Psych Exam 3
The nurse completes an intake assessment for a client. Which symptoms are associated with dependent personality disorder? Select all that apply.
-Difficulty making everyday decisions -Withdrawal from adult responsibilities -Expresses fears of being unable to manage self-care
The nurse provides education to the parent of a child diagnosed with intermittent explosive disorder. In addition to medication, what additional therapy does the nurse recommend?
Anger management
Which term describes feelings of being disconnected from oneself, as seen in a panic attack?
Depersonalization
A group of nursing students are reviewing signs and symptoms of anxiety. The students demonstrate a need for additional review when they identify what?
Tearfulness
The psychiatric mental health nurse is performing a suicide assessment of a client who has obsessive-compulsive disorder (OCD). What data should the nurse prioritize in order to maximize the accuracy of this assessment?
The amount of psychological distress that the client's compulsions cause
A nurse is talking with a client who has experienced panic attacks. The client asks the nurse, "What causes these attacks?" Which information would the nurse most likely integrate into the response about the etiology of panic disorders?
There is evidence of a substantial familial predisposition to panic disorder
When discussing a school-aged child's behavioral contract with the school staff, how should the nurse most effectively explain a time-out?
a retreat away to regain self-control
A nurse is visiting an elderly client at home. The client has been seen hoarding, and the smell is offensive when the nurse comes to visit. Which is an indicator of hoarding?
a single path throughout the yard and house
A client has been receiving medications and supportive therapy for the outpatient treatment of obsessive-compulsive disorder. When asked about the effect of treatment on the rituals, the client is vague and noncommittal. Which action would the nurse do next?
consults with the client's family
The psychiatric mental health nurse has taught a client with obsessive-compulsive disorder (OCD) about the use of cue cards. This intervention will allow the client to:
counter obsessive thinking with positive messages.
The nurse is providing care for a psychiatric-mental health client who has a diagnosis of anxiety. Which statement by the nurse is likely the most therapeutic intervention?
"Anxiety is a feeling that is experienced by everyone at some point and it can never be completely removed from one's life."
A client with generalized anxiety disorder states that the client is worried about the client's job. The client never feels like the client has control over the client's responsibilities, even though the client puts in extra hours. The client adds that the client is afraid the client will be fired. Which response by the nurse is most therapeutic?
"Has something changed at work that is causing you to worry?"
A client with a dependent personality disorder is receiving treatment on a medical unit. The client asks the nurse for assistance to open the tube of toothpaste so they can brush their teeth. Which is the best response by the nurse?
"I'll stay here and you can show me what you've tried to do to get the top off"
At 2200 hrs a client diagnosed with antisocial personality disorder (ASPD) demands to phone a lawyer to argue his involuntary status in a psychiatric facility. The unit follows a policy that prohibits the use of the phone after 2200 hrs. What is the nurse's best response?
"It is after the 2200 hrs phone curfew. You will be able to call tomorrow."
A client asks the nurse, "Why do I have to go to counseling? Why can't I just take medications?" The best response by the nurse would be:
"Medications combined with therapy help you change how well you function."
A nurse is giving a presentation on mental health promotion to college students. One student asks the nurse to explain the difference between normal anxiety and an anxiety disorder. Which response is best?
"People with anxiety disorders generally find that the anxiety interferes with daily activities."
It is 2000 hrs and a voluntary client with the diagnosis of antisocial personality disorder (ASPD) is out on a leave from the inpatient unit. The leave is supported by the treatment plan. The psychiatrist's order states the client is to return at 2100 hrs. The client calls the unit, speaks with the nurse and states, "2000 hrs doesn't give me enough time." What is the nurse's best response?
"Return on time or future restrictions will be imposed."
A new client with a long-standing history of obsessive-compulsive disorder (OCD) is describing to the nurse the complex ritual of locking and unlocking a door after entering a room alone. What is the nurse's most therapeutic response?
"The process you're describing sounds like it must require quite a bit of time and energy."
The nurse is talking to a client with schizoid personality disorder about finding a job. Which suggestion by the nurse would be most helpful?
"There is a job posting at the hospital for a file clerk in medical records."
The client has an order for an anxiolytic agent, lorazepam (Ativan). Which of the following statements by the client would indicate that client education about this medication has been effective?
"This medication will relax me so I can focus on problem solving."
An anxiolytic agent, lorazepam, has been prescribed for the client. Which statement by the client would indicate to the nurse that client education about this medication has been effective?
"This medication will relax me, so I can focus on problem solving."
Which statement, made by a client diagnosed with an anxiety disorder, should trigger the nurse's concern about the client's understanding of the use of defense mechanisms?
"When I have a problem, I just deny it until it goes away."
A client is currently experiencing a panic attack. Which is the most appropriate response by the nurse?
"You are safe. Take a deep breath."
A nurse providing care to a client with avoidant personality disorder establishes the underlying cause of problematic behavior. The client states, "I've pushed all my friends away and I hardly ever get out to have fun." Which is the nurse's best response?
"You have a fear of being rejected by others."
A nurse has worked for a year with a client with Antisocial Personality Disorder (ASPD). The client offers to provide fitness consultation for the nurse at a gym the client attends. Which is an effective response?
"You seem interested in fitness and helping others"
A nurse is caring for a variety of children on a psychiatric unit. Which child is at risk to develop narcissistic personality disorder? Select all that apply.
-A child movie actor -An only child of a prominent sports celebrity -A child of parents with narcissistic personality disorder
A client with a history of obsessive-compulsive disorder has been brought to the emergency department after being found attempting to cut his wrists. His sister states, "His rituals have been getting worse and worse for months, and it's pushed him to the absolute breaking point." What should the client's immediate care include? Select all that apply.
-Administration of benzodiazepines as prescribed -Continuous observation due to suicide risk -Admission for inpatient treatment
The nurse caring for clients with antisocial personality disorder (ASPD) has determined patterns that challenge her capacity to establish a therapeutic relationship with clients with ASPD. Which are challenges to the therapeutic relationship? Select all that apply.
-An initial bond that is only superficial -A loss of trust when client is challenged by the nurse
After reviewing the different types of personality disorders, a group of nurses demonstrates understanding when they identify which type as being associated with emotional volatility? Select all that apply.
-Histrionic -Narcissistic
A nurse working in an outpatient recovery program for clients with serious mental illness receives a referral to accept a client with a co-occurring schizoid personality disorder. The nurse establishes that this new client would have some challenges with group-based therapy in the program. Which are characteristics expected with the client? Select all that apply.
-Limited social skills -Reluctance to join group activities -Limited expressions of feelings and emotions
A nurse working in an inner city youth support program identifies that antisocial personality disorder (ASPD) can develop in those who have dysfunctional attachments. Which are risks for developing dysfunctional attachments? Select all that apply.
-Losing of a parent through death -Experiencing physical or sexual abuse -Experiencing parental abandonment or neglect
A nurse is assessing a client diagnosed with obsessive-compulsive personality disorder (OCPD). Which would the nurse expect to find? Select all that apply.
-Need for perfection -Adherence to a highly structured life -Overly moralistic
Which would a nurse assess in a client suspected of having paranoid personality disorder? Select all that apply.
-Need to be in a position of power in a relationship -Suspiciousness and guarded behavior -Outwardly argumentative
The nurse seeks to establish trust while assessing the social history of a client with antisocial personality disorder (ASPD). Which findings demonstrate understanding of the client's relationship challenges? Select all that apply.
-Relationships end suddenly -A pattern of failed relationships -Success establishing relationships
A school-age child has a diagnosis of disruptive behavior disorder. The school nurse conducts an education session to help the parents understand the diagnosis and to teach skills that the parents can implement to help address disruptive behavior. What can parents do to help? Select all that apply.
-Teach problem-solving skills - Use time out for disruptive behavior -Make behavioral expectations clear and consistently enforce them
The client has shown much improvement for obsessive-compulsive disorder (OCD). Which would be appropriate outcomes for a client with OCD? Select all that apply.
-The client will spend less time performing rituals. -The client will complete daily routine activities within a realistic time frame. -The client will demonstrate effective use of behavior therapy techniques.
Which are features of the thinking of a person who has obsessive-compulsive disorder (OCD), according to the cognitive model? Select all that apply.
-The person with OCD believes one's thoughts are overly important and has a need to control those thoughts as they overestimate the threat posed by their thoughts. -The person with OCD is concerned with perfectionism and has an intolerance of uncertainty. -The person with OCD has an inflated personal responsibility.
A client with a diagnosis of antisocial personality disorder would exhibit a history of conduct disorder before which age?
15 years
A nurse is preparing a presentation for a group of staff nurses on personality disorders. When describing antisocial personality disorders (ASPD), the nurse would explain that for a person to be diagnosed with the disorder, the person must be at least which age?
18 years
The nurse recognizes that who is the client most likely experiencing generalized anxiety disorder (GAD)?
40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months
Which client is most likely to be diagnosed with body dysmorphic disorder (BDD)?
A client who firmly believes that everyone who sees the client fixates on the size of the client's ears
Which client is most likely to benefit from the administration of selective serotonin reuptake inhibitors (SSRIs)?
A client whose obsessive-compulsive disorder (OCD) has not responded to cognitive- behavioral therapy
The nurse provides education about antisocial personality disorder (ASPD) to a group of vocational support workers involved with former inmates entering the workforce. Which description outlines how ASPD is defined?
A pattern of disregard for and violation of the rights of others
Which client is most likely to be at risk for drug dependence and difficulties with withdrawal?
A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident
A patient's mental health disorder is characterized by the patient's excessive cleaning of her surroundings. How can the nurse best address the biochemical aspects of the patient's disorder?
Administer sustained serotonin reuptake inhibitors (SSRIs) as prescribed
The psychiatric mental health nurse is participating in an interdisciplinary meeting about an inpatient client with severe obsessive-compulsive disorder. It comes to light that some members of the care team are allowing the client unlimited time to complete her rituals while others are enforced strict limits. What is the team's best response?
Agree on specific limits that will be consistently enforced
Panic disorder is treated with cognitive-behavioral techniques and deep breathing and relaxation, in addition to which of the following?
Anti-anxiety medication
The nurse is interviewing a client with diagnoses of obsessive-compulsive disorder (OCD) and depression. The client has scored high on the Yale-Brown Obsessive Compulsive Scale and acknowledges that his rituals cause him great distress. What is the nurse's best initial action?
Assess the client's risk for self-harm
When planning for a client with obsessive-compulsive disorder (OCD) who has been admitted for severe exacerbation of symptoms, the nurse should set which intervention as a priority?
Assessing the client for suicide risk since because the client may also have a major depression.
A client with antisocial personality disorder uses manipulation to try leaving the unit with another client's family members after visiting hours. Which of the following interventions is best to deal with the manipulative behavior?
Assist the client to identify patterns of behavior and consequences as determined by the team plan.
The nurse is preparing for outpatient placement of the client with obsessive-compulsive disorder (OCD). Which treatment modality is most effective for OCD?
Behavioral techniques and medication
When a client with obsessive-compulsive disorder (OCD) has developed self-harming thoughts and actions, the emergency department nurse should expect to administer which medication to assist with the client's anxiety/panic?
Benzodiazepines such as lorazepam
The nurse collaborates with a client with antisocial personality disorder (ASPD) on their recovery plan. The nurse is aware that many clients with ASPD do not engage in criminal activity and can meet some of their needs in their workplace. Which job does the nurse identify to the client for their consideration?
CEO (Chief executive officer)
While administering an admission assessment for a client with obsessive-compulsive disorder (OCD), which of the following is the best technique for the nurse to use?
Calm, nonauthoritarian approach with patience and active listening
A nurse is planning care for a client who has been diagnosed with trichotillomania. Which outcome should the nurse include in the client's plan of care?
Client will demonstrate healthy coping strategies for dealing with stressors
A client with antisocial personality disorder (ASPD) is seen in the emergency department (ED) following threats of taking an overdose. The suicidality was prompted by fraud and the client being barred from living with family. During the assessment the nursing diagnosis of dysfunctional family processes was identified. What is the outcome for this session?
Communicate to the client's family that the client is safe
A client spends hours stacking and unstacking towels. The client is repeatedly checking to make sure that the towels are in order of color. What term is used to identify this behavior?
Compulsion
The mental health nurse explains that the difference between an obsession and a compulsion can correctly be identified as what?
Compulsion involves repeating a purposeful action
Clients taking benzodiazepines need education about what?
Concomitant use of alcohol
To be diagnosed with antisocial personality disorder (APD) as an adult, characteristics of which mental health disorder must be met?
Conduct disorder
The nurse is educating a client and family about managing panic attacks after discharge from treatment. The nurse includes which in the discharge teaching? Select all that apply.
Continued practice of relaxation techniques Continued development of positive coping skills Development of a regular exercise program
A young parent tells the nurse, "I can't stop smoking. That is what I do to make myself feel better." What is the term used to describe this behavior?
Coping Mechanism
A client responds to bad news regarding test results by crying uncontrollably. What is the term for this response to a stressor?
Coping Mechanisms
A nurse is reviewing the medical record of a 10-year-old client diagnosed with conduct disorder. The nurse identifies which situation as supportive of the client's diagnosis?
Cruelty to family pet
The nurse documents that the client is in a state of panic anxiety when she is observed doing which of the following?
Crying hysterically and complaining of a shortness of breath prior to a cardiac procedure
A nurse working in a children's hospital is mindful of those at greatest risk of developing dependent personality disorder as adults. A child with which diagnosis is at highest risk of developing this disorder?
Cystic Fibrosis
The client has been defensive toward communication with the nurse today. Which can be a positive outcome of using defense mechanisms?
Defense mechanisms can help a person to reduce anxiety.
The nurse in a medical setting provides care for a client with histrionic personality disorder concurrent with their medical challenges. During the initial assessment with the client, the nurse identifies an altered expression of sexuality. To guide further assessment, what factor does the nurse anticipate from the client?
Demonstration of seductive behavior
The nurse assesses a client who states they have only two friends. The client shares that they are willing to do anything to maintain these relationships, including putting others' needs before theirs, being submissive and adapting their behavior to please these two friends. The client explains that they find decision making a challenge and that these two friends make most of the decisions. These characteristics are associated with which personality disorders?
Dependent
An adult female client presents to the mental health clinic and is assessed by the nurse. During the assessment, the nurse observes the client engage warmly with an appropriately variable affect and to be open to share their life story. The story included a pattern of failed intimate relationships, which the client attributes to a mild form of cerebral palsy. The client lives in the parental home. The client's father died when she was in high school and her mother passed away three months prior to the assessment. Interpersonally the client says she works hard to avoid conflict. References are made to being "unlovable" and that she is "engulfed in sadness" to the point of needing a disability income. This is due to the expressed fear of being "unable" to care for everyday needs independently. What disorder does the nurse suspect?
Dependent personality disorder
The nurse is teaching parents of infants about the importance of autonomy and instilling coping skills in children. The nurse explains that these abilities can fail to develop in children whose parents offer high levels of affection as the parents overprotect their children. Which disorder is associated with overprotection in children?
Dependent personality disorder
A nurse is providing care to a client diagnosed with kleptomania. When reviewing the client's history, which mental health disorder would the nurse expect to find?
Depression
The nurse correctly identifies that which of a client with OCD's self-soothing behaviors may involve self-destruction of the body? Select all that apply.
Dermatillomania Trichotillomania Onychophagia
The nurse is conducting an admission assessment of a client who has a history of generalized anxiety disorder. After gauging the client's level of anxiety, what other assessment should the nurse prioritize?
Determining whether there is potential for the client to harm himself or herself or others
A client diagnosed with body dysmorphic disorder (BDD) will primarily focus on what?
Discussing real or imagined defects in appearance, such as having a "long" nose
A client has been diagnosed with obsessive-compulsive disorder (OCD). What action by the nurse best addresses the behavioral factors that are believed to underlie the disease?
Discussing the "payoff" of anxiety reduction that results from performing compulsions
A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding?
Distorted sensory awareness
In teaching a client who has been prescribed a benzodiazepine for panic disorder, the nurse must be certain to do what?
Educate the client that this medication has a high risk for withdrawal symptoms, and the client should not discontinue without a doctor's supervision.
The nurse working in an outpatient clinic collaboratively establishes a plan for a client with schizoid personality disorder. An initial outcome is identified related to social isolation. Which activity identifies successful achievement of the outcome?
Engaged in solitary activity such as walking
A nurse is preparing a teaching plan for a client with antisocial disorder. Which would the nurse most likely employ to promote successful education?
Engaging the client in a discussion to direct the topic to the client.
A client with obsessive-compulsive disorder has been prescribed clomipramine. What action should the nurse encourage so the client can prevent adverse effects?
Ensure adequate fluid intake throughout the day
A client is admitted to a hospital medical unit. The admitting diagnosis is antisocial personality disorder. The client has alcohol use and also expressed a suicidal plan. What is the nurse's priority intervention for this client?
Ensure safety of the client
A nurse prepares an educational program for women during antenatal care. An outcome of the teaching is to lower the risk of antisocial personality disorder (ASPD) in the population who access the program. Which is a priority teaching need?
Ensuring attachment after birth
A client states that the client has just had an argument with the client's spouse over the phone. What can the nurse expect that the client's sympathetic nervous system has stimulated the client's adrenal gland to release?
Epinephrine
Nursing interventions for physical stress related illness should include what?
Establishing daily routines of meals and sleeping
Which assessment question is most likely to allow the nurse to differentiate between anxiety disorder due to a general medical condition and psychological factors affecting a medical condition?
Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first
The student nurse correctly identifies that which are characteristics of hoarding disorder? Select all that apply.
Excessive acquisition of animals or apparently useless things Cluttered living spaces that become uninhabitable Significant distress or impairment for the individual
A teenager and the teenager's parents visit the clinic to discuss the teen's skin picking. There are many bleeding wounds and various stages of scabs located up and down both arms. The parents are very upset about this behavior and want it to stop. Which would the health care provider document?
Excoriation disorder
The psychiatric mental health nurse is planning the care of a client whose elaborate room entry and exit rituals have led to a diagnosis of obsessive-compulsive disorder (OCD). What action by the nurse best addresses possible psychodynamic aspects of the etiology?
Exploring the characteristics of the client's defense mechanisms
A nurse is assessing the vital signs of a client in the cardiac clinic. The nurse observes the client's blood pressure and heart rate are higher than what is normally expected for this client. The client tells the nurse, "I'm always so nervous when I come to the clinic." The nurse interprets the client's statement and vital signs as reflecting which situation?
Fight or flight response
Which area of the brain can be impaired for an individual with antisocial personality disorder (ASPD)? Click the affected region.
Frontal lobe
A client asks how the client's prescribed alprazolam helps the client's anxiety disorder. The nurse explains while teaching the client about medications that antianxiety medications such as alprazolam affect the function of which neurotransmitter that is believed to be dysfunctional in anxiety disorders?
GABA
Following an incident of self-harm, a client with obsessive-compulsive disorder is being admitted to the psychiatric unit. How should the nurse best address the client's anxiety around performing compulsive rituals in this unfamiliar setting?
Give the client a clear and detailed description of unit routines
A client is diagnosed with obsessive-compulsive disorder. Which of the following should be included in the plan of care for this client?
Giving the client time to perform rituals
Before eating a meal, a client with obsessive-compulsive disorder must wash her hands for 14 minutes, comb her hair for 114 strokes, and switch the light off and on 44 times. What is the most important treatment goal for this client?
Gradually decrease the amount of time spent performing rituals.
The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which characteristic?
Heightened focus
The nurse is working in a prison setting with a client diagnosed with Antisocial Personality Disorder (ASPD). The client has identified impulse control issues particularly around urges for sexual intimacy. The client has assaulted people who have interfered with their gratification. What is the priority intervention for the nurse?
Helping to express anger in an adaptive and non-violent manner
A 36-year-old client demonstrates a pattern of overexpressiveness with emotions. The client has a relationship history in which the client is attention seeking. The client has recently been experiencing difficulty maintaining appropriate boundaries with colleagues at a new job. The nurse would most likely suspect which disorder?
Histrionic personality disorder
Concomitant use of antidepressants with monoamine oxidase inhibitors (MAOIs) can cause which life-threatening drug interaction?
Hypertensive crisis
A client diagnosed with obsessive-compulsive disorder (OCD) is attempting to resist a compulsion. Based on this finding, the nurse should assess the client for ...
Increased anxiety
Linn is a 42-year-old woman who is in the process of moving house after her divorce. She reports experiencing bouts of increased anxiety recently. How can the nurse best explain the physiological adaptation that occurs during fight or flight to this client?
Increased blood flow to the muscles
After teaching a group of nurses about different personality disorders, the group leader determines that the education was successful when the nurses identify which characteristic of schizotypal personality disorder?
Increased eccentricity
An adolescent client reveals that she is about to take a math test from her tutor. Nursing assessment reveals mild anxiety. The nurse explains that this level of anxiety does what?
Is conducive to concentration and problem solving
The nurse is providing education to a group of persons from several community agencies about hoarding by elder persons. Which is important for the nurse to emphasize?
It is not beneficial to tell the client that the client's thoughts and rituals interfere with the client's life or that the client's ritual actions really have no lasting effect on anxiety.
An adolescent who is seeing the school health nurse states, "I won't be able to hang out with my friends on Friday night because I have two essays due Monday." What level of anxiety is the adolescent experiencing?
Mild
During which type of anxiety does a person's perceptual field actually increase?
Mild
A client presents to a mental health clinic. The nurse notes that the client is grandiose and brags that that they earn "a six-figure income" and tells the nurse that they are more well known that the president. Which diagnosis is grandiosity associated with?
Narcissistic personality disorder
After reviewing information about the various impulse control disorders, a nurse demonstrates understanding of the information by identifying which disorder as involving a persistent pattern of disobedience and argumentativeness?
Oppositional defiant disorder
The school nurse is observing children in a classroom at the teacher's request. The teacher has concerns that one child is continuously disruptive. The nurse observes that the child sits alone without an obvious friend. The child goes to a group of classmates using building blocks. The child knocks down the tower and blames another child for the mishap. The teacher intervenes and the child is immediately argumentative with the teacher. The child has an angry outburst and kicks the blocks while walking away. Which disorder does the nurse identify from the child's behavior?
Oppositional defiant disorder
The psychiatric mental health nurse has received a referral from a community health nurse regarding a client who appears to have hoarding disorder. When planning this client's care, the nurse should prioritize what consideration?
Promoting the client's safety in the home environment
A client with obsessive-compulsive disorder has obsessions related to the threat of contamination and compulsions of handwashing. In order to protect the client's skin integrity, the nurse should:
Provide soap with moisturizer in it
Upon admission, a client with a personality disorder identifies areas of concern for which the client would like help. The nurse is aware that which will most likely be addressed by the health care team?
Psychological distress
Relaxation techniques help clients with anxiety disorders because they can promote what?
Reduction of autonomic arousal
A client in a psychiatric unit is diagnosed with antisocial personality disorder (ASPD). The client becomes aggressive and hits another client on the unit in a disagreement over the TV remote. Staff gains control of the situation. When planning for the next day, what is the priority intervention for the client?
Reinforce strategies to express anger in an adaptive manner
A psychiatric-mental health nurse is conducting a program for a group of young adults at a community center about anxiety. The nurse determines that the teaching was successful when the group identifies which aspect about anxiety?
Relief behaviors can prevent anxiety from increasing.
The nurse is caring for clients in the outpatient unit. Which would be key points for the nurse to remember when working with clients who are suffering from anxiety disorders?
Remember to practice techniques to manage stress and anxiety in the nurse's own life.
When discussing a school-aged child's behavioral contract with the school staff, how should the nurse most effectively explain a time-out?
Retriet away to gain self control
A client arrives on the psychiatric unit exhibiting restlessness, disorientation, incoherent speech, agitation, purposeless physical activity, and suicidal ideations. Which of the following is the priority nursing diagnosis for this client?
Risk for injury
A client with antisocial personality disorder (ASPD) is admitted to hospital. The nurse identifies which nursing diagnosis as the priority?
Risk for other directed violence
A nurse is providing care to a client with social anxiety disorder. Based on the nurse's understanding of pharmacotherapy, which medication would the nurse anticipate being used as part of the treatment plan?
SSRI (selective serotonin reuptake inhibitors)
Which medication classification has most commonly been used to treat social phobia?
SSRI's
A nurse working in a community health promotion program knows that disruptive behavior disorder is a precursor to some personality disorders in adults. Which population has the highest prevalence of disruptive behavior disorder?
School-age boys
After reviewing various etiologic theories associated with panic disorder, the nurse demonstrates understanding of the psychodynamic theory, identifying which as the underlying cause?
Separation or loss
A 30-year-old client who has been unemployed secondary to the client's anxiety disorder states that the client would like to have a job where the client is alone and no one needs to evaluate the client's work. The nurse interprets these comments as an indicator of what?
Social Anxiety Disorder
A client who experiences panic anxiety around dogs is sitting in a room with a dog and the client's nurse therapist. The nurse therapist is using which behavioral intervention for this type of anxiety?
Systematic desensitization
A client with obsessive-compulsive disorder (OCD) states making a concerted effort to reduce the frequency and duration of rituals. What intervention should the nurse include to assist in these efforts?
Teach the client nonpharmacologic relaxation techniques
Which is the main reason why the periodic team meetings are important when caring for a client with antisocial personality?
Team consistency is important to prevent manipulation by the client.
A client with a diagnosis of dependent personality disorder is recovering from surgery. The nurse considers the importance of avoiding some interventions that could be therapeutic for another client without a personality disorder. Which intervention will the nurse avoid?
Telling the client what to do
The nurse conducts an assessment to rule out antisocial personality disorder (ASPD) in a young adult. What aspect of the client's childhood is the priority assessment?
Temperament
A male client addicted to cocaine is interviewed by the nurse in a community outpatient addiction program. The client reveals that he engages in criminal behavior to support his drug habit. When in the pursuit of drugs, the client relies on stealing and prostitution; otherwise, the client does not engage in criminal activity. For what reason does the nurse determine a diagnosis of antisocial personality disorder (ASPD) is not warranted?
The client engages in antisocial behavior only to obtain drugs
The nurse is performing an assessment of a client who has obsessive-compulsive disorder (OCD). When assessing the client's risk for suicide, the nurse should prioritize what assessment finding?
The client expresses that he feels "utterly hopeless" change his behavior
The nurse is caring for the nurse's first client with obsessive-compulsive disorder. During the treatment team meeting, the nurse shares frustration as to the client's inability to stop washing the hands. The nurse manager offers which explanation?
The client feels terrible but cannot stop washing the hands to try to get rid of anxiety.
The nurse understands that a certain level of anxiety is required in a client for effective learning. Which anxiety-related symptom indicates the client may be able to learn effectively?
The client has heightened awareness
A client reports the client has been experiencing increased stress at work. The client has been managing the stress by drinking 2-3 glasses of wine per evening. Despite the nurse recommending that drinking alcohol is not an effective way to manage the stress, the client reports it is unlikely that the client will be able to stop. Which statement explains why this will be difficult for the client?
The client has no adaptive coping mechanisms.
The client and nurse have interacted for several months. Which is the most important variable in determining the likelihood of success in improving life for a client with obsessive-compulsive disorder (OCD)?
The client must be willing to make changes in his or her behavior.
The psychiatric mental health nurse has taught some relaxation techniques to a client with obsessive-compulsive disorder (OCD). What outcome would most clearly suggest that this intervention has been successful?
The client reports increased quality and quantity of sleep
A client recovering from a medical condition expresses low self-esteem, has difficulty making decisions, minimizes their ability to carry through with interventions to promote recovery and seeks more support than would be expected from the nurse. The nurse determines the client has a personality disorder. What is the probable etiology of the disorder?
The client was overprotected as a child and independence was discouraged
A client with obsessive-compulsive disorder (OCD) has been taught thought-stopping techniques. The nurse should recognize what potential benefit of this intervention?
The client will be able to take control of obsessions
The nurse is planning the care of a client who has been referred for the treatment of trichotillomania. What outcome should the nurse prioritize when planning care?
The client will demonstrate healthy skills for coping with anxiety
The nurse is providing care for a client who has obsessive-compulsive disorder (OCD). What aspect of this client's history was the most likely contributor to its etiology?
The clients mother had OCD
Which is essential for the nurse to communicate to the client with obsessive-compulsive disorder (OCD) and to the client's family?
The importance of medication compliance and that it may be necessary for medication to be changed to find the one that works best.
A psychaitric-mental health nurse is preparing a presentation for a group of colleagues on anxiety disorders. As part of the presentation the nurse plans to discuss the concept of interoceptive conditioning. Which information would the nurse most likely include in this discussion?
There is an association between physical symptoms and a panic attack.
A teenage girl has been diagnosed with obsessive-compulsive disorder (OCD) that manifests with excessive handwashing. The client's father is exasperated, stating, "The simplest solution would be to take away her access to soap and water." How should the nurse best interpret the father's suggestion?
This action would cause the client significant anxiety and distress
Which of the following is inconsistent with panic-level anxiety?
This level of anxiety can be sustained indefinitely.
A mental health nurse is consulted by staff on a surgical unit for a client who believes their actions are being monitored by their intravenous pump. The client is assessed and determined to fit the criteria for schizotypal personality disorder. There was no evidence of major depressive disorder or significant anxiety. What is the recommendation of the nurse?
To have the surgical care team focus on surgical recovery
Which are reasons that the nurse must understand why and how anxiety behaviors work? Select all that apply.
To provide better care for the client To help understand the role anxiety plays in performing nursing responsibilities To help nurses to function at a high level
A nursing instructor is describing the care of a client with acute anxiety to a class of nursing students. The instructor determines that more education is necessary when the students identify which intervention as appropriate?
Touching the client in an attempt to comfort the client
After teaching a group of mental health nursing students about the care of a client experiencing a panic attack, the instructor determines that additional education is required when the students identify which as an appropriate intervention?
Touching the client in an attempt to comfort the client
Which would not be an initial intervention for the client with acute anxiety?
Touching the client in an attempt to comfort the client
New research by Singh and Jones (2013) found that clients diagnosed with hoarding may benefit from which of the following?
Using a "buddy" system where members support each other outside the group
A nurse is preparing a plan of care for a client with anxiety. Which would the nurse likely include? Select all that apply.
Using appropriate coping skill Identifying treatment modalities Involving family for support, if appropriate Providing supportive feedback
A client is prescribed a serotonin-norepinephrine reuptake inhibitor. The nurse would identify that which of the following is most commonly prescribed?
Venlafaxine
Which statement about the assessment of persons with anxiety and anxiety disorders is most accurate?
When an elder person has an onset of anxiety for the first time in his or her life, it is possible that the anxiety is associated with another condition.
While reading an article on the psychodynamic theory behind symptoms of obsessive-compulsive disorder (OCD), a nurse reads about reaction formation. The nurse demonstrates understanding of this concept, identifying which situation as an appropriate example?
When parents are too harsh during potty training, the child may feel dirty and ashamed. Then the child may deliberately soil his or her clothes as an act of rebellion.
During an interview, a client diagnosed with obsessive-compulsive disorder tells the nurse, "I'm constantly worrying that something bad will happen to my mother and that she will die. So, I'm always praying so that this won't happen." The nurse interprets this as which obsessive-compulsive symptom dimension?
aggressive/sexual/religious/checking
A psychiatric nurse visits a client at home. The client tells the nurse that he or she experiences chest pain, shortness of breath, and sweating whenever leaving home. The client has been unable to go to work for six weeks. The nurse recognizes this problem as which behavior?
agoraphobia
Which medication classification has been found to be effective in reducing or eliminating panic attacks?
antidepressants
The nurse is interviewing a client with a history of violence. The client boasts that the client "put a kid in a wheelchair" once when the client was younger and has maimed others. The client states, "Who cares? Life's tough." Violence and insensitivity are associated with which personality disorder?
antisocial personality disorder
A client states, "I will just die if I don't get this job." The nurse then asks the client, "What will be the worst that will happen if you don't get the job?" The nurse is using this response to ...
appraise the client's situation more realistically.
The nurse has been working with a client who has obsessive-compulsive disorder (OCD) and the nurse is meeting the client's mother and father for the first time. During this interaction, the nurse should:
assess the parents' willingness to assist with behavioral techniques the client has been taught.
A school nurse suspects that a student may have trichotillomania based on the irregular patches of hair loss on her head and her absence of eyebrows. When planning the care of this client, the nurse should first:
assess whether hair-pulling is acceptable in this student's culture.
Which nursing intervention is focused on the primary goal of anxiety management and treatment?
assessing the client's ability to implement stress management techniques effectively
When a psychiatrist prescribes alprazolam for acute anxiety experienced by a client with agoraphobia, health teaching should include which instructions?
avoid alcoholic beverages
A client with a diagnosis of obsessive-compulsive disorder (OCD) has been admitted to the psychiatric unit prior to undergoing psychosurgery. The nurse who is caring for this client should understand that:
behavioral therapy and drug treatment have failed.
A family member of a client asks the nurse a question about personality disorders. The family member asks, "What personality disorder diagnosis makes a client most at risk for self-harm behaviors?" What is the nurse's best response?
borderline personality disorder
A client is learning to cope with anxiety and stress. The expected outcome is that the client will:
change reactions to stressors
A client spends hours arranging and rearranging furniture in his room. This behavior is identified as a ...
compulsion
The client has begun to wash the hands every hour due to the fear of germs becoming embedded in the client's skin leading the client to develop cancer. The nurse interprets this behavior as indicating which condition?
compulsion
A 35-year-old client with a diagnosis of antisocial personality disorder is being seen by a psychiatrist. He has been arrested three times for aggravated battery within the last year. Which disorder may have been seen in this client prior to age 18?
conduct
The client was brought to the clinic after breaking out several windows. The nurse questions the client regarding this action. Further assessment reveals that the client has been involved with vandalism, conning others, running away from home, verbal bullying and intimidation, drinking alcohol, and sexual promiscuity. Which disorder woudl teh nurse most likely suspect?
conduct disorder
A client who suffers from frequent panic attacks describes the attack as feeling disconnected from the self. The nurse notes in the client's chart that the client reports experiencing ...
depersonalization
A nurse is seeing a client who is having severe to panic level anxiety after a physical assault months previously. The client tells the nurse, "When the panic starts I feel like I am watching myself through a window." The nurse can most accurately describe this experience as:
depersonalization.
The psychiatric-mental health nurse is providing care for a client who has obsessive-compulsive disorder (OCD). The nurse can best promote the client's recovery and enhance therapeutic rapport by:
disguising any surprise at the client's rituals and demonstrating empathy.
A client with obsessive-compulsive disorder tells the nurse, "I never thought I'd be able to survive the feeling of leaving a room without going back through the door eight times, but I just did it with my therapist!" This client's treatment most likely included:
exposure and response prevention.
A client with obsessive-compulsive disorder has told the nurse, "Everyone's got routines. I don't see why everyone is so determined to focus on mine." The nurse should be aware that the client's behaviors would be categorized as compulsions because they:
interfere with the client's quality of life.
A nurse is seeing a client who is experiencing symptoms of moderate anxiety. She tells the nurse she and her parents disagree over her sexual orientation. Which theory would best explain the course of the client's anxiety?
interpersonal
The psychiatric mental health is reviewing the health record of a client who will soon be admitted. The client's health history includes a diagnosis of body dysmorphic disorder. The nurse should anticipate that this client:
is fixated on a specific physical flaw.
The nurse in an outpatient clinic conducts an assessment for a client employed full time as a professional. The client has an unstable mood and feels sad most of the time. The client shares that they were recently charged for shoplifting cosmetics valued under $10. The client has admitted to shoplifting more than five times before this incident. In addition to a mood disorder, what other disorder does the nurse identify?
kleptomania
The overall goals of care for individuals experiencing a stress response are to focus on interventions to develop ...
positive coping skills
A client is seeking treatment for a specific phobia. The nurse in the anxiety disorders clinic documents that the client's anxiety is related to exposure to the phobic object. Which is a realistic outcome for anxiety self-control in this situation?
practice relaxation techniques and report decreased physiological sensations associated with thoughts of the feared object
A nurse detects that a client is experiencing panic-level anxiety. Which intervention should be immediately implemented?
provide calm, brief, directive communication
The nurse provides care to clients who have a tendency toward antisocial and criminal behavior. Which term was used in the past to describe people with this disorder?
psychopath
A client can protect himself from the negative effects of stress with which of the following?
social and emotional resources
The nurse caring for a client with avoidant personality disorder identifies increased self-esteem in social situations as the primary outcome for the plan of care. Which program does the nurse recommend?
social skills training
The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to:
stand at the doorway and say, "You seem upset."
A young client, diagnosed with oppositional defiant disorder, becomes angry and defiant over the rules of the day treatment program. The client is shouting at the nurse. Which action by the nurse can help defuse the situation?
suggesting that the client go to the gym and shoot baskets
When prescribing an antidepressant for the treatment of an adolescent with obsessive-compulsive disorder (OCD), a higher dose is usually ordered by the health care provider. As part of the education of the client/family, the health care provider should warn about safety due to an increased risk for which of the following?
suicide
The advanced practice psychiatric nurse is teaching thought stopping techniques to a client with obsessive-compulsive disorder (OCD). When providing this educational intervention, the nurse should:
teach the client how to identify and interrupt obsessional thinking.
Which question in the assessment of a client with anxiety is most clinically appropriate?
"How do you feel about everything that is happening in your life right now?"
Which statement made by the nurse to the family of a client diagnosed with obsessive-compulsive disorder (OCD) demonstrates the best general understanding of the chronic nature of the disorder and its management?
"It's important to know that the symptoms will intensify during periods of stress."
