(N129/2) Mental Health

A nurse collaborates with a depressed client to increase self-esteem. What behavior should the nurse recall as typical of this type of client? 1. Sets unrealistic goals 2. Engages in criminal activity 3. Attempts to manipulate others 4. Overestimates current strengths

1 Rationale: A depressed client may formulate goals that are unrealistic and therefore unattainable because of a lack of physical or emotional energy. This may trigger further negative feelings and decrease self-esteem. Goals based on cognitive distortions will also be unrealistic and lead to further negative feelings. Depressed clients are experiencing cognitive distortions and negativity and usually do not have a desire to manipulate others. Depressed clients are usually unable to see their strengths and abilities as a result of their negative thinking. Criminal activity is typically associated with antisocial personality disorder, not depression.

A client with a history of alcohol abuse says to the nurse, "Drinking is a way out of my depression." Which strategy will probably be most effective for the client at this time? 1. A self-help group 2. Psychoanalytical therapy 3. A visit with a religious advisor 4. Talking with an alcoholic friend

1 Rationale: Members of self-help groups, particularly Alcoholics Anonymous, are living with the problem themselves; therefore problem identification and self-responsibility are emphasized, and manipulation is limited. Long-term therapy tends to increase anxiety until resolution occurs; level of commitment and duration of therapy render it a less desirable choice for substance abusers. Depending on the client's feelings about religion, talking with a religious advisor may or may not be helpful. Whether talking with an alcoholic friend will be useful depends on the friend's drinking status; it may be helpful or harmful. These variables negate the effectiveness of this choice.

What are the "four As" for which nurses should assess clients with suspected Alzheimer disease? 1. Amnesia, apraxia, agnosia, aphasia 2. Avoidance, aloofness, asocial, asexual 3. Autism, loose association, apathy, affect 4. Aggressive, amoral, ambivalent, attractive

1 Rationale: Neurofibrillary tangles in the hippocampus cause recent memory loss (amnesia); temporoparietal deterioration causes cognitive deficiencies in speech (aphasia), purposeful movements (apraxia), and comprehension of visual, auditory, and other sensations (agnosia). Avoidance, aloofness, asocial, and asexual are characteristics of the schizoid personality. Autism, loose association, apathy, and affect are characteristics of schizophrenia. Aggressive, amoral, ambivalent, and attractive are characteristics of an antisocial personality.

A nurse is assessing a client with a diagnosis of primary insomnia. Which findings from the client's history may be the cause of this disorder? Select all that apply. 1. Fatigue 2. Severe anxiety 3. Acute pain 4. Loss of motivation 5. Reduced concentration 6. Irritability

1, 4, 5, 6 Rationale: Acute or primary insomnia [1] [2] is caused by emotional or physical stress not related to the direct physiologic effects of a substance or illness. Symptoms of primary insomnia that the nurse might assess in this client would be fatigue, loss of motivation, reduced concentration, and irritability. Severe anxiety and acute pain are not included in symptoms of primary insomnia.

The wife of a client who has completed alcohol detoxification relates that she is concerned about her husband's behavior if he starts drinking again. She says, "When the drinking starts it really disrupts my family, and I'm not sure how to handle it." What is the best response by the nurse? 1. "Include your husband in the family's activities even when he's been drinking." 2. "Attend Al-Anon meetings and avoid assuming responsibility for your husband's behavior." 3. "Search the house regularly for hidden alcohol and accompany your husband outside the home." 4. "Help your husband avoid embarrassment by making excuses for him when it's impossible for him to function."

2 Rationale: Encouraging the wife to attend Al-Anon and to stop making excuses for the husband supports the family of the addicted individual and allows the family to continue on with life by reducing their guilt. Including the husband in the family's activities even when he has been drinking will be impossible to accomplish; the wife has stated that the drinking disrupts the family. Telling the wife to search the house regularly for hidden alcohol and to accompany her husband outside the home places the burden for preventing drinking on the family and will produce feelings of resentment and guilt. The husband must assume responsibility for his behavior resulting from the drinking. Telling the woman to help her husband avoid embarrassment by making excuses for him when it's impossible for him to function is enabling behavior, which does not help the abuser or the family.

A client has just been admitted with the diagnosis of borderline personality disorder. There is a history of suicidal behavior and self-mutilation. What does the nurse remember is the main reason that clients use self-mutilation? 1. Control others 2. Express anger or frustration 3. Convey feelings of autonomy 4. Manipulate family and friends

2 Rationale: Typically, recurrent self-mutilation is an expression of intense anger, helplessness, or guilt or is a form of self-punishment. Self-mutilation is used not to control others but for self-validation; also, it is a means of blocking psychological pain by inducing physical pain. Self-destructive behaviors are not an expression of autonomy but rather an expression of negative feelings of anger, rage, and abandonment. Self-destructive behaviors represent not an attempt to manipulate others but rather a way to blunt emotional pain.

It is observed that at times a client with a personality disorder clings to the nurse and at other times he maintains a noticeable distance. From this pattern of behavior what does the nurse determine are the client's conflicting fears? 1. Shame versus rejection 2. Lost self-esteem versus hostility 3. Abandonment versus identity loss 4. Engulfment versus interdependence

3 Rationale: Alternating clinginess and distance reflects a reenactment of the mother-child relationship; behavior vacillates between distancing to avoid engulfment and clinging to avoid being rejected. Shame often results from a struggle but is not the focus of a conflicting fear. Self-esteem and fear of hostility are outcomes, not the focus of a conflict. Engulfment is part of the conflict, but interdependence is not a conflicting fear and may be a healthy balance of dependence and independence.

A client is admitted to the mental health hospital with the diagnosis of major depression. What is a common problem that clients experience with this diagnosis? 1. Loss of faith in God 2. Visual hallucinations 3. Decreased social interaction 4. Feelings about the future are absent

3 Rationale: Depressed clients demonstrate decreased social interaction because of a lack of psychic or physical energy. They tend to withdraw, speak in monosyllables, and avoid contact with others. Loss of faith and visual hallucinations are not commonly associated with the diagnosis of major depression. Hallucinations are associated with schizophrenic disorders. Depressed clients are commonly negative and pessimistic, especially regarding their future.

A client arrives at the mental health clinic complaining about feelings of extreme terror when attempting to ride in an elevator and feelings of uneasiness in large crowds. He reports that these fears are interfering with his concentration at work. What does the nurse identify as the source of these symptoms? 1. Conflict with society, resulting in an obsession 2. Depression about life events, resulting in unreasonable fears 3. Generalized anxiety about conflicts, resulting in unreasonable fears 4. Repression of a terrifying incident in an elevator, resulting in a phobia

3 Rationale: Phobias are specific fears that often serve as a means of coping with generalized anxiety. Conflicts with society do not result in phobias. Although depression is related to phobias, finding a direct connection to life events is difficult. Repression of a terrifying incident in an elevator does not result in a phobia. Repression is utilized as a coping mechanism to protect the client's conscious mind from thoughts or events that will cause them anxiety.

While identifying behaviors commonly exhibited by the client who has a diagnosis of schizophrenia, what can the nurse expect to observe? 1. Disorientation, forgetfulness, and anxiety 2. Grandiosity, arrogance, and distractibility 3. Withdrawal, regressed behavior, and lack of social skills 4. Slumped posture, pessimistic outlook, and flight of ideas

3 Rationale: Withdrawal, regressed behavior, and lack of social skills are classic behaviors exhibited by clients with a diagnosis of schizophrenia. Disorientation, forgetfulness, and anxiety are more commonly associated with dementia. Grandiosity, arrogance, and distractibility are more commonly associated with bipolar disorder, manic phase. Slumped posture, pessimistic outlook, and flight of ideas are more commonly associated with depression.

A client who has a long history of alcoholism has not worked for the past 10 years. When the nurse asks about daily activities the client responds, "I currently work in the office of a local construction company." Which mental mechanism should the nurse suspect that the client is using? 1. Regression 2. Sublimation 3. Compensation 4. Confabulation

4 Rationale: Confabulation is often used by people with alcoholism to cover lapses of memory that occur with Korsakoff syndrome; it is an unconscious means of self-protection. Regression is a return to a prior stage of development as a way to cope with stress. Sublimation is the channeling of unacceptable thoughts and feelings into socially acceptable behaviors. Compensation is replacement of a real or imagined deficit with a more positive attribute or trait.

A nurse who plans to care for a client with an obsessive-compulsive disorder should understand that the client's personality can usually be characterized in what way? 1. Marked emotional maturity 2. Rapid, frequent mood swings 3. Elaborate delusional systems 4. Doubts, fears, and indecisiveness

4 Rationale: This disorder is characterized by anxiety and minor distortions of reality. The anxiety results in an inability to reach a decision because all alternatives are threatening. Part of emotional maturity is the ability to relate to people, and these clients have difficulty in this area. Elaborate delusions are indicative of severe emotional illness, not an anxiety disorder. Rapid mood swings are indicative of a mood disorder.

__________ is replacement of a real or imagined deficit with a more positive attribute or trait

Compensation

___________ is the channeling of unacceptable thoughts and feelings into socially acceptable behaviors.

Sublimation