mental health nclex

A client is receiving nasogastric tube feedings as nutritional rehabilitation for anorexia nervosa. After a weigh-in, the client learns of gaining 2 lb (0.9 kg) and says to the nurse, "See what your force feeding has done to me? I'm fatter and uglier than ever." What is the best action by the nurse? A. have the client keep a joournal and write abt her feelings B. initiate one -one supervision of the client during feeding C. remind the client that gaining weght means being able to go home D. Say that the client is not fat and ugly

B Nutrition support (enteral tube feedings and total parenteral nutrition) is usually reserved for clients with anorexia nervosa who are severely ill and/or have not responded to oral nutritional therapy. Such clients are at high risk for medical complications from anorexia nervosa, including death. Criteria for nutrition support include: Severe weight loss that is life threatening Client's unwillingness to adhere to a treatment plan of oral feedings The priority nursing actions for this high-risk client include interventions to meet physiological and safety needs. Providing one-on-one supervision during the tube feeding will ensure that the client is actually receiving the feeding and prevent the client from stopping the feeding and/or pulling out the nasogastric tube. During the one-on-one contact with the client, the nurse can promote a therapeutic and trusting relationship with the client by: Being honest and accepting of the client Presenting the reality of the condition Acknowledging the client's feelings of loss of control and anger Encouraging the client to express feelings and fears (Option 1) This is an appropriate intervention for a client with anorexia nervosa. Feelings related to lack of control are an underlying problem for these clients, who use food as a way to deal with them. Keeping a diary or journal of feelings will help the client recognize and express them more clearly. However, this is not the priority nursing action. (Option 3) This may be a true statement; clients with anorexia nervosa are usually discharged to out-patient follow-up and treatment or to a residential treatment facility once an acceptable weight gain has been achieved and maintained. However, this is not the priority nursing action. (Option 4) Clients with anorexia nervosa have a distorted body image and a morbid fear of being overweight; they perceive themselves as "fat and ugly" even when they are emaciated. Saying that the client is not "fat and ugly" will not change this perception. Educational objective: The priority nursing care for a client with anorexia nervosa is nutritional rehabilitation and prevention of medical complications, including death. Clients who are severely ill and/or resistant to oral refeeding may require nutrition support with intense monitoring to achieve adequate caloric intake and weight gain.

Which statement made by the nurse during a therapy session demonstrates a need for further instruction regarding effective therapeutic communication techniques? A. I dont understan what you mean. Can you give me an example B. It is doubtful the president is out to get you C. Tell me more about the day your child die D. Why did you get so angry when she ignores you?

D Therapeutic communication allows the nurse to develop a healthy interpersonal relationship with the client. A "why" question is often avoided as it is viewed negatively by clients and can make them feel defensive about their choices or emotions (Option 4). (Option 1) Asking for an example is asking for clarification and is considered a therapeutic communication technique. (Option 2) Voicing doubt is a therapeutic communication technique that allows the nurse to dispel misconceptions or delusions without directly confronting the client's beliefs. (Option 3) Exploring is a therapeutic communication technique that encourages the client to discuss relevant situations and feelings. If the client chooses not to share information, the nurse should respect that decision and not probe further. Educational objective: For people who are anxious or overwhelmed, a "why" question asked by the nurse is often interpreted as being critical, judgmental, and intrusive. These feelings are damaging to the development of the nurse-client relationship and therapeutic communication.

The nurse is caring for a client with schizophrenia who has been experiencing visual hallucinations. The client says in a trembling voice, "There's a bad man standing over there in the corner of my room." What is the best response by the nurse? A.I know you are frightened but I do not see a man in your room B. I'll make the bad man go away C. Let's go into the day room and play checkers D. Your illness is making you hallucinates

A An important step toward self-management of hallucinations is for the client to recognize that the hallucinations are not real. When a client is experiencing hallucinations, the nurse needs to reinforce reality and acknowledge how the client may be feeling. The nurse can point out his/her own perceptions without denying the client's experience. It is nontherapeutic to argue with or challenge the client about the hallucination, saying, for example, "How could a man get into your room? This is a locked hospital unit." Examples of additional therapeutic responses to a client who is experiencing hallucinations include the following: "I don't see anything, but I understand that what you are seeing may be very upsetting to you." "I understand that you are worried about the voices you are hearing. They are a part of your disease and not real." "I know the voices seem real to you and may be scary. I do not hear the voices." (Option 2) This response reinforces the hallucination and does not present reality to the client. (Option 3) This response ignores what the client is experiencing and does nothing to reduce the client's feeling of discomfort. (Option 4) This response provides an explanation for the client's experience but does not acknowledge the client's feelings or reinforce reality. Educational objective: The most therapeutic response to a client experiencing hallucinations presents reality and acknowledges how the client may be feeling. This approach promotes self-management by helping the client recognize that the hallucinations are not real.

A client with schizophrenia is started on clozapine. Which periodic measurements take priority in this client? A. CBC and Absolute neutrophil count B ECG and BP C. Fasting blood glucose and Fasting lipid panel D. Height weight and waist circumference

A Clozapine (Clozaril) is an atypical antipsychotic medication used to treat schizophrenia that has not responded to standard, more traditional treatment. Clozapine is associated with a risk for agranulocytosis (a potentially fatal blood disorder causing a dangerously low WBC count) and is therefore used only in clients with treatment-resistant schizophrenia. A client must have a WBC count of ≥3500/mm3 (3.5 × 109/L) and an absolute neutrophil count (ANC) of ≥2000/mm3 (2 × 109/L) before starting clozapine, so it is critical to obtain a baseline complete blood count and ANC. Because agranulocytosis is reversible if caught early, the client's WBC count and ANC must also be monitored regularly throughout the course of clozapine therapy (initially once a week) (Option 1). Clients should also contact the health care provider immediately if they develop fever or sore throat, which can indicate infection due to neutropenia. (Option 2) ECG and blood pressure monitoring is performed before therapy initiation and periodically during therapy because prolonged QT interval and orthostatic hypotension are potential side effects of clozapine; however, agranulocytosis poses a more significant danger to the client. (Options 3 and 4) Hyperglycemia, dyslipidemia, and weight gain are potential side effects of clozapine therapy but are not as serious as agranulocytosis. Educational objective: Agranulocytosis, a serious adverse effect of clozapine, is potentially fatal. Pretreatment assessment and ongoing monitoring of WBC and absolute neutrophil counts are critical. Clients should contact the health care provider if they develop fever or sore throat, which can indicate infection due to neutropenia.

A 60-year-old client wanders away during halftime at a football game and is found 48 hours later sleeping on a park bench, 100 miles from home. The client is brought to the emergency department by the police. The client can state the name and address but has no recollection of the past 2 days. What is the priority nursing action? A. Assess vital signs B. Contact family member C. Encourage the client to recall recent events D. Perform a mental status assessment

A This client is experiencing amnesia of undetermined origin. The cause could stem from a medical condition, substance abuse, traumatic brain injury, cognitive disorder such as dementia, or psychiatric condition such as dissociative fugue. Regardless of the diagnosis, the priority nursing action is to assess the client's physical status. This client has been wandering for 2 days and cannot recall previous locations, arriving at the present location, and the timetable involved. It is highly probable that the client is dehydrated and fatigued. It is most important to assess the client's physical needs and implement interventions to stabilize the physiologic condition before assessing psychosocial status and needs. (Option 2) It is appropriate to contact this client's family members. However, this is not the priority nursing action. (Option 3) This client may never be able to remember the events of the past 2 days. Encouraging a client to remember something when there is no sign of recollection may only increase client frustration. (Option 4) A mental status examination is an important component of the nurse's assessment. However, it is not the priority assessment. Educational objective: Assessment of a client's physiologic status and needs is the priority nursing action when the client is suffering from amnesia with no recollection of where he has been or what he has been doing for a period of time. Interventions need to be implemented to stabilize the client physically before psychosocial needs are addressed.

The nurse is admitting a client with malnutrition related to anorexia nervosa. Which of the following actions are appropriate to include in the care of this client? Select all that apply. A. Allow the client to continue to exercise as per usual routine B. Assist the client in reflecting on triggers of disordered eating C. Maintain strict recording of protien and calorie intake D. Remain with the client for the duration of each meal E. weigh the client each morning prior to any oral intake

BCDE Anorexia nervosa Clinical features BMI <18.5 kg/m2 Fear of weight gain, distorted body image Medical complications Osteoporosis Amenorrhea Lanugo, hair loss, dry skin Gastroparesis, constipation Enlarged parotid glands (if binge/purge type) Hypotension, hypothermia, bradycardia Cardiac atrophy, arrhythmias Anorexia nervosa is a psychogenic eating disorder with potentially fatal physiological implications. Clients commonly become extremely underweight and protein-energy malnourished. Clients admitted for anorexia nervosa are typically in a crisis state, and the priority is restoring physiological integrity through appropriate weight gain and nutritional intake. Nursing care includes: Assisting the client in reflecting on triggers for dysfunctional eating and fears and feelings related to gaining weight (Option 2) Maintaining strict documentation of dietary protein and calorie intake to ensure healthy weight gain (Option 3) Remaining with the client during and 1 hour following meals to ensure intake and prevent purging behaviors (Option 4) Establishing a weekly weight-gain goal (typically 2-3 lb/wk [0.91-1.36 kg/wk]) Weighing the client at the same time each morning (after voiding and before any oral intake) and wearing the same clothing to assess efficacy of nutritional support (Option 5) Limiting physical activity initially and gradually increasing as oral intake improves Not focusing on food initially, but encouraging participation in meal planning as the client nears target weight (Option 1) Clients admitted with anorexia nervosa should not continue to exercise, because this would cause further energy deficit and worsen malnutrition and end-organ damage (eg, renal failure). Educational objective: Clients admitted with anorexia nervosa must increase caloric intake and stop exercising to promote weight gain. The nurse should record consumed calories, weigh the client daily, remain with the client during and for 1 hour following meals, and encourage discussion about dysfunctional eating triggers.

A client with a history of obsessive-compulsive personality disorder (OCPD) is seeking treatment for a gastrointestinal disorder and is scheduled for a colonoscopy at 10:00 AM. Due to a computer glitch, the procedure is postponed to 3:00 PM. Which response would be characteristic of an individual with OCPD? A. How dare they changed my appt, I insist that the procedure bedone at 10.00 am B. That's fine I can come in whenever its convenient for everyone C. This is unacceptable I had my whole day plan out D. Why are they doing this to me

Individuals with obsessive-compulsive personality disorder are typically self-willed and obstinate, punctual, pay attention to rules and regulations, and need to control both internal and external experiences. These traits are very extreme and result in rigidity and inflexibility. In this scenario, a change has been made in the client's schedule for the day and is outside of the client's control. This could cause significant distress and impaired functioning so that the client feels emotionally paralyzed. (Option 1) This response is characteristic of a client with narcissistic personality disorder, who may behave in grandiose, demanding, and entitled ways and needs to have his/her own way. (Option 2) This response could be attributed to a client with dependent personality disorder, who tends to be passive and submissive and wants to please others. (Option 4) This response would be more characteristic of an individual with paranoid personality disorder, who may feel slighted or is overly sensitive. Educational objective: An individual with obsessive-compulsive personality disorder is typically rigid and inflexible and has a need to control both internal and external experiences. A change in a schedule that is outside of the client's control could cause significant distress.

A child with a high level of school absenteeism has been determined to have school phobia. The school nurse should counsel the child's parent/caregiver to take which action? A. Allow the child to stay at home when the child is pariticularly anxious B. Encourage the parent/caregiver to sit withthe child in the classroom C. Insist on school attendance immediately starting with a few hours a day D. Return the childto school when the cause of the cause of the school phobia is been identified

School phobia (also known as school refusal or school avoidance) is a childhood anxiety disorder in which the child experiences an irrational and persistent fear of going to school. Having the child return to school immediately is the best approach for resolving school phobia and is associated with a faster recovery. If necessary, gradual exposure to the school environment can be implemented; the child can attend school for a few hours and then gradually increase the time to a full day. A gradual approach may decrease the child's sensitization to the classroom. If the child is allowed to remain out of school, the problem will only worsen, with potential deterioration of academic performance and social relationships. (Option 1) Allowing the child to stay home will only reinforce the acting-out behaviors associated with refusal to attend school. The parent/caregiver needs to support the child and talk about the cause of the anxiety, but the child needs to go to school. (Option 2) Having the parent/caregiver stay in the classroom with the child is not a permanent solution to relieving the child's anxiety and is not recommended. (Option 4) Determining the cause of the school phobia is important in helping to alleviate the child's symptoms and in coping with the return to school. However, returning the child to the classroom immediately is the most important action. Educational objective: A child with school phobia needs to return to the classroom immediately. Insisting on school attendance, along with other supportive interventions, will help the child make a faster adjustment.

The nurse is caring for a new mother whose infant has been diagnosed with Down syndrome. The client says to the nurse, "I'm so worried. My husband is so devastated that he won't even look at the baby." What is the best response by the nurse? A. both of you will benifit from supportive councelling B. How are you feeling about your baby? C. I will have the doc speak to your husband D. Why do you think your husband feels this way?

b Learning that their newborn has a genetic disorder (eg, Down syndrome) is an overwhelming experience for most parents. They may initially react with shock, disbelief, and/or denial. Once they accept the diagnosis, parents may be filled with uncertainty and doubt and experience an array of emotions, including guilt, depression, and anger about the presumed loss of their perfect child. When helping the family cope with the crisis, the nurse needs to keep the lines of communication open and offer support. The nurse should use open-ended therapeutic communication techniques that encourage the family members to verbalize what they are feeling or experiencing (Option 2). (Option 1) This is a true statement; supportive counseling is usually beneficial to new parents of children with disabilities. The nurse can refer clients to family support groups or even make the initial phone call for them. However, the nurse should first encourage the parents to express how they are feeling. (Option 3) This is not the best response. The nurse has a role and responsibility to offer support to clients experiencing a crisis. (Option 4) This is accusatory and nontherapeutic. The nurse should avoid asking "why" questions when attempting to gain more information. Educational objective: Parents of newborns diagnosed with Down syndrome or other developmental disabilities may experience shock or disbelief along with a wide array of emotions. Nurses should be supportive by using therapeutic communication techniques that encourage the family to talk about what they are experiencing and/or feeling.

A client recently admitted to an inpatient unit for treatment of alcoholism says to the nurse, "I only came here to get away from my nagging spouse. Sometimes I think my spouse is the one who should be here. I can stop drinking any time I want." The nurse recognizes that the client is exhibiting which of the following defense mechanisms?

A Defense mechanisms are strategies or responses, usually unconscious, used by individuals to distance themselves from a full awareness of unpleasant thoughts, internal conflicts, and external stresses. Defense mechanisms protect the ego from threatening thoughts and anxiety. Denial is the refusal to accept the reality of threatening situations, or painful thoughts, feelings, or events. It is the most frequent defense mechanism used by clients with alcoholism; the client may deny that drinking is a significant problem and that any issues or problems can be handled alone. This client is also using projection by saying that the spouse should be hospitalized; projection involves placing one's own thoughts, feelings, or impulses onto someone else. (Options 2, 3, and 4) Rationalization, regression, displacement, sublimation, and reaction formation are not the primary defense mechanisms used by the client. This client displays no symptoms of depression. Educational objective: The most common defense mechanism used by persons with alcoholism is denial, the refusal to accept the reality of threatening situations, or painful thoughts, feelings, or events. Projection involves placing one's own thoughts, feelings, or impulses onto someone else.

The new nurse is providing teaching to a client scheduled for electroconvulsive therapy (ECT). What information given by the new nurse would cause the charge nurse to intervene? A. Be sure to take the valporic acid prior to the procedure B. Do not drive during the course of the ECT treatment C. Temporary confusion is common immediately after the treatment D. You should avoid eating 8hrs prior to the procedure

A Electroconvulsive therapy (ECT) induces a generalized seizure by passing an electrical current through electrodes applied to the scalp. Although the exact mechanism is unknown, 15-20-second seizures are proven effective in treating mood disorders (eg, major depression, bipolar disorder) and schizophrenia. Client teaching includes: NPO status is required for 6-8 hours prior to treatment except for sips of water with medications (Option 4). Anesthesia (eg, methohexital, propofol) and a muscle relaxant (eg, succinylcholine) will be administered; clients are unconscious and feel no pain during the procedure. Driving is not permitted during the course of ECT treatment (Option 2). Temporary memory loss and confusion in the immediate recovery period are common side effects of ECT (Option 3). Post-treatment nursing care includes monitoring vital signs, ensuring a patent airway, assessing mental status, and providing frequent reorientation during periods of postictal confusion. (Option 1) Valproic acid (Depakote) is an anticonvulsant that is also prescribed for bipolar disorder; therefore, it would prevent the therapeutic effect of ECT. Any prescribed anticonvulsants should be discontinued prior to ECT. Educational objective: Electroconvulsive therapy (ECT) uses an electrical current applied to the scalp to induce a generalized seizure in an anesthetized client. Prior to the procedure, the client should be NPO and not take anticonvulsant medications. Temporary confusion and memory loss are common after the procedure. Clients should be instructed not to drive during the course of ECT treatment.

A client with borderline personality disorder says to the nurse, "You're the only one I trust around here. The others don't know what they are doing and they don't care about anyone except themselves. I only want to talk with you." What is the priority action for the client's nursing care plan? A. Assign the different staff members to care for the client each day B. Continue assigning the client stated preferred nurse to care for the client C. Frequently reassure the client that all staff members are competent in their job D. Reinforce unit rules and consequences of inappropraite behaviour

A Individuals with borderline personality disorder (BPD) live in fear of rejection and abandonment. To avoid abandonment, they use manipulation and control, often unconsciously, to prevent a person from leaving. The manipulative behavior may be of a positive nature, such as the use of flattery, or a negative nature, such as distancing from the other person. An individual with BPD may also engage in self harm or suicidal behaviors in an attempt to gain attention from the other person and keep that person from leaving. For this client, the nursing care plan must include the assignment of different staff members. This will help diminish the client's dependence on a particular individual and help the client learn to relate to more than one person. (Option 2) Continuing to assign the client's stated preferred nurse will reinforce the manipulative behavior and the need to cling to one person. (Option 3) Simply telling the client about staff competency will not facilitate behavior change. The client is engaging in this behavior as a protection against abandonment. (Option 4) It is important to reinforce unit rules and the consequences of inappropriate behaviors. However, this is not the best action to address the client's attempt to manipulate the staff. Educational objective: Clients with borderline personality disorder, in an attempt to prevent abandonment and control their environment, may flatter and cling to one staff member while making derogatory remarks about others. The best nursing action is to rotate staff members assigned to care for the client.

A client, who has been hospitalized for 3 days with major depressive disorder, has stayed in the room and not gotten out of bed except for toileting. The nurse enters the room to remind the client that breakfast will be served in the dining room in 20 minutes. The client says, "I'm not hungry and I don't feel like doing anything." What is the best response by the nurse? A. I will help you get ready then we can walk to the dining room together B. Ill hac=ve breakfast brought to your room C. its ok you can join us when your ready D. Youll feel better when you get up

A Reduced appetite and low energy level are common clinical findings in major depressive disorder. The lethargy accompanying the depressed mood makes it difficult for a client with this diagnosis to even get up and out of bed. Personal hygiene and grooming are neglected, and there is no desire to interact with others. The client needs direction and structure in performing activities of daily living (ADLs); waiting for the client to feel more energetic and initiate activity and interaction on one's own is not helpful. Assisting the client with ADLs helps convey a sense of caring, provides an opportunity for interaction with the nurse, and helps raise the client's self esteem. (Option 2) This action reinforces the client's desire to stay in the room and is not therapeutic. (Option 3) This response is non-therapeutic; the client needs assistance with ADLs. (Option 4) Clients with depression often do feel better after even minimal exercise and activity. However, this response does not give the client direction or structure. Educational objective: Clients with low energy, lethargy, or fatigue associated with major depressive disorder need structure and direction in performing basic ADLs, including personal hygiene and grooming. The nurse needs to provide assistance to the client in completing ADLs and in initiating social interaction with others.

The nurse is reviewing the records of an adolescent client. Which findings suggest that the client may need referral for depression screening? Select all that apply. A. Client has had disciplinary issues due to absentism and angry outburst B. The client has loss aprox 8 lbs over the last three weeks without trying C. The client as often found sleeping during class or other activities D. Client quit sports despite recieving athletic awards and trophies E. Client voices concern about appearance r/t facial acne

ABCD Adolescent clients are at increased risk for developing depressive and anxiety-related mood disorders as they begin to identify their role in adult life and develop new personal relationships. However, they frequently report vague somatic symptoms (eg, headache, stomachache) and may exhibit an irritable or cranky mood rather than a sad or dejected mood. Signs of depression in adolescent clients include: Hypersomnolence or insomnia; napping during daily activities (Option 3) Low self-esteem; withdrawal from previously enjoyable activities (Option 4) Outbursts of angry, aggressive, or delinquent behavior (eg, vandalism, absenteeism); inappropriate sexual behavior (Option 1) Weight gain or loss; increased food intake or lack of interest in eating (Option 2) Depression is also a significant cause of suicide in adolescents. (Option 5) Adolescent clients begin to become more aware of body image and may express concern regarding their appearance. It is normal for clients in this age group to experience insecurity about their appearance (eg, acne, body hair). These insecurities do not correlate with the onset of a depressive disorder. Educational objective: Adolescent clients with depression frequently report vague somatic symptoms (eg, headache, stomachache) and may exhibit an irritable or cranky mood rather than a sad or dejected mood. In addition, changes in sleep patterns; low-self esteem; withdrawal from previously enjoyable activities; outbursts of aggressive or delinquent behavior; and precipitous weight changes may indicate the onset of a depressive disorder.

The nurse cares for a client newly diagnosed with acute stress disorder following a traumatic event. Which of the following communications by the nurse are appropriate? Select all that apply. A. how as this situation affects your relationships with family and friend B.It is important to focus on coping startegies and not dwell on the event C. It is normal to experience difficult symptoms after traumatic events D. Please tell me about your current use of alchoal and any drugs E.Share with me thoughts or plans of self harm that you have had

ACDE Acute stress disorder (ASD) occurs following a traumatic or extremely stressful event. ASD is characterized by intrusive memories of the event, negative mood, dissociative symptoms (eg, altered sense of reality), and arousal and reactivity symptoms (eg, hyperactive sensory state, sleep disturbances, difficulty concentrating, easily startled). If these symptoms continue beyond a month after the event, the diagnosis becomes post-traumatic stress disorder. Nursing interventions for a client with ASD include: Assessing for ideas and plans to commit self-harm (Option 5) Assessing for ineffective coping (eg, use of drugs and alcohol) (Option 4) Assessing impact of ASD on the client's job performance, relationships, sleep pattern, and ability to perform activities of daily living (Option 1) Explaining that feelings and/or symptoms occurring after traumatic events are normal, as this can help alleviate the client's anxiety (Option 3) Exploring coping strategies used in previous stressful situations (Option 2) The client should be encouraged to discuss the traumatic event. As part of the debriefing process, the nurse should acknowledge and validate the associated feelings and behaviors. Educational objective: Clients with acute stress disorder (ASD) should be encouraged to discuss the traumatic event and explore the associated feelings. The nurse should validate the client's feelings; assess risk for self-harm and ineffective coping (eg, drug and alcohol use); and evaluate the impact of ASD on the client's sleep, occupation, and relationships.

After a daily weigh-in, a client with anorexia nervosa realizes a 2-lb weight gain. The client says to the nurse in a distressed voice, "This is terrible. I'm so fat." What is the best response by the nurse? A. But you look so thin B. I dont see you that way you are making progress to a healthy weight C. If you continue to gain weight at this rate you'll be able to go home soon D. Your not fat it's all in your imagination

B A nursing diagnosis associated with anorexia nervosa is disturbed body image/low self esteem. There is often a large disparity between actual weight and the client's perceived weight. Clients with anorexia nervosa think of themselves as overweight and fat. The nursing care plan should include helping the client develop a realistic perception of weight and body image. The nurse can confront the client about the misinterpretation of body weight by presenting reality without challenging the client's illogical thinking. The client's weight should be discussed in the context of overall health. The nurse also needs to be aware of his/her own reaction to the client's behaviors and statement. It is not uncommon for caregivers and care providers to feel frustrated or even angry when caring for a client with an eating disorder. The nurse must maintain a neutral attitude and approach, avoiding arguing or disagreeing with the client's statements. (Option 1) This response is judgmental, reinforces the idea of "thinness," and does not help the client develop a more realistic body image. (Option 3) Establishing a goal weight is part of the nursing care plan for the client with anorexia nervosa; clients are usually not discharged from inpatient treatment until goal weight is achieved. However, this response does not address the client's misperception of body weight. (Option 4) This response dismisses the client's concern and does not present the reality of the situation. Educational objective: Clients with anorexia nervosa have disturbed body image and see themselves as being fat or overweight even when they are severely underweight or even at a normal body weight. The nurse can help the client develop a more realistic self image by presenting the situation realistically and discussing weight in terms of the client's health.

The nurse is caring for a client newly admitted with an acute manic episode of bipolar disorder. The nurse identifies which dinner selection as the most appropriate to promote client nutrition? a Baked sweet potato kale yeast roll and water b cheesburger apple vanilla milkshake c spegghetti with meatball fruit sald milk d vegetable soup salad dinner roll and ice tea

B Bipolar disorder is a psychiatric condition characterized by cycling periods of depression and mania. Clients with acute mania often display elevated mood, increased and excessive activity levels, and altered decision-making that can result in high-risk behavior (eg, hypersexuality, excessive spending). Clients with mania are also easily distractible, leading to neglect of personal needs (eg, hydration, nutrition, sleep, hygiene) and the need for medical intervention. When managing the nutritional needs of clients with mania, the nurse should frequently offer energy- and protein-dense foods that are easily carried and consumed (eg, sandwiches, shakes, hamburgers, pizza slices, burritos, fruit juices, granola bars). These "on-the-go" foods promote nutritional intake in clients who are unable to sit down and complete a traditional meal (Option 2). (Option 1) Sweet potatoes and kale are low in energy and protein and difficult to eat on the go. (Option 3) Spaghetti with meatballs and fruit salad are difficult to eat on the go. (Option 4) Vegetable soups and salads are often low in protein and energy and difficult to eat on the go. Caffeinated drinks (eg, soda, tea, coffee) should be avoided as they may increase mania and activity. Educational objective: Clients with acute mania often have elevated activity levels that increase their risk for malnutrition and dehydration. Nurses should provide easily carried and consumed foods high in energy and protein (eg, burgers, sandwiches, shakes) to promote adequate nutritional intake.

Yesterday, the client was weaned from the mechanical ventilator and an intravenous infusion of lorazepam. The client has been alert and oriented for 24 hours but is now experiencing confusion. The nurse now evaluates new-onset confusion by assessing the client's sense of place and time, difficulty focusing, short-term memory loss, and increasing lethargy. The nurse suspects which condition in this client? A. Amnesia B. Delarium C. Dementia D. Psychosis

B Delirium or acute cognitive dysfunction is a syndrome commonly seen in hospitalized clients; it is reversible but difficult to diagnose. Clients may manifest delirium states that can be hypoactive (eg, quiet, disorientation, change in level of consciousness, memory loss), hyperactive (eg, restlessness, agitation, hallucinations, paranoia), or mixed. Manifestations of delirium develop acutely and are difficult to differentiate from those associated with pain, anxiety, and medications. Early diagnosis and treatment are advantageous as delirium is associated with increased mortality (especially in critically ill clients on mechanical ventilation). Delirium is difficult to assess; it is recommended that nurses use a standardized tool (eg, Confusion Assessment Method for the ICU) or checklist (eg, Intensive Care Delirium Screening) for this purpose. (Option 1) Amnesia affects short- and long-term memory loss. It can be intentionally induced by drug use or may occur as a result of trauma or underlying physical/psychological disease processes. Amnesia is not the most likely condition manifested by this client. (Option 3) In contrast to delirium, dementia is gradual in onset and causes an irreversible and progressive cognitive decline. Remote memory is spared initially and there is no impairment of consciousness until the late stages of the disease. (Option 4) Psychosis does not have an acute onset. Clients with this condition are usually oriented but have auditory (not visual) hallucinations. It is not likely in this client. Educational objective: New-onset confusion regarding sense of place and time, difficulty focusing, short-term memory loss, and increasing lethargy can be manifestations of delirium in a critically ill client who was previously alert and oriented.

A client with schizophrenia says to the nurse, "The world turns as the world turns on a ball at the beach. But all the world's a stagecoach and I took the bus home." The nurse recognizes this statement as an example of which of the following? A. Concrete thinking B. Loose association C. Tangentiality D. word salad

B Disturbance in logical form of thought is characteristic and one of the positive symptoms of schizophrenia. The client will often have trouble concentrating and maintaining a train of thought. Thought disturbances are often accompanied by a high level of functional impairment, and the client may also be agitated and behave aggressively. Types of impaired thought processes seen in individuals with schizophrenia include the following: Neologisms - made-up words or phrases usually of a bizarre nature; the words have meaning to the client only. Example: "I would like to have a phjinox." Concrete thinking - literal interpretation of an idea; the client has difficulty with abstract thinking. Example: The phrase, "The grass is always greener on the other side," would be interpreted to mean that the grass somewhere else is literally greener (Option 1). Loose associations - rapid shifting from one idea to another, with little or no connection to logic or rationality (Option 2) Echolalia - repetition of words, usually uttered by someone else Tangentiality - going from one topic to the next without getting to the point of the original idea or topic (Option 3) Word salad - a mix of words and/or phrases having no meaning except to the client. Example: "Here what comes table, sky, apple." (Option 4) Clang associations - rhyming words in a meaningless, illogical manner. Example: "The pike likes to hike and Mike fed the bike near the tyke." Perseveration - repeating the same words or phrases in response to different questions Educational objective: Disturbance in thought process (form of thought) is one of the positive symptoms of schizophrenia. The nurse needs to be able to recognize and identify the various types of thought disturbances experienced by clients with schizophrenia. These include loose associations, neologisms, word salad, echolalia, tangentiality, clang association, and perseveration.

A client with bipolar disorder is admitted to the psychiatric unit with acute mania and dehydration. Which prescription does the nurse question? A. Administer Zolpidem at bedtime as needed for insomnia B. Continue prescribed home dose of 300 mg lithium PO q8hr C. give Haloperidol and lorazepam IM together for aggressive behavior D. Infuse 500 ml of normal saline IV bolus over 1 hr

B Lithium toxicity Features Acute: Gastrointestinal findings - nausea, vomiting, diarrhea; neurologic findings occur later Chronic: Neurologic - ataxia, sluggishness, confusion, agitation, neuromuscular excitability (coarse tremor) Prevention Avoid sodium depletion; low sodium intake precipitates lithium toxicity Eat regular diet & drink adequate fluids (2-3 L/day) Therapeutic level is 0.6-1.2 mEq/L (0.6-1.2 mmol/L) Level >1.5 mEq/L (1.5 mmol/L) is considered toxic Lithium is a mood stabilizer commonly prescribed for mania (eg, bipolar disorder) as long-term maintenance therapy. Because lithium has a narrow therapeutic range (eg, 0.6-1.2 mEq/L [0.6-1.2 mmol/L]), serum levels should be monitored regularly (eg, following dose changes) to prevent toxicity (>1.5 mEq/L [1.5 mmol/L]). Lithium is excreted through the kidneys. To prevent toxicity the nurse should hold doses and clarify prescriptions for clients who have: Conditions/illnesses in which the kidneys try to conserve sodium (eg, hyponatremia, dehydration) as sodium and lithium are absorbed in proximal tubules simultaneously (Option 2) Decreased glomerular filtration rate (eg, severe renal dysfunction) as less of the drug is filtered into the urine Consistent amounts of fluid (2-3 L/day) and sodium prevent fluctuations in serum lithium. Clients should report signs (eg, weight changes, dizziness) and precipitating factors (eg, vomiting, diarrhea, increased sweating) of fluid and electrolyte imbalance. (Option 1) Zolpidem (Ambien) is a hypnotic medication that induces sleep for clients with sleep disturbances (eg, acute mania). (Option 3) Haloperidol (a first-generation antipsychotic) and lorazepam (a benzodiazepine) are commonly administered together to depress the central nervous system and decrease aggressive behaviors. (Option 4) Isotonic IV fluid boluses (eg, normal saline) are often required to reverse moderate to severe dehydration and prevent lithium toxicity. Educational objective: Lithium, a mood stabilizer commonly prescribed for clients with mania, has a narrow therapeutic range. Clients with conditions that increase serum lithium levels (eg, dehydration, hyponatremia, severe renal dysfunction) are at increased risk for toxicity (>1.5 mEq/L [1.5 mmol/L]).

A client with social anxiety disorder is receiving treatment at the local community mental health center. Which situation most likely caused the client to seek therapy? A. The client and spouse are spouse are soon move into a new neighborhood B. The client boss has ask the client to represent the company confusion C. The client health care provider for over 30 yrs wiil be retiring soon and the client will have to see a new hcp D. The client son is getting married in a few months

B Social anxiety disorder (SAD) is characterized by an excessive and persistent fear of social or performance situations in which the client is exposed to strangers and the possibility of scrutiny by others. Examples of such social interactions include meeting unfamiliar people, being observed eating or drinking in public, and giving a speech. The client may fear criticism, embarrassment, humiliation, and rejection from unfamiliar people in unfamiliar social situations and will exhibit physical symptoms of anxiety such as sweating, trembling, palpitations, diarrhea, and blushing. Although all these situations could provoke some degree of anxiety in a client with SAD, having to represent the company at a convention with hundreds of strangers is most likely what brought this client to the community mental health center. Clients with SAD often have anticipatory anxiety and worry for days or weeks before a feared event. They may recognize that their fear is exaggerated and will seek assistance and counseling. (Option 1) The prospect of a new neighborhood may cause the client some anxiety; however, in this situation, the client has some control over exposure to new neighbors. The client can control this fear by limiting encounters or avoiding the neighbors altogether. (Option 3) Seeing a new HCP may cause some degree of discomfort in a client with SAD; however, as a one-on-one encounter, it is not like to cause severe anxiety or panic. (Option 4) In this situation, the client will be around familiar and possibly unfamiliar people. If necessary, the client can create a comfort zone by limiting contact with unfamiliar people. Educational objective: Clients with social anxiety disorder have an excessive, persistent fear of social or performance situations involving strangers and the possibility of criticism, embarrassment, humiliation, and rejection. The fear of the situation(s) causes severe anxiety and avoidance.

The nurse is caring for a client admitted with abdominal pain, who has been diagnosed with somatic symptom disorder after a thorough evaluation finds no medical cause for the symptoms. Which intervention should the nurse include in the plan of care? A. Advocate for an elimination diet to identiy the cause of the symptoms B. Limit time spent discussing physical symptoms with the client C. Reinfore negative examination results when pain medicationis requested D. When abdominal pain is mentioned, remind client that it is not real

B Somatic symptom disorder (SSD) is a psychological disorder that develops from stress, resulting in medically unexplainable physical symptoms (eg, abdominal pain) that disrupt daily life. Clients with SSD focus an excessive amount of time, thought, and energy on the symptoms, often seeking medical care from multiple health care providers. Nursing interventions focus on minimizing indirect benefits and developing client insight. To minimize the indirect benefits from being "sick" (secondary gains), the nurse should: Redirect somatic complaints to unrelated, neutral topics Limit time spent discussing physical symptoms (Option 2) To promote insight and healthy coping mechanisms, the nurse should assist the client to: Identify secondary gains (eg, increased attention, freedom from responsibilities) Recognize factors that intensify symptoms (eg, increased stress, reminders of a deceased family member) Incorporate appropriate coping strategies (eg, relaxation training, physical activity) (Option 1) An elimination diet would increase the client's focus on the symptoms and is inappropriate, as physiological causes have already been ruled out. (Option 3) The client's symptoms are real despite the lack of diagnostic findings. The nurse should administer analgesics as prescribed. (Option 4) Disputing the validity of the client's symptoms may increase the client's stress level and exacerbate symptoms. Educational objective: Somatic symptom disorder occurs when stress causes medically unexplainable physical symptoms that disrupt daily life. Nursing interventions include limiting discussion of symptoms and identifying secondary gains, factors that intensify symptoms, and coping strategies.

An elderly client with dementia frequently exhibits sundowning behavior while living in a community-based residential facility. When the nurse finds the client wandering at night, which of the following statements is most appropriate? A. Dont you know its not morning yet? B Its time to get back to bed now C You might fall if you wander in the dark D You should not leave the room without assistance

B Sundowning refers to the increased confusion experienced by an individual with dementia; it occurs at night, when lighting is inadequate, or when the client is excessively fatigued. Wandering is a common associated behavior. A client with mild-to-moderate dementia may need frequent reality reorientation to promote appropriate behaviors. However, with advanced dementia, reality orientation may not be effective and might cause the client to feel anxious, leading to inappropriate behaviors and aggression. In this situation, validation therapy is more appropriate and involves recognizing and exploring the client's feelings and concerns but not reinforcing or arguing with any incorrect perceptions. (Option 1) This statement calls attention to the client's memory and cognitive issues but does not provide any useful information for reorientation. In addition, this type of statement may reinforce anxieties and fears in a client who is already feeling insecure and scared about the cognitive changes, leading to anger and possible aggression. (Option 3) This option provides little reorientation information. (Option 4) This statement has a paternalistic tone and seems to penalize the client. This type of statement may cause the client to get angry, leading to escalating negative behaviors. Educational objective: Appropriate communication techniques to assist a client with dementia while avoiding anxiety and other negative behaviors include reorientation in the earlier stage of dementia and validation in the later stage of dementia.

A client with a 20-year history of schizophrenia is hospitalized. The client appears visibly upset, approaches the nurse, and says in a shaky voice, "I can't find my headband. I can't find my headband. The oil is going to leak out of the crack in my head." What is the best response by the nurse? A. How long as the oil been leaking from your head? B. Lets go back to your room and look for the headband together C. There is no oil coming out of your head D. You are to miss breakfast if you do not go into the dinning room

B The client, while delusional, is exhibiting signs of anxiety. The priority action for the nurse is to intervene in a manner that will assist in reducing the client's unease. The headband is part of the client's delusional system; it is highly likely that the client will continue to be apprehensive until the headband or substitute is found. Offering to help the client look for the headband conveys a sense of caring and helps establish a trusting relationship. Once the client has calmed down, the nurse will minimize any conversation about the "crack" and the "oil" and can direct the client to reality-oriented activities. Delusions are fixed, false beliefs that are accepted by the client as real and cannot be changed by logic, reason, or persuasion. Categories of delusions include the following: Persecutory - client thinks others are "out to get me" Ideas of reference - common events refer specifically to the client Grandiose - client has the perception of special importance or powers that are not realistic Somatic - false ideas about bodily functioning Nursing interventions include the following: Not arguing or challenging the belief Reinforcing reality by talking about and encouraging the client to participate in real events. The nurse should not delve into or have long conversations about the delusional belief system. (Option 1) This response focuses on the delusional content and is not therapeutic. It does not help alleviate the client's anxiety. (Option 3) Challenging the delusional content is not therapeutic and will not change the client's belief. (Option 4) This statement does not help reduce the client's anxiety. Educational objective: The priority nursing action for a client exhibiting anxiety is to intervene in a manner that helps make the client feel more at ease. Delusions are fixed, false beliefs; challenging a client's delusional content system will increase the client's anxiety and will not change the client's beliefs.

The nurse assigned to care for the client with a diagnosis of histrionic personality disorder expects to observe which characteristics and behaviors? A. Fears abondonment, agreeable, needs constant reassurance B. Likes to be the center of attention, exxagerated emotional expression, little tolerance for frustration C. Seems uncomfortable around ppl, lack of close friends, indiferent to critisism and praises D. Tries to intimidate others, maniulative and lack of empathy

B The nurse should recognize the following characteristics associated with histrionic personality disorder: Self-dramatizing, exaggerated or shallow emotional expression Attention-seeking, needs to be the center of attention Overly friendly and seductive, attempts to keep others engaged Demands immediate gratification and has little tolerance for frustration An individual with histrionic personality disorder displays these behaviors and characteristics persistently. The signs and symptoms are maladaptive and have a negative impact on the client's social, interpersonal, and occupational life. (Option 1) Clients with dependent personality disorder fear separation and tend to be indecisive and unable to take the initiative. They are often preoccupied with the thought of being left to fend for themselves and want others to assume responsibility for all major decision making. (Option 3) Clients with schizoid personality disorder exhibit social detachment and an inability to express emotion. They do not enjoy close relationships and prefer to be aloof and isolated. (Option 4) Clients with antisocial personality disorder have a pattern of disregard for and violation of the rights of others. They manipulate others for personal gain and lack empathy. Educational objective: Histrionic personality disorder is characterized by persistent attention-seeking behavior and exaggerated emotionality. The client with this disorder demands immediate gratification and has little tolerance for frustration.

A new nurse is caring for an adolescent transgender client. What question would be appropriate when assessing the client's gender identity? A. Do you prefer to be reffered to as he or she B. how would you describe your gender? C. What gender were you originally? D. What is your preferred name?

B Transgender clients may fear judgment or embarrassment and withhold information, avoid seeking treatment, or refuse care as a result. This is often related to past experiences of discrimination or stigma when receiving health care. Therefore, it is important to use therapeutic communication and avoid stereotypes to establish trust. Transgender clients may identify as male or female or as neither or both genders. It is important for the nurse to determine clients' gender identity by asking open-ended questions that allow clients to explain their identities in their own words (Option 2). (Option 1) The client may not identify as simply male or female. Asking closed-ended questions (eg, whether the client prefers "he" or "she") does not allow for client elaboration. (Option 3) Because the client does not identify with the gender designated at birth, referring to a transgender client's "original gender" may cause distress and discomfort. The nurse should instead ask what sex the client was assigned on the original birth certificate. (Option 4) Asking "What is your preferred name?" is not open-ended and does not thoroughly assess gender identity. However, the client's preferred and legal names may be different. The nurse should use the client's preferred name to show respect and to develop a therapeutic relationship. Educational objective: Transgender clients may identify as male or female or as neither or both genders. The nurse should use open-ended questions that allow clients to explain their identities in their own words.

A client with moderate Alzheimer disease becomes agitated during mealtime and throws a plate of food on the floor. Which of the following responses by the nurse are appropriate? Select all that apply. A. Administer a dose of prescribed PRN haloperidol before the client behavior escalated furthure B. Distract and redirect the client by asking for help folding napkins for the next day's meal C. Inform the client that the healthcare provider will be notified abt his inappropriate behavior D. Promptly obtain another plate of food and insist that a uap feeds the client E. Use direct eye contact and say to the client, "I can see your upset this is a safe place"

B E Clients with Alzheimer disease (AD) often exhibit behavioral problems (eg, agitation, resisting care) due to cognitive decline. Behavioral management techniques include: Acknowledgement of the client's emotions, which reduces feelings of being isolated and misunderstood (Option 5) Reassurance that the client will be kept safe from harm Distraction (eg, photographs, music, television) to divert the client's attention Redirection to simple tasks (eg, folding towels/napkins, stacking plates) (Option 2) (Option 1) Antipsychotic medications (eg, haloperidol, risperidone, olanzapine) are associated with increased mortality when used for agitation in clients with dementia. These medications should be used after all other measures have failed. (Option 3) Threatening to call the health care provider disrupts the nurse-client relationship and may worsen the client's agitation and behavioral problems. (Option 4) Offering activities that may have precipitated the behavior will likely worsen the agitation. The nurse should assess the client to determine the cause of the agitation (eg, pain, fear, fatigue) and address it. A new meal can be offered after the client is calm. In addition, the nurse should promote autonomy for as long as possible and should not feed clients who are still able to feed themselves (eg, client with moderate AD). Educational objective: Behavioral management for agitated clients with Alzheimer disease includes acknowledging client feelings, reassuring safety, distracting, and redirecting.

The nurse is developing a plan of care for a 16-year-old client with bulimia nervosa. Which interventions would be included in the plan of care? Select all that apply. A. Allow the client to continue use laxatives B. Assess client for electrolyte imbalances C.Be alert to hidden or discarded food wrapper D. Do not allow the client to keep a food diary during hospitalization E. Monitor client for 1-2 hr after meal in a central area

BCE Bulimia nervosa is an eating disorder common among adolescent girls and characterized by cycles of uncontrollable overeating (binging) followed by compensating behaviors to avoid weight gain (purging). Weight-maintenance behaviors include self-induced vomiting, fasting, laxative abuse, and excessive exercise. Clients may be of normal weight, which contributes to the hidden nature of this disorder. Clients with bulimia often experience extreme guilt associated with their increasing lack of control and attempt to hide evidence of their actions (eg, hidden food wrappers from binging, discarded food from unfinished meals). Clients should be monitored around meal times, and particularly for 1-2 hours after eating to observe for purging. Purging behaviors, particularly vomiting, may result in electrolyte imbalances, such as hypokalemia, that can cause cardiac arrhythmias. (Option 1) Clients with bulimia nervosa often use laxatives inappropriately to rid their bodies of undigested food in an effort to control their weight. Such measures should not continue in the treatment setting. (Option 4) A food diary helps the client and caregivers track the type and amount of food that the client has eaten. It is also an excellent means of helping the client understand the health implications of the disorder. Educational objective: Clients with bulimia nervosa should be monitored for signs of hidden binging or purging activity, particularly for 1-2 hours after meals. Excessive vomiting may result in electrolyte imbalances, including hypokalemia.

The nurse reinforces teaching for a client newly prescribed buspirone for generalized anxiety disorder. Which client statement indicates that teaching has been effective? A. Driving is not recommended until I stop taking this meds B. If I expeience a panic attack I should take an extra dose of meds C. It will be 2-4 wks before I feel the full effects of this meds D. Withdrawal symptoms will occur if I abruptly stop taking this meds

C Buspirone (Buspar) is an anxiolytic medication that differs from other medications used to manage anxiety disorders (eg, benzodiazepines) because it typically lacks central nervous system depressant effects and has a low abuse potential. Therefore, buspirone has a favorable side-effect profile because it usually does not produce withdrawal symptoms, dependence, or psychomotor slowing (eg, slowing of thought, impaired movement). However, unlike other anxiolytic medications, buspirone does not work immediately. Onset of symptom relief occurs after 1 week of therapy, with full effects occurring between 2 and 4 weeks (Option 3). (Option 1) As with any medication, the nurse should advise clients to avoid driving until individual effects are known. However, it is unlikely that buspirone will cause psychomotor impairment and require cessation of driving or operating machinery for the duration of treatment. (Option 2) Buspirone should be taken as prescribed and is not indicated for relief of acute anxiety or panic attacks. The health care provider may prescribe an additional medication with a fast-acting effect for panic attacks. (Option 4) Buspirone does not cause physical dependence or tolerance, and withdrawal symptoms do not occur with discontinuation of use. Educational objective: Buspirone is an anxiolytic medication that does not have central nervous system depressant effects; therefore, it does not cause dependence, tolerance, psychomotor slowing, or withdrawal symptoms. Full therapeutic effects occur between 2 and 4 weeks of therapy.

A client with a diagnosis of antisocial personality disorder was given a 2-hour pass to leave the hospital. The client returned to the unit 15 minutes past curfew and did not sign in. The next day, this behavior is brought up in a group meeting. The client says, "It's all the nurse's fault. The nurse was right there and did not remind me to sign in." What is the best response by the nurse? a. i'M SORRY. i SHOULD HAVE REMINDED YOU TO SIGN IN B. It's not my fault that you forgot to sign in C. It is your responsibility to sign in when yu return from a pass D. You were late coming back from your pass. Is that why you did not sign in?

C Clients with antisocial personality disorder often disregard the rules, have a history of irresponsible behavior, and blame others for their behavior. They avoid responsibility for their own behavior and the consequences of their actions using numerous excuses and justifications. Nursing interventions include setting firm limits and making clients with antisocial personality disorder aware of the rules and acceptable behaviors. The nurse should require the client to take responsibility for his/her own behavior and the consequences of not following the rules and regulations of the unit. (Option 1) This is a non-therapeutic response; by apologizing to the client, the nurse is implying that it was the nurse's responsibility to remind the client to sign in. (Option 2) This is a non-therapeutic response as the nurse is on the defensive and not focusing on the client. (Option 4) This is a non-therapeutic response; it is confrontational and assumes the reasoning behind the client's behavior. The response also requires a yes or no answer, which does not facilitate communication. Educational objective: Clients with antisocial personality disorder often disregard the rules, have a history of irresponsible behavior, and blame others for their behavior. Nursing interventions include setting firm limits and making clients aware of the rules and acceptable behaviors.

A child with attention-deficit hyperactivity disorder (ADHD) has been taking methylphenidate for a year. What are the priority nursing assessments when the client comes to the clinic for a well-child visit? A. Attention span and activity level B. Dental health and mouth dryness C. Height weight and BP D. Progress with sch work and in making friends

C Methylphenidate (Ritalin, Concerta) is a central nervous system stimulant used to treat ADHD and narcolepsy. It affects neurotransmitters (dopamine and norepinephrine) in the brain that contribute to hyperactivity and lack of impulse control. A common side effect of methylphenidate is loss of appetite with resulting weight loss. Parents and caregivers should be instructed to weigh the child with ADHD at least weekly due to the risk of temporary interruption of growth and development. It is very important to compare weight/height measures from one well-child checkup to the next. If weight loss becomes a serious problem, methylphenidate can be given after meals; however, before meals is preferable. Another side effect of methylphenidate is increased blood pressure and tachycardia. These should be monitored before and after starting treatment with stimulants. (Option 1) Therapeutic effects of methylphenidate include increased attention span and improvement in hyperactivity. These would be important components of a well-child assessment, but not the priority. (Option 2) Evaluating dental health is part of any well-child assessment. Dry mouth is not a common side effect of methylphenidate. (Option 4) Expected outcomes of methylphenidate therapy include improvement in schoolwork and social relationships. These would be important components of a well-child assessment, but not the priority. Educational objective: Side effects of methylphenidate therapy that require on-going monitoring are delayed growth and development and increased blood pressure. Children with ADHD should be weighed regularly at home or school; weight loss trends should be reported and discussed with the health care provider. Blood pressure and cardiac function also should be monitored on an on-going basis.

A client with severe major depressive disorder is lying in bed and has not moved for 3 hours. The client will respond slowly to "yes" and "no" questions; otherwise, the client does not respond when spoken to. The clinical manifestations exhibited by the client are known as: A. Psychogenic Dystonia B. Psychogenic gait C. Psychogenic retardation D. Somatization

C Psychomotor retardation is a clinical symptom of major depressive disorder. Manifestations of psychomotor retardation include slowed speech, decreased movement, and impaired cognitive function. The individual may not have the energy or ability to perform activities of daily living or to interact with others. Psychomotor retardation may range from severe (total immobility and speechlessness -catatonia) or mild (slowing of speech and behavior). Specific clinical findings of psychomotor retardation include the following: Movement impairment - body immobility, slumping posture, slowed movement, delay in motor activity, slow gait Lack of facial expression Downcast gaze Speech impairment - reduced voice volume, slurring of speech, delayed verbal responses, short responses Social interaction - reduced or non-interaction Clients with major depressive disorder may also show symptoms of psychomotor agitation, characterized by increased body movement, pacing, hand wringing, muscle tension, and erratic eye movement. (Option 1) Psychogenic dystonia is a psychogenic movement disorder characterized by involuntary muscle contractions that cause slow, repetitive movements such as twisting and abnormal postures. (Option 2) Psychogenic gait is a psychogenic movement disorder characterized by unusual standing postures and walking. The client may experience knee buckling and falling or may veer from side to side as if staggering. (Option 4) Somatization is a term to describe physical symptoms that cannot be explained by a medical condition or disease. Educational objective: Psychomotor retardation is a clinical finding in some clients diagnosed with major depressive disorder. The key features include decreased movement, inability or decreased ability to talk, and impaired cognitive function.

The registered nurse is counseling the parent of a child recently diagnosed with attention-deficit hyperactivity disorder (ADHD), combined type. Which statement by the parent requires an intervention? A. I should offer a choice between two things for my child clothes or meal B. I will need to advocate for an individualised educational plan for my child C. My child will outgrow this disorder by age 20 D.When talking to my child I should not be multitasking

C Symptoms of ADHD usually continue into adulthood; current research indicates that children do not outgrow the condition. However, individuals with ADHD learn to cope with and manage the symptoms and achieve their full potential, leading healthy and satisfying lives. They may move into a condition of being "recovered," but this is usually a dynamic and ongoing state. (Option 1) Children with ADHD are usually overwhelmed and overstimulated when faced with numerous choices. Offering 2 choices will help organize and structure the child's decision-making process. (Option 2) There are legal mandates requiring school-based services and accommodations for children with ADHD. However, some teachers and/or school systems may not be as familiar with these requirements; it is important that parents of children with ADHD advocate for these individualized services. (Option 4) Parents and caregivers should make direct eye contact and focus on their children when giving instructions. Other distractions should be minimized to avoid overstimulation. Educational objective: Two common misunderstandings about ADHD are that children outgrow it as they become adults, and that dietary modifications (eg, restricting additives and/or sugar) will improve or "cure" the symptoms. Neither statement is true. These individuals learn to cope with and manage their symptoms as they grow older, but they do not outgrow ADHD.

The nurse is working in the emergency department. Which client should the nurse see first? A. 12 y/o w/severe neck muscle spasm who is taking Haloperidol for Tourette syndrome B. 80 y/o w/irritability and agitation who has takn aloperozam for 2 weeks C. Client with clozapine who has sudden onset of high fever diaphoresis and change in mental status D. Client with Olanzapine who has dry mouth blurry vission and constipation

C The client taking clozapine is exhibiting classic signs of neuroleptic malignant syndrome (NMS), an uncommon but life-threatening adverse reaction to anti-psychotic medications. NMS is characterized by high fever, muscular rigidity, altered mental status, and autonomic dysfunction. Treatment includes supportive care (eg, rehydration, cooling body temperature) and immediate discontinuation of the medication. Due to the life-threatening nature of NMS, this client needs to be seen first to assess for generalized muscle rigidity. (Option 1) Severe neck spasms in an individual taking haloperidol (and other psychotropic medications) indicate a dystonic reaction. This client is in no immediate danger but needs treatment with IV benztropine (Cogentin) as soon as possible. The client should be seen second. (Option 2) Benzodiazepines can cause paradoxical worsening of agitation in elderly clients. This client needs a change in medication but does not need to be seen immediately. (Option 4) Dry mouth, blurry vision, and constipation are common anti-cholinergic side effects of olanzapine (and other psychotropic medications). These symptoms usually resolve after the client has taken the medication for a few weeks; treatment is symptomatic (eg, increased fluids, sugar-free chewing gum, high-fiber foods, avoidance of driving). This client can be seen last. Educational objective: Neuroleptic malignant syndrome (NMS) usually presents with mental status changes, fever, muscle rigidity, and autonomic instability after starting antipsychotic medications. Treatment involves discontinuation of the medication and supportive care (eg, rehydration, cooling body temperature). NMS is a life-threatening condition.

An 87-year-old client has been admitted to the hospital with signs and symptoms of a urinary tract infection along with agitation, confusion, and disorientation to time and place. What is the most important nursing action? A. Encourage increase fluid intake B. Keeping the bed elevated with the side rails railed C.Providing one -one supervision D. Turning lights off in client's room to reduce stimulation

C This client is experiencing impairment in cognitive and psychomotor functioning and most likely has delirium brought on by the urinary tract infection. This is not an uncommon occurrence in elderly clients. The client's most immediate needs are safety and prevention of physical injury. Initially, the client should be placed in a room near the nurses' station with one-on-one supervision and frequent reorientation to time, place, and situation. As the condition improves, the client will continue to require frequent observation. (Option 1) It is important for this client to be well hydrated; this can best be accomplished through IV fluids and electrolyte replacement but not by encouraging the client to increase fluid intake. (Option 2) Clients who are agitated often try to get out of bed, even if it means climbing over the side rails. Keeping the bed elevated and side rails raised increases the risk of a fall or other injury as the client attempts to leave the bed. (Option 4) A dark room could worsen the client's confusion, agitation, and disorientation. Lighting helps maintain orientation to the environment; the client's room should be well lit during the day, and dim nightlights should be used at night. Educational objective: Safety is a high priority for clients with delirium. Disorientation, confusion, agitation, and difficulty interpreting reality all increase the risk for physical injury. Close observation, including one-on-one supervision, is essential to ensure client safety.

A client is brought to the emergency department after the spouse finds the client locked in the car inside their garage with the motor running. The spouse says to the nurse, "If I hadn't come home early from work, my spouse would be dead. I can't believe this is happening." What is the best response by the nurse? A. Do you have any close friend or relatives to help you through this B. Has your spouse seem depressed latley C.This has been very overwhelming for you. What are you feeling right now D. Well, you did find your spouse. You need to focus on helping yourspouse get better

C This client's spouse has experienced a traumatic or crisis event (also referred to as "a critical incident"). When faced with a traumatic situation, clients are often overwhelmed and respond with a wide range of emotions and thoughts, including shock, denial, anger, helplessness, numbness, disbelief, and confusion. Clients may also experience physical symptoms, such as hyperventilation, abdominal pain, and dizziness. Priority nursing actions need to be directed at the here and now, providing therapeutic interventions aimed at alleviating the immediate emotional impact of this disruptive crisis event. Acknowledging the severity of the event validates and normalizes the spouse's reaction. Assisting the spouse in identifying feelings and giving the spouse opportunity to ventilate will help reduce immediate emotional stress. (Option 1) Assessing this family's support system is important. However, it is not the priority action at this time. (Option 2) This statement does not address what this client's spouse is experiencing at the moment. At a later time, the nurse can explore the client's history and any events that may have lead to this situation. (Option 4) This response does not address the spouse's concerns. Also, the wording is judgmental and nontherapeutic. Educational objective: Initial reactions to a crisis event may include shock, disbelief, denial, helplessness, and confusion. Nursing actions are directed at providing support to the client. Acknowledging the impact of the event and encouraging the client to ventilate are therapeutic interventions.

The nurse develops a teaching care plan for the client with a prescription to change antidepressant medications from imipramine to phenelzine. Which instruction is appropriate to include in the teaching? A.continue avoinding food high in tyramine until the imipramine withdrawal period is over B. skip the nightime dose of imipramine and start the phenelzine nex morning C. Taper down the imipramine the discontinue for two weeks before starting phenelzine D. taper down the imipramine while gradually increasing the phenelzine

C When a client switches from a tricyclic antidepressant (TCA) (eg, imipramine, amitriptyline, nortriptyline) to a monoamine oxidase inhibitor (MAOI) (eg, phenelzine, isocarboxazid, tranylcypromine), a drug-free period of at least 2 weeks should elapse between the tapered discontinuation of the TCA and the initiation of the MAOI. This timing is based on the half-life value and allows for the first medication to leave the system. Without a washout period, the client could experience hypertensive crisis (eg, blurred vision, dizziness, severe headache, shortness of breath). If the TCA is withdrawn abruptly, the client may experience a discontinuation syndrome. (Option 1) A tyramine-restricted diet is indicated for clients on an antidepressant regimen containing an MAOI to decrease the risk of hypertensive crisis. Because this client is starting an MAOI, the diet should be initiated 2 weeks prior to starting the medication. If the switch was from an MAOI inhibitor to another antidepressant, the client would need to continue to follow the dietary restrictions for 2 weeks after discontinuing the MAOI. (Option 2) An overnight washout period is inadequate to clear the imipramine from the client's system before starting the phenelzine. (Option 4) TCAs and MAOIs cannot be taken at the same time due to the risk of a hypertensive crisis. Educational objective: Caution must be taken when a client switches from a tricyclic antidepressant to a monoamine oxidase inhibitor to avoid adverse reactions (eg, hypertensive crisis, discontinuation syndrome). Usually, antidepressants are withdrawn gradually with a drug-free period before the new antidepressant is initiated.

The clinic nurse reinforces education about intimate partner violence for a group of graduate nurses. Which of the following are appropriate for the nurse to include? Select all that apply. A. IPV is most common in low income families B. IPV is rare in same sex partnership C. The abusive partner often demonstrates jealousy and posessiveness D Victims may not leave due to financial concern or fear of harm by the abuser E. Violence against a female often intensifies during pregnancy

CDE Intimate partner violence (IPV) is physically, emotionally, verbally, sexually, or economically abusive behavior inflicted by one partner against another in an intimate relationship, to maintain power and control. Nurses must be aware of the risk factors and signs of IPV to recognize victims of abuse and to intervene (eg, separating the victim from the abuser during the health history interview, providing information about community resources). Features of IPV include: The abusive partner exhibits intense jealousy and possessiveness (Option 3). The victim of IPV chooses to stay in the relationship for a variety of reasons (eg, fear for life, financial or child custody concerns, religious beliefs) (Option 4). The abuse begins or intensifies during pregnancy (Option 5). (Options 1 and 2) IPV occurs in all religious, socioeconomic, racial, and educational groups, and in both heterosexual and same-sex partnerships. Educational objective: Intimate partner violence (IPV) is abusive behavior inflicted by one partner against the other in an intimate relationship. IPV occurs in all religious, socioeconomic, racial, and educational groups, and in both heterosexual and same-sex partnerships. IPV often begins or intensifies during pregnancy. Victims often stay in the relationship due to fear, financial or child custody concerns, or religious beliefs, among other reasons.

A newly admitted client with schizophrenia has been exhibiting severe social withdrawal, odd mannerisms, and regressive behavior. The client is sitting alone in the room when the nurse enters, says "good morning," and proceeds to sit down next to the client. Without responding, the client stands up and starts to leave. Which of the following actions is best for the nurse to take? A. Ask where the client is going B. Immediately follow the client out the door C. In a loud voice, direct the client to go back to the room D. Remain silent an allow the client to leave

D Clients with schizophrenia often become anxious when around other individuals and will seek to be alone to relieve anxiety. Impaired social and interpersonal functioning (eg, social withdrawal, poor social interaction skills) are common negative symptoms of schizophrenia. These are more difficult to treat than the positive symptoms (eg, hallucinations, delusions) and contribute to a poor quality of life. Nursing interventions directed at improving the social interaction skills of a client with schizophrenia include the following: Making brief, frequent contacts Accepting the client unconditionally by minimizing expectations and demands Assessing the client's readiness for longer contacts with the nurse and/or other staff and clients Being with or close by the client during group activities Offering positive reinforcement when the client interacts with others (Option 1) Asking where this client is going is nontherapeutic as it requires an explanation of the client's actions. (Option 2) Following this client out the door could increase the client's anxiety. (Option 3) Directing this client to come back to the room is placing a demand that may be unrealistic and does not help develop a sense of trust. Educational objective: Social isolation and impaired social interaction are common negative symptoms of schizophrenia. The client will seek to be alone to relieve anxiety associated with being around others. The nurse needs to be accepting of the client's behavior and continue attempts at brief contact until the client is comfortable.

A client with a history of major depressive disorder with psychotic features was rescued before jumping off a dam. The client is pacing, picking at the arms, and repeatedly mumbling, "I have to die. You cannot stop me." When the health care provider recommends electroconvulsive therapy (ECT) as the initial treatment, the client's spouse says to the nurse, "I can't allow such a cruel treatment. Why can't they just give my spouse medication?" Which is the best response by the nurse? A. ECT is safe and your spouse will not feel a thing B. It could take up to 3 weeks for the medication to become effective C. Your spouse could die by not recieving this tx D Your spouse is very ill and ECT might be the best tx at this time. What are your concerns abt ECT?

D Due to the severity of this client's clinical presentation, ECT would be the appropriate initial treatment. The client's depression has psychotic features and the suicide attempt used a highly lethal method. The client continues to be highly suicidal as evidenced by behavior and thought content. ECT can be highly effective in helping severe depression, when clients pose a severe threat to themselves and it is not safe to wait until medications take effect. ECT is also used in clients who have not responded to medication or cannot tolerate side effects. During ECT, the client is treated with pulses of electrical energy through electrodes applied to the scalp; the electrical stimulus is sufficient to cause a brief convulsion. General anesthesia and a skeletal muscle relaxant are administered to minimize the motor seizure and prevent musculoskeletal injury. The client feels nothing from the procedure, but confusion and memory loss are common side effects. The usual course of acute therapy is 6-12 ECT treatments performed 2-3 times a week. Response to ECT can be dramatic and life-saving. Maintenance therapy (treatment at 1- to 8-week intervals) can continue on a long-term basis to help prevent relapses. Medication therapy is often given in combination with ECT and is associated with improved outcomes. The best response to a client or family member who expresses doubts about ECT is to ask about their concerns. Responses such as, "Tell me about your concerns," or "What do you understand about ECT?" allow the nurse to assess their knowledge and implement educational interventions to address any misinformation or knowledge gaps. (Option 1) This response does not address the spouse's concerns. (Option 2) Although this statement may be true, it does not address the spouse's concerns. It is not the best response. (Option 3) This is a non-therapeutic statement; it does not address the spouse's concerns and suggests a threatening tone. Educational objective: ECT is an effective treatment for major depression with psychotic features or for a client who is highly suicidal. ECT is used when it is unsafe to wait for medication treatment to become effective. It is also used in clients who do not respond to or cannot tolerate psychotropic medications.

The nurse cares for a client who has a do-not-resuscitate prescription, and notes extensive skin mottling and vital signs consistent with impending death. The client's spouse states, "I hope my spouse can hang on a little longer; our anniversary is in 2 days." What response by the nurse is appropriate? A. Tell me abt a favourite anniversary memory that you shared B. That would be very special but please understand that may not happen C. we never know. Death happens in its own time despite what we may want D. Your spouse's body is shutting down and the time is near. I will stay here with you

D End-of-life care includes providing psychosocial support to the client's family members and assisting them through the dying process. This is accomplished by providing factual, open, and honest communication while conveying empathy. The nurse can reduce family members' fear and anxiety by helping them anticipate what to expect as death becomes imminent, while using the therapeutic communication technique of offering self (Option 4). (Option 1) Encouraging the client's spouse to recall fond memories is comforting and therapeutic but does not provide information about the client's imminent death. (Option 2) Telling the client's spouse that the client may not be present for an upcoming event does not convey empathy or provide factual information about the client's impending death. (Option 3) Statements such as "death happens in its own time" are cliché; providing platitudes or trite statements is not therapeutic. Educational objective: When assisting a client's family through the dying process, the nurse should provide factual, open, and honest communication; help the family anticipate what is happening and when death is imminent; and use the therapeutic technique of offering self.

A client on the locked unit of an inpatient psychiatric hospital says to a nurse on the evening shift, "During the day they let me out to go to the gift shop. You're my favorite nurse; I know you'll be a good sport and give me a pass." What is the best response by the nurse? A. The gift shop is not even open right now B. I guess the day shift staff need to be reminded of the rules C. What do you want to get from the gift shop? D. You do not have the privallage for leaving the unit I cannot give you a pass.

D Manipulative behaviors, such as attempts at staff splitting, are common in clients with borderline and antisocial personality disorders, substance abuse problems, somatic symptom disorder, and bipolar disorder (during the manic phase). The manipulative behavior is aimed at gaining control/power over a person/situation or for material gratification. Clients manipulate by flattery or by pitting staff members against each other. They may "tell" on a staff member or act in a way to give the impression of sincerity and caring. Nursing interventions for manipulative behaviors include: Setting limits that are realistic, nonpunitive, and enforceable Using a nonthreatening, matter-of-fact tone when discussing limits and consequences of unacceptable behaviors Enforcing all unit, hospital, or center rules (Option 4) Ensuring consistency from all staff members in enforcing set limits (Option 1) Telling the client the gift shop is closed does not address the client's manipulative behavior. (Option 2) Believing the client's statement is not appropriate as it will only reinforce the client's manipulative behavior. (Option 3) Asking the client the reason for going to the gift shop ignores the fact that the client is trying to break the rules. Educational objective: Clients who want to gain power or control over a situation or desire material gratification may use manipulative behaviors (eg, staff splitting). Nursing interventions include setting behavioral limits; using a neutral, matter-of-fact tone when discussing rules and consequences of unacceptable behavior; and ensuring consistency from staff members in enforcing limits.

A young adult with obesity comes to the free clinic for a 2-week post-antibiotic follow-up visit for a superficial abdominal skin abscess. The client has a history of major depressive disorder and was hospitalized twice in the past 6 months for attempted suicide. The client now reports feeling "emotionally upset, alone, and at the end of my rope," due to difficulty finding a job and inability to qualify for medical insurance. The client is currently prescribed fluoxetine but has not been able to follow up with the prescribing health care provider (HCP). What is the priority nursing diagnosis (ND) at this time? A. Hopelessness B Ineffective coping C Risk for infection D Risk for suicide

D Suicide is the second leading cause of death in people age 15-24. The risk for suicide is increased in individuals with psychiatric disorders, such as depression, and in those who have attempted suicide within the past 2 years. Based on the client's history and statements, the HCP must perform a suicide assessment and take action (ie, psychiatry referral) to provide for the client's safety. This is imperative as the client is prescribed the antidepressant fluoxetine (Prozac) and has had no follow-up with the prescribing HCP. Risk for suicide related to depression is the priority ND. (Option 1) Hopelessness is the belief that a situation or problem is intolerable, inescapable, or unending, and the individual is unable to find a solution. Hopelessness related to inability to find a job, social isolation, lack of medical insurance, and feeling at the "end of my rope" is an appropriate ND for this client, but it is not the priority ND at this time. (Option 2) Ineffective coping is the inability to manage stressors and problems effectively. Depression can affect a client's cognitive ability (eg, poor concentration, lack of judgment) and ability to cope with feelings of despair. Ineffective coping related to inadequate support network, limited socioeconomic resources, and impaired cognitive ability is an appropriate ND for this client, but it is not the priority ND at this time. (Option 3) Risk for infection related to inadequate primary defenses secondary to impaired skin integrity is an appropriate ND for this client, but it is not the priority ND at this time. Educational objective: Risk for suicide related to depression is a priority ND for a client with previous suicide attempts.

The student nurse is performing an assessment of a 10-year-old diagnosed with attention-deficit hyperactivity disorder (ADHD). In addition to the 3 core symptoms of ADHD (hyperactivity, impulsiveness, and inattention), which of the following would the student nurse expect to find during the assessment? A. Confusion and a learning disability B. Delayed physical and emotional development C. Disorientation and cognitive impairment D. Low self esteem and impaired social skills

D The core symptoms of ADHD include hyperactivity, impulsiveness, and inattention. Hyperactive children are restless; have difficulty remaining seated when required; and exhibit excessive talking, blurting out answers prematurely, and interrupting others. Inattention is characterized by reduced ability to focus and attention to detail, easy distractibility, and failure to follow through (eg, homework, chores). The primary symptoms of ADHD have a negative impact and can make life difficult for children in school, at work, and in social situations. Symptoms interfere with opportunities to acquire social skills and may also result in rejection and critical judgment by peers. The negative consequences of ADHD include: Poor self-esteem Increased risk for depression and anxiety Increased risk for substance abuse Academic or work failure Trouble interacting with peers and adults (Option 1) Children with ADHD are more likely to have a learning disability. Confusion is not a typical clinical finding. (Option 2) Although children with ADHD may appear to be emotionally immature for their age, ADHD is not associated with delayed physical growth. (Option 3) Children with ADHD are not disoriented. ADHD is associated with a range of cognitive impairments, but no single cognitive dysfunction typifies all children with the disorder. Some children have no impairment at all. Educational objective: The diagnosis of ADHD includes the presence of hyperactivity, impulsiveness, and inattention. The negative consequences of the core manifestations include impaired social skills, poor self-esteem, academic or work failure, increased risk for depression and anxiety, and increased risk for substance abuse.

The nurse on the mental health unit receives report about a client diagnosed with schizophrenia who is experiencing a delusion of reference. Which client statement supports this symptom? A. "I need you to get rid of these bugs that are crawling under my skin" B. Hear that? she told me to kill my father C. That song is a message sent to me in secret code D. Those Martians are trying to poison me with tap water

Delusions are one of the positive symptoms of schizophrenia. Delusions are false beliefs that have no basis in reality and are unrelated to a client's culture or intelligence. When presented with proof that the delusion is irrational or untrue, the client continues to believe it is real. Clients experiencing delusions of reference will believe that songs, newspaper articles, and other events are personal and significant to them. Other examples of delusions are below: Grandeur - "I need to get to Washington for my meeting with the president." Control - "Don't drink the tap water. That's how the government controls us." Nihilistic - "It doesn't matter if I take my medicine. I'm already dead." Somatic - "The doctor said I'm fine, but I really have lung cancer." (Option 1) This client statement is an example of a tactile hallucination, which gives the client the sensation of being touched. (Option 2) This client statement is an example of an auditory hallucination, specifically a command hallucination. Clients experiencing auditory hallucinations hear sounds and voices others do not. (Option 4) This client statement is an example of a persecutory (paranoid) delusion. Clients with such delusions believe that they are being threatened or treated unfairly in some way. Educational objective: Delusions are a positive symptom of schizophrenia. Delusions of reference cause clients to feel as if songs, newspaper articles, and other events are personal to them.

The nurse in a psychiatric clinic is evaluating the client's response to treatment for somatic symptom disorder with cardiac manifestations. Which client statement indicates a need for further treatment? A. I'm looking for another heart specialist to evaluate my symptoms B. I ask my spouse for sipport while I deal with my mother's death C. I have start carrying a sketchbook to draw whenever I feel upset D. I journal daily abt my stress level and any cardiac related symptoms

Somatic symptom disorder (SSD) is a psychological disorder in response to stress that results in symptoms of physical disorders (eg, chest pain, syncope) for which there is no identifiable medical source (eg, myocardial infarction, hypotension). Periods of increased stress (eg, work demands, family events) frequently precede the onset, or worsening, of physical symptoms and result in frequent requests for medical attention and treatment. SSD and care-seeking behaviors may then be reinforced and perpetuated by secondary gains (eg, social affirmation, "sick role," avoidance of unpleasant activities). When evaluating clients' responses to treatment for SSD, the nurse should monitor for the following indicators of positive progress: Identification of alternate support systems for stress (eg, spouse, friends) (Option 2) Identification of perceived benefits (ie, secondary gains) of behaviors Use of stress-reducing strategies (eg, drawing, meditating) rather than fixation on symptoms (Option 3) Verbalization of factors causing or worsening symptoms (Option 4) (Option 1) When medical treatment does not support a diagnosis for the physical symptoms, the client may become frustrated and seek the opinion of additional health care providers. This indicates a lack of treatment progress. Educational objective: Somatic symptom disorder (SSD) occurs when psychological stresses manifest as physical symptoms of illness without physiological cause. Treatment has been effective if the client with SSD is able to identify alternate support systems for stress, identify perceived benefits of behaviors, employ stress management strategies, and verbalize factors associated with symptoms.