PREP U ::: Exam 1: Mood & Affect / Mental Health Concepts
What are the most common mental health problems in the United States? Select all that apply. Depression Schizophrenia Anxiety Substance abuse
Depression Anxiety Substance abuse Explanation: The most common mental health problems in the United States are depression, anxiety, and substance abuse, not schizophrenia. It is important to note that very often a person has several psychiatric diagnoses concurrently, not just one. Schizophrenia is not as common.
The nurse is educating the client with somatic symptoms disorder about the relationship between stress and physical symptoms. Which interventions can the nurse include in the education plan so the client will connect the mind-body relationship?
Keep a journal of physical symptoms and what the situation is at the time. Explanation: The nurse will educate the client about how stress and physical symptoms correlate and link the mind-body relationship. The client should be encouraged to keep a journal that helps them link the situation and feelings with the physical symptoms are present and whether they get better or worse. Limiting the time that clients can focus on physical concerns alone may be necessary. The nurse should provide attention and positive feedback for efforts to identify and discuss feelings. The client may require medication, but it should not be a substitute for dealing or coping with emotional issues.
A 15-year-old child has difficulty falling asleep on a nightly basis. The health care provider suspects a lack of melatonin. What endocrine gland secretes melatonin? Thyroid gland Thymus gland Parathyroid gland Pineal gland
Pineal gland Explanation: The pineal gland is attached to the thalamus in the brain. It secretes melatonin, which aids in regulating sleep cycles and mood.
A nurse's response to aggressive behavior on the unit is influenced by which characteristic of the nurse?
Self-awareness of reactions to aggression by others Explanation: Nurses' beliefs about themselves as individuals and professionals influence their responses to aggressive behaviors. The nurse's self-awareness of responses to anger, including fear of others' anger and any tendency to become angry, will help the nurse maintain composure and use good judgment. The nurse should not respond to negative emotions with similar emotions; the nurse must be calm, nonjudgmental, and nonpunitive when using techniques to control a client's aggressive behavior. The nurse can become more skilled in these techniques through practice and by observing more experienced staff. The response to aggression does not depend on understanding the client's thought processes.
At an outpatient clinic, a medical assistant interviews a client and documents the findings. The staff nurse reads the progress note and begins planning client care based on which nursing diagnosis?
fear related to potential diagnosis of malignant melanoma Explanation: Documentation reveals that the client is anxious about the symptoms. These symptoms most closely resemble malignant melanoma. Therefore, fear related to potential diagnosis of malignant melanoma is the most appropriate nursing diagnosis. The nursing note does not indicate that the client presently has deficient knowledge. The characteristics of the lesion are not consistent with a basal or squamous cell carcinoma or a benign nevus (mole).
The nursing instructor is illustrating the various types of play. The instructor determines the class is successful when the students correctly choose which example as best representing onlooker play? acting out a troubling situation observing without participating playing in an organized group with each other playing apart from others without being part of a group
observing without participating Explanation: Onlooker play occurs when there is observation without participation, such as watching television. Solitary independent play means playing apart from others without making an effort to be part of the group or group activity. Dramatic play allows a child to act out a troubling situation. During cooperative play, children play in an organized group with each other as in team sports.
A nurse is caring for a client in the postpartum period. When observing the client's condition, the nurse notices that the client tends to speak incoherently. The client's thought process is disoriented, and the client frequently indulges in obsessive concerns. The nurse notes that the client has difficulty in relaxing and sleeping. The nurse interprets these findings as suggesting which condition?
postpartum psychosis Explanation: The client's signs and symptoms suggest that the client has developed postpartum psychosis. Postpartum psychosis is characterized by clients exhibiting suspicious and incoherent behavior, confusion, irrational statements, and obsessive concerns about the baby's health and welfare. Delusions, specific to the newborn, are present. Sudden terror and a sense of impending doom are characteristic of postpartum panic disorders. Postpartum depression is characterized by a client feeling that life is rapidly tumbling out of control. The client thinks of oneself as an incompetent parent. Emotional swings, crying easily—often for no reason—and feelings of restlessness, fatigue, difficulty sleeping, headache, anxiety, loss of appetite, decreased ability to concentrate, irritability, sadness, and anger are common findings are characteristic of postpartum blues.
A nurse is assessing military personnel who have experienced combat and are diagnosed with posttraumatic stress disorder. Which client statement requires immediate intervention? "I have been increasing my lorazepam, but I am so tired I take naps every afternoon," "I have seen my therapist every week, but the therapist wants me to come twice a week now." "I had one glass of wine with my family during supper last night." "I cannot stop the nightmares, even the extra oxycodone pills I take do not work. It is not worth it."
"I cannot stop the nightmares, even the extra oxycodone pills I take do not work. It is not worth it." Explanation: Client safety is the priority. Increased use of opioids and stating "it is not worth it" can be considered suicidal. A client who increased lorazepam intake requires follow up, but this client is not the priority. Increasing benzodiazepine will cause fatigue, so afternoon naps are expected. Increasing the frequency of visits to a therapist are encouraged; there are no immediate concerns with seeing a therapist more often. Avoiding alcohol with posttraumatic stress disorder is encouraged; however, there's nothing immediately concerning with an adult having one glass of wine with supper.
A nurse is performing a psychosocial assessment on a 14-year-old adolescent. Which response to the assessment questions is not typical during early adolescence? "These questions are so stupid. When can I leave?" "I just want to go back to bed. When will this be done?" "I'm sorry for how I acted earlier. Let's finish these questions." "If I sit through this whole appointment, what do I get out of it?"
"I'm sorry for how I acted earlier. Let's finish these questions." Explanation: Moodiness may occur often during early adolescence. Moodiness occurs due to immature cognitive control and emotional development. Essentially, early adolescent clients (age 10-14) have difficulty coping with emotions. These emotions are affected by the hormonal and maturing issues that occur during this time period. Anger and combativeness are more typical of middle adolescence. Cooperativeness typically occurs during late adolescence. Indications of depression are taken seriously and are not attributed to moody behaviors or statements.
The parents of a toddler are concerned their child is not developing correctly and are questioning the nurse concerning the child's lack of effort to join other children in a group activity. Which response should the nurse prioritize in answering the parents? "You should try to get your child involved in a local Boys and Girls club to encourage more interaction." "Perhaps getting your child interested in sports will improve their other play habits." "This is normal for this age group. It's referred to as solitary independent play." "Your child is involved with others, just indirectly. See how they sit next to the other children and play with the same toys?"
"This is normal for this age group. It's referred to as solitary independent play." Explanation: Solitary independent play means playing apart from others without making an effort to be part of the group or group activity, which is normal for this age group. Associative play occurs when children play together and are engaged in a similar activity but without organization, rules, or a leader, and each child does what she or he wishes. During cooperative play, children play in an organized group with each other as in team sports. Parallel play occurs when the toddler plays alongside other children but not with them. As the child continues to mature, they will be more prepared and willing to join with others to play alongside in organized or unorganized situations.
The nurse is about to administer lithium carbonate to a client with bipolar disorder in a mania state. What is the nurse's action after assessing the client's lithium level to be 1.0 mEq/L (mmol/L)? Notify the healthcare provider. Hold the lithium carbonate. Repeat the lithium level. Administer the lithium carbonate.
Administer the lithium carbonate. Explanation: To treat acute mania, the client's serum lithium level should be between 0.6 and 1.2 mEq/L (mmol/L). The serum lithium level shouldn't exceed 2 mEq/L (mmol/L). The nurse must monitor the client continuously for signs and symptoms of lithium toxicity, such as diarrhea, vomiting, drowsiness, muscular weakness, ataxia, stupor, and lethargy. The nurse must also keep in mind that even a normal lithium level can become toxic. Notifying the healthcare provider of the normal level with a client in mania is not appropriate. There are no signs and symptoms of toxicity, so the medication should not be held. There is no reason to repeat the level.
When assessing a client with depression, the client states, "I just feel so sad and hopeless. I just don't care anymore. I don't even enjoy doing the crossword puzzles like I used to." A nurse documents this finding as indicative of what condition? Dysthymic disorder. Anhedonia. Delusion. Psychosis.
Anhedonia. Explanation: The client's statements reflect anhedonia, a loss of interest or pleasures such that the client does not experience any enjoyment in activities that were previously considered pleasurable. Dysthymic disorder is a milder but more chronic depression. Delusion is manifested as false, fixed beliefs. Psychosis is a state in which a person experiences symptoms such as hallucinations, delusions, or disorganized thoughts, speech, or behavior.
The parents of a 14-year-old child voice their concern to the clinic nurse about their child showing signs of depression. The parents have reported that the client has difficulty in school and that they have brought the child to the community mental health center for further assessment and treatment. What would be the priority assessments for the nurse to preform? Select all that apply. Labile moods Behavioral difficulties Cognitive impairment Anxiety disorder Irritability
Behavioral difficulties Irritability Explanation: Adolescents with depression typically demonstrate irritability and behavioral problems. Anxiety would not be a priority assessment because anxiety disorders are most commonly associated with younger children. Cognitive impairments are typically comorbid with delirium, dementia, and learning difficulties, and not a priority assessment with adolescent depression. Labile mood would be more characteristic of a client with bipolar disorder.
In which phase of the aggression cycle can techniques of seclusion or restraint be used to deal with the aggression quickly? Recovery Crisis Escalation Triggering
Crisis Explanation: In the crisis phase, seclusion or restraint may be used to deal with aggression quickly.
The nurse is caring for a young child whose parents are constantly arguing in front of the child. When the parents do this, the child becomes withdrawn and does not interact with anyone. Which of the following would be a priority intervention for the nurse to manage this situation? Consult a social worker to help the parents. Ask the parents to leave the room when they are arguing. Restrict the parents from visiting the child. Explain the effect of arguing on the child's well-being.
Explain the effect of arguing on the child's well-being. Explanation: Initially, information should be provided to the parents so that they understand the effect they are having on the child and the care that is being provided. If the situation does not change after this initial intervention, more serious options may be needed.
A healthcare provider (HCP) has prescribed valproic acid for a client with bipolar disorder who has achieved limited success with lithium carbonate. Which information should the nurse teach the client about taking valproic acid?
Follow-up blood tests are necessary while on this medication. Explanation: Valproic acid can cause hepatotoxicity, so regular liver function tests are needed. Other side effects include nausea and drowsiness. Extended-release tablets should not be split or crushed; doing so changes their absorption. Alcohol should never be mixed with this medication. There will be medication in the client's body at all times. Nausea and tachycardia are not common side effects of valproic acid.
A nurse is caring for clients with posttraumatic stress disorder (PTSD). Negative alterations in cognition and mood associated with the traumatic event are important features of PTSD. Knowing this, which symptoms is the nurse likely to find in such clients? Select all that apply. Getting angry with little or no provocation Trying to help people who have been victims of the traumatic incident Having negative beliefs about oneself Inability to remember important aspects of the traumatic event Seeking company of others
Having negative beliefs about oneself Getting angry with little or no provocation Inability to remember important aspects of the traumatic event Clients with PTSD have persistent and exaggerated negative beliefs or expectations about themselves. They have a persistent inability to experience positive emotions, that is, inability to experience happiness, satisfaction, or loving feelings. These clients have hyperarousal and get angry with little provocation. They are unable to remember important aspects of the traumatic event because of dissociative amnesia. Such patients have feelings of detachment from others and do not seek the company of others. Trying to help people who have been victims of the traumatic incident is a positive behavior that is not commonly seen in clients with PTSD.
A 28-year-old client in her first trimester of pregnancy reports conflicting feelings. She expresses feeling proud and excited about her pregnancy while at the same time feeling fearful and anxious of its implications. Which action should the nurse do next? Determine if the client's significant other is experiencing similar feelings about the pregnancy. Provide the client with information about pregnancy support groups. Schedule the client a consult with a psychiatric health care provider. Inform the client this is a normal response to pregnancy that many women experience.
Inform the client this is a normal response to pregnancy that many women experience. Explanation: The maternal emotional response experienced by the client is ambivalence. Ambivalence, or having conflicting feelings at the same time, is universal and is considered normal when preparing for a lifestyle change and new role. Pregnant women commonly experience ambivalence during the first trimester.
A psychiatric-mental health nurse is feeling highly anxious before conducting an interview with a client. The nurse's experience of anxiety will impact the client assessment in which way? It will be detrimental to the interaction by decreasing the client's self-awareness. It will be detrimental to the interaction by decreasing the nurse's focus and attention. It will be beneficial to the interaction by increasing the nurse's focus and attention. It will be beneficial to the interaction by increasing the client's focus and attention.
It will be detrimental to the interaction by decreasing the nurse's focus and attention. Explanation: Anxiety on the nurse's part is one of many factors that can influence outcomes. It is widely recognized that as anxiety increases, the person's ability to focus narrows. Nurses who begin interviews in a highly anxious state may find it difficult to focus on thorough data collection or interpretation.
The adolescent client has become bored with the video game system, which had been the positive reward for cleaning one's room. Which intervention would be most effective intervention at this time?
Let the adolescent choose another reward that would be more fun. Explanation: Positive rewards need to be viewed as desirable to motivate desired behavior changes. One method of rewards/punishment is the token system. The child is rewarded for good behavior with a token and the token is taken away for inappropriate behavior. When the child has collected a specified amount of tokens or a specific time has occurred the token can be exchanged for a reward. If the adolescent is bored or distracted with the video game then it is not serving the purpose for which it was intended. The nurse should allow the adolescent to select another reward as a result of good behavior and as specified by the parents in the rules for the adolescent. Making the adolescent continue to use the gaming system only increases anger, frustration and aggression.
The nurse is caring for a 10-year-old recently diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse would expect to provide teaching regarding which medication?
Methylphenidate Explanation: Methylphenidate is a psychostimulant commonly prescribed for ADHD. Trazodone is used to treat depression. Buspirone is used for anxiety. Fluoxetine is used for depression.
A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what? Hypersomnia Terminal insomnia Initial insomnia Middle insomnia
Middle insomnia Explanation: The most common sleep disturbance associated with major depression is insomnia, which is categorized according to three categories: initial insomnia (difficulty falling asleep), middle insomnia (waking up during the night and having difficulty returning to sleep), and terminal insomnia (waking too early and being unable to return to sleep). Less frequently, the sleep disturbance is hypersomnia (prolonged sleep episodes at night or increased daytime sleep).
The partner of a pregnant client in her first trimester asks the nurse about the client's behavior recently, stating that she is very moody, seems happy one moment and is crying the next and all she wants to talk about is herself. What response would correctly address these concerns?
Pregnant women often experience mood swings and self-centeredness but this is normal. Explanation: During the first trimester of pregnancy, the woman often has mood swings, bouts of irritability and is hypersensitive. The partner needs to know that these are all normal behaviors for a pregnant woman.
A nurse caring for a client with multiple sclerosis notes that the client has mood swings. Which cause can best explain this? Psychological manifestation due to involvement of white matter of cerebral cortex A side effect of treatment Depression over new diagnosis Likely a preexisting mental illness
Psychological manifestation due to involvement of white matter of cerebral cortex Explanation: Involvement of the cerebral cortex can lead to a variety of mood and cognitive disruptions.
A parent brings a 6-year-old child in for a wellness checkup and tells the nurse that the child sometimes wakes up screaming at night. When the parent goes to check on the child, the parent observes the child "sitting up in bed, screaming, sweating, and breathing rapidly." The nurse knows that these symptoms may indicate:
Sleep terrors Explanation: Sleep terrors are marked by repeated episodes of awakening from sleep. They usually occur during the first third of the night lasting between 30 seconds and 3 minutes. The peak onset is usually between 5 and 7 years of age. In a typical episode, the child sits up abruptly in bed, appears frightened, and demonstrates signs of extreme anxiety, including dilated pupils, excessive perspiration, rapid breathing, and tachycardia.
The nurse is examining a 3-year-old girl during a regular visit. Which finding would disclose a developmental delay in this child? The child imitates the nurse in use of a stethoscope. The child demonstrates separation anxiety. The child copies a circle on a piece of paper. The child follows directions when made one at a time.
The child demonstrates separation anxiety. Explanation: The child should be past the stage of separation anxiety by age 3 years. Imitating actions, copying a circle on paper, and responding to single requests are developmentally appropriate.
A nurse is developing a presentation for families who have members diagnosed with bipolar disorders. When describing this condition to the group, which would the nurse most likely include? As the person ages, the episodes tend to decrease. Environmental stressors are a key cause of these disorders. The risk for suicide is high with either depression or mania. Risk-taking behaviors are more common during a depressive episode.
The risk for suicide is high with either depression or mania. Explanation: The risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may feel that life is not worth living. During a manic episode, the client may believe that they have supernatural powers, such as the ability to fly. As clients recover from a manic episode, they may be so devastated by the consequences of their impulsive behavior and poor judgment that suicide seems like the only option. Manic or depressive episodes tend to accelerate over time, with each episode leaving a trace and increasing the person's vulnerability (or sensitizing the person to have another episode with less stimulation). Environmental conditions contribute to the timing of an episode of the illness but are not a cause of the illness. During a manic episode, poor judgment and impulsivity lead to risk-taking behaviors.
A client in her seventh week of the postpartum period is experiencing bouts of sadness and insomnia. The nurse suspects that the client may have developed postpartum depression. What signs or symptoms are indicative of postpartum depression? Select all that apply. inability to concentrate decreased interest in life manifestations of mania bizarre behavior loss of confidence
inability to concentrate loss of confidence decreased interest in life Explanation: The nurse should monitor the client for symptoms such as inability to concentrate, loss of confidence, and decreased interest in life to verify the presence of postpartum depression. Manifestations of mania and bizarre behavior are noted in clients with postpartum psychosis.
Which behaviors are forms of emotional abuse? Select all that apply. humiliating incest rape destroying another's property insulting
insulting humiliating destroying another's property Explanation: Emotional abuse includes behaviors such as criticizing, insulting, humiliating, or ridiculing someone in private or in public. It can also involve actions such as destroying another's property, threatening or harming pets, controlling or monitoring spending and activities, or isolating a person from family and friends. Rape and incest are forms of sexual assault.
A nurse is working with the parents of a child just diagnosed with attention deficit hyperactivity disorder (ADHD). Which aspect will the nurse emphasize as crucial for the child?
structured learning environment Explanation: Although medication and counseling/support are important, a structured learning environment is crucial for children with attention deficit hyperactivity disorder (ADHD). Children and adolescents with ADHD respond best in an environment that is structured and predictable, with clear and consistent rules and expectations.
