of three levels of care, including primary care, secondary care, and tertiary care. Primary care is intended to reduce stress and promote the mental health of the client. At this level the nurse teaches relaxation techniques to the client to reduce the stress. Secondary care is established during an acute crisis to prevent prolonged anxiety in the client. The nurse plans the crisis interventions based on the coping styles and support systems of the client. Tertiary care is provided to those clients who have experienced a severe crisis and are now recovering from a disabling mental state. At this level the nurse learns more about the clients' support systems and may suggest other support options that are available. The nurse might suggest such clients join a rehabilitation center, for instance. p. 330

When the spouse of a client who is manic asks about genetic transmission of bipolar disorder, what knowledge informs the nurse's answer? A) No research exists to suggest genetic transmission. B) Much depends on the socioeconomic class of the individuals. C) Highly creative people tend toward development of the disorder. D) The rate of bipolar disorder is higher in first-degree relatives of people with bipolar disorder.

The rate of bipolar disorder is higher in first-degree relatives of people with bipolar disorder. Knowing that the rate of bipolar disorder is higher among first-degree relatives of people with the disease can inform the nurse's answer. It is incorrect to state that no research exists suggesting genetic transmission. While socioeconomic class may affect a client's experience of the disease, it does not preclude genetic factors. Stating that highly creative people tend to develop bipolar disorder is tangential and misleading. p. 225

A client admitted with a diagnosis of depression has been having angry outbursts with staff and peers on the unit since being admitted. Based on the client's behavior, what is the nurse's primary concern? A) The nurse should encourage the client's newfound assertiveness. B) This type of behavior places a depressed client at high risk for self-harm. C) The client who is angry and depressed is likely experiencing transference. D) The client is likely angry with someone else and projecting that anger to staff.

This type of behavior places a depressed client at high risk for self-harm. Overt hostility is highly correlated with suicide; therefore, the client may be considered high risk, and appropriate precautions should be taken. There is no evidence to support encouraging the client's new found assertiveness or transference, or that the client is likely angry at someone else. p. 206

The nurse must initially assess a client in crisis for which equilibrium-focused behavior? A) Self-report of feeling depressed B) Unrealistic report of a crisis-precipitating event C) Report of a high level of anxiety D) Admission that he or she is abusing drugs

Unrealistic report of a crisis-precipitating event A person's equilibrium may be affected adversely by one or more of the following: an unrealistic perception of the precipitating event, inadequate situational supports, and inadequate coping mechanisms. These factors must be assessed when a crisis situation is evaluated because data gained from the assessment are used as guides for both the nurse and the client to set realistic and meaningful goals, as well as to plan possible solutions to the problem situation. Feelings of depression or anxiety and admission of drug use are important to the crisis management process, but they are secondary to assessing the client's report of the event. p. 327

What clients are at risk for posttraumatic stress disorder (PTSD)? Select all that apply. A) A child after the violent death of his mother from spousal abuse B) A young man who just completed his first marathon C) An older woman after the death of her daughter after a long illness D) A football player after winning a championship game E) A woman who has just lost her child to cancer F) A teenage victim of sexual abuse

A, C, E, F PTSD is associated with traumatic events such as violent deaths, deaths after long illnesses, and sexual abuse. A marathon runner and a football player are likely to experience eustress related to major athletic performance events. pp. 123-125

What statement regarding depression is true? Select all that apply. A) Depression can be present in association with other mental and physical disorders. B) While depression coexists with other disorders, it does not impact these disorders. C) The symptomology of depression is relatively similar regardless of age or culture. D) Social relationships can suffer when an individual is depressed. E) Depression can range from mild to severe in its effect on individuals.

A, D, E Depression can exist alone or in conjunction with other disorders and illnesses. Depression results in significant pain and suffering that disrupts social relationships, performance at school or on the job, and the ability for a person to live a full and happy life. Depression can manifest on a continuum from mild to severe. Depression can impact other comorbid disorders. Depression can present differently in different populations and different age groups. p. 197

Which interventions are associated with primary crisis care? Select all that apply. A) Discussing impact of crisis on the client B) Administering antidepressant medication as prescribed C) Planning for discharge, beginning with the admission interview D) Assisting the client with learning new problem-solving techniques E) Helping the client to identify environmental changes necessary to reduce stress

A, D, E Primary care promotes mental health and reduces mental illness to decrease the incidence of crisis. On this level the nurse can work with a client to recognize potential problems by evaluating the client's experience of stressful life events; teaching the client specific coping skills, such as decision making, problem solving, assertiveness skills, meditation, and relaxation skills; and assisting the client in evaluating the timing or reduction of life changes to decrease the negative effects of stress as much as possible. This may involve working with a client to plan environmental changes, to make important interpersonal decisions, and to rethink changes in occupational roles. Administering antidepressant medication and planning for discharge are examples of secondary care. p. 330

A nurse has been caring for a client diagnosed with posttraumatic stress disorder. Which client behaviors indicate an improved ability to cope? Select all that apply. A) Improved eye contact B) Fewer physical complaints C) Asks for help when required D) Improved grooming skills E) More restful sleep periods

B, C, E Posttraumatic stress disorder usually occurs after a stressful event. It is characterized by reexperiencing, hypervigilance, and depression. Fewer physical complaints result from a better ability to cope. The client asking for help when required and sleeping better indicate improved coping abilities. Improved eye contact and grooming skills are related to improved self-esteem. p. 126

Which statements are true regarding psychopharmacological therapy for posttraumatic stress disorder (PTSD)? Select all that apply. A) Nightmares in clients with PTSD cannot be addressed through pharmacology. B) Initial therapy may include fluoxetine. C) Monoamine oxidase inhibitors (MAOIs) may be prescribed for panic attacks. D) High-potency benzodiazepines may exacerbate symptoms of PTSD and should be avoided. E) Anticonvulsant medications may be used in PTSD that is resistant to treatment.

B, C, E Initial medication therapy for PTSD may include a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine to decrease anxiety and depressive symptoms. Monoamine oxidase inhibitors (MAOIs) may be prescribed for panic attacks. Anticonvulsant medications may be used in PTSD that is resistant to treatment. Prazosin may be helpful for nightmares. High-potency benzodiazepines may be prescribed for panic attacks associated with PTSD. p. 126

Which clinical behavior demonstrates a main category of posttraumatic stress disorder (PTSD) symptoms? Select all that apply. A) Represses memories of childhood abuse resulting in denial of any such experience B) Has difficulty keeping full-time employment because of frequent reliving of trauma C) Reacts aggressively whenever spoken to in a manner perceived as disrespectful D) Is afraid to go to public parks since being victimized in one E) Displays signs of hyperarousal in noisy, crowded environments since being abducted from a large, busy mall

B, D, E PTSD symptoms can include re-experiencing the trauma; avoidance, fears, and phobias; and hyperarousal. PTSD does not involving repressing memories or difficulty accepting the interactions of others. p. 355

Which symptoms would lead a health care provider to suspect posttraumatic stress disorder (PTSD) in an adult client? Select all that apply. A) Visiting the scene of the accident over and over B) Talking with strangers about the events of the accident C) Flashbacks of the accident D) Hypervigilance E) Irritability F) Difficulty concentrating

C, D, E, F Flashbacks of the accident, hypervigilance, irritability, and difficulty concentrating are symptoms of PTSD. Visiting the scene of the accident over and over and talking with strangers about the events of the accident are not associated with PTSD. p. 123

A client with a diagnosis of obesity has been participating in a new program of exercise for 60 minutes a day, five times a week to facilitate a weight loss. What type of stress is the client experiencing? A) Eustress B) Distress C) Stress response D) Chronic stress

Eustress Eustress is beneficial stress; it motivates people to develop the skills they need to solve problems and meet personal goals. Distress causes problems both emotionally and physically. Stress response is also referred to as flight or fight response that is a survival mechanism by which our body and mind become immediately ready to meet a threat or stress. Chronic stress is a long-term stress that can cause physiological harm and increased chronic emotional difficulties. p. 120

Administration of which medication calls for careful nursing assessment of fluid and electrolyte balance? A) Fluvoxamine B) Clozapine C) Lamotrigine D) Lithium

Lithium Lithium can cause disturbances in fluid balance in various body compartments. Sodium and potassium play a strong role in regulating fluid balance. Hyponatremia can increase the risk of lithium toxicity because increased renal reabsorption of sodium leads to increased reabsorption of lithium. Fluvoxamine is a selective serotonin reuptake inhibitor (SSRI) and has minimal effect on fluid and electrolyte balance. Clozapine is a second-generation antipsychotic medication; it is important to monitor for agranulocytosis with administration of this drug. Lamotrigine is an anticonvulsant used as a mood stabilizer. It modulates the release of glutamate and aspartate. It is important to monitor for skin rashes with administration of this drug. p. 46

The nurse cares for an adult who repeatedly says, "My dead relatives try to talk to me and penetrate my body." This comment is most associated with which disorder? A) Seasonal affective disorder B) Substance-induced depressive disorder C) Disruptive mood dysregulation disorder D) Psychotic depression

Psychotic depression Depressive disorders are classified according to symptoms or the situations under which they occur. Delusional thinking is an aspect of psychosis that may be present in cases of psychotic depression. Seasonal affective disorder is characterized by marked seasonal differences in mood associated with decreased daylight. Substance-induced depressive disorder applies when symptoms of a major depressive episode arise associated with drug or alcohol intoxication or withdrawal. Disruptive mood dysregulation disorder relates to children and refers to situations in which a person has frequent temper tantrums, resulting in verbal or behavioral outbursts out of proportion to the situation. p. 198

A nurse observes that a client arguing with the hospital staff is tense and impatient. What nursing diagnosis should the nurse add to the client's plan of care? A) Ineffective impulse control B) Risk for self-directed violence C) Risk for stress overload D) Ineffective coping

Risk for stress overload Clients at risk for stress overload have feelings of anger, tension, and impatience. They demonstrate negative actions such as arguing with and abusing others. Symptoms of ineffective impulse control are offensive body language such as rigid posture and clenching fists, a history of violence, a history of substance abuse, and impulsivity. Symptoms of risk for self-directed violence are suicidal ideation and feelings of worthlessness, hopelessness, and helplessness. Symptoms of ineffective coping are poor problem-solving, poor cognitive functioning, and difficulty in doing simple tasks such as eating, dressing, and other activities of daily living. p. 377

A nurse caring for a client with depression instructs the client to rest after group activity. The nurse provides warm milk to the client in the morning and at night. What change does the nurse find in the client after implementation of these interventions? A) The client interacts with the nurse. B) The client maintains good hygiene. C) The client sleeps properly. D) The client has an increased appetite.

The client sleeps properly Depressive clients often have insomnia. The nurse should ensure that clients rest adequately after group activity. This helps to reduce fatigue, which can intensify the symptoms of depression. The client can be given warm milk at night to induce sleep. Improving the client's interactions with the nurse, good hygiene, or appetite may be treatment goals but are not directly related to the nurse's intervention with encouraging rest. p. 209

Which situation has the potential for early crisis intervention to occur? A) The client tells the nurse in the well-baby clinic that she's feeling uptight and has arranged to see a primary care therapist. B) The client is hospitalized after an unsuccessful suicide attempt that she states, "was a mistake." C) The client asks for reassurance that he will be welcome at the day hospital after his hospital discharge. D) The client enters the emergency department with a strong smell of alcohol on his person, stating he is anxious and depressed.

The client tells the nurse in the well-baby clinic that she's feeling uptight and has arranged to see a primary care therapist Phase I intervention is when a person confronted by a conflict or problem that threatens the self-concept responds with increased feelings of anxiety. The increase in anxiety stimulates the use of problem-solving techniques and defense mechanisms in an effort to solve the problem and lower anxiety. An unsuccessful suicide attempt deemed a mistake indicates a phase 4 response to a crisis; reassurance would be a phase 3 response. The inebriated client is using inappropriate coping mechanisms that are not effective to treat depression and anxiety. p. 327

A nurse who has worked for a community hospice organization for eight years says, "My clients and their families experience overwhelming suffering. No matter how much I do, it's never enough." Which problem should the nursing supervisor most suspect? A) The nurse is experiencing spiritual distress. B) The nurse is at risk for burnout and compassion fatigue. C) The nurse is not receiving adequate recognition from others. D) The nurse is at risk for over-helping, which creates dependency.

The nurse is at risk for burnout and compassion fatigue. The nurse is most likely experiencing compassion fatigue, a stress response caused by working with traumatized individuals. The negative thoughts put the nurse at risk for burnout and decreased work performance. Spiritual distress is a nursing diagnosis that applies to grief and is not related to self-care for nurses. The nurse's statement suggests self-criticism and not a lack of recognition from others. The nurse's statement does not likely represent over-helping. p. 395

A client reports to the nurse, "I want treatment to be stopped, and I want to be discharged immediately." Following interaction with the health professional, the nurse is instructed to prolong the client's treatment plan. Which condition is likely responsible for the present situation? A) The client has suicidal tendencies. B) The client is admitted informally. C) The client is under 18 years of age. D) The client is placed in a secluded area.

The client has suicidal tendencies. Clients with chronic mental conditions like suicidal tendencies are prone to self-harm or suicide. Such clients require attentive medical care without their own consent; they are hospitalized for a prolonged period until recovery is complete. Clients who are admitted informally, or those who are under 18 years of age, need not be hospitalized for a longer time if they are not willing. Clients admitted informally are free to make decisions regarding continuing or discontinuing the treatment regimen. Minor clients are given a written consent as a part of voluntary admission. It is unnecessary and unethical to place this client in seclusion. p. 103

A client admitted for treatment of depression after the recent death of her only child tells the nurse that she has accepted the death as God's will and is at peace with the situation. The nurse also notes during the interaction that the client is wringing her hands and not making eye contact. The nurse would interpret this as what type of message? A) Congruent B) Double-bind C) Nontherapeutic D) Culturally filtered

Double-bind A message which has incongruences between the verbal and the nonverbal aspects is considered a double-bind, or mixed, message. In this situation the message is incongruent, not congruent; thus this is incorrect. "Nontherapeutic" would not be an appropriate term to use in reference to the client's communication behaviors. Cultural filters impact the way that one interacts and listens and would not be a correct use in this situation. p. 94

Which statement made by a depressed client would provide insight into a common feeling associated with depression? A) "I still pray and read my Bible every day." B) "My mother wants to move in with me, but I want to be independent." C) "I still feel bad about my sister dying of cancer. I should have done more for her!" D) "I've heard others say that depression is a sign of weakness."

"I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible are coping mechanisms. Wanting independence and feeling that depression is a weakness are not feelings associated specifically with depression. p. 202

A nurse reports to the nurse manager that she is overwhelmed with work. She tearfully states to the nurse manager, "There is so much death all of the time. My work never seems to be enough." Which response by the nurse manager is most appropriate? A) "Have you tried to talk to a therapist?" B) "I'm not sure if there is anything I can do to help." C) "We all have those days and I've been in nursing for many years. You need to have a thicker skin in order to be a nurse." D) "I was thinking of starting a support group for the nursing staff. Many nurses have been coming to me with similar concerns."

"I was thinking of starting a support group for the nursing staff. Many nurses have been coming to me with similar concerns." The response by the manager about starting a support group is correct, because the nurse manager recognizes the potential for compassion fatigue and burnout and a support group is one way the organization can help to support nursing staff. Asking the nurse if she has talked to a therapist is incorrect, because it is not an appropriate response. Telling the nurse that there is nothing she can do is incorrect, because the manager needs to do something to support the nursing staff. Telling the nurse everyone has those days and to have a thicker skin is incorrect, because it does not support self-care of nurses and will not reduce the potential for compassion fatigue and burnout. p. 395

Which nursing statement illustrates the concept of client advocacy for a female client who was admitted after a suicide attempt? A) "The client has stated to me that she does not want to take the prescribed medication because she had adverse effects when it was prescribed previously." B) "During her admissions interview the client stated that she has had three other suicide attempts in the past." C) "Can you tell me more about your depression and your suicide attempt?" D) "I will take you on a tour of the unit and orient you to the rules."

"The client has stated to me that she does not want to take the prescribed medication because she had adverse effects when it was prescribed previously." By letting the health care provider know that the client does not want the treatment the health care provider is prescribing, the nurse has advocated for the client and her right to make decisions regarding her treatment. Past suicide attempts, depression, and giving a tour of the unit do not describe client advocacy. p. 2

A nurse is interviewing a client who attempted suicide. What question should the nurse ask to initiate the interview? A) "Are you happy that you survived?" B) "What made you attempt suicide?" C) "Did you really want to commit suicide?" D) "What if you hadn't survived?"

"What made you attempt suicide?" A nurse always starts an interview by asking open-ended questions of the client, for instance, asking about the conditions that led to the client's suicide attempt. This turns the interview over to the client and keeps the focus on his or her perceptions and feelings. Whether the client is happy about his or her survival or whether the client really wanted to attempt suicide are closed-ended questions. These questions limit the conversation and stop the client from sharing information; they also have an implication about how the nurse thinks the client should feel. Asking the client, "What if you hadn't survived?" is not productive and may make the client feel guilty and therefore hinder the conversation. p. 120

Which comment by a client diagnosed with bipolar disorder most indicates the client is experiencing mania? A) "I have been sleeping about six hours each night." B) "Yesterday I made 487 posts on my social network page." C) "I am having dreams about my father's death eight years ago." D) "My appetite is so robust that I've gained 4 lb in the past two weeks."

"Yesterday I made 487 posts on my social network page." The client who claims to have made 487 posts in one day on his or her social network page is indicating he or she may be experiencing mania; people experiencing mania can be extremely focused on certain activities to the point of excess and ignoring other tasks (like self-care). Sleeping about six hours per night does not indicate mania. For many adults, this is a normal amount of sleep. Those experiencing mania have difficulty with regular sleep patterns. Dreaming about a loved one's death does not indicate mania. Often people in a manic state experience appetite loss, so a regular appetite and weight gain is likely not an indicator of mania. pp. 229-230

After a power outage, a facility must serve a dinner of sandwiches and fruit to clients. Which comment is most likely from a client diagnosed with a narcissistic personality disorder? A) "These sandwiches are probably contaminated with bacteria." B) "I suppose it's the best we can hope for under these circumstances." C) "You should have ordered a to-go meal from a local restaurant for me." D) "I would rather wait to eat until the dietary department can prepare a meal."

"You should have ordered a to-go meal from a local restaurant for me." Expecting special treatment in the form of a to-go meal from a restaurant is indicative of the arrogant demeanor and the sense of entitlement that are hallmarks of narcissistic personality disorder. Concerns over bacteria, accepting the circumstances, or expressing a desire to wait for the dietary department to be operational again are more reflective of symptoms of other disorders. p. 170

A client was diagnosed with bipolar disorder many years ago. The client tells the nurse, "When I have a manic episode, there's always a feeling of gloom behind it, and I know I will soon be totally depressed." What is the nurse's most appropriate response? A) "Most clients diagnosed with bipolar disorder report the same types of feelings." B) "Feelings of gloom associated with depression result from serotonin dysregulation." C) "If you take your medication as it is prescribed, you will not have those experiences." D) "Your comment indicates you have an understanding and insight about your disorder."

"Your comment indicates you have an understanding and insight about your disorder." Clients diagnosed with bipolar disorder often experience depression during and after a manic episode. The correct response is therapeutic communication because it reflects the client's understanding of the disorder. It is possible that many people diagnosed with bipolar disorder do experience the stated feeling, but this response does not address the client in a way that helps him or her feel empowered to express him or herself. Explaining where depression can come from does not address the client's concern or his or her insight, so this is not the best response. Even with a prescription, feelings of gloom may occur, so the implication that the client should not have that experience if he or she takes his or her medication as described is unhelpful and inaccurate. pp. 226, 228

Postvention for the family and friends who are survivors of a suicide is most successful when initiated within which time frame? A) 4 to 8 hours B) 24 to 72 hours C) After 72 hours D) Within 24 hours

24 to 72 hours Intervention for family and friends of a person who has completed a suicide is called postvention and should be initiated within 24 to 72 hours after the death. Survivors may still be in shock within the firs 4 to 8 hours. Unfortunately, few friends or family members of a family member of a person who has completed suicide seek counseling, therefore waiting after 72 hours decreases the success of postvention. Natural feelings of denial and avoidance predominate during the first 24 hours. p. 369

Which individual has the highest risk for major depression? A) 35-year-old married male who recently lost his job B) 6-year-old child who suffers from frequent ear infections C) 55-year-old single female recently diagnosed with rheumatoid arthritis D) 16-year-old male whose family recently moved from one state to another

55-year-old single female recently diagnosed with rheumatoid arthritis The 55-year-old single female has the most risk factors for depression. Primary risk factors include female gender, unmarried, low socioeconomic class, early childhood trauma, a negative life event, family history of depression, ineffective coping ability, postpartum time period, medical illness, absence of social support, and alcohol or substance abuse. The 35-year-old married male, 6-year-old child, and 16-year-old male have fewer risk factors. p. 198

Which scenario presents the highest statistical risk for suicide? A) 60-year-old black female whose husband died three months ago B) 70-year-old white female scheduled for hip replacement in two weeks C) 80-year-old white male was recently diagnosed with pancreatic cancer D) 90-year-old black male who recently moved in with his adult daughter

80-year-old white male was recently diagnosed with pancreatic cancer The 80-year-old white male who was recently diagnosed with pancreatic cancer has the highest statistical risk for suicide. The highest suicide rate is for white males aged 65 and older. Although suicide risk should always be assessed on an individual level, statistically, the 60-year-old black female, 70-year-old white female, and 90-year-old black male are at a lower risk of committing suicide. p. 444

Which complaint is associated with the physical manifestations of depression? Select all that apply. A) Insomnia B) Headache C) Back pain D) Stomach pain E) Respiratory infections

A, B, C, D Physical manifestations associated with depression include insomnia, fatigue, headache, and stomach, back, and neck pain. Respiratory infections are not commonly associated with depression. pp. 442-443

Which guidelines should the nurse consider when conducing an assessment of a client diagnosed with a paraphilic disorder? Select all that apply. A) Assessing for suicidal risk B) Focusing on the presenting problem C) Assessing for acting on ritualistic behaviors D) Assessing for psychological disorders like depression E) Assessing the client's awareness about the disorder and its effects

A, B, D, E The aim of the assessment should be to focus on the presenting problem, such as depression with suicidal tendency. Assessing the possibility of self-harm is important, because such clients can become hopeless and may attempt to harm themselves. It is important to know about the client's awareness of the disorder to plan for its management. Suicidal risk needs to be considered, because clients with paraphilic disorders have an increased risk of suicide. Depression is known to be associated with paraphilic disorders; thus, the nurse should consider this while assessing a client with paraphilic disorder. The nurse would assess the client for acting on ritualistic behaviors if the health care team suspected the client of having obsessive-compulsive disorder. p. 428

What suicidal predictors does the nurse assess for in the client diagnosed with impulse disorder? Select all that apply. A) Past suicidal attempts B) Family history of suicide attempt C) Hostile laughter D) Clenching of fists and jaws E) Feeling of hopelessness F) Drug or alcohol use

A, B, E, F A past suicide attempt is the number one predictor of future suicide attempts. Clients with a family or close friend who committed or attempted suicide may show suicidal tendencies. A feeling of hopelessness also leads to suicidal behavior. Drug abuse and alcohol consumption also increase a tendency toward suicide. Hostile laughter shows a client's ineffective coping skills. Clenched fists and jaws demonstrate aggression and a risk of other-directed violence. p. 366

The health history for an adolescent diagnosed with conduct disorder indicates frequent callous behavior toward others. When this adolescent reaches adulthood, which personality disorder is most likely to emerge? A) Histrionic B) Antisocial C) Dependent D) Schizotypal

Antisocial Conduct disorder may be a predictor of a future antisocial personality disorder in adults. Conduct disorder is marked by callous behavior, such as disregarding and being unconcerned about the feelings of others, lack of remorse or guilt, being unconcerned about meeting obligations, and demonstrating a shallow, unexpressive, and superficial affect. Histrionic, dependent, and schizotypal disorders are not strongly associated with conduct disorder. p. 413

An adult was caught shoplifting merchandise from a community thrift shop. When confronted, the individual replies, "All this stuff was donated, so I can take it." This comment suggests features of which personality disorder? A) Antisocial B) Histrionic C) Borderline D) Schizotypal

Antisocial The person's statement shows disregard for others and a lack of remorse, both of which are characteristic of antisocial personality disorder. People with histrionic personality disorder attempt to become and remain the center of attention through manipulative behaviors. Borderline personality disorder (BPD) is marked by unstable, frequent mood changes. Schizotypal personality disorder is characterized by patterns of peculiar behavior and odd speech, which are not evident in this person's statement. P. 169

As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at highest risk for developing what? A) Antisocial personality disorder B) Obsessive-compulsive disorder C) Kleptomania D) Depression

Antisocial personality disorder Individuals with childhood-onset conduct disorder are more likely to have problems that persist through adolescence, and without intensive treatment, they develop antisocial personality disorder as adults. There is no research to definitively associate childhood onset conduct disorder with any of the other options. p. 413

A client admitted to the hospital for radiation therapy for lung cancer wants to end his life. How should the nurse initially respond to this client? A) Inform the health care provider. B) Inform the hospital security staff. C) Ignore the client and continue with the assessment. D) Ask if the client has any plans to commit suicide.

Ask if the client has any plans to commit suicide. It is important for the nurse to directly ask clients if they have any plans to commit suicide. Research shows that asking about suicidal ideation does not induce ideas of suicide in a person, and in fact it is a professional responsibility of a nurse to do so. Talking about it can lead to problem-solving alternatives and decrease isolation in a client. Asking the client about plans to commit suicide is priority, and once this is confirmed, the health care provider and security staff may be informed. Ignoring the client may put the client at high risk of self-harm. p. 367

The nurse is concerned when a depressed client presents another client with a favorite shirt as a "gift." What is the nurse's initial intervention? A) Place the client on suicide precautions, including 15-minute checks. B) Ask the client if he or she is experiencing suicidal ideations with a plan to hurt him or herself. C) Support the client by telling him or her that he or she will need the shirt when upon discharge. D) Document that the client has shown behaviors that are likely subtle suicide threats.

Ask the client if he or she is experiencing suicidal ideations with a plan to hurt him or herself. Nonverbal suicide threats are generally indirect actions that a person is planning to take his or her own life, such as giving away prized possessions. Assessing the individual in a direct manner is the initial intervention in managing the risk for personal harm. Placing the client on suicide precautions is appropriate once the behavior has been identified as a suicide threat. Telling the client that he or she will need the shirt does not help identify whether the gesture is truly a suicide threat. Documentation is appropriate after the behavior has been identified as a suicide threat. The documentation as it is stated in the option is nonconclusive and subjective. p. 366

A nurse is planning care for a client diagnosed with illness anxiety disorder. Which intervention does the nurse perform to prevent the client from self-harm? A) Assess suicidal ideation in the client. B) Develop a relationship with the client. C) Encourage the client to identify anxiety. D) Counsel the client about sharing feelings.

Assess suicidal ideation in the client Assessing suicidal ideation is important to take necessary precautions to protect the client from self-harm. It can be done through hospitalization, providing appropriate outpatient treatment, and administering medications. Developing a relationship with the client will help to develop a behavior therapy plan for the client. Encouraging the client to identify anxiety will help manage the client's distress and promote self-care behavior. Counseling the client about sharing or expressing feelings will help in reducing stress and form a supportive environment. p. 159

In order to demonstrate integration of evidence-based practice (EBP) into the care of a client hospitalized for severe depression who has been taking a selective serotonin reuptake inhibitors (SSRIs) for several weeks, the nurse will include which action in the plan of care? A) Assess the client for the presence of suicidal ideations with feasible plans. B) Ask the health provider to prescribe the medication to be administered orally. C) Acquire the advice of a proficient nurse about implementing suicide precautions. D) Apply restraints when the client repeatedly attempts to self-mutilate with a plastic knife.

Assess the client for the presence of suicidal ideations with feasible plans. A simple method to state the process of integrating EBP into clinical practice is referred to as the five As: Ask the question; acquire the literature; appraise the literature; apply the evidence; and assess the performance. By assessing the client for suicidal ideation and a feasible plan the nurse is evaluating the effectiveness of the SSRI. Requesting an oral prescription does not evaluate the effectiveness of the medication. Asking for advice about suicide precautions may not be necessary if the client is not suicidal. Applying restraints is a safety precaution that does not evaluate the effectiveness of a treatment plan. p. 3

A nurse prepares the plan of care for a client having a manic episode. Which nursing diagnoses are most likely to apply? Select all that apply. A) Social isolation B) Sleep deprivation C) Disturbed thought processes D) Risk for deficient fluid volume E) Altered nutrition: more than body requirements

B, C, D A person experiencing mania sleeps poorly, has disturbed thought processes does not take time to eat or drink, which may result in fluid imbalance. Impaired social interaction rather than social isolation may occur. Because people experiencing mania do not take time to eat or drink, the client is at risk for altered nutrition due to less than body requirements rather than more than body requirements. p. 230

A nurse is assessing a client diagnosed with conduct disorder. Which assessment findings would indicate suicidal risk in the client? Select all that apply. A) Effective coping skills B) Feelings of despair C) Impulsive behavior D) Past suicide attempts E) Improved decision making

B, C, D Feelings of despair, hopelessness, or changes in energy levels are associated with an increased risk of suicide. Impulsive behavior and poor judgment increase the client's risk of suicidal behavior. A history of suicide attempts increases the client's likelihood of repeating suicidal behavior. Effective coping skills show better adaptability, whereas clients with ineffective coping skills are at an increased risk of suicide. Improved decision making shows positive performance; decreased decision-making ability indicates low self-esteem and an increased risk of suicide. p. 364

The nurse is performing an assessment of a client with severe mental illness. The nurse documents that the client has the signs of indirect risk to others and self. On which factors does the nurse base this conclusion? Select all that apply. A) The client avoids discussing his problems. B) The client has inadequate nutrition. C) The client is easily distracted. D) The client has no proper clothing. E) The client is intoxicated by drugs.

B, C, D It is important to properly assess clients with severe mental illness. The nurse should check for signs of indirect risk to self or others. Inadequate nutrition, being distracted easily, and inadequate clothing are indications of this. Inadequate nutrition and improper clothing reflect that the client cannot meet basic needs because of a lack of income. The client may have chronic low self-esteem because of this and may develop suicidal intentions. The client will be prone to accidents if easily distracted. Clients who are nonadherent to medications avoid discussing their problems with the nurse. Drug intoxication is an indication of psychiatric illness or caused by adverse drug interactions. p. 421

A client is expressing difficulty with social relationships. What signs of posttraumatic stress disorder (PTSD) does the nurse identify? Select all that apply. A) Ability to clearly remember all aspects of the trauma B) Persistent negative emotions of guilt and shame C) Long criminal history of abuse and crime D) Participation in the group activities E) Unable to sleep throughout the night without nightmares F) Able to complete a skills task list with good concentration

B, C, E PTSD is associated with negative emotions of guilt and shame, criminal behaviors, and inability to sleep without nightmares. These clients will not be able to clearly remember all aspect of the trauma, participate well with groups, or complete tasks with good concentration. pp. 123-124

Which statements are true of antisocial personality disorder (APD)? Select all that apply. A) Clients diagnosed with APD display magical thinking. B) Frontal lobe dysfunction is a brain change identified in APD. C) It is characterized by rigidity and inflexible standards of self and others. D) It is characterized by deceitfulness, disregard for others, and manipulation. E) Clients diagnosed with APD are concerned with personal pleasure and power. F) Clients diagnosed with APD usually present for treatment because of awareness of how their behavior is affecting others.

B, D, E Characteristics of APD include personal pleasure-seeking, deceitfulness, disregard for others, manipulation, and frontal lobe dysfunction. Magical thinking is characteristic of schizotypal personality disorder. Rigidity and inflexible standards are characteristic of obsessive-compulsive personality disorder. People diagnosed with APD may present with depression because of the consequences of their behaviors, not because they care about the effects of their actions on others. P. 169

Which personality traits are associated with borderline personality disorder? Select all that apply. A) Shyness B) Impulsivity C) Disinhibition D) Hypersensitivity E) Aggressive disregard F) Emotional dysregulation

B, D, F Borderline personality disorder is highly associated with impulsivity, hypersensitivity, and emotional dysregulation. People with this disorder act quickly and impulsively in response to their emotions without considering the consequences. Because of their hypersensitivity, they exhibit separation anxiety. The emotional dysregulation trait is indicated by frequent mood swings. The trait of shyness predisposes people to schizoid personality disorder. People with the disinhibition trait show a lack of concern for the consequences of their actions. They are predisposed to antisocial personality disorder. People with an aggressive disregard trait who exhibit violent tendencies with no concern for others often have antisocial personality disorder. pp. 169-170

Current information suggests that the most disabling mental disorders are the result of what? A) Biological influences B) Psychological trauma C) Learned ways of behaving D) Faulty patterns of early nurturance

Biological influences The biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive and panic disorders, posttraumatic stress disorder, and autism. Therefore, many (but not all) of the most prevalent and disabling mental disorders have been found to have strong biological influences. Psychological trauma, learned behaviors, and faulty patterns of nurturance may contribute to some forms of mental illness, but they are not major factors in most disabling mental disorders. pp. 11, 17

Which stress management behavior is most reflective of personality disorders? A) Binge drinking every weekend B) Demonstrating ritualistic behaviors C) Blaming a spouse for the client's poor performance at work D) Having difficulty making a decision concerning which movie to view

Blaming a spouse for the client's poor performance at work In people diagnosed with personality disorders (PDs), personality traits tend to be inflexible and unpredictable, and coping strategies tend to be more primitive and immature. They often blame others for their difficulties or even deny having a problem. Binge drinking is associated with addiction. Ritualistic behaviors are associated with obsessive compulsive disorder. Difficulty deciding what movie to view is not associated with a personality disorder. p. 166

A client who is manic with rapid cycling manic symptoms is treated with carbamazepine. Which adverse effect should the nurse report to the health care provider for a client who is on continuous administration of this drug? A) Seizures B) Severe hypotension C) Bone marrow suppression D) Changes in the electroencephalograph

Bone marrow suppression Carbamazepine is an anticonvulsive drug. With continuous administration, it can cause bone marrow suppression and liver inflammation due to an increase in liver enzymes. Seizures, severe hypotension, and changes in a client's electroencephalograph are caused by increased levels of lithium in the blood, more than or equal to 1.5 mEq/L, not continuous administration of carbamazepine. p. 237

A client at the mental health center says to the nurse, "The other staff members do not care about me, but you are different. You understand my problems." When the nurse tells this client about an upcoming career change, the client becomes very angry. An hour later, the client loudly announces, "I'm going to cut my wrists." Given this scenario, which personality disorder does the client most likely have? A) Narcissistic B) Borderline C) Avoidant D) Histrionic

Borderline The scenario describes splitting of staff and impulsivity associated with self-mutilation. These are common behaviors among clients diagnosed with borderline personality disorder. Clients diagnosed with narcissistic personality disorder are exploitive, grandiose, and disparaging. Clients diagnosed with avoidant personality disorder are excessively anxious in social situations and hypersensitive to negative evaluation. Clients diagnosed with histrionic personality disorder are seductive, flamboyant, attention-seeking, and shallow. pp. 169-170

Which personality disorder is considered a Cluster B personality disorder? A) Avoidant personality disorder B) Borderline personality disorder C) Paranoid personality disorder D) Schizotypal personality disorder

Borderline personality disorder Borderline personality disorder is considered a Cluster B personality disorder. Avoidant personality disorder is one of the disorders in Cluster C. Paranoid and schizotypal personality disorders are Cluster A personality disorders. P. 169

Which clients does the nurse know can be safely prescribed lithium therapy to treat bipolar disorder? A) Clients with myasthenia gravis B) Clients with erectile dysfunction C) Clients with thyroid disorders D) Clients with renal diseases

Clients with erectile dysfunction Clients with erectile dysfunction can be prescribed lithium therapy; lithium does not interfere with sexual function. Lithium therapy must be avoided in clients with myasthenia gravis, because it can cause ataxia and severe muscle weakness. Lithium can cause hypothyroidism by reducing the levels of thyroxine hormone. It should not be prescribed to clients with thyroid disorders. Lithium can cause impairment in kidney functioning. It should not be prescribed to clients with renal diseases. p. 236

Which disorder in childhood is recognized as a precursor to future antisocial personality disorder in adults? A) Reactive attachment disorder B) Rumination disorder C) Oppositional defiant disorder D) Conduct disorder

Conduct disorder Conduct disorder is a recognized precursor of future antisocial personality disorder in adults. There is no research to definitively associate any of the other options with the development of antisocial personality disorder in adults. p. 413

Which is the most concerning behavior for a woman attempting to escape a chronically abusive relationship to demonstrate? A) Relying on alcohol to escape the emotional pain of abuse B) Adopting an aggressive attitude toward her abuser to scare him or her C) Considering ways to commit suicide D) Threatening to call the police if she is abused again

Considering ways to commit suicide A person experiencing violence may feel so trapped in a detrimental relationship, yet so desperate to get out, that suicide may seem the only answer. A suicide attempt may be the presenting symptom in the emergency department. Risk of self-harm is more serious than using alcohol, adopting an aggressive attitude, or threatening to call the police. p. 335

The nurse is speaking to a Japanese client who attempted suicide. Upon assessment the nurse finds that the client does not show any signs of mental illness or depression. What does the nurse keep in mind about this client? A) The client is trying to get attention B) The client may have an underlying health issue C) Cultural factors affect how people view the act of suicide D) The client should be prescribed antidepressants to prevent suicide

Cultural factors affect how people view the act of suicide Some traditional Japanese consider suicide to be an act of honor, whereas suicide attempts are seen as a symptom of mental illness in Western cultures; the correct response is that cultural factors can affect how people view the act of suicide. The nurse can perform a general health assessment of the client, but should not assume that this particular client has an unrelated health issue. Similarly, the nurse should not assume that the client is simply trying to get attention or needs to be put on antidepressants. Before making assumptions about a client, the nurse should consider the larger cultural context. p. 15

A client hospitalized with an acute manic episode shows progressive improvement with lithium therapy. At the time of discharge, what information should the nurse provide to the client and family? Select all that apply. A) "Water pills or diuretics will help reduce lithium side effects." B) "Over-the-counter medications are safe if taken as instructed on the box." C) "You can reduce the lithium dose if you experience excessive weight gain." D) "Schedule regular check-ups to test the function of your thyroid and kidney." E) "Contact your primary health care provider if there is any excessive vomiting."

D, E Lithium affects the thyroid and kidney functioning, so the client should be advised to have regular assessments of both after being discharged. Lithium may cause diarrhea, vomiting, or sweating causing dehydration, so the client should be advised to consult his or her primary health care provider if these symptoms occur. Lithium causes dehydration, so clients should not take water pills or other diuretics. Clients on lithium should be advised not to take over-the-counter medicine without consulting the primary health care provider first. Clients should not be advised to reduce the dose if there is a weight gain; dosage should only be adjusted by the health care provider. p. 236

Which interventions by the nurse are best associated specifically with care provided for a client diagnosed with paranoid disorder? Select all that apply. A) Monitoring the client for behaviors associated with psychosis B) Discussing how the client's statements hurt the feelings of others C) Failing to react when the client speaks disrespectfully to the nurse D) Giving the client a copy of the daily routine he or she is expected to follow E) Explaining why the scheduled therapy session will be delayed 30 minutes

D, E The paranoid client is suspicious and mistrustful, and he or she may develop perceptional distortions. Giving clear instructions and explanations will help minimize these tendencies. This can be done by giving the client a copy of a daily routine and explaining any scheduling delays. Monitoring for psychotic behavior is appropriate for any client with a risk for cognitive or perceptual distortions; it is not specific to paranoid disorder. The narcissistic client is associated with thoughtless, disparaging comments such as calling the nurse fat or making hurtful statements about others on the unit. pp. 168-169

For which characteristics will the nurse look when assessing a client suspected of having antisocial personality disorder? A) Deceitfulness, impulsiveness, and lack of empathy B) Perfectionism, preoccupation with detail, and verbosity C) Avoidance of interpersonal contact and preoccupation with being criticized D) A need for others to assume responsibility for decision-making and nurture-seeking

Deceitfulness, impulsiveness, and lack of empathy Clients with antisocial personality disorder lack conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others. Perfectionism and related traits are associated with obsessive-compulsive disorder. Avoidance of interpersonal contact is associated with avoidant personality disorder. A need for others to assume responsibility is associated with dependent personality disorder. P. 169

The nurse cares for a client diagnosed with major depressive disorder. Assessment findings include psychosis and repeated threats to murder members of the immediate family. Which treatment modality is most likely for this client? A) Light therapy B) St. John's wort C) Electroconvulsive therapy D) Cognitive behavioral therapy

Electroconvulsive therapy The client described in this scenario demonstrates psychosis and homicidal thinking. While medication is generally the first line of treatment for ease of use, electroconvulsive therapy may be a primary treatment when a client is suicidal, homicidal, or psychotic. Light therapy is appropriate for a person diagnosed with seasonal affective disorder. St. John's wort is an over-the-counter herb sometimes used for its antidepressant effects; however, the urgency and acuity of this client's symptoms necessitate use of an intervention that will produce more immediate effects. Cognitive behavioral therapy is used in the treatment of depression, but is more effective in the maintenance phase. p. 218

A 28-year-old second-grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12 years old. Which combination of factors in this scenario most demonstrates the stress-diathesis model? A) Cold climate coupled with history of abuse B) Current age of 28 coupled with family history of depression C) Family history of mental illness coupled with history of abuse D) Female gender coupled with the stressful profession of teaching

Family history of mental illness coupled with history of abuse The stress-diathesis model explains depression from the perspective of environmental, interpersonal, and life events combined with biological vulnerability or predisposition. The client's family history of mental illness combined with her history of abuse best demonstrates this model. The teacher's age is not a factor in this model. The factors of climate and family history of abuse exclude predisposition, as does gender combined with the stress of her profession. p. 199

A veteran who has come for treatment for depression also has diabetes and heart disease. The veteran states he recently got a divorce. What factor will most support a positive outcome for treatment? A) Self-medicates with alcohol B) Takes prescription drugs for chronic pain C) Has reliable family support D) Is employed at a local factory

Has reliable family support A reliable and supportive family is a predictor for a positive outcome for depression related to posttraumatic stress disorder. Self-medication with alcohol and prescription use for chronic pain are negative indicators. Employment in a skilled labor does provide financial support but may not fulfill the veteran's emotional and social needs. p. 125

When a client in an outpatient program scores a 7 on the SAD PERSONS scale, what action should the nurse take? A) Closely follow up; consider hospitalization B) Hospitalization of the client C) Send the client home with follow-up D) Strongly consider hospitalization

Hospitalization of the client A score of 7 to 10 on the SAD PERSONS scale indicates hospitalization or commitment, because the person would be considered a high risk for suicide. Closely following up refers to a score of 3 to 4. Sending home with follow-up refers to a score of 0 to 2. Strongly considering hospitalization refers to a score of 5 to 6. p. 365

Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment? A) How long the client has been suicidal. B) Whether the plan has specific details. C) Whether the method is one that causes death quickly. D) Whether the client has the means to implement the plan.

How long the client has been suicidal. Lethality refers to how deadly a plan is. The length of time a client has been suicidal has nothing to do with the lethality of the plan. Evaluation of specific details, speed of death, and means to implement the plan all contribute to the lethality of a plan. p. 367

A nurse plans care for a client diagnosed with borderline personality disorder (BPD). Which nursing diagnosis is most likely to apply to this client? A) Ineffective relationships related to frequent splitting B) Social isolation related to fear of embarrassment or rejection C) Ineffective impulse control related to violence as evidenced by cruelty to animals D) Disturbed thought processes related to recurrent suspicion of people and situations

Ineffective relationships related to frequent splitting Frequent use of spitting is a characteristic of BPD and often results in ineffective relationships. People diagnosed with BPD do not isolate themselves; in fact, they seek relationships to avoid feelings of abandonment. The poor impulse control associated with BPD is evidenced by self-destructive behaviors rather than cruelty to animals. Recurrent suspicion is not associated with BPD. p. 170

Research has indicated that an individual diagnosed with an antisocial personality may present with which characteristic? A) Social isolation B) Lack of remorse C) Learning difficulties D) Difficulty with reality testing

Lack of remorse Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others. Social isolation, learning difficulties, and difficulty with reality generally are not associated with antisocial personality disorder. P. 169

A client hospitalized after unsuccessfully attempting suicide had been adherent to antidepressant medication therapy for two weeks. The nurse observes the client is now brighter and more sociable. What is the nurse's highest priority intervention? A) Begin discharge planning for the client. B) Maintain continuous supervision of the client. C) Consider discontinuation of suicide precautions. D) Refer the client for cognitive behavioral therapy.

Maintain continuous supervision of the client. A change from sad or depressed to happy and peaceful may be a red flag. Often a decision to commit suicide gives a feeling of relief and calm. The nurse should continue 24-hour supervision of this client. Discharge plans, discontinuation of suicide precautions, and referring the client for cognitive behavior therapy may apply, but are not the priority action. p. 366

The nurse is caring for a hospitalized adolescent diagnosed with major depressive disorder. The health care provider prescribes a low-dose antidepressant. In consideration of published warnings about use of antidepressant medications in younger clients, which action should the nurse employ? A) Notify the facility's client advocate about the new prescription. B) Teach the adolescent about black box warnings associated with antidepressant medication. C) Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. D) Remind the health care provider about warnings associated with use of antidepressants in children and adolescents.

Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. The nurse's priority is to ensure client safety, so the nurse should monitor the adolescent closely for evidence of adverse effects of the medication. Notifying the advocate is not necessary because the health care provider determined the prescription was necessary and there is no conclusive evidence to support the labeling of all antidepressants. Teaching the adolescent about black box warnings does not fully address safety because the adolescent is unlikely to self-monitor. Reminding the health care provider of the warnings associated with the use of antidepressants in children does not fulfill the nurse's obligation to monitor client safety. p. 212

When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with which characteristic behavior in the client? A) Grief, anger, and social isolation B) Mood shifts, impulsivity, and splitting C) Altered sensory perceptions and suspicion D) Perfectionism and preoccupation with detail

Mood shifts, impulsivity, and splitting Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Individuals diagnosed with borderline personality disorder desperately seek relationships to avoid feeling abandoned. They often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings. Grief, anger, and social isolation; altered sensory perceptions and suspicious; and perfectionism are more characteristic of other personality disorders. pp. 169-170

A client has been diagnosed with narcissistic personality disorder. Which aspect of the nursing assessment is most important? A) Pain rating B) Level of anxiety C) Nutritional status D) Attention span and hyperactivity

Nutritional status Anorexia nervosa and substance use disorders are often comorbidities for clients diagnosed with narcissistic personality disorder; therefore, it is important for the nurse to assess the client's nutritional status, because these disorders compromise this. Whereas it's important to assess pain in all clients, the greater risk in this scenario applies to the client's nutritional status. Anxiety is associated with antisocial, avoidant, and obsessive-compulsive personality disorders rather than narcissistic personality disorder. Attention deficit hyperactivity disorder is more often a comorbidity of borderline personality disorder. p. 170

A client diagnosed with major depressive disorder was hospitalized for two weeks on an acute unit. One day after discharge, the client commits suicide. Which action should the nursing supervisor implement? A) Provide a private setting for staff to talk about feelings associated with the event. B) Remind staff that suicide is a risk for the client population and they are not at fault. C) Invite a guest speaker to conduct an educational session for staff about suicide risk factors. D) Assess staff members individually for information about the client's suicidal intent and/or plans.

Provide a private setting for staff to talk about feelings associated with the event. All health care members who provided care for a suicide victim, including medical staff, nursing staff, and ancillary staff are at risk of being traumatized by suicide. Staff may also experience guilt, shock, anger, shame, and decreased self-esteem. To reduce the trauma associated with the sudden loss, posttrauma loss debriefing can help initiate an adaptive grief process and prevent self-defeating behaviors. It is not necessary to assess staff members for suicidal intent and/or plans without any signs of such intent or plans. Reminding staff via a blanket statement that they are not at fault does not address individual staff members' reactions and feelings. Having a guest speaker discuss suicide risk factors does not address the staff members' potential trauma in the aftermath of this suicide. p. 371

The nursing diagnosis, "Risk for self-directed violence" has been added to the care plan of a suicidal client. During hospitalization, what is the most appropriate short-term goal for this client? A) Reclaim any prized possessions that were given away B) Name three personal strengths C) Seek help when feeling self destructive D) Participate in a self-help group

Seek help when feeling self destructive Having the client cope with self-destructive impulses in a healthy way is the only appropriate short-term goal here. Prized possessions, naming of strengths, and participating in a self-help group are not appropriate short-term goals, because they are not related to the client's immediate safety. p. 367

A nurse is conducting a clinical interview on a client with a history of both chronic renal failure and alcoholism and notes that the client reports being recently divorced. After an assessment with the SAD PERSONS scale, what action should the nurse take? A) Strongly encourage the client to take prescribed medications regularly. B) Strongly discourage any further alcohol consumption. C) Immediately arrange for admittance of the client to the hospital. D) Provide follow-up that includes a possible hospital admission.

Provide follow-up that includes a possible hospital admission. The nurse can assess the suicidal potential of the client by using the SAD PERSONS scale. Based on the presence of the above traits scoring is given to the client. A client who is divorced, alcoholic, and suffers from chronic illness scores 3. A client with a score of 3 to 4 has to be closely followed up with and should be considered for hospitalization. A client with a score of 0 to 2 can be given advice to take prescribed medications regularly and avoid alcohol. These clients don't require hospitalization. A client with a score of 7 to 10 must be immediately admitted to the hospital. p. 365

The nurse is assessing a client for a possible personality disorder. Which finding does the nurse identify as feature of paranoid personality disorder? A) Dichotomous thinking B) Excessive emotionality C) Reluctance to answer any questions D) Deferring questions to a family member

Reluctance to answer any questions A person diagnosed with paranoid personality disorder generally views others with suspicion and may be reluctant to answer any questions. A person with diagnosed borderline personality disorder may have dichotomous thinking. People diagnosed with histrionic personality disorder may exhibit excessive emotionality to the extent of being considered melodramatic. A person diagnosed with dependent personality disorder may have low self-esteem and therefore be dependent on others for minor issues like answering questions. exemplified by splitting or an inability to view both the positive and negative aspects as a part of the whole. pp. 168-169

A client is withdrawn and suspicious and states, "I always prefer to be alone." The client also states, "I have special powers and read other's thoughts at times." Based on this presentation, the nurse suspects which personality disorder? A) Obsessive-compulsive B) Narcissistic C) Avoidant D) Schizotypal

Schizotypal The main traits that describe schizotypal personality disorder are psychoticism, such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obsessive-compulsive personality disorder the main pathological personality traits are rigidity and inflexible standards of self and others, along with persistence to goals long after it is necessary, even if it is self-defeating or negatively affects relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people. p. 168

A client experiences extreme anxiety in social situations and seems to have some intellectual and perceptual distortions but can be made aware of the misinterpretations of reality. With which disorder does the nurse expect the client to be diagnosed? A) Schizoid personality disorder B) Schizotypal personality disorder C) Paranoid personality disorder D) Obsessive-compulsive personality disorder

Schizotypal personality disorder People diagnosed with schizotypal personality disorder have severe social and interpersonal deficits. They experience anxiety in social situations. They may have some intellectual and perceptual distortions but can be made aware of reality, unlike those with schizophrenia. Schizoid personality disorder can be a precursor to schizophrenia or delusional disorder. People diagnosed with this disorder are emotionally detached loners who do not seek out or enjoy close relationships. People diagnosed with paranoid personality disorder tend to be afraid that others will harm or deceive them, so they are hostile and view others with suspicion. People diagnosed with obsessive-compulsive disorder have a fear of imminent catastrophe. They tend to rehearse over and over how they will respond in a social circumstance. p. 168

An adult client diagnosed with depression and recently prescribed paroxetine reports, "My depression might be getting worse. I've started having more difficulty with sleep." Which information should the nurse provide to this client? A) The sleep problems are more likely to be associated with the depression than with the medication. B) The medication is stimulating dreaming, which will help the client resolve unconscious conflicts. C) Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, often cause sleep disturbances when first taken. The problem may be short-term. D) SSRIs, such as paroxetine, more commonly cause hypersomnolence rather than insomnia.

Selective serotonin reuptake inhibitors (SSRIs), such as paroxetine, often cause sleep disturbances when first taken. The problem may be short-term. Paroxetine is an SSRI commonly used to treat depression. Clients frequently report difficulty sleeping when first starting on one of these agents. Sleep problems often accompany depression, but timing of the client's reported problem indicates it is likely associated with beginning an SSRI. Dreaming relates to the rapid eye movement (REM) sleep stage and suggests that this client is moving through all the stages of sleep, but conflicts may or may not be resolved through dreaming. Clients who begin taking SSRIs commonly complain of the side effect of insomnia rather than hypersomnolence. pp. 184-185

A client scores 1 on the SAD PERSONS scale. What should the nurse's next step be? A) Hospitalize the client B) Consider hospitalization C) Send the client home with follow-up D) Strongly consider hospitalization

Send the client home with follow-up The SAD PERSONS scale assesses risk factors for suicide in a client. If the score is 0 to 2, then the nurse should send the client home and ask him or her to return for follow-up. A score of 7 to 10 indicates that the client needs to be hospitalized. If the score is 3 to 4, then the client should be considered for hospitalization. A score of 5 to 6 indicates that he or she should be strongly considered for hospitalization. p. 365

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? A) γ-Aminobutyric acid B) Dopamine C) Serotonin D) Acetylcholine

Serotonin Low serotonin levels have been noted among individuals who have committed suicide. While γ-aminobutyric acid, dopamine and acetylcholine are neurotransmitters, they are not believed to be associated with suicidal ideations. p. 364

The nurse is assessing a client with a history of attempted suicide. Which method used by the client in the previous suicide attempt would put the client at higher risk? A) Ingesting sleeping pills B) Inhaling natural gas C) Slashing the wrists D) Staging a car crash

Staging a car crash A method can be considered high or low risk based on the lethality, that is, how quickly a person can die using that particular method. Therefore, staging a car crash would put the client at higher risk. Ingesting pills, inhaling natural gas, and slashing one's wrists are considered low-risk methods. If the client uses these methods to commit suicide, there may be time to rescue the client from dying. p. 367

A nurse is planning a diet chart for a client who is manic and receiving lithium therapy. Which instruction should the nurse include on the diet chart? A) Reduce sodium intake. B) Take lithium with meals. C) Take lithium on an empty stomach. D) Avoid taking lithium before going to bed.

Take lithium with meals. Lithium should be taken with meals because it can cause irritation of the stomach lining. Clients on lithium therapy should ensure they have adequate salt in their diets, because lithium decreases sodium reabsorption, leading to a possible deficiency of sodium. Lithium intake should not affect sleep patterns, so it is fine for the client to take it before bed. Lithium should not be taken on an empty stomach in order to avoid an upset stomach. p. 236

During a home visit, the nurse identifies that the client is experiencing suicidal ideations but refuses to seek treatment. Which nursing action could result in the nurse being guilty of abandonment? A) The nurse respects the client's rights and does not force the client to seek treatment. B) The nurse enlists the assistance of the legal system for involuntary admission of the client. C) The nurse ensures that the client is in a safe environment with minimal risk for injury. D) The nurse informs the family members and advises them to keep the client safe.

The nurse respects the client's rights and does not force the client to seek treatment. Abandonment happens when the nurse fails to ensure client's safety despite knowing the risk of harm. If the client has suicidal tendencies, and the nurse does not force the client to seek treatment, the client may commit suicide. This action amounts to abandonment of the client. To prevent abandonment, the nurse should enlist the assistance of the legal system for involuntary admission of the client. This helps to prevent self-injury in the client. Alternatively, the nurse may ensure safety of the client's environment and ensure that the family members are informed of the client's suicidal tendencies. p. 110

A client diagnosed with major depressive disorder has been socially isolated. The nurse invites the client to a staff luncheon to honor the supervisor. Which analysis best applies to this scenario? A) The invitation supports development of the client's self-esteem. B) The nurse's action blurs the boundaries of a therapeutic relationship. C) The nurse's invitation exposes the client to a therapeutic social activity. D) The invitation provides an opportunity for the client to practice interactions with others.

The nurse's action blurs the boundaries of therapeutic relationship. The nurse-client relationship should be conducted within appropriate and clear boundaries. In this scenario, the nurse's invitation blurs those boundaries by adding a social dimension. Supporting the client's self-esteem, exposing the client to a therapeutic social activity, and providing the client an opportunity to interact with others move the relationship toward a social, rather than therapeutic, one. p. 110

When a client taking lithium reports an upset stomach, how does the nurse suggest taking the medication? A) With meals B) With an antacid C) 30 minutes before meals D) 2 hours after meals

With meals Many patients find that taking lithium with or shortly after meals minimizes gastric distress. Clients should not take over-the-counter medications like antacids without consulting their physicians first. Taking lithium before meals on an empty stomach will contribute to gastric distress rather than minimizing it as will taking it too long after meals. p. 236

A nurse is performing an assessment of a client in the local community clinic. The nurse observes that the client looks older than the age mentioned in the medical record. The client avoids making eye contact with the nurse and speaks in a monotone. On examination the nurse does not find any signs and symptoms of a physical illness. Which assessment tool does the nurse use to assess the client's behavior? A) Zung Depression Scale B) Geriatric Depression Scale C) Psychogeriatric Assessment Scale D) Montreal Cognitive Assessment

Zung Depression Scale The nurse should use the Zung Depression Scale for assessing depression in clients. The client is given a questionnaire and asked to mark the appropriate behavior that characterizes what the client feels. The Geriatric Depression Scale is used to assess levels of depression in older adults. The Psychogeriatric Assessment Scale is used to assess cognitive impairment in older adults. The Montreal Cognitive Assessment is used to screen for mild cognitive impairments. p. 202