Psych: Exam 3 PrepU
The facilitator of a social skills training program contacts a mental health nurse about a client diagnosed with histrionic personality disorder attending the program. The facilitator feels the client has well-developed social skills and does not need assertiveness training. How does the nurse respond?
"Their interpersonal relationships tend to be shallow and their self-esteem is low. Having success interacting with others in group will help the client." Clients with histrionic personality disorder engage in superficial interpersonal relationships. In most cases their interactions are aimed at having their own needs addressed and they lack the levels of empathy and social intelligence to sustain relationships beyond the superficial level. These individuals may benefit from social skills training to better understand their capacities, improve their interpersonal approaches, and improve self-esteem in more mature ways. They do not have fulfilling or enduring relationships in general. They feel dependence and are not independent in their patterns. Their self-esteem is low and not inflated.
The mental health nurse is preparing a presentation about prescription drug abuse to a local community group. When describing the incidence, which age group would the nurse identify as experiencing an increase?
Adolescents Alcohol, tobacco, marijuana, and illegal prescription drug use have reached epidemic proportions in the United States, with the incidence rising in younger age groups, particularly among adolescents and young adults.
A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder?
Affective instability Affective instability is a rapid and extreme shift in mood and a core characteristic of borderline personality disorder. It is evidenced by erratic emotional responses to situations and intense sensitivity to criticism, perceived slights, or both.
Which of the following terms describes an inability to recognize or name objects despite intact sensory abilities?
Agnosia Agnosia is the inability to recognize the name of objects. Apraxia is the impaired ability to execute motor functions despite intact motor abilities. Aphasia is a deterioration of language function. Executive functioning is the ability to think abstractly and to plan, initiate, sequence, monitor, and stop complex behavior.
A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The nurse assesses the client and finds the client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. Which is typical of these symptoms?
Alcohol withdrawal syndrome Withdrawal from alcohol produces shakiness, weakness, diaphoresis, and GI symptoms. These are not symptoms of continuing intoxication. Delirium tremens produce hypertension, delusions, hallucinations, and agitated behavior. Wernicke-Korsakoff syndrome is a type of dementia caused by long-term, excessive alcohol intake that results in a chronic thiamine or vitamin B6 deficiency.
A nurse is assessing a client with substance abuse for evidence of possible long-term complications. Which finding would alert the nurse to the development of a complication affecting the hematologic system?
Anemia Leukemia Hematomas Medical complications associated with the hematologic system related to alcohol abuse include anemia, leukemia, and hematomas. Gastrointestinal complications include pancreatitis, ulcers, and liver diseases.
During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium?
Disoriented to person Clients with delirium have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations. Dementia symptoms include aphasia (deterioration of language function), apraxia (impaired ability to execute motor functions despite intact motor abilities), and agnosia (inability to recognize or name objects despite intact sensory abilities).
A nurse is providing education to the care provider of a cognitively impaired client who is prescribed a cholinesterase inhibitor. Which information about medication side effects should the nurse be sure to include?
Gastrointestinal (GI) symptoms All four of the commonly prescribed cholinesterase inhibitors have the possibility of producing GI symptoms.
After teaching a group of nursing students about intellectual disability, the instructor determines that the teaching was successful when the students identify which as the most common etiology?
Genetic syndromes Although exposure to toxins, perinatal complications, and environmental effects are associated with intellectual disability, the most common etiology is related to genetic syndromes.
The parents of a child diagnosed with ADHD ask the nurse about the restricted elimination diet. When describing this diet, which food would the nurse include as being allowed?
Gluten-free grains Fish Nuts The restricted elimination diet has been shown to improve behavior in some children and can be used as an instrument to determine whether ADHD behaviors are induced by food. In this diet, all-natural, chemical-free foods are eaten, and most of the foods that are regularly eaten are removed. Fruits, vegetables, nuts, nut butters, beans, seeds, gluten-free grains (e.g., rice, quinoa), fish, lamb, wild game meats, organic turkey, and large amounts of water are consumed.
The nurse working with students in a modified school setting completes a screening with the intention to identify students at risk for antisocial personality disorder (ASPD). Which findings predict a risk of developing ASPD? Select all that apply.
Harming a sibling Pattern of impulsive behavior Treatment for attention deficit hyperactivity disorder For a diagnosis to be made for ASPD, the individual must meet the criteria for conduct disorder prior to 15 years of age. A child or adolescent who causes harm to a sibling, maintains a pattern of behavior that is not modified or planned or who meets criteria for ADHD are at greatest risk of developing ASPD. The use of substances including tobacco and alcohol would be considered high risk if they were being abused. Substance use is not considered to be a significant risk.
A peer reports for work looking unkempt and disheveled. The peer's movements are uncoordinated, and the peer's breath smells of alcohol. Another nurse suspects this peer is intoxicated. Which action by the nurse who suspects that a peer is intoxicated would be most appropriate?
Immediately call the supervisor to report the peer's behavior. Client safety is a priority; the impaired nurse should not be caring for clients. After client safety is ensured, the nurse should call the supervisor to handle the situation. According to the nurse practice acts, any nurse who knows of any health care provider's incompetent, unethical, or illegal practice must report that information through proper channels. It is not the nurse's responsibility to tell the peer to go home or to give out information on the hospital's employee assistance program. It is not appropriate to ignore the situation because of the safety risk.
When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include?
In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints. Clients with somatic symptom disorder do not intentionally cause, and have no conscious or voluntary control over, their symptoms. Lack of voluntary control is in contrast to factitious disorder and malingering. In factitious disorder, clients deliberately make up or inflict symptoms.
The nurse is counseling a client who is grieving the loss of her spouse 4 months ago. The client reports having trouble falling and staying asleep at least 3 to 4 nights per week. The nurse recognizes the client is most likely experiencing which sleep-wake disorder?
Insomnia disorder Insomnia disorder is characterized by dissatisfaction with sleep quantity or quality and difficulty initiating or maintaining sleep, or in waking early in the morning, and being unable to return to sleep at least 3 nights per week for at least 3 months. Insomnia has a greater prevalence among older people and among divorced, separated, and widowed adults. The essential characteristic of hypersomnolence disorder is excessive sleepiness at least three times a week for at least 3 months. The overwhelming urge to sleep is the primary symptom of narcolepsy. This irresistible urge to sleep occurs at any time of the day, regardless of the amount of sleep. Falling asleep often occurs in inappropriate situations, such as while driving a car or reading a newspaper. Non-rapid eye movement (NREM) sleep arousal disorders including sleepwalking and sleep terror types, usually occur the first third of the major sleep episode.
A nurse is conducting a presentation about autism spectrum disorder for a group of parents. When describing this condition, the nurse would identify that approximately 50% of those with this condition also experience which of the following?
Intellectual disability About half of children with autism spectrum disorder have intellectual disability, and about 25% have seizure disorders. Hypertension and motor decline are not associated with autism.
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 client can afford to pay for the make-up but shoplifts instead. This condition is called kleptomania. Stealing provides a psychological release of cognitive tension rather than economic or personal need for the item. Hypomania describes expansive thoughts and overly goal-directed behavior associated with bipolar disorder. Trichotillomania is a term that describes hair pulling. It is not associated with stealing yet the release of tension by pulling hair has some similarities with kleptomania. Schizo-affective disorder is a mood disorder with episodes of psychosis or mania often in response to periods of stress.
Which of the following is used as a substitute for heroin in some maintenance programs?
Methadone Methadone, a potent synthetic opiate, is used as a substitute for heroin in some maintenance programs. The client has essentially substituted his or her addiction to heroin for an addiction to methadone.
A client is admitted for a drug overdose with a barbiturate. Which is the priority nursing action when planning care for this client?
Monitor respiratory function. Barbiturates are potent central nervous system depressants and can greatly decrease respiratory functioning. Respiratory depression would be a more likely and life-threatening complication than seizures, and would consequently be prioritized. Locating additional drugs does nothing to address life-threatening complications. Inducing vomiting would not remove drugs that the client has already metabolized, so would be of little benefit.
A child is diagnosed with Tourette's disorder. The nurse would anticipate developing a plan of care for this disorder in conjunction with which other disorder?
Obsessive-compulsive disorder Although any disorder can occur with Tourette's disorder, obsessive-compulsive disorder frequently occurs with Tourette's.
An 8-year-old boy has been diagnosed with ADHD. His mother is shocked that he will be prescribed a psychostimulant, stating, "His whole problem is that he's too stimulated, not understimulated!" Which of the following facts should underlie the nurse's response to the mother?
Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior. Psychostimulants stimulate the areas of the brain that control attention, impulses, and self-regulation of behavior, with the resulting effect of improved self-control.
When establishing a relationship with a client who has borderline personality disorder, which is most important for the nurse to do?
Respect the client's boundaries at all times. Clients with borderline personality disorder have issues with boundaries; by respecting the client's boundaries, the nurse can assist the client to develop better boundary control and directly address the most significant characteristic of this personality disorder. Aggression by the nurse is never appropriate or necessary. Ensuring brief interactions has no particular benefit for the client; prolonged engagement can better facilitate rapport. The nurse-client relationship does not carry on after the client's current treatment is complete.
Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa?
Restoring nutritional status to normal Physiologic safety and homeostasis are the priority concerns. Changing of thought patterns and gaining insight into the effects of anorexia on her physical health are not immediate goals in the management of anorexia nervosa because these are psychosocial, not physiologic, aspects of care. Achieving a client's target weight requires a lengthy process that is unlikely to be completed during inpatient care.
A nurse is assessing a child with a suspected intellectual disability. The nurse is evaluating the child's adaptive behavior, focusing on practical skills. Which area would the nurse most likely address?
Safety Schedules Activities of daily living Practical skills involve activities of daily living, occupational skills, health care, travel and transportation, schedules and routines, safety, use of money, and use of a telephone. Self-esteem and ability to follow rules are social skills.
When describing the treatment plan for a child with ADHD, which area would the nurse identify as important to address?
School accommodations Medication Individual treatment Family treatment Supportive services The treatment plan for the child with ADHD would include individual treatment for the child, school accommodations, medications, family treatment, and supportive services.
A client in the emergency department has self-inflicted wounds on both arms. Assessment reveals that the client was diagnosed with borderline personality disorder 6 months ago, for which the client has been receiving outpatient treatment. The client tells the nurse that the client recently found out the client's therapist is moving and will no longer be able to work with the client. What is the priority nursing diagnosis for this client?
Self-mutilation Although all the above are problems for this client, the highest priority nursing diagnosis is self-mutilation. If left untreated, self-mutilation can lead to suicide attempts.
A nurse is describing the effects of inhalants to a group of high school students attending a substance abuse prevention class. Which effects would the nurse include in the description? Select all that apply.
Slurred speech Hallucinations Euphoria Dizziness Inhalants, except for nitrates, are CNS depressants. When inhaled, they cause euphoria, sedation, emotional lability, and impaired judgment. Most inhalants other than nitrites depress the CNS similar to alcohol (slurred speech, lack of coordination, euphoria, and dizziness). They may cause light-headedness, hallucinations and delusions.
The psychiatric mental health nurse will perform the initial assessment of a client who has just been diagnosed with posttraumatic stress disorder. Which area would the nurse most likely address first?
Specific events of the trauma Provided the client is willing, the nurse should begin the assessment by addressing the trauma. This should ideally precede other areas such as substance use, sleep, and coping.
The parents of a child with attention deficit hyperactivity disorder (ADHD) bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives the first dose of methylphenidate at about 7:30 a.m. every morning before leaving for school. The teacher and school nurse have noticed a return in the child's overactivity and distractibility just before lunch. The child's second dose is scheduled for about 12 p.m. Which might the nurse suggest as a possible solution to control the child's symptoms a bit more effectively?
Switch to a longer-acting preparation. Methylphenidate has a total duration of action of about 4 hours. Thus, parents or teachers often describe a return of overactivity and distractibility as the first dose of medication wears off. This "rebound effect" can often be managed by moving the second dose of the day slightly closer to the first dose. Longer-acting preparations of methylphenidate or amphetamine-dextroamphetamine do not require frequent dosing and may be a better fit with a school day schedule. Splitting the dose in half would affect the duration. Switching to another class of medication would be appropriate if the drug was ineffective in controlling the symptoms even with a change in the dosage schedule or after a switch to a longer acting preparation.
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. It is important to be consistent and firm with the care plan and not to make independent changes in rules or consequences. Any change should be made by the staff as a group and conveyed to all staff members working with this client. Consistency is essential and may require team dialogue. If the client can find just one person to make independent changes, any plan will become ineffective. Care providers must be kept up to date on the components of the client's treatment plan, but this can be accomplished without meetings. Similarly, updates can be communicated or documented in different ways. Staff's frustrations must be dealt with appropriately, but the primary focus for all treatment planning should be centered on meeting the client's needs.
A client with anorexia nervosa describes herself as "a whale." However, the nurse's assessment reveals that the client is 5' 8" tall and weighs only 90 lb. When considering the client's unrealistic body image, which intervention should be included in the care plan?
Telling the client of the nurse's concern for her health and desire to help her make decisions to keep her healthy A client with anorexia nervosa has an unrealistic body image that causes consumption of little or no food. Therefore, the client needs assistance with making decisions about nutritious foods to keep her healthy.
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 child's temperament emerges soon after birth and remains relatively stable. It is understood to have a biological basis. The characteristics of a child's temperament include levels of energy, mood, adaptability to new environments, and intensity. These traits persist into adulthood and are fundamental consideration for personality disorder diagnostic criteria including ASPD. Physiological functioning including bowel patterns, the development of speech and school performance can be relevant assessment areas yet their importance is less significant than for temperament.
The mother of a 6-year-old boy reports that the child has had increasing somatic complaints that have no physical basis and disappear when he is allowed to remain home from school. The nurse should suspect what?
The child has a school phobia. The child's wanting to remain home from school may be an example of parents' explanations for some behaviors. The data in the question indicate an ongoing and progressive problem. Some aspects of the school experience are feared by the child. Separation anxiety is thought to play a role in this disorder. The data neither indicate ADHD nor suggest childhood developmental disorder.
The client was diagnosed with cocaine abuse at age 30. When the client was 23, the client was diagnosed with major depressive episode, and has continued to have depression off and on since then. Which statement would reflect this situation?
The client most likely has a dual diagnosis since she has both a substance dependence and depression. The client has a dual diagnosis: a primary substance dependence and a mental health disorder. The client requires concurrent treatment of both disorders. Cocaine is a stimulant so it would counteract the action of the antidepressants. Prognosis is variable and dependent on the effectiveness of the treatment for both disorders.
The psychiatric mental health nurse is assessing a client who was diagnosed with posttraumatic stress disorder (PTSD) after the death of the client's child from a medical error. What assessment finding would most warrant interventions aimed at addressing the client's dissociation?
The client reports large gaps in memory of the traumatic event Amnesia about traumatic events is characteristic of dissociation. Emotional lability, apathy, and agitation are not unusual in a client dealing with PTSD, but these do not directly indicate the presence of dissociation.
A nurse tells the child and caregiver that the nurse will interview each of them separately. The caregiver questions why this needs to occur. What is the nurse's best response?
"Both interviews provide unique and meaningful information." To get an accurate picture of the child, the nurse should interview the child and parent individually because each can provide unique meaningful information. Research has shown that when parent and child are interviewed separately the children provide information about internalizing symptoms and the parents provide information about externalizing symptoms.
During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic?
"Has something occurred that caused you to measure your thighs?" The nurse helps the client recognize the influence of maladaptive thoughts and identify situations and events that cause concern about physical appearance and weight. In discussing these situations, the nurse and client can begin to identify anxiety-provoking events and develop strategies for managing such situations without resorting to self-damaging behaviors.
A client with anorexia weighs less than 85% of the client's normal body weight. The client says, "I'm so fat, I can't even get through this doorway, much less fit into any of my clothes." Which is the nurse's most therapeutic response?
"I understand what you are saying. However, you are under your ideal body weight, and it is causing you to have the medical problems that we have talked about." People with eating disorders tend to have perfectionistic personalities and to think in all-or-nothing terms. The nurse communicates caring to the client through a kind, firm, matter-of-fact approach, acknowledging the client's statement and at the same time, being honest and factual about the client's condition without being condescending or punitive.
A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate?
"I will accompany you to the bathroom." After each meal or snack, clients may be required to remain in view of staff for a period of time to ensure they do not empty the stomach by vomiting. Some treatment programs limit client access to bathrooms without supervision, particularly after meals, to discourage vomiting. The response "I will accompany you to the bathroom" is appropriate. Any client suspected of self-induced vomiting should be accompanied to the bathroom for the nurse to be able to deter this behavior. The response, "I'll stand outside your door to give you privacy" does not address the nurse's responsibility to deter the behavior. The nurse should accompany the client to the bathroom. Providing privacy is secondary to preventing further nutritional deficits.
A nurse is teaching a family how to best help their child who has been recently diagnosed with a neurodevelopmental disorder. Which statement indicates to the nurse that teaching has been effective?
"We will be able to enjoy more structure in our home." Children with a neurodevelopmental disorder need structure, routine, and short task instructions to be more functional. Often families do not do well with children with ADHD due to disruptive behaviors and lack of focus. Attending races every weekend may be overwhelming with the loud noises and large crowds. Going on a long bus tour with church may be very hard to accomplish, since children with this disorder have difficulty sitting still for very long periods of time or do not adapt to change well.
In a person who abuses alcohol or is a chronic drinker, alcohol withdrawal syndrome usually begins within which time frame from abrupt discontinuation or an attempt to decrease consumption?
12 hours In clients with alcoholism or in chronic drinkers, alcohol withdrawal syndrome usually begins within 12 hours after abrupt discontinuation or an attempt to decrease consumption.
The body can metabolize how much beer per hour without intoxication?
12 oz The body can metabolize 1 oz of liquor, a 5-oz glass of wine, or a 12-oz can of beer per hour without intoxication.
An individual with which body mass index (BMI) would be classified as having mild anorexia nervosa?
17.4 kg/m2 The severity of anorexia nervosa is classified as follows: mild: BMI ≥ 17 kg/m2; moderate: BMI 16-16.99 kg/m2; and severe: BMI 15-15.99 kg/m2. A BMI of 20 kg/m2 is considered normal.
A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range?
18 to 22 years old The onset of bulimia nervosa commonly occurs in late adolescence or early adulthood. Bulimia nervosa is more prevalent than anorexia nervosa. Research suggests that bulimia occurs primarily in societies that place emphasis on thinness as the model of attractiveness for women and in which an abundance of food is available.
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 To be diagnosed with ASPD, the individual must be at least 18 years old and must have exhibited one or more childhood behavioral characteristics of conduct disorder before the age of 15 years, such as aggression to people or animals, destruction of property, deceitfulness or theft, or serious violation of rules.
A client with a history of anorexia nervosa comes to the clinic for evaluation. During the visit, the client's body mass index (BMI) is obtained. The nurse determines that treatment has been effective based on which BMI measurement?
19.2 kg/m2 An acceptable BMI is between about 19 and 25. Therefore a BMI of 19.2kg/m2 would be considered effective for the client. A BMI of 17 kg/m2 suggest mild anorexia. A BMI of 16.5 kg/m2 suggests moderate anorexia. A BMI of 15.9 suggests severe anorexia.
According to the Centers for Disease Control and Prevention, approximately what percentage of Americans sleep less than seven hours per night?
33% More than one-third of Americans report sleeping less than 7 hours per night (CDC, 2016), with the average sleep duration of U.S. adults between 6 and 6.5 hours, down from a high of 8.5 hours in 1960.
Assessment of an 8-year-old client reveals communication difficulties and an inability to manage age-appropriate tasks. The child undergoes standardized testing. An intelligent quotient (IQ) of which would support a diagnosis of intellectual disability?
65 The usual threshold for intellectual disability is an IQ of 70 or less (i.e., two standard deviations below the population mean).
Which is the underlying issue in kleptomania?
Act of stealing In kleptomania, individuals cannot resist the urge to steal, and they independently steal items that they could easily afford. These items are not particularly useful or wanted. The underlying issue is the act of stealing. Low income, anxiety, and a need for recognition are not underlying issues seen with kleptomania.
After teaching a group of nurses about borderline personality disorder, the leader determines that the education was successful when the group identifies that symptoms typically begin in which age group?
Adolescence Many children and adolescents show symptoms similar to those of BPD, such as moodiness, self-destruction, impulsiveness, lack of temper control, and rejection sensitivity. Because symptoms of BPD begin in adolescence, it makes sense that some of the children and adolescents would meet the criteria for BPD even though it is not diagnosed before young adulthood.
A client is 5 feet 6 inches tall, weighs 105 pounds, exercises 4 hours per day, and does not engage in any binging or purging behaviors. The client believes that he or she is becoming obese and states, "I'm shocked that you think I'm underweight. You don't understand me." The most likely diagnosis for this client is what?
Anorexia nervosa, restricting type Anorexia nervosa is characterized by a voluntary refusal to eat and a weight less than 85% of normal for height and age. Clients with anorexia nervosa, restricting type have a distorted body image, eat very little, and often obsessively pursue vigorous physical activity to burn "excess calories."
A client has a diagnosis of borderline personality disorder and lives at home with the client's parents. The client has been in the psychiatric unit for 2 weeks and is scheduled to be discharged tomorrow. Which would be most therapeutic when the client's parents come in to discuss discharge plans?
Ask the parents to keep a written schedule of activities for each day for the client When providing family and client education upon discharge, it is important for the nurse to ask the parents to keep a written schedule of daily activities for the client in order to keep a fixed routine with the aim of preventing chronic boredom and emptiness that is often associated with borderline personality disorder.
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. Following the team plan ensures consistency of response to the client's manipulative behavior. Learning the relationship between behavior and consequences is a positive outcome for the client. Answers A, C, and D are not appropriate interventions for the client exhibiting manipulative behavior.
The nurse is helping a client with an eating disorder to accept the client's body image. The client must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills?
Being able to cope in healthy ways improves the ability to accept a realistic body image. When clients experience relief from emotional distress, have increased self-esteem, and can meet their emotional needs in healthy ways, they are more likely to accept their weight and body image. Coping skills can be learned and honed even if the client's upbringing was less than supportive. Changes in body image result from enhanced coping; they do not cause enhanced coping. Eating disorders have biologic elements to their etiology, but this does not rule out the development of positive coping.
A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment?
Bradycardia Associated physical exam findings include cold intolerance, complaints of constipation and abdominal pain, hypotension, and bradycardia.
Which is a family risk factor for bulimia nervosa?
Chaotic family A chaotic family life is a risk factor for bulimia nervosa. Lack of emotional support, self-perception of being overweight, and inability to deal with conflict are family risk factors for anorexia nervosa.
The nurse is providing care to a client with somatic symptom disorder (SSD). Which would the nurse expect to be included in the client's plan of care?
Cognitive behavior therapy The cornerstone of management is trust and believing. Ideally, the client should see only one health care provider at regularly scheduled visits. During each primary care visit, the provider should conduct a partial physical examination of the organ system in which the client has complaints. Physical symptoms are treated conservatively using the least intrusive approach. In the mental health setting, the use of cognitive behavior therapy is effective. Medications may be used, such as monoamine oxidase inhibitors or selective serotonin reuptake inhibitors, but not mood stabilizers. Electroconvulsive therapy is not typically used.
When working with the family of a client with anorexia nervosa, which issue must be addressed?
Control Clients with anorexia often believe the only control they have is over their eating and weight; all other aspects of their life are controlled by their family. Codependence, self-discipline, and sexual identity may be relevant to some clients, but the presence of control issues is relevant in all clients with anorexia nervosa.
A client with borderline personality disorder tells the nurse, "Everything bad happens to me. I'm absolutely no good." The nurse interprets this statement as which of the following?
Dichotomous thinking People with BPD have dichotomous thinking. Cognitively, they evaluate experiences, people, and objects in terms of mutually exclusive categories (e.g., good or bad, success or failure, trustworthy or deceitful), which informs extreme interpretations of events that would normally be viewed as including both positive and negative aspects. Dissociation (times when thinking, feeling, or behaviors occur outside a person's awareness) can be conceptualized on a continuum from minor dissociations of daily life (such as daydreaming) to a breakdown in the integrated functions of consciousness, memory, perception of self or the environment, and sensory-motor behavior. Affective instability (rapid and extreme shift in mood) is a core characteristic of BPD and is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. Impulsivity reflects actions that the person does on the spur of the moment.
A client is diagnosed with anorexia nervosa, restricting type. The nurse interprets this as indicating the use of which of the following? Select all that apply.
Dieting Exercising Anorexia nervosa is categorized into two major types: restricting (dieting and exercising with no binge eating or misuse of laxatives, diuretics, or enemas) and binge eating and purging (binge eating and misuse of laxatives, diuretics, or enemas).
Which nursing diagnosis would be most difficult to successfully resolve in a client who had anorexia nervosa?
Disturbed body image The client's dissatisfaction with body image is an enduring belief pattern that is firmly ingrained and, therefore, very difficult to change. Imbalanced nutrition—less than body requirements, deficient knowledge (nutritious eating patterns), and social isolation are nursing diagnoses that can be worked through with education and support more easily than the diagnosis of disturbed body image.
When teaching a child with ADHD and parents about the prescribed psychostimulant therapy, the nurse integrates understanding about the drug's action. Which neurotransmitter would the nurse identify as being enhanced?
Dopamine Norepinephrine Psychostimulants enhance dopamine and norepinephrine activity and thereby improve attention and focus, increase inhibition of impulsive actions, and quiet the "noise" associated with distractibility and shifting attention.
A client meets some (but not all) of the diagnostic criteria for anorexia nervosa. Despite having lost considerable weight, the client's weight is within the normal range. The nurse understands that based on DSM-5 criteria, this client would most likely be diagnosed with which of following?
Eating disorder not otherwise specified Subclinical cases, also called partial syndromes, are usually diagnosed as Eating Disorder Not Otherwise Specified (EDNOS). These individuals still need treatment despite not meeting criteria for anorexia nervosa or bulimia nervosa.
A nurse is describing the various etiologies and risk factors associated with ADHD. Which of the following would the nurse include?
Family stress Poverty Overcrowded living conditions Genetics Marital discord Although genetic endowment clearly plays a fundamental role in the etiology of ADHD, psychosocial factors are also important risk factors, particularly related to inattention (Freitag et al., 2011). Family stress, marital discord, and parental substance use are also associated with ADHD. Other implicated psychosocial factors are poverty, overcrowded living conditions, and family dysfunction.
Exacerbation of anorexia nervosa results from the client's effort to do what?
Gain control of one part of life A client with anorexia nervosa is unconsciously attempting to gain control over the only part of the client's life the client feels the client can control. Anorexia does not incorporate manipulation of family members or work as a means of diminishing conflict. This eating disorder carries with it a high incidence in families that emphasize achievement.
People who are impulse-driven and have difficulty delaying gratification frequently participate in which of the following behaviors? Select all that apply.
Gambling Shopping beyond their means Binge eating Abusing alcohol Impulsivity is a characteristic of people with borderline personality disorder (BPD). They have difficulty delaying gratification and often act "in the moment." Gambling, spending money irresponsibly, binge eating, engaging in unsafe sex, and abusing substances are typical.
Which of the following occurs when self-definition is poorly developed?
Identity diffusion Identity diffusion occurs when a person lacks aspects of personal identity, or when personal identity is poorly developed. Affective instability is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. Dichotomous thinking occurs when a person evaluates experiences, people, and objects in terms of mutually exclusive categories. Dissociation occurs in instances when thinking, feelings, or behaviors occur outside a person's awareness.
A client is experiencing severe alcohol withdrawal. Which would the nurse most likely assess?
Marked diaphoresis Auditory hallucinations Gross uncontrollable tremors A person experiencing severe alcohol withdrawal would exhibit marked diaphoresis, auditory and visual hallucinations, a heart rate between 120 and 140 beats/min, gross uncontrollable tremors, and a complete inability to eat or drink.
A client has a blood alcohol level of 0.05%. The nurse would expect which behavior to occur?
Impaired judgment A blood alcohol level of 0.05% (1-2 drinks) would produce impaired judgment, giddiness, and mood changes. Difficulty driving occurs at a level of 0.10%. Stupor and coma occur at levels of 0.30% and 0.40%, respectively.
Psychosocial theorists propose that somatic symptom illnesses are an indirect expression of stress and anxiety through physical symptoms. Which is the primary defense mechanism used in somatoform disorders?
Internalization Psychosocial theorists believe that people with somatic symptom illnesses keep stress, anxiety, or frustration inside rather than expressing them outwardly. This is called internalization. Clients express these internalized feelings and stress through physical symptoms (somatization). In this conceptualization of the illness, the client's internalization is the primary defense mechanism that causes somatization. Identification is trying to ease distress by emulating others whom one admires and repression is the unconscious exclusion of distressing situations from one's memory; neither process is included in the major psychosocial theories of somatic symptom illnesses.
Which of the following is the best description of the term substance use disorders, according to the American Psychiatric Association?
Is an umbrella term for substance abuse and substance dependence Substance use disorders, as defined by the American Psychiatric Association, is an umbrella term for substance abuse and substance dependence.
A nurse is exploring treatment options with a client addicted to heroin. Which information regarding the use of methadone is important for the nurse to include?
Methadone will meet the physical need for opiates without producing cravings for more. Methadone, a potent synthetic opiate, is used as a substitute for heroin in some maintenance programs. The client takes one daily dose of methadone, which meets the physical need for opiates but does not produce cravings for more. Methadone does not produce the high associated with heroin. The client has essentially substituted his or her addiction to heroin for an addiction to methadone; however, methadone is safer because it is legal, controlled by a physician, and available in tablet form. The client avoids the risks of intravenous drug use, the high cost of heroin (which often leads to criminal acts), and the questionable content of street drugs.
When comparing dementia and dementia syndrome, the nurse understands that dementia is characterized by which of the following?
Mood fluctuations Dementia has an insidious onset, symptoms of long duration, and mood and behaviors fluctuations. The client conceals his or her disabilities.
After educating a group of nursing students on somatic symptom disorder, the instructor determines that the education was successful when the group identifies which of the following as the most common problem?
Pain Pain is the most common problem in people with somatic symptom disorder. Because pain is usually related to symptoms of all the major body systems, it is unlikely that somatic intervention (such as an analgesic) will be effective on a long-term basis. Nausea, muscle weakness, and paresthesias in the extremities are not the most common problems associated with somatic symptom disorder.
A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client?
Self-monitoring Self-monitoring is a type of behavioral therapy. It is designed to help the client with bulimia. Guided imagery, distraction, and music therapy can be used to manage emotions, such as anxiety, by using relaxation techniques.
People diagnosed with bulimia nervosa have lower levels of which neurotransmitter?
Serotonin The most frequently studied biochemical theory in bulimia nervosa relates to lowered brain serotonin neurotransmission. People with bulimia nervosa are believed to have altered modulation of central serotonin neuronal systems.
A client who is abusing substances is to undergo brief intervention. The nurse understands that this technique is most effective for a client who exhibits which symptoms?
Short history of drug use Brief intervention is most successful when working with individuals who are experiencing few problems with their drug use, have low levels of dependence, have a short history of drug use, and have stable backgrounds.
The nurse understands that when working with a child with a disruptive behavior disorder, the family must be included in the care. Which is one of the best ways the nurse can advocate for the child?
Teach the parents age-appropriate expectations of the child. Working with parents is a crucial aspect of dealing with children with these disorders. The nurse can teach parents age-appropriate activities and expectations for clients and consequently increase the child's chance of meeting expectations for behavior. Transferring the child to a new home would be a measure of last resort with the goal of protecting the child's safety. The nurse should avoiding appearing to "side" with the parents in an effort to advocate for the child and maintain a therapeutic relationship. It is presumptuous for the nurse to believe that he or she knows the child's thoughts and feelings best, and has to interpret them to the parents.
Which assessment details demonstrates to the nurse that a client has an obsessive-compulsive personality disorder rather than obsessive compulsive disorder (OCD)?
The client is able to delay hand washing A person with obsessive-compulsive personality disorder is more likely than someone with OCD to be able to delay hand washing without obvious distress. The rituals associated with obsessive-compulsive personality disorder are a stable aspect of a person's patterns of living. The behaviors observed are less likely to be associated with anxiety than for OCD. Clients with obsessive-compulsive personality disorder do not have the characteristic obsessions associated with the problematic behaviors.
The nurse is talking with the friend of a client with alcoholism. The friend tells the nurse that the friend's relationship with the client was codependent and enabling. Which is an example of codependent behavior?
The friend called the client every night to make sure the client got home safely and went looking for the client if not at home. Codependent behavior appears helpful on the surface but actually prolongs the drinking behavior. Watching out for the client's safety may appear helpful but it facilitates the client's behavior because it releases the client from being responsible. Calling Alcoholics Anonymous, confronting the client and refusing to participate are actions that show personal support for the client while not enabling or accepting his or her harmful behaviors.
A child is diagnosed with obsessive-compulsive disorder (OCD). When reviewing the child's medical record, which of the following would the nurse most likely note as possibly being present?
Tic disorder Mood disorder Anxiety disorder More than half of the cases of OCD in youth involve a comorbid disorder such as a tic, mood, or anxiety disorder. Personality and somatic symptom disorders are not associated cormorbidities.
When admitted to the inpatient unit, a client is 5 feet 10 inches tall and weighs 100 pounds. What is the initial goal in the client's care?
To stop losing weight The first goal is for the client to stop losing weight. Short-term goals focus on decreasing anxiety, stopping weight loss, restoring the person to an acceptable weight, and normalizing eating behaviors. Long-term goals focus on helping the client (and if possible the family) to resolve the psychological issues that precipitated the eating disorder and to develop more constructive coping mechanisms.
A nurse is working with an adolescent client with a diagnosis of conduct disorder. The nurse is helping the client reflect on a situation in which the client became aggressive and asks how the client could have handled it differently. The nurse is employing which intervention?
improving coping skills and self-esteem Nursing interventions for conduct disorder include teaching and practicing problem-solving skills. In this scenario, the nurse is asking the client to reflect on the situation in order find healthier, adaptive solutions. Teaching and practicing problem-solving skills is aimed at the ultimate goal of improving coping skills and self-esteem for clients with conduct disorder.
Which are included in the mental health comprehensive evaluation of children and adolescents?
medical history mental status examination school records A comprehensive evaluation includes a history, mental status examination, records of the child's school performance and medical-physical history, screening tools, and information from other agencies.
