Psych exam 4

Mr. Lim who is diagnosed with moderate dementia has frequent catastrophic reactions during shower time. Which of the following interventions should be implemented in the plan of care? Select all that apply. A. Assign consistent staff members to assist the client. B. Accomplish the task quickly, with several staff members assisting. C. Schedule the client's shower at the same time of day. D. Sedate the client 30 minutes prior to showering. E. Tell the client to remain calm while showering. F. Use a calm, supportive, quiet manner when assisting the client.

Correct Answer: A, C, and F Maintaining a consistent routine with the same staff members will help decrease the client's anxiety that occurs whenever changes are made. A calm, quiet manner will be reassuring to the client, also helping to minimize anxiety. Maintain a regular daily schedule routine to prevent problems that may result from thirst, hunger, lack of sleep, or inadequate exercise. Limit decisions that the patient makes. Be supportive and convey warmth and concern when communicating with the patient. The patient may be unable to make even the simplest choice decisions and this will result in frustration and distraction. By avoiding this, the patient has an increased feeling of security. Patients frequently have feelings of loneliness, isolation and depression, and they respond positively to a smile, friendly voice, and gentle touch.

A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. He was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior, he is diagnosed with chronic undifferentiated schizophrenia. The nurse should assign the highest priority to which nursing diagnosis? A. Anxiety B. Impaired verbal communication C. Disturbed thought processes D. Self-care deficit: Dressing/grooming

Correct Answer: A. Anxiety For this client, the highest-priority nursing diagnosis is Anxiety (severe to panic-level), manifested by the client's extreme withdrawal and attempt to protect himself from the environment. The nurse must act immediately to reduce anxiety and protect the client and others from possible injury. Use a non-judgemental, respectful, and neutral approach with the client. Use clear and simple language when communicating with a suspicious client. Be honest and consistent with the client regarding expectations and enforcing rules.

A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction? A. Dystonia B. Akinesia C. Akathisia D. Tardive dyskinesia

Correct Answer: A. Dystonia Dystonia, a common extrapyramidal reaction to fluphenazine decanoate, manifests as muscle spasms in the tongue, face, neck, back, and sometimes the legs. Dystonia is a dynamic disorder that changes in severity based on the activity and posture. Dystonia may assume a pattern of overextension or over-flexion of the hand, inversion of the foot, lateral flexion or retroflection of the head, torsion of the spine with arching and twisting of the back, forceful closure of the eyes, or a fixed grimace. It may come to an end when the body is in action and during sleep.

Positive symptoms of schizophrenia include which of the following?A. Hallucinations, delusions, and disorganized thinking A. Flat affect, avolition, and anhedonia B. Somatic delusions, echolalia, and a flat affect C. Waxy flexibility, alogia, and apathy D. Hallucinations, delusions, and disorganized thinking

Correct Answer: A. Hallucinations, delusions, and disorganized thinking The positive symptoms of schizophrenia are distortions of normal functioning. Option A lists the positive symptoms of schizophrenia. The typical positive symptoms of schizophrenia, such as hallucinatory experiences or fixed delusional beliefs, tend to be very upsetting and disruptive—not a positive experience at all for you or someone you care about who is experiencing them. From the outside, a person with positive symptoms might seem distracted, as if they are listening to something (psychiatrists call this "responding to internal stimuli").

A client is admitted with a diagnosis of delusions of grandeur. This diagnosis reflects a belief that one is: A. Highly important or famous B. Being persecuted C. Connected to events unrelated to oneself D. Responsible for the evil in the world

Correct Answer: A. Highly important or famous. A delusion of grandeur is a false belief that one is highly important or famous. A delusion of grandeur is the false belief in one's own superiority, greatness, or intelligence. People experiencing delusions of grandeur do not just have high self-esteem; instead, they believe in their own greatness and importance even in the face of overwhelming evidence to the contrary. Someone might, for example, believe they are destined to be the leader of the world, despite having no leadership experience and difficulties in interpersonal relationships. Delusions of grandeur are characterized by their persistence. They are not just moments of fantasy or hopes for the future.

A client with paranoid schizophrenia is admitted to the psychiatric unit of a hospital. Nursing assessment should include careful observation of the client's: A. Thinking, perceiving, and decision-making skills B. Verbal and nonverbal communication processes C. Affect and behavior D. Psychomotor activity

Correct Answer: A. Thinking, perceiving, and decision-making skills Nursing assessment of a psychotic client should include careful inquiry about and observation of the client's thinking, perceiving, symbolizing, and decision-making skills and abilities. Assessment of such a client typically reveals alterations in thought content and process, perception, affect, and psychomotor behavior; changes in personality, coping, and sense of self; lack of self-motivation; presence of psychosocial stressors; and degeneration of adaptive functioning.

A client is admitted to the psychiatric hospital with a diagnosis of catatonic schizophrenia. During the physical examination, the client's arm remains outstretched after the nurse obtains the pulse and blood pressure, and the nurse must reposition the arm. This client is exhibiting: A. Waxy flexibility B. Negativity C. Suggestibility D. Retardation

Correct Answer: A. Waxy flexibility Waxy flexibility, the ability to assume and maintain awkward or uncomfortable positions for long periods, is characteristic of catatonic schizophrenia. Clients commonly remain in these awkward positions until someone repositions them. Catatonic patients may also display "waxy flexibility", meaning that they allow themselves to be moved into new positions, but do not move on their own. Most of the time, this is not an act or a show but rather a genuine and unpremeditated symptom of the illness that patients cannot help.

The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as: A. Delusions B. Hallucinations C. Loose associations D. Neologisms

Correct Answer: B. Hallucinations Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality. The word "hallucination" comes from Latin and means "to wander mentally." Hallucinations are defined as the "perception of a nonexistent object or event" and "sensory experiences that are not caused by stimulation of the relevant sensory organs." In layman's terms, hallucinations involve hearing, seeing, feeling, smelling, or even tasting things that are not real. Auditory hallucinations, which involve hearing voices or other sounds that have no physical source, are the most common type.

The nurse is aware that antipsychotic medications may cause which of the following adverse effects? A. Increased production of insulin B. Lower seizure threshold C. Increased coagulation time D. Increased risk of heart failure

Correct Answer: B. Lower seizure threshold Antipsychotic medications exert an effect on brain neurotransmitters that lowers the seizure threshold and can, therefore, increase the risk of seizure activity. First-generation antipsychotics can also lower the seizure threshold, and chlorpromazine and thioridazine are more epileptogenic than others. First-generation antipsychotics are dopamine receptor antagonists (DRA) and are known as typical antipsychotics. They include phenothiazines (trifluoperazine, perphenazine, prochlorperazine, acetophenazine, triflupromazine, mesoridazine), butyrophenones (haloperidol), thioxanthenes (thiothixene, chlorprothixene), dibenzoxazepines (loxapine),

A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which of the following disorders? A. Personality disorder B. Mood disorder C. Thought disorder D. Amnestic disorder

Correct Answer: B. Mood disorder According to the DSM-IV, schizoaffective disorder refers to clients suffering from schizophrenia with elements of a mood disorder, either mania or depression. The prognosis is generally better than for the other types of schizophrenia, but it's worse than the prognosis for a mood disorder alone. The term schizoaffective disorder first appeared as a subtype of schizophrenia in the first edition of the DSM. It eventually became its own diagnosis despite lack of evidence for unique differences in etiology or pathophysiology. Therefore, there have been no conclusive studies on the etiology of the disorder. However, investigating the potential causes of mood disorders and schizophrenia as individual disorders allows for further discussion.

A client's medication order reads, "Thioridazine (Mellaril) 200 mg P.O. q.i.d. and 100 mg P.O. p.r.n." The nurse should: A. Administer the medication as prescribed. B. Question the physician about the order. C. Administer the order for 200 mg P.O. q.i.d. but not for 100 mg P.O. p.r.n. D. Administer the medication as prescribed but observe the client closely for adverse effects.

Correct Answer: B. Question the physician about the order. The nurse must question this order immediately. Thioridazine (Mellaril) has an absolute dosage ceiling of 800 mg/day. Any dosage above this level places the client at high risk for toxic pigmentary retinopathy, which can't be reversed. As written, the order allows for administering more than the maximum 800 mg/day; it should be corrected immediately before the client's health is jeopardized.

Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)? A. Monthly blood tests will be necessary. B. Report a sore throat or fever to the physician immediately. C. Blood pressure must be monitored for hypertension. D. Stop the medication when symptoms subside.

Correct Answer: B. Report a sore throat or fever to the physician immediately. A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine. The risk of developing agranulocytosis is around 1% in patients who take clozapine, which may be independent of dosing. Most cases occur early in the treatment, within six weeks to six months, and require extensive monitoring of blood absolute neutrophil counts. The definition of neutropenia is an ANC level below 1500/mm, and agranulocytosis is an ANC level below 500/mm.

When teaching the family of a client with schizophrenia, the nurse should provide which information? A. Relapse can be prevented if the client takes the medication. B. Support is available to help family members meet their own needs. C. Improvement should occur if the client has a stimulating environment. D. Stressful family situations can precipitate a relapse in the client.

Correct Answer: B. Support is available to help family members meet their own needs. Because family members of a client with schizophrenia face difficult situations and great stress, the nurse should inform them of support services that can help them cope with such problems. Provide information on client and family community resources for the client and family after discharge: day hospitals, support groups, organizations, psychoeducational programs, community respite centers (small homes), etc. Schizophrenia is an overwhelming disease for both the client and the family. Groups, support groups, and psychoeducational centers can help

The nurse is teaching a psychiatric client about her prescribed drugs, chlorpromazine, and benztropine. Why is benztropine administered? A. To reduce psychotic symptoms. B. To reduce extrapyramidal symptoms. C. To control nausea and vomiting. D. To relieve anxiety.

Correct Answer: B. To reduce extrapyramidal symptoms Benztropine is an anticholinergic medication, administered to reduce the extrapyramidal adverse effects of chlorpromazine and other antipsychotic medications. Consequently, it reduces central cholinergic effects by blocking muscarinic receptors that appear to improve the symptoms of Parkinson's disease. Thus, benztropine blocks the cholinergic muscarinic receptor in the central nervous system. Therefore, it reduces the cholinergic effects significantly during Parkinson's disease which becomes more pronounced in the nigrostriatal tract because of reduced dopamine concentrations.

A client with borderline personality disorder becomes angry when he is told that today's psychotherapy session with the nurse will be delayed 30 minutes because of an emergency. When the session finally begins, the client expresses anger. Which response by the nurse would be most helpful in dealing with the client's anger? A. "If it had been your emergency, I would have made the other client wait." B. "I know it's frustrating to wait. I'm sorry this happened." C. "You had to wait. Can we talk about how this is making you feel right now?" D. "I really care about you and I'll never let this happen again."

Correct Answer: C. "You had to wait. Can we talk about how this is making you feel right now?" This response may diffuse the client's anger by helping to maintain a therapeutic relationship and addressing the client's feelings. Regardless of the clinical setting, the nurse must provide structure and limit setting in the therapeutic relationship; in a clinic setting, this may mean seeing the client for scheduled appointments of a predetermined length rather than whenever the client appears and demands the nurse's immediate attention.

A client is admitted to the psychiatric unit with a tentative diagnosis of psychosis. Her physician prescribes the phenothiazine thioridazine (Mellaril) 50 mg by mouth three times per day. Phenothiazines differ from central nervous system (CNS) depressants in their sedative effects by producing: A. Deeper sleep than CNS depressants. B. Greater sedation than CNS depressants. C. A calming effect from which the client is easily aroused. D. More prolonged sedative effects, making the client more difficult to arouse.

Correct Answer: C. A calming effect from which the client is easily aroused. Shortly after phenothiazine administration, a quieting and calming effect occurs, but the client is easily aroused, alert, and responsive and has good motor coordination. The precise mechanism of action exhibited by phenothiazines is not entirely known. Yet, phenothiazines act primarily through inhibiting the dopamine receptor at the mesolimbic pathway with a selective activity at the D2 receptor. This inhibition antagonizes the hyperactivity of dopamine at the synapse and reduces positive symptoms such as delusions and hallucinations associated with schizophrenia.

A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior? A. Word salad B. Tangential C. Avolition D. Perseveration

Correct Answer: C. Avolition Avolition refers to impairment in the ability to initiate goal-directed activity. Avolition, a lack of motivation or reduced drive to complete goal-directed activities, is a concerning and common characteristic in people with schizophrenia. It is one of the negative symptoms of schizophrenia. Negative symptoms involve those that cause a decrease or loss in mental functioning and can interfere with daily functioning, including maintaining a job, relationship, or social life.

A woman is admitted to the psychiatric emergency department. Her significant other reports that she has difficulty sleeping, has poor judgment, and is incoherent at times. The client's speech is rapid and loose. She reports being a special messenger from the Messiah. She has a history of depressed mood for which she has been taking an antidepressant. The nurse suspects which diagnosis? A. Schizophrenia B. Paranoid personality C. Bipolar illness D. Obsessive-compulsive disorder (OCD)

Correct Answer: C. Bipolar illness Bipolar illness is characterized by mood swings from profound depression to elation and euphoria. Delusions of grandeur along with pressured speech are common symptoms of mania. The bipolar affective disorder is a chronic and complex disorder of mood that is characterized by a combination of manic (bipolar mania), hypomanic and depressive (bipolar depression) episodes, with substantial subsyndromal symptoms that commonly present between major mood episodes.

A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses schizophrenia after ruling out several other conditions. Schizophrenia is characterized by: A. Loss of identity and self-esteem. B. Multiple personalities and decreased self-esteem. C. Disturbances in affect, perception, and thought content and form. D. Persistent memory impairment and confusion.

Correct Answer: C. Disturbances in affect, perception, and thought content and form. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, defines schizophrenia as a disturbance in multiple psychological processes that affect thought content and form, perception, affect, sense of self, volition, relationship to the external world, and psychomotor behavior. Traditionally, symptoms have divided into two main categories: positive symptoms which include hallucinations, delusions, and formal thought disorders, and negative symptoms such as anhedonia, poverty of speech, and lack of motivation.

Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do? A. Assume that the client is posturing. B. Tell the client to lie down and relax. C. Evaluate the client for adverse reactions to haloperidol. D. Put the client on the list for the physician to see tomorrow.

Correct Answer: C. Evaluate the client for adverse reactions to haloperidol. An antipsychotic agent, such as haloperidol, can cause muscle spasms in the neck, face, tongue, back, and sometimes legs as well as torticollis (twisted neck position). The nurse should be aware of these adverse reactions and assess for related reactions promptly. The extrapyramidal symptoms are muscular weakness or rigidity, a generalized or localized tremor that may be characterized by the akinetic or agitation types of movements, respectively. Due to the blockade of the dopamine pathway in the brain, typical antipsychotic medications such as haloperidol have correlations with extrapyramidal side effects.

A client begins clozapine (Clozaril) therapy after several other antipsychotic agents fail to relieve her psychotic symptoms. The nurse instructs her to return for weekly white blood cell (WBC) counts to assess for which adverse reaction? A. Hepatitis B. Infection C. Granulocytopenia D. Systemic dermatitis

Correct Answer: C. Granulocytopenia Clozapine can cause life-threatening neutropenia or granulocytopenia. To detect this adverse reaction, a WBC count should be performed weekly. Weekly complete blood count (CBC) to measure ANC levels. ANC levels less than 1500 indicate neutropenia. Levels less than 500 indicate agranulocytosis. A complete blood count should be taken weekly for the first six months, then every other week for the next six months. A national registry is in place to monitor for safe use.

During a group therapy session in the psychiatric unit, a client constantly interrupts with impulsive behavior and exaggerated stories that cast her as a hero or princess. She also manipulates the group with attention-seeking behaviors, such as sexual comments and angry outbursts. The nurse realizes that these behaviors are typical of: A. Paranoid personality disorder B. Avoidant personality disorder C. Histrionic personality disorder D. Borderline personality disorder

Correct Answer: C. Histrionic personality disorder This client's behaviors are typical of histrionic personality disorder, which is marked by excessive emotionality and attention seeking. The client constantly seeks and demands attention, approval, or praise; may be seductive in behavior, appearance, or conversation; and is uncomfortable except when she is the center of attention. Histrionic personality disorder, or dramatic personality disorder, is a psychiatric disorder distinguished by a pattern of exaggerated emotionality and attention-seeking behaviors. Histrionic personality disorder falls within the "Cluster B" of personality disorders.

An agitated and incoherent client, age 29, comes to the emergency department with complaints of visual and auditory hallucinations. The history reveals that the client was hospitalized for paranoid schizophrenia from ages 20 to 21. The physician prescribes haloperidol (Haldol), 5 mg I.M. The nurse understands that this drug is used for this client to treat: A. Dyskinesia B. Dementia C. Psychosis D. Tardive dyskinesia

Correct Answer: C. Psychosis By treating psychosis, haloperidol, an antipsychotic drug, decreases agitation. Haloperidol is a first-generation (typical) antipsychotic medication that is used widely around the world. Food and Drug Administration (FDA) approved the use of haloperidol is for schizophrenia, Tourette syndrome (control of tics and vocal utterances in adults and children), hyperactivity (which may present as impulsivity, difficulty maintaining attention, severe aggressivity, mood instability, and frustration intolerance), severe childhood behavioral problems (such as combative, explosive hyperexcitability), intractable hiccups.

Hormonal effects of the antipsychotic medications include which of the following? A. Polydipsia and dysmenorrhea B. Dysmenorrhea and increased vaginal bleeding C. Retrograde ejaculation and gynecomastia D. Akinesia and dysphasia

Correct Answer: C. Retrograde ejaculation and gynecomastia Decreased libido, retrograde ejaculation, and gynecomastia are all hormonal effects that can occur with antipsychotic medications. Reassure the client that the effects can be reversed or that changing medication may be possible. Among women taking conventional antipsychotics, 26% to 78% experienced amenorrhea; some had galactorrhea. There was some evidence that hyperprolactinemia decreases libido, an effect that could cause nonadherence to treatment. In addition, bone loss appeared to be a secondary drug side effect in some studies. Finally, physician surveys indicated that the prevalence and severity of hyperprolactinemia are underestimated.

The nurse is providing care to a client with a catatonic type of schizophrenia who exhibits extreme negativism. To help the client meet his basic needs, the nurse should: A. Ask the client which activity he would prefer to do first. B. Negotiate a time when the client will perform activities. C. Tell the client specifically and concisely what needs to be done. D. Prepare the client ahead of time for the activity.

Correct Answer: C. Tell the client specifically and concisely what needs to be done. The client needs to be informed of the activity and when it will be done. Use clear and simple language when communicating with a client. Minimize the opportunity for miscommunication and misconstruing the meaning of the message. Set limits in a clear matter-of-fact way, using a calm tone. Giving threatening remarks to Jeremy is unacceptable. They can talk more about the proper ways of dealing with the client's feelings. A calm and neutral approach may diffuse the escalation of anger. Offer an alternative to verbal abuse by finding appropriate ways to deal with feelings.

Which non-antipsychotic medication is used to treat some clients with schizoaffective disorder?A. phenelzine (Nardil) A. phenelzine (Nardil) B. chlordiazepoxide (Librium) C. lithium carbonate (Lithane) D. imipramine (Tofranil)

Correct Answer: C. lithium carbonate (Lithane) Lithium carbonate, an antimanic drug, is used to treat clients with cyclical schizoaffective disorder, a psychotic disorder once classified under schizophrenia that causes affective symptoms, including manic-like activity. Lithium helps control the affective component of this disorder. Lithium was the first mood stabilizer and is still the first-line treatment option, but is underutilized because it is an older drug. Lithium is a commonly prescribed drug for a manic episode in bipolar disorder as well as maintenance therapy of bipolar disorder in a patient with a history of a manic episode. The primary target symptoms of lithium are mania and unstable mood.

Important teaching for a client receiving risperidone (Risperdal) would include advising the client to: A. Double the dose if missed to maintain a therapeutic level. B. Be sure to take the drug with a meal because it's very irritating to the stomach. C. Discontinue the drug if the client reports weight gain. D. Notify the physician if the client notices an increase in bruising.

Correct Answer: D. Notify the physician if the client notices an increase in bruising. Bruising may indicate blood dyscrasias, so notifying the physician about increased bruising is very important. Although there are no mandatory requirements for therapeutic drug monitoring (TDM) with risperidone, monitoring plasma concentrations for this medication is strongly recommended by European guidelines because of data that shows interdependent variability. Therapeutic monitoring can be of benefit to assess compliance and in identifying low drug concentrations that may be low resulting in therapeutic failure. Also, monitoring the drug level can aid in evaluating for potential drug interactions and side effects.

A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development? A. Autonomy versus shame and doubt B. Generativity versus stagnation C. Integrity versus despair D. Trust versus mistrust

Correct Answer: D. Trust versus mistrust This client's paranoid ideation indicates difficulty trusting others. Erikson believed that early patterns of trust help children build a strong base of trust that's crucial for their social and emotional development. If a child successfully develops trust, they will feel safe and secure in the world. You're essentially shaping their personality and determining how they will view the world.

A client receiving fluphenazine decanoate (Prolixin Decanoate) therapy develops pseudoparkinsonism. The physician is likely to prescribe which drug to control this extrapyramidal effect? A. diphenhydramine (Benadryl) B. phenytoin (Dilantin) C. benztropine (Cogentin) D. amantadine (Symmetrel)

Correct Answer: D. amantadine (Symmetrel) An antiparkinsonian agent, such as amantadine, may be used to control pseudoparkinsonism. Amantadine is now used mostly for Parkinson's disease. Clinical trials have shown that amantadine decreases symptoms of bradykinesia, rigidity, and tremor. There is a combined synergistic effect with added levodopa, which is converted to dopamine by striatal enzymes in the CNS. There can be a transient benefit to the drug, so short-term therapy for patients with mild disease is best.

Important teaching for clients receiving antipsychotic medication such as haloperidol (Haldol) includes which of the following instructions? Select all that apply. A. Use sunscreen because of photosensitivity. B. Take the antipsychotic medication with food. C. Have routine blood tests to determine levels of the medication. D. Abstain from eating aged cheese.

Correct Answers: A & B Photosensitivity is an adverse effect of many drugs, characteristically producing skin lesions in the areas exposed to light, which includes the face, "V" area of the neck, extensor surfaces of forearms, and dorsa of hands with sparing of submental and retroauricular areas. Two major mechanisms mediating drug-induced photosensitivity reactions are phototoxic and photoallergic responses. Antipsychotics should be taken with food to avoid gastric upset.

Nursing preparation for a client undergoing electroconvulsive therapy (ECT) resemble those used for: A. General anesthesia B. Cardiac stress testing C. Neurologic examination D. Physical therapy

A. General anesthesia The nurse should prepare a client for ECT in a manner similar to that for general anesthesia. ECT utilizes general anesthesia. Anesthetic induction medications used include barbiturates such as thiopental and methohexital and nonbarbiturate agents such as propofol and etomidate. Seizure-induced by ECT should last longer than 30 seconds. Methohexital is the most commonly used induction agent due to its quick onset, effectiveness, low cost, and minimal effect on seizure duration. Propofol and thiopental have been shown to reduce seizure duration. Etomidate has correlations with myoclonus and increased seizure duration.

A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse? A. "I get upset once in a while, too." B. "I know just how you feel. I'd feel the same way in your situation." C. "I worry, too, when I think people are talking about me." D. "At times, it's normal not to trust anyone."

Correct Answer: A. "I get upset once in a while, too." Sharing a benign, non-threatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can't know how the client feels. Identify with the client symptoms he experiences when he or she begins to feel anxious around others. Increased anxiety can intensify agitation, aggressiveness, and suspiciousness. If a client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate. The client is free to choose his level of interaction; however, concentration can help minimize distressing paranoid thoughts or voices.

A client tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be most therapeutic? A. "That must be frightening to you. Can you tell me how you feel about it?" B. "There are no people living on Mars." C. "What do you mean when you say they're going to invade the earth?" D. "I know you believe the earth is going to be invaded, but I don't believe that."

Correct Answer: A. "That must be frightening to you. Can you tell me how you feel about it?" This response addresses the client's underlying fears without feeding the delusion. Attempt to understand the significance of these beliefs to the client at the time of their presentation. Important clues to underlying fears and issues can be found in the client's seemingly illogical fantasies.

A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be mostappropriate? A. "Your behavior won't be tolerated. Go to your room immediately." B. "You're just doing this to get back at me for making you come to therapy." C. "Your cursing is interrupting the activity. Take time out in your room for 10 minutes." D. "I'm disappointed in you. You can't control yourself even for a few minutes."

Correct Answer: A. "Your behavior won't be tolerated. Go to your room immediately." The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended. Maintain a consistent approach, employ consistent expectations, and provide a structured environment. Clear and consistent limits and expectations minimize the potential for client's manipulation of staff.

Which statement is correct about a 25-year-old client with newly diagnosed schizophrenia? A. Age of onset is typical for schizophrenia. B. Age of onset is later than usual for schizophrenia. C. Age of onset is earlier than usual for schizophrenia. D. Age of onset follows no predictable pattern in schizophrenia.

Correct Answer: A. Age of onset is typical for schizophrenia. The primary age of onset for schizophrenia is late adolescence through young adulthood (ages 17 to 27). Paranoid schizophrenia may sometimes have a later onset. The incidence is also up to ten times greater in children of African and Caribbean migrants compared to Caucasians according to a study conducted in Britain. All of the other options are incorrect.

Propanolol (Inderal) is used in the mental health setting to manage which of the following conditions? A. Antipsychotic-induced akathisia and anxiety. B. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior. C. Delusions for clients suffering from schizophrenia. D. The manic phase of bipolar illness as a mood stabilizer.

Correct Answer: A. Antipsychotic-induced akathisia and anxiety Propranolol is a potent beta-adrenergic blocker and produces a sedating effect, therefore it is used to treat antipsychotic-induced akathisia and anxiety. Off-label use of propranolol includes the use in performance anxiety, which is a subset of a social phobia presenting with tachycardia, sweating, and flushing that occurs secondary to increased activation of the sympathetic nervous system.

Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions? A. Antipsychotic-induced akathisia and anxiety. B. The manic phase of bipolar illness as a mood stabilizer. C. Delusions for clients suffering from schizophrenia. D. Obsessive-compulsive disorder (OCD) to reduce ritualistic behavior.

Correct Answer: A. Antipsychotic-induced akathisia and anxiety Propranolol is a potent beta-adrenergic blocker and produces a sedating effect; therefore, it's used to treat antipsychotic-induced akathisia and anxiety. Off-label use of propranolol includes the use in performance anxiety, which is a subset of a social phobia presenting with tachycardia, sweating, and flushing that occurs secondary to increased activation of the sympathetic nervous system.

Which activity would be most appropriate for a severely withdrawn client? A. Art activity with a staff member B. Board game with a small group of clients C. Team sport in the gym D. Watching TV in the dayroom

Correct Answer: A. Art activity with a staff member. The best approach with a withdrawn client is to initiate brief, non-demanding activities on a one-to-one basis. This approach gives the nurse an opportunity to establish a trusting relationship with the client. When the client is in the most depressed state, Involve the client in one-to-one activity; maximizes the potential for interactions while minimizing anxiety levels. Give positive feedback after a task is achieved. Positive reinforcement has a big part in building self-esteem.

A client with major depression has not verbalized problem areas to staff or peers since admission to a psychiatric unit. Which activity should the nurse recommend to help this client express himself? A. Art therapy in a small group. B. Basketball game with peers on the unit. C. Reading a self-help book on depression. D. Watching a movie with the peer group.

Correct Answer: A. Art therapy in a small group Art therapy provides a non-threatening vehicle for the expression of feelings, and use of a small group will help the client become comfortable with peers in a group setting. Initially, provide activities that require minimal concentration (e.g., drawing, playing simple board games). Depressed people lack concentration and memory. Activities that have no "right or wrong" or "winner or loser" minimizes opportunities for the client to put himself/herself down.

A client tells the nurse that psychotropic medicines are dangerous and refuses to take them. Which intervention should the nurse use first? A. Ask the client about any previous problems with psychotropic medications. B. Ask the client if an injection is preferable. C. Insist that the client takes medication as prescribed. D. Withhold the medication until the client is less suspicious.

Correct Answer: A. Ask the client about any previous problems with psychotropic medications. The nurse needs to clarify the client's previous experience with psychotropic medication in order to understand the meaning of the client's statement. Attempt to understand the significance of these beliefs to the client at the time of their presentation. Important clues to underlying fears and issues can be found in the client's seemingly illogical fantasies. Explain the procedures and try to be sure the client understands the procedures before carrying them out. When the client has full knowledge of procedures, he or she is less likely to feel tricked by the staff.

The most critical factor for nurse Linda to determine during crisis intervention would be the client's: A. Available situational supports. B. Willingness to restructure the personality. C. Developmental theory. D. Underlying unconscious conflict.

Correct Answer: A. Available situational supports Personal internal strength and supportive individuals are critical factors that can be employed to assist the individual to cope with a crisis. A crisis intervention is an immediate and short-term emergency response to mental, emotional, physical, and behavioral distress. Crisis interventions help to restore an individual's equilibrium to their biopsychosocial functioning and minimize the potential for long-term trauma or distress.

The nurse understands that the therapeutic effects of typical antipsychotic medications are associated with which neurotransmitters change? A. Decreased dopamine level B. Increased acetylcholine level C. Stabilization of serotonin D. Stimulation of GABA

Correct Answer: A. Decreased dopamine level Excess dopamine is thought to be the chemical cause of psychotic thinking. The typical antipsychotics act to block dopamine receptors and therefore decrease the amount of neurotransmitter at the synapses. First-generation antipsychotics are dopamine receptor antagonists (DRA) and are known as typical antipsychotics. They include phenothiazines (trifluoperazine, perphenazine, prochlorperazine, acetophenazine, triflupromazine, mesoridazine), butyrophenones (haloperidol), thioxanthenes (thiothixene, chlorprothixene), dibenzoxazepines (loxapine), dihydroxyindole (molindone), and diphenylbutylpiperidine (pimozide).

Nurse John is aware that a serious effect of inhaling cocaine is? A. Deterioration of nasal septum. B. Acute fluid and electrolyte imbalances. C. Extrapyramidal tract symptoms. D. Esophageal varices.

Correct Answer: A. Deterioration of nasal septum Cocaine is a chemical that when inhaled, causes destruction of the mucous membranes of the nose. Despite the fast delivery and more powerful effects that come with snorting drugs, the nose simply wasn't meant to inhale powders. Even a single use can cause swelling of the inner linings of the nose, lung infections, nasal blockages, and compromised respiratory tracts. These damaging outcomes are usually not the result of the drug being snorted, but of all the other things that might have been added to the powder to stretch it or that otherwise contaminate it.

Ramsay is diagnosed with schizophrenia paranoid type and is admitted to the psychiatric unit of Nurseslabs Medical Center. Which of the following nursing interventions would be most appropriate? A. Establishing a non-demanding relationship. B. Encouraging involvement in group activities. C. Spending more time with Ramsay. D. Waiting until Ramsay initiates interaction

Correct Answer: A. Establishing a non-demanding relationship A non-threatening, non-demanding relationship helps decrease the mistrust that is common in a client with paranoid schizophrenia. Use a non-judgemental, respectful, and neutral approach with the client. There is less chance for a suspicious client to misinterpret intent or meaning if content is neutral and approach is respectful and non-judgemental.

Nurse Dorothy is evaluating care of a client with schizophrenia; the nurse should keep which point in mind? A. Frequent reassessment is needed and is based on the client's response to treatment. B. The family does not need to be included in the care because the client is an adult. C. The client is too ill to learn about his illness. D. Relapse is not an issue for a client with schizophrenia.

Correct Answer: A. Frequent reassessment is needed and is based on the client's response to treatment. Because the client responds to treatment in different ways, the nurse must constantly evaluate the client and his potential. A premorbid adjustment must also be considered. Assess if incoherence in speech is chronic or if it is more sudden, as in an exacerbation of symptoms. Establishing a baseline facilitates the establishment of realistic goals, the foundation for planning effective care.

A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following? A. Help the client execute actions that are feared. B. Help the client develop insight into irrational fears. C. Help the client substitutes one fear for another. D. Help the client decrease anxiety.

Correct Answer: A. Help the client execute actions that are feared Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear, without experiencing anxiety. This therapy aims to remove the fear response of a phobia and substitute a relaxation response to the conditional stimulus gradually using counter conditioning. The number of sessions required depends on the severity of the phobia. Usually, 4-6 sessions, up to 12 for a severe phobia. The therapy is complete once the agreed therapeutic goals are met (not necessarily when the person's fears have been completely removed).

Before helping a male client who has been sexually assaulted, nurse Maureen should recognize that the rapist is motivated by feelings of: A. Hostility B. Inadequacy C. Incompetence D. Passion

Correct Answer: A. Hostility Rapists are believed to harbor and act out hostile feelings toward all women through the act of rape. Displays anger or aggression, either physically or verbally. (The anger need not be directed toward the victim, but may be displayed during conversations by general negative references to women, vulgarity, curtness toward others, and the like. Women are often viewed as adversaries).

A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client? A. Ineffective protection related to blood dyscrasias B. Urinary frequency related to adverse effects of antipsychotic medication C. Risk for injury related to a severely decreased level of consciousness D. Risk for injury related to electrolyte disturbances

Correct Answer: A. Ineffective protection related to blood dyscrasias Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias, that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have anticholinergic effects, such as urine retention, dry mouth, and constipation. Leukopenia, thrombocytopenia, and blood dyscrasia are rare side effects of treatment with FGAs.

The nurse is assigned to a client with catatonic schizophrenia. Which intervention should the nurse include in the client's plan of care? A. Meeting all of the client's physical needs. B. Giving the client an opportunity to express concerns. C. Administering lithium carbonate (Lithonate) as prescribed. D. Providing a quiet environment where the client can be alone.

Correct Answer: A. Meeting all of the client's physical needs Because a client with catatonic schizophrenia can't meet physical needs independently, the nurse must provide for all of these needs, including adequate food and fluid intake, exercise, and elimination. The initial management includes supportive measures such as IV fluids and even nasogastric tubes given that patients with catatonia are susceptible to malnutrition, dehydration, pneumonia, etc. The key is early identification of catatonia in a patient with schizophrenia and initiation of treatment.

When nurse Hazel considers a client's placement on the continuum of anxiety, a key in determining the degree of anxiety being experienced is the client's: A. Perceptual field B. Delusional system C. Memory state D. Creativity level

Correct Answer: A. Perceptual field Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases. The impact of anxiety on cognitive function is a major contributing factor to these costs; anxiety disorders can promote a crippling focus upon negative life-events and make concentration difficult, which can lead to problems in both social and work environments. In such situations, the state of anxiety can be seen as maladaptive.

Barbara with bipolar disorder is being treated with lithium for the first time. Nurse Clint should observe the client for which common adverse effect of lithium? A. Polyuria B. Seizures C. Constipation D. Sexual dysfunction

Correct Answer: A. Polyuria Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit. Before starting treatment with lithium, it is essential to get kidney function tests and thyroid function tests. Lithium is not recommended in patients with renal impairment. It is also not recommended in patients with cardiovascular disease. Avoid all diuretics. If the patient has severe renal dysfunction or failure, or severely altered mental status, then start with hemodialysis.

Tony with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobia include: A. Severe anxiety and fear. B. Withdrawal and failure to distinguish reality from fantasy. C. Depression and weight loss. D. Insomnia and inability to concentrate.

Correct Answer: A. Severe anxiety and fear Phobias cause severe anxiety (such as panic attacks) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia, and elevated B.P. Patients with a specific phobia experience high levels of anxiety and panic attacks along with excessive and unreasonable fear due to either exposure or anticipation of exposure to a feared stimulus. As a result, these patients will try to avoid the anxiety-provoking stimulus to any extent possible.

The nurse is caring for a client with schizophrenia. Which of the following outcomes is the least desirable? A. The client spends more time by himself. B. The client doesn't engage in delusional thinking. C. The client doesn't harm himself or others. D. The client demonstrates the ability to meet his own self-care needs.

Correct Answer: A. The client spends more time by himself. The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn't be a desirable outcome. Rather, a desirable outcome would specify that the client spends more time with other clients and staff on the unit. Delusions are false personal beliefs. Eventually engage other clients and significant others in social interactions and activities with the client (card games, ping pong, sing-a-songs, group sharing activities) at the client's level. Client continues to feel safe and competent in a graduated hierarchy of interactions.

A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful? A. The parents reinforced increased decision-making by the client. B. The parents clearly verbalize their expectations for the client. C. The client verbalizes that family meals are now enjoyable. D. The client tells her parents about feelings of low-self esteem.

Correct Answer: A. The parents reinforced increased decision making by the client One of the core issues concerning the family of a client with anorexia is control. The family's acceptance of the client's ability to make independent decisions is key to successful family intervention. Discourage members from asking for approval from each other. Be alert to verbal or nonverbal checking with others for approval. Acknowledge the competent actions of the patient. Each individual needs to develop own internal sense of self-esteem. Individuals often are living up to others' (family's) expectations rather than making their own choices. Acknowledgment provides recognition of self in positive ways.

Initial interventions for Marco with acute anxiety include all except which of the following? A. Touching the client in an attempt to comfort him. B. Approaching the client in a calm, confident manner. C. Encouraging the client to verbalize feelings and concerns D. Providing the client with a safe, quiet, and private place.

Correct Answer: A. Touching the client in an attempt to comfort him The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety. Converse using a simple language and brief statements. When experiencing moderate to severe anxiety, patients may be unable to understand anything more than simple, clear, and brief instruction.

A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms? A. benztropine (Cogentin) B. dantrolene (Dantrium) C. clonazepam (Klonopin) D. diazepam (Valium)

Correct Answer: A. benztropine (Cogentin) Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Thus, benztropine blocks the cholinergic muscarinic receptor in the central nervous system. Therefore, it reduces the cholinergic effects significantly during Parkinson's disease which becomes more pronounced in the nigrostriatal tract because of reduced dopamine concentrations.

A client with schizophrenia is referred for psychosocial rehabilitation. Which of the following are typical of this type of program? Select all that apply. A. Analyzing family issues and past problems B. Developing social skills and supports C. Learning how to live independently in a community D. Learning job skills for employment E. Treating family members affected by the illness F. Participating in in-depth psychoanalytical counseling

Correct Answer: B, C, D The goal of psychosocial rehabilitation as a treatment method is to help the client develop the skills and supports necessary for successful living, learning, and working in the community. Analysis of family issues and past problems and treatment of family members are not commonly part of this type of program. The emphasis of psychosocial rehabilitation is on the client's development of skills in the here and now; consequently, psychoanalytic counseling is not part of the approach.

Rosana is in the second stage of Alzheimer's disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain? A. "Where is your pain located?" B. "Do you hurt? (pause) "Do you hurt?" C. "Can you describe your pain?" D. "Where do you hurt?"

Correct Answer: B. "Do you hurt? (pause) "Do you hurt?" When speaking to a client with Alzheimer's disease, the nurse should use close-ended questions. Those that the client can answer with "yes" or "no" whenever possible and avoid questions that require the client to make choices. Repeating the question aids comprehension. Alzheimer's disease and other dementias gradually diminish a person's ability to communicate. Communication with a person with Alzheimer's requires patience, understanding, and good listening skills.

82-year-old Mr. Robeson together with his daughter arrived at the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client's daughter best supports the diagnosis? A. "Maybe it's just caused by aging. This usually happens by age 82." B. "The changes in his behavior came on so quickly! I wasn't sure what was happening." C. "Dad just didn't seem to know what he was doing. He would forget what he had for breakfast." D. "Dad has always been so independent. He's lived alone for years since mom died."

Correct Answer: B. "The changes in his behavior came on so quickly! I wasn't sure what was happening." Delirium is an acute process characterized by abrupt, spontaneous cognitive dysfunction. Delirium, also known as the acute confusional state, is a clinical syndrome that usually develops in the elderly. It is characterized by an alteration of consciousness and cognition with reduced ability to focus, sustain, or shift attention. It develops over a short period and fluctuates during the day.

Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)? A. The absence of anticholinergic effects. B. A lower incidence of extrapyramidal effects. C. Photosensitivity and sedation. D. No incidence of neuroleptic malignant syndrome.

Correct Answer: B. A lower incidence of extrapyramidal effects Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. SGAs have loose binding to D2 receptors and can quickly dissociate from the receptor, potentially accounting for the lower likelihood of causing extrapyramidal symptoms (EPS). Moreover, SGAs have agonism at the 5HT1A receptor. Serotonin and norepinephrine reuptake inhibition are potential mechanisms by which risperidone is postulated to produce antidepressant effects. The improvement of positive symptoms is thought to be accomplished through the blockade of D2 receptors specifically in the mesolimbic pathway.

A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response? A. Say, "You know it's your medicine." B. Allow him to open the individual wrappers of the medication. C. Say, "Don't worry about what is in the pills. It's what is ordered." D. Ignore the comment because it's probably a joke.

Correct Answer: B. Allow him to open the individual wrappers of the medication. This is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Talk openly with the client about their beliefs and thoughts, showing empathy and support. Help build trust and rapport with clients. Paranoid clients may be more reluctant to trust anyone, but open communication generally offers more cooperation. Explain all procedures clearly and carefully, and their purpose, before starting them. Prevents aggressive behavior and suspicion. Promotes cooperation and compliance. Helps develop trust.

Which medication can control the extrapyramidal effects associated with antipsychotic agents? A. Clorazepate (Tranxene) B. Amantadine (Symmetrel) C. Doxepin (Sinequan) D. Perphenazine (Trilafon)

Correct Answer: B. Amantadine (Symmetrel) Amantadine is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects such as muscle weakness, involuntary muscle movements, pseudoparkinsonism, and tardive dyskinesia. Amantadine is used to treat the symptoms of Parkinson's disease (PD; a disorder of the nervous system that causes difficulties with movement, muscle control, and balance) and other similar conditions. It is also used to control movement problems that are a side effect of certain medications used to treat Parkinson's disease. It also is used to prevent symptoms of influenza A virus infection and for treatment of respiratory infections caused by influenza A virus. Amantadine is in a class of medications called adamantanes. It is thought to work to control movement problems by increasing the amount of dopamine in certain parts of the body. It works against influenza A virus by stopping the spread of the virus in the body.

Which of the following best explains why tricyclic antidepressants are used with caution in elderly patients? A. Central Nervous System effects B. Cardiovascular system effects C. Gastrointestinal system effects D. Serotonin syndrome effects

Correct Answer: B. Cardiovascular system effects The TCAs affect norepinephrine as well as other neurotransmitters and thus have significant cardiovascular side effects. Therefore, they are used with caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. TCAs may also cause cardiovascular complications, including arrhythmias, such as QTc prolongation, ventricular fibrillation, and sudden cardiac death in patients with preexisting ischemic heart disease. Therefore, the examination of a patient's cardiac health is important before TCA prescription.

A client with dysthymic disorder reports to a nurse that his life is hopeless and will never improve in the future. How can the nurse best respond using a cognitive approach? A. Agree with the client painful feelings B. Challenge the accuracy of the client's belief. C. Deny that the situation is hopeless. D. Present a cheerful attitude.

Correct Answer: B. Challenge the accuracy of the client's belief Use of cognitive techniques allows the nurse to help the client recognize that these negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful. Assess individual signs of hopelessness. These aids focus attention on aspects of individual needs. These signs may include social withdrawal, decreased physical activity, and comments made by the patient that indicate despair and hopelessness.

A client with depressive symptoms is given prescribed medications and talks with his therapist about his belief that he is worthless and unable to cope with life. Psychiatric care in this treatment plan is based on which framework? A. Behavioral framework B. Cognitive framework C. Interpersonal framework D. Psychodynamic framework

Correct Answer: B. Cognitive framework Cognitive thinking therapy focuses on the client's misperceptions about self, others, and the world that impact functioning and contribute to symptoms. Using medications to alter neurotransmitter activity is a psychobiologic approach to treatment. The cognitive framework is based on a unique set of elements from psychosocial theories that are consistent with economic theory, experimental data, and historical data on human behavior. The theories are consistent with one another and are easily translated into mathematical equations.

A 48-year-old male client is brought to the psychiatric emergency room after attempting to jump off a bridge. The client's wife states that he lost his job several months ago and has been unable to find another job. The primary nursing intervention at this time would be to assess for: A. A past history of depression. B. Current plans to commit suicide. C. The presence of marital difficulties. D. Feelings of excessive failure.

Correct Answer: B. Current plans to commit suicide Whether there is a suicide plan is a criterion when assessing the client's determination to make another attempt. Keep accurate and thorough records of client's behaviors (verbal and physical) and all nursing/physician actions. Put on either suicide precaution (one-on-one monitoring at one arm's length away) or suicide observation (15-minute visual check of mood, behavior, and verbatim statements), depending on level of suicide potential. Protection and preservation of the client's life at all costs during crisis is part of medical and nursing staff's responsibility. Follow unit protocol.

Kris periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, Kris may experience: A. Heightened concentration B. Decreased perceptual field C. Decreased cardiac rate D. Decreased respiratory rate

Correct Answer: B. Decreased perceptual field Panic is the most severe level of anxiety. During a panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self, less aware of surroundings, and unable to process information from the environment. The decreased perceptual field contributes to impaired attention and inability to concentrate. Panic attacks are defined by the Diagnostic and Statistical Manual of Mental Health Disorders (DSM) as "an abrupt surge of intense fear or discomfort" reaching a peak within minutes.

Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe: A. Hyperactivity B. Depression C. Suspicion D. Delirium

Correct Answer: B. Depression There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug. When cocaine use is stopped or when a binge ends, a crash follows almost right away. The cocaine user has a strong craving for more cocaine during a crash. Other symptoms include fatigue, lack of pleasure, anxiety, irritability, sleepiness, and sometimes agitation or extreme suspicion or paranoia. Cocaine withdrawal often has no visible physical symptoms, such as the vomiting and shaking that accompany withdrawal from heroin or alcohol.

Joy who has just experienced her second spontaneous abortion expresses anger towards her physician, the hospital and the "rotten nursing care". When assessing the situation, the nurse recognizes that the client may be using the coping mechanism of: A. Projection B. Displacement C. Denial D. Reaction formation

Correct Answer: B. Displacement The client's anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time. Displacement is a psychological defense mechanism in which a person redirects a negative emotion from its original source to a less threatening recipient. A classic example of defense is displaced aggression. If a person is angry but cannot direct their anger toward the source without consequences, they might "take out" their anger on a person or thing that poses less of a risk.

Discharge instructions for a male client receiving tricyclic antidepressants include which of the following information? A. Restrict sodium intake. B. Don't consume alcohol. C. Discontinue if dry mouth and blurred vision occur. D. Restrict fluid.

Correct Answer: B. Don't consume alcohol Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants. Drinking can counteract the benefits of antidepressant medication, making symptoms more difficult to treat. Alcohol may seem to improve the mood in the short term, but its overall effect increases symptoms of depression and anxiety. Many medications can cause problems when taken with alcohol — including anti-anxiety medications, sleep medications, and prescription pain medications. Side effects may worsen if you drink alcohol and take one of these drugs along with an antidepressant.

Nurse Winona educates the family about symptom management for when the schizophrenic client becomes upset or anxious. Which of the following would Nurse Winona state be helpful? A. Call the therapist to request a medication change. B. Encourage the use of learned relaxation techniques. C. Request that the client be hospitalized until the crisis is over. D. Wait before the anxiety worsens before intervening.

Correct Answer: B. Encourage the use of learned relaxation techniques. The client with schizophrenia can learn relaxation techniques, which help reduce anxiety. The family can be supportive and helpful by encouraging the client to use these techniques. When client is ready, introduce strategies that can minimize anxiety and lower voices and "worrying" thoughts, teach client to do the following: focus on meaningful activities; learn to replace negative thoughts with constructive thoughts; perform deep breathing exercise; use a calming visualization or listen to music; or seek support from staff, family, or other supportive people.

The nurse formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate? A. Helping the client to participate in social interactions. B. Establishing a one-on-one relationship with the client. C. Establishing alternative forms of communication. D. Allowing the client to decide when he wants to participate in verbal communication with the nurse.

Correct Answer: B. Establishing a one-on-one relationship with the client By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations. Assess if incoherence in speech is chronic or if it is more sudden, as in an exacerbation of symptoms. Establishing a baseline facilitates the establishment of realistic goals, the foundation for planning effective care.

Cersei is diagnosed as having disorganized schizophrenia. Which behaviors would Nurse Sansa most likely assess in the client? A. Absence of acute symptoms impaired role function. B. Extreme social withdrawal, odd mannerisms, and behavior. C. Psychomotor immobility; presence of waxy flexibility. D. Suspiciousness toward others increased hostility.

Correct Answer: B. Extreme social withdrawal, odd mannerisms, and behavior Disorganized schizophrenia is characterized by regressive behavior with extreme social withdrawal and frequently odd mannerisms. In the most general sense, disorganized schizophrenia refers to the disorganization of thought processes, behavior, and affect regulation (emotions). The DSM-IV included five subtypes of schizophrenia, including disorganized, paranoid, catatonic, undifferentiated, and residual. The subtypes were removed from the current version of the DSM (DSM-5, released in 2013), as it was determined that they were not helpful when treating the disorder.

Which of the following client behaviors documented in Gio's chart would validate the nursing diagnosis of Risk for other-directed violence? A. Gio's description of being endowed with superpowers. B. Frequent angry outburst noted toward peers and staff. C. Refusal to eat cafeteria food. D. Refusal to join in group activities.

Correct Answer: B. Frequent angry outburst noted toward peers and staff Anger is an important factor that indicates the potential for acting out. Because the client is angry with both peers and staff, any acting out would probably be directed toward others. Frequently assess client's behavior for signs of increased agitation and hyperactivity. Early detection and intervention of escalating mania will prevent the possibility of harm to self or others, and decrease the need for seclusions.

When performing a physical examination on a female anxious client, nurse Nelli would expect to find which of the following effects produced by the parasympathetic system? A. Muscle tension B. Hyperactive bowel sounds C. Decreased urine output D. Constipation

Correct Answer: B. Hyperactive bowel sounds The parasympathetic nervous system would produce incomplete G.I. motility resulting in hyperactive bowel sounds, possibly leading to diarrhea. The parasympathetic nervous system, in contrast, exerts both excitatory and inhibitory control over gastric and intestinal tone and motility. Although GI functions are controlled by the autonomic nervous system and occur, by and large, independently of conscious perception, it is clear that the higher CNS centers influence homeostatic control as well as cognitive and behavioral functions.

A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he: A. Sit in a quiet, dark room and concentrate on the voices. B. Listen to a personal stereo through headphones and sing along with the music. C. Call a friend and discuss the voices and his feelings about them. D. Engage in strenuous exercise.

Correct Answer: B. Listen to a personal stereo through headphones and sing along with the music. Increasing the amount of auditory stimulation, such as by listening to music through headphones, may make it easier for the client to focus on external sounds and ignore internal sounds from auditory hallucinations. Work with the client to find which activities help reduce anxiety and distract the client from a hallucinatory material. Practice new skills with the client. If clients' stress triggers hallucinatory activity, they might be more motivated to find ways to remove themselves from a stressful environment or try distraction techniques.

Which ability should Nurse Rebecca expect from a client in the mild stage of dementia of the Alzheimer's type? A. Remembering the daily schedule. B. Recalling past events. C. Coping the anxiety. D. Solving problems of daily living.

Correct Answer: B. Recalling past events Recent memory loss is the characteristic sign of cognitive difficulty in early Alzheimer's disease. The ability to recall past events is usually retained until the later stages of this disorder. Symptoms of Alzheimer's disease depend on the stage of the disease. Alzheimer's disease is classified into preclinical or presymptomatic, mild, and dementia-stage depending on the degree of cognitive impairment. These stages are different from the DSM-5 classification of Alzheimer's disease. The initial and most common presenting symptom is episodic short-term memory loss with relative sparing of long-term memory and can be elicited in most patients even when not the presenting symptom.

Malou with schizophrenia tells Nurse Melinda, "My intestines are rotted from worms chewing on them." This statement indicates a: A. Jealous delusion B. Somatic delusion C. Delusion of grandeur D. Delusion of persecution

Correct Answer: B. Somatic delusion Somatic delusions focus on bodily functions or systems and commonly include delusion about foul odor emissions, insect manifestations, internal parasites, and misshapen parts. Of the delusional symptoms, somatic delusions-those that pertain to the body-are rather rare. Somatic delusions are defined as fixed false beliefs that one's bodily function or appearance is grossly abnormal. They are a poorly understood psychiatric symptom and pose a significant clinical challenge to clinicians.

Gio told his nurse that the FBI is monitoring and recording his every movement and that microphones have been placed in the unit walls. Which action would be the most therapeutic response? A. Confront the delusional material directly by telling Gio that this simply is not so. B. Tell Gio that this must seem frightening to him but that you believe he is safe here. C. Tell Gio to wait and talk about these beliefs in his one-on-one counseling sessions. D. Isolate Gio when he begins to talk about these beliefs.

Correct Answer: B. Tell Gio that this must seem frightening to him but that you believe he is safe here. The nurse must realize that these perceptions are very real to the client. Acknowledging the client's feelings provides support; explaining how the nurse sees the situation in a different way provides reality orientation. Recognize the client's delusions as the client's perception of the environment. Recognizing the client's perception can help you understand the feelings he or she is experiencing.

Which client outcome would best indicate successful treatment for a client with an antisocial personality disorder? A. The client exhibits charming behavior when around authority figures. B. The client has decreased episodes of impulsive behaviors. C. The client makes statements of self-satisfaction. D. The client's statements indicate no remorse for behaviors.

Correct Answer: B. The client has decreased episodes of impulsive behaviors A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. Therefore, decreased frequency of impulsive behaviors would be evidence of improvement. Of those children with conduct disorder, 25% of girls and 40% of boys will meet the diagnostic criteria for antisocial personality disorder. Boys exhibit symptoms earlier than girls, who often only elicit these symptoms in puberty.

Which goal is a priority for a client with a DSM-IV-TR diagnosis of delirium and the nursing diagnosis acute confusion related to recent surgery secondary to traumatic hip fracture? A. The client will complete activities of daily living. B. The client will maintain safety. C. The client will remain oriented. D. The client will understand communication.

Correct Answer: B. The client will maintain safety. Maintaining safety is the priority goal for an acutely confused client who recently had surgery. All measures to promote physiologic safety and psychosocial wellbeing would be implemented. Remove all potentially dangerous objects from the client's environment; in a disoriented, confused state, clients may use objects to harm self or others. Have sufficient staff available to execute a physical confrontation, if necessary; assistance may be required from others to provide for the physical safety of the client or primary nurse, or both.

A 26-year-old client is admitted to the psychiatric unit with acute onset of schizophrenia. His physician prescribes the phenothiazine chlorpromazine (Thorazine), 100 mg by mouth four times per day. Before administering the drug, the nurse reviews the client's medication history. Concomitant use of which drug is likely to increase the risk of extrapyramidal effects? A. guanethidine (Ismelin) B. droperidol (Inapsine) C. lithium carbonate (Lithonate) D. Alcohol

Correct Answer: B. droperidol (Inapsine) When administered with any phenothiazine, droperidol may increase the risk of extrapyramidal effects. Despite being a low-potency drug, chlorpromazine can still cause extrapyramidal side effects (EPS) such as acute dystonia, akathisia, parkinsonism, and tardive dyskinesia (TD). The evolution of EPS side effects can occur through hours to days. Acute dystonia refers to muscle stiffness or spasm of the head, neck, and eye muscles that can start hours after starting the medication. Akathisia includes restlessness and fast pacing. Parkinsonism includes bradykinesia, "cogwheel" rigidity, and shuffling gait.

Every day for the past 2 weeks, a client with schizophrenia stands up during group therapy and screams, "Get out of here right now! The elevator bombs are going to explode in 3 minutes!" The next time this happens, how should the nurse respond? A. "Why do you think there is a bomb in the elevator?" B. "That is the same thing you said in yesterday's session." C. "I know you think there are bombs in the elevator, but there aren't." D. "If you have something to say, you must do it according to our group rules."

Correct Answer: C. "I know you think there are bombs in the elevator, but there aren't." This is the most therapeutic response because it orients the client to reality. Identify feelings related to delusions. If a client believes someone is going to harm him/her, the client is experiencing fear. When people believe that they are understood, anxiety might lessen.

Jose who is receiving monoamine oxidase inhibitor antidepressant should avoid tyramine, a compound found in which of the following foods? A. Figs and cream cheese B. Fruits and yellow vegetables C. Aged cheese and Chianti wine D. Green leafy vegetables

Correct Answer: C. Aged cheese and Chianti wine Aged cheese and Chianti wine contain high concentrations of tyramine. MAOIs prevent the breakdown of tyramine found in the body as well as certain foods, drinks, and other medications. Patients that take MAOIs and consume tyramine-containing foods or drinks will exhibit high serum tyramine level. A high level of tyramine can cause a sudden increase in blood pressure, called the tyramine pressor response. Even though it is rare, a high tyramine level can trigger a cerebral hemorrhage, which can even result in death.

A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client? A. Take the medication 1 hour before a meal. B. Decrease the dosage if signs of illness decrease. C. Apply sunscreen before being exposed to the sun. D. Increase the dosage up to 50 mg twice per day if signs of illness don't decrease.

Correct Answer: C. Apply a sunscreen before being exposed to the sun. Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. Photosensitivity is an adverse effect of many drugs, characteristically producing skin lesions in the areas exposed to light, which includes the face, "V" area of the neck, extensor surfaces of forearms, and dorsa of hands with sparing of submental and retroauricular areas. Two major mechanisms mediating drug induced photosensitivity reactions are phototoxic and photoallergic responses.

80-year-old Mr. Stevens is accompanied to the clinic by his son, who tells the nurse that the client's constant confusion, incontinence, and tendency to wander are intolerable. The client was diagnosed with chronic cognitive impairment disorder. Which nursing diagnosis is most appropriate for the client's son? A. Risk for other-directed violence. B. Disturbed sleep pattern. C. Caregiver role strain. D. Social isolation.

Correct Answer: C. Caregiver role strain The son's description exemplifies some of the problems commonly encountered by a primary caregiver who is caring for someone with a cognitive impairment disorder. Assess family's knowledge of patient's disease and erratic behaviors and possible violent reactions. Knowledge will enhance the family's understanding of dementia associated with the disease and development of coping skills and strategies.

Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following? A. Increased incidence of dysmenorrhea while taking the drug. B. Occurrence of incomplete libido due to medication adverse effects. C. Continuing previous use of contraception during periods of amenorrhea. D. Instruction that amenorrhea is irreversible.

Correct Answer: C. Continuing previous use of contraception during periods of amenorrhea Women may experience amenorrhea, which is reversible while taking antipsychotics. Amenorrhea doesn't indicate cessation of ovulation thus, the client can still be pregnant. Antipsychotic?induced menstrual dysfunction has prevalence rates of approximately 45% for oligomenorrhoea/amenorrhoea and 19% for galactorrhoea (Kinon 2003; Wieck 2003). An illness?related under?function of the hypothalamic?pituitary?gonadal axis in women with schizophrenia may also contribute to menstrual irregularities. This review will focus on amenorrhoea. In an extensive study conducted in India, the prevalence of amenorrhoea in women on risperidone was 60%.

Nurse Ronald could evaluate that the staff's approach to setting limits for a demanding, angry client was effective if the client: A. Apologizes for disrupting the unit's routine when something is needed. B. Understands the reason why frequent calls to the staff were made. C. Discuss concerns regarding the emotional condition that required hospitalizations. D. No longer calls the nursing staff for assistance.

Correct Answer: C. Discuss concerns regarding the emotional condition that required hospitalizations This would document that the client feels comfortable enough to discuss the problems that have motivated the behavior. Chart, in nurse's notes, behaviors; interventions; what seemed to escalate agitation; what helped to calm agitation; when as-needed (PRN) medications were given and their effect; and what proved most helpful. Staff will begin to recognize potential signals for escalating manic behaviors and have a guideline for what might work best for the individual client.

A client with depression has been hospitalized for treatment after taking a leave of absence from work. The client's employer expects the client to return to work following inpatient treatment. The client tells the nurse, "I'm no good. I'm a failure". According to cognitive theory, these statements reflect: A. Learned behavior B. Punitive superego and decreased self-esteem C. Faulty thought processes that govern behavior D. Evidence of difficult relationships in the work environment

Correct Answer: C. Faulty thought processes that govern behavior The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation - issues that are typically examined using a cognitive theory approach. Cognitive-behavioral theorists suggest that depression results from maladaptive, faulty, or irrational cognitions taking the form of distorted thoughts and judgments. Depressive cognitions can be learned socially (observationally) as is the case when children in a dysfunctional family watch their parents fail to successfully cope with stressful experiences or traumatic events. Or, depressive cognitions can result from a lack of experiences that would facilitate the development of adaptive coping skills.

Which of the following drugs has been known to be effective in treating obsessive-compulsive disorder (OCD)? A. Divalproex (depakote) and Lithium (lithobid) B. Chlordiazepoxide (Librium) and diazepam (valium) C. Fluvoxamine (Luvox) and clomipramine (anafranil) D. Benztropine (Cogentin) and diphenhydramine (benadryl)

Correct Answer: C. Fluvoxamine (Luvox) and clomipramine (Anafranil) The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD. Fluvoxamine is used to treat obsessive-compulsive disorder (bothersome thoughts that won't go away and the need to perform certain actions over and over) and social anxiety disorder (extreme fear of interacting with others or performing in front of others that interferes with normal life). Fluvoxamine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. Clomipramine is used to treat people with obsessive-compulsive disorder (a condition that causes repeated unwanted thoughts and the need to perform certain behaviors over and over). Clomipramine is in a group of medications called tricyclic antidepressants. It works by increasing the amount of serotonin, a natural substance in the brain that is needed to maintain mental balance.

A nurse who explains that a client's psychotic behavior is unconsciously motivated understands that the client's disordered behavior arises from which of the following? A. Abnormal thinking B. altered neurotransmitters C. Internal Needs D. Response to stimuli

Correct Answer: C. Internal needs The concept that behavior is motivated and has meaning comes from the psychodynamic framework. According to this perspective, behavior arises from internal wishes or needs. Much of what motivates behavior comes from the unconscious. The psychodynamic approach includes all the theories in psychology that see human functioning based upon the interaction of drives and forces within the person, particularly unconscious, and between the different structures of the personality.

Nurse Isabelle enters the room of a client with a cognitive impairment disorder and asks what day of the week it is; what the date, month, and year are; and where the client is. The nurse is attempting to assess: a. confabulation b. delirium c. orientation d. Preservation

Correct Answer: C. Orientation. The initial, most basic assessment of a client with cognitive impairment involves determining his level of orientation (awareness of time, place, and person). The tools for reality orientation aim to reinforce the naming of objects and people as well as a timeline of events, past or present. Multiple studies have demonstrated that the use of reality orientation has improved cognitive functioning for people living with dementia when compared to control groups who did not receive it. As a rule, reality orientation must be mixed with compassion and used appropriately to benefit someone living with the confusion of dementia. Applying it without evaluating if it might cause emotional distress to the individual since there are some times when it would not be appropriate.

Mrs. Jordan is an elderly client diagnosed with Alzheimer's disease. She becomes agitated and combative when a nurse approaches to help with morning care. The most appropriate nursing intervention in this situation would be to: A. Tell the client firmly that it is time to get dressed. B. Obtain assistance to restrain the client for safety. C. Remain calm and talk quietly to the client. D. Call the doctor and request an order for sedation.

Correct Answer: C. Remain calm and talk quietly to the client. Maintaining a calm approach when intervening with an agitated client is extremely important. Use a rather low voice and speak slowly to patients to increase the possibility of understanding. Divert attention of the client when agitated or behaving dangerously like getting out of bed by climbing the fence bed to promote safety and prevent risk of injury.

When working with children who have been sexually abused by a family member it is important for the nurse to understand that these victims usually are overwhelmed with feelings of: A. Humiliation B. Confusion C. Self blame D. Hatred

Correct Answer: C. Self blame These children often have nonsexual needs met by individuals and are powerless to refuse. Ambivalence results in self-blame and also guilt. Sexual abuse can cause serious physical and emotional harm to children both in the short term and the long term. In the short term, children may suffer health issues, such as sexually transmitted infections, physical injuries, and unwanted pregnancies.

The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolonged stay in a state hospital. The client lives in a boarding home, reports no family involvement, and has little social interaction. The nurse plan to refer the client to a day treatment program in order to help him with: A. Managing his hallucinations B. Medication teaching C. Social skills training D. Vocational training

Correct Answer: C. Social skills training Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking questions or directions, placing an order in a restaurant, taking turns in a group setting activity. Provide opportunities for the client to learn adaptive social skills in a non-threatening environment. Initial social skills training could include basic social behaviors (e.g., appropriate distance, maintain good eye contact, calm manner/behavior, moderate voice tone). Social skills training helps the client adapt and function at a higher level in society, and increases the client's quality of life.

Which of the following is not included in the care plan of a client with a moderate cognitive impairment involving dementia of the Alzheimer's type? A. Daily structured schedule. B. Positive reinforcement for performing activities of daily living. C. Stimulating environment. D. Use of validation techniques.

Correct Answer: C. Stimulating environment. A stimulating environment is a source of confusion and anxiety for a client with a moderate level of impairment and, therefore, would not be included in the plan of care. Limit sensory stimuli and independent decision-making. This decreases frustration and distractions from the environment. Decreasing stress of making a choice helps to promote security. Instruct the family to utilize distraction techniques, such as soothing music, going for a walk, or looking at picture albums if the patient has delusions. Distraction may be effective to calm the patient if stressful situations occur.

In clients with a cognitive impairment disorder, the phenomenon of increased confusion in the early evening hours is called: A. Aphasia. B. Agnosia. C. Sundowning. D. Confabulation.

Correct Answer: C. Sundowning. Sundowning is a common phenomenon that occurs after daylight hours in a client with a cognitive impairment disorder. The term "sundowning" refers to a state of confusion occurring in the late afternoon and spanning into the night. Sundowning can cause a variety of behaviors, such as confusion, anxiety, aggression, or ignoring directions. Sundowning can also lead to pacing or wandering. Sundowning isn't a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer's disease. The exact cause of this behavior is unknown.

Nurse John is aware that the therapy that has the highest success rate for people with phobias would be: A. Psychotherapy aimed at rearranging maladaptive thought processes. B. Psychoanalytical exploration of repressed conflicts of an earlier development phase. C. Systematic desensitization using relaxation techniques. D. Insight therapy to determine the origin of the anxiety and fear.

Correct Answer: C. Systematic desensitization using relaxation technique The most successful therapy for people with phobias involves behavior modification techniques using desensitization. Behavior therapy is the most effective treatment for phobias is behavioral therapy. This includes systematic desensitization and flooding. In methodical desensitization, the patient is exposed to a list of stimuli ranking from the least to the most anxiety-provoking. With this method, patients are taught various techniques to deal with anxiety such as relaxation, breathing control, and cognitive approaches.

Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate? A. Dismantling the showerhead and showing the client that there is nothing in it. B. Explaining that other clients are complaining about the client's body odor. C. Asking a security officer to assist in giving the client a shower. D. Accepting these fears and allowing the client to take a sponge bath.

Correct Answer: D. Accepting these fears and allowing the client to take a sponge bath By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Attempt to understand the significance of these beliefs to the client at the time of their presentation. Important clues to underlying fears and issues can be found in the client's seemingly illogical fantasies. Recognize the client's delusions as the client's perception of the environment. Recognizing the client's perception can help you understand the feelings he or she is experiencing.

The nurse describes a client as anxious. Which of the following statements about anxiety is true? A. Anxiety is usually pathological. B. Anxiety is directly observable. C. Anxiety is usually harmful. D. Anxiety is a response to a threat.

Correct Answer: D. Anxiety is a response to a threat Anxiety is a response to a threat arising from internal or external stimuli. Anxiety is linked to fear and manifests as a future-oriented mood state that consists of a complex cognitive, affective, physiological, and behavioral response system associated with preparation for the anticipated events or circumstances perceived as threatening.

Nurse Trish suggests a crisis intervention group to a client experiencing a developmental crisis. These groups are successful because the: A. Crisis intervention worker is a psychologist and understands behavior patterns. B. Crisis group supplies a workable solution to the client's problem. C. Clients are encouraged to talk about personal problems. D. Client is assisted to investigate alternative approaches to solving the identified problem.

Correct Answer: D. Client is assisted to investigate alternative approaches to solving the identified problem Crisis intervention groups help clients reestablish psychologic equilibrium by assisting them to explore new alternatives for coping. It considers realistic situations using rational and flexible problem-solving methods. Crisis intervention is a short-term management technique designed to reduce potential permanent damage to an individual affected by a crisis. A crisis is defined as an overwhelming event, which can include divorce, violence, the passing of a loved one, or the discovery of a serious illness.

Nurse Jessie is assessing a client suffering from stress and anxiety. A common physiological response to stress and anxiety is: A. Urticaria B. Vertigo C. Sedation D. Diarrhea

Correct Answer: D. Diarrhea Diarrhea is a common physiological response to stress and anxiety. The ability of stress to impair physiological processes such as growth, reproduction, and immune competence and its association with diseases such as cardiovascular disease, type 2 diabetes, anxiety, and depression are well known. While acute responses to stress are generally considered effective in dealing with immediate threats, prolonged activation of stress processes could have significant adverse consequences for individuals

Which of the following is the most distinguishing feature of a client with an antisocial personality disorder? A. Attention to detail and order B. Bizarre mannerisms and thoughts C. Submissive and dependent behavior D. Disregard for social and legal norms

Correct Answer: D. Disregard for social and legal norms Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder. Antisocial personality disorder (ASPD) is a deeply ingrained and rigid dysfunctional thought process that focuses on social irresponsibility with exploitive, delinquent, and criminal behavior with no remorse. Disregard for and the violation of others' rights are common manifestations of this personality disorder, which displays symptoms that include failure to conform to the law, inability to sustain consistent employment, deception, manipulation for personal gain, and incapacity to form stable relationships.

Which of the following statements should be included when teaching clients about monoamine oxidase inhibitor (MAOI) antidepressants? A. Don't take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). B. Have blood levels screened weekly for leukopenia. C. Avoid strenuous activity because of the cardiac effects of the drug. D. Don't take prescribed or over-the-counter medications without consulting the physician.

Correct Answer: D. Don't take prescribed or over the counter medications without consulting the physician MAOI antidepressants, when combined with a number of drugs, can cause life-threatening hypertensive crises. It's imperative that a client checks with his physician and pharmacist before taking any other medications. Tramadol, meperidine, dextromethorphan, and methadone are contraindicated in patients on MAOIs as they are at high risk for causing serotonin syndrome. In general, SSRIs, SNRIs, TCAs, bupropion, mirtazapine, St. John's Wort, and sympathomimetic amines, including stimulants, are contraindicated with MAOIs.

Nurse Fred is assessing a client who has just been admitted to the ER department. Which signs would suggest an overdose of an antianxiety agent? A. Suspiciousness, dilated pupils, and incomplete BP B. Agitation, hyperactivity, and grandiose ideation C. Combativeness, sweating, and confusion D. Emotional lability, euphoria, and impaired memory

Correct Answer: D. Emotional lability, euphoria, and impaired memory Signs of anxiety agent overdose include emotional lability, euphoria, and impaired memory. In long-term users who have developed dependence, cessation of BZDs can result in a withdrawal syndrome, with manifestations including anxiety, irritability, confusion, seizures, and sleep disorders. Alprazolam withdrawal syndrome may be especially severe, with associated delirium, psychosis, and hyperadrenergic states.

Mrs. Mendoza is a 75-year-old client who has dementia of the Alzheimer's type and confabulates. The nurse understands that this client: A. Denies confusion by being jovial. B. Pretends to be someone else. C. Rationalizes various behaviors. D. Fills in memory gaps with fantasy.

Correct Answer: D. Fills in memory gaps with fantasy. Confabulation is a communication device used by patients with dementia to compensate for memory gaps. Confabulation is a type of memory error in which gaps in a person's memory are unconsciously filled with fabricated, misinterpreted, or distorted information. When someone confabulates, they are confusing things they have imagined with real memories. A person who is confabulating is not lying. They are not making a conscious or intentional attempt to deceive. Rather, they are confident in the truth of their memories even when confronted with contradictory evidence.

The family of a schizophrenic client asks the nurse if there is a genetic cause of this disorder. To answer the family, which fact would the nurse cite? A. Conclusive evidence indicates a specific gene transmits the disorder. B. Incidence of this disorder is variable in all families. C. There is a little evidence that genes play a role in transmission. D. Genetic factors can increase the vulnerability for this disorder.

Correct Answer: D. Genetic factors can increase the vulnerability for this disorder. Research shows that family history statistically increases the risk for the development of schizophrenia. Genetics also play a fundamental role - there is a 46% concordance rate in monozygotic twins and a 40% risk of developing schizophrenia if both parents are affected. The gene neuregulin (NGR1) which is involved in glutamate signaling and brain development has been implicated, alongside dysbindin (DTNBP1) which helps glutamate release, and catecholamine O-methyltransferase (COMT) polymorphism, which regulates dopamine function.

Which nursing action is most appropriate when trying to diffuse a client's impending violent behavior? A. Place the client in seclusion. B. Leaving the client alone until he can talk about his feelings. C. Involving the client in a quiet activity to divert attention. D. Helping the client identify and express feelings of anxiety and anger.

Correct Answer: D. Helping the client identify and express feelings of anxiety and anger In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statements as "What happened to get you this angry?" may help the client verbalize feelings rather than act on them. Frequently assess client's behavior for signs of increased agitation and hyperactivity. Early detection and intervention of escalating mania will prevent the possibility of harm to self or others, and decrease the need for seclusions.

A student nurse was asked which of the following best describes dementia. Which of the following best describes the condition? a. Memory loss occurring as part of the natural consequence of aging. b. Difficulty coping with physical and psychological change. c. Severe cognitive impairment that occurs rapidly. d. Loss of cognitive abilities, impairing ability to perform activities of daily living.

Correct Answer: D. Loss of cognitive abilities, impairing ability to perform activities of daily living. The impaired ability to perform self-care is an important measure of a client's dementia progression and loss of cognitive abilities. Difficulty or impaired ability to perform normal activities of daily living, such as maintaining hygiene and grooming, toileting, making meals, and maintaining a household, are significant indications of dementia. Slowing of processes necessary for information retrieval is a normal consequence of aging. However, the global statement that memory loss occurs as part of natural aging is not true.

Jaime has a diagnosis of schizophrenia with negative symptoms. In planning care for the client, Nurse Brienne would anticipate a problem with: A. auditory hallucination B. bizarre behaviors C. Ideas of references D. Motivation for activities

Correct Answer: D. Motivation for activities. In a client demonstrating negative symptoms of schizophrenia, avolition, or the lack of motivation for activities, is a common problem. These "negative" symptoms are so-called because they are an absence as much as a presence: inexpressive faces, blank looks, monotone, and monosyllabic speech, few gestures, seeming lack of interest in the world and other people, inability to feel pleasure or act spontaneously. It is important to distinguish between lack of expression and lack of feeling, between lack of will and lack of activity. When questioned, patients with schizophrenia often express a full range of feelings and desires.

A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include: A. Rhinorrhea, convulsions, subnormal temperature B. Nausea, dilated pupils, constipation C. Lacrimation, vomiting, drowsiness D. Muscle aches, papillary constriction, yawning

Correct Answer: D. Muscle aches, papillary constriction, yawning These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates. According to Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, signs and symptoms of opioid withdrawal include lacrimation or rhinorrhea, piloerection "goose flesh," myalgia, diarrhea, nausea/vomiting, pupillary dilation and photophobia, insomnia, autonomic hyperactivity (tachypnea, hyperreflexia, tachycardia, sweating, hypertension, hyperthermia), and yawning.

Which factor is associated with increased risk for schizophrenia? A. Alcoholism B. Adolescent pregnancy C. Overcrowded schools D. Poverty

Correct Answer: D. Poverty Low socioeconomic status or poverty is an identified environmental factor associated with an increased incidence of schizophrenia. A criticism of this research field, which is in fact a criticism relevant to much social science research, is that the investigation of socio-environmental factors in the environment invariably focuses on poverty and deprivation to the exclusion of other important variables. One such variable is income inequality. Income inequality is a measure of the 'rich-poor gap' in any given society and therefore it exists at the ecological level.

Which nursing diagnosis is most appropriate for a client with anorexia nervosa who expresses feelings of guilt about not meeting family expectations? A. Anxiety B. Disturbed body image C. Defensive coping D. Powerless

Correct Answer: D. Powerlessness The client with anorexia typically feels powerless, with a sense of having little control over any aspect of life besides eating behavior. Often, parental expectations and standards are quite high and lead to the clients' sense of guilt over not measuring up. Promote self-concept without moral judgment. Patient sees herself as weak-willed, even though part of a person may feel a sense of power and control (dieting, weight loss).

A family member expresses concern to a nurse about behavioral changes in an elderly aunt. Which would cause the nurse to suspect a cognitive impairment disorder? A. Decreased interest in activities that she once enjoyed. B. Fearfulness of being alone at night. C. Increased complaints of physical ailments. D. Problems with preparing a meal or balancing her checkbook.

Correct Answer: D. Problems with preparing a meal or balancing her checkbook. Making a meal and balancing a checkbook are higher-level cognitive functions that, when unable to be performed, may signal onset of a cognitive disorder. Dementia is a disorder that is characterized by cognitive decline involving memory and at least 1 of the other domains, including personality, praxis, abstract thinking, language, executive functioning, complex attention, social and visuospatial skills. In addition to the noted decline, the severity must be significant enough to interfere with daily functionality. It is often a progressive disorder, and individuals often do not have insight into their deficits.

A client refuses to remain on psychotropic medications after discharge from an inpatient psychiatric unit. Which information should the community health nurse assess first during the initial follow-up with this client? A. Income level and living arrangements. B. Involvement of family and support systems. C. Reason for inpatient admission. D. Reason for refusal to take medications

Correct Answer: D. Reason for refusal to take medications The first area for assessment would be the client's reason for refusing medication. The client may not understand the purpose of the medication, may be experiencing distressing side effects or may be concerned about the cost of medicine. In any case, the nurse cannot provide appropriate intervention before assessing the client's problem with the medication.

In the diagnosis of a possible pervasive developmental autistic disorder. The nurse would find it most unusual for a 3-year-old child to demonstrate: A. An interest in music. B. An attachment to odd objects. C. Ritualistic behavior. D. Responsiveness to the parents.

Correct Answer: D. Responsiveness to the parents One of the symptoms of autistic child displays a lack of responsiveness to others. There is little or no extension to the external environment. The diagnostic category of pervasive developmental disorders (PDD) refers to a group of disorders characterized by delays in the development of socialization and communication skills. Parents may note symptoms as early as infancy, although the typical age of onset is before 3 years of age.

Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which adverse reaction? A. Hypertension B. respiratory arrest C. Tourette syndrome D. Retinal pigmentation

Correct Answer: D. Retinal pigmentation Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The development of pigmentary retinopathy is a unique adverse manifestation associated with thioridazine, and not with other antipsychotics. Patients may have nonspecific symptoms while taking thioridazine, such as dry mouth, dry eyes, sedation, weight gain, dizziness, erectile dysfunction, pruritus, photosensitivity, and constipation. Other rare and more unique side effects of thioridazine include irreversible retinal pigmentation, poikilothermia, and agranulocytosis.

How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated? A. Several minutes B. Several hours C. Several days D. Several weeks

Correct Answer: D. Several weeks Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear. It can take a few days for chlorpromazine to take effect. It's difficult to determine how long one can expect to wait, as the medication affects each person differently. Ideally, the client should stay on an antipsychotic medication for four to six weeks before deciding whether to continue taking it in the long term. This gives the medication a chance to build up in the system and to begin delivering its full effects.

Which of the following will Nurse Dory use when communicating with a client who has cognitive impairment? a. Complete explanations with multiple details. b. Pictures or gestures instead of words. c. Stimulating words and phrases to capture the client's attention. d. Short words and simple sentences.

Correct Answer: D. Short words and simple sentences. Short words and simple sentences minimize client confusion and enhance communication. Assess the patient's ability to speak, language deficit, cognitive or sensory impairment, presence of aphasia, dysarthria, aphonia, dyslalia, or apraxia. Presence of psychosis, and/or other neurologic disorders affecting speech. This identifies problem areas and speech patterns to help establish a plan of care.

Upon Sam's admission for acute psychiatric hospitalization, Nurse Jona documents the following: Client refuses to bathe or dress, remains in the room most of the day, speaks infrequently to peers or staff. Which nursing diagnosis would be the priority at this time? A. Anxiety B. Decisional conflict C. Self care deficit D. Social isolation

Correct Answer: D. Social isolation These behaviors indicate the client's withdrawal from others and possible fear or mistrust of relationships. If a client is found to be very paranoid, solitary or one-on-one activities that require concentration are appropriate. The client is free to choose his level of interaction; however, concentration can help minimize distressing paranoid thoughts or voices. If a client is unable to respond verbally or in a coherent manner, spend a frequent, short period with clients. An interested presence can provide a sense of being worthwhile.

The nurse is caring for a client with an autoimmune disorder at a medical clinic, where alternative medicine is used as an adjunct to traditional therapies. Which information should the nurse teach the client to help foster a sense of control over his symptoms? A. Pathophysiology of disease process. B. Principles of good nutrition. C. Side effects of medications. D. Stress management techniques.

Correct Answer: D. Stress management techniques In autoimmune disorders, stress and the response to stress can exacerbate symptoms. Stress management techniques can help the client reduce the psychological response to stress, which in turn will help reduce the physiologic stress response. This will afford the client an increased sense of control over his symptoms.

A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom? A. Dystonia B. Akathisia C. Pseudoparkinsonism D. Tardive dyskinesia

Correct Answer: D. Tardive dyskinesia An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech. Tardive dyskinesia (TD) is a syndrome which includes a group of iatrogenic movement disorders caused due to a blockade of dopamine receptors. The movement disorders include akathisia, dystonia, buccolingual stereotypy, myoclonus, chorea, tics and other abnormal involuntary movements which are commonly caused by the long-term use of typical antipsychotics.

Drogo, who has had auditory hallucinations for many years, tells Nurse Khally that the voices prevent his participation in a social skills training program at the community health center. Which intervention is most appropriate? A. Let Drogo analyze the content of the voices. Shrek B. Advise Drogo to participate in the program when the voices cease. C. Advise Drogo to take his medications as prescribed. D. Teach Drogo to use thought-stopping techniques.

Correct Answer: D. Teach Drogo to use thought-stopping techniques. Clients with long-lasting auditory hallucinations can learn to use thought-stopping measures to accomplish tasks. In this technique, when the obsessive or racing thoughts begin, the client says, clearly and distinctly, "Stop!" This then allows the client to substitute a new, healthier thought. Many therapists encourage the client to, at first, yell out the "Stop!" This helps focus the attention on the word and away from the obsessive thought. Later, the client will be able to mentally yell the word to themselves without needing to say it aloud.

Which of the following outcome criteria is appropriate for the client with dementia? A. The client will return to an adequate level of self-functioning. B. The client will learn new coping mechanisms to handle anxiety. C. The client will seek out resources in the community for support. D. The client will follow an established schedule for activities of daily living.

Correct Answer: D. The client will follow an established schedule for activities of daily living. Following established activity schedules is a realistic expectation for clients with dementia. Maintain a regular daily schedule routine to prevent problems that may result from thirst, hunger, lack of sleep, or inadequate exercise. If the needs of a patient with AD are not met, it may cause the patient to become agitated and anxious. Predictable behavior is less threatening to the patient and does not tax limited ability to function with ADLs.

Erlinda, age 85, with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. When assessing the client immediately after ECT, the nurse expects to find: A. Permanent short-term memory loss and hypertension. B. Permanent long-term memory loss and hypomania. C. Transitory short-term memory loss and permanent long-term memory loss. D. Transitory short and long-term memory loss and confusion.

Correct Answer: D. Transitory short and long-term memory loss and confusion ECT commonly causes transitory short and long-term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short and long-term memory loss. The most persistent adverse effect is retrograde amnesia. Shortly after ECT, most patients have gaps in their memory for events that occurred close in time to the course of ECT, but the amnesia may extend back several months or years. Retrograde amnesia usually improves during the first few months after ECT.

Andy is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. Nurse Hilary should expect the assessment to reveal: A. Coldness, detachment, and lack of tender feelings B. Somatic symptoms C. Inability to function as responsible parent D. Unpredictable behavior and intense interpersonal relationships

Correct Answer: D. Unpredictable behavior and intense interpersonal relationships A client with borderline personality displays a pervasive pattern of unpredictable behavior, mood, and self-image. Interpersonal relationships may be intense and unstable and behavior may be inappropriate and impulsive. Borderline personality disorder (BPD) is characterized by hypersensitivity to rejection and resulting instability of interpersonal relationships, self-image, affect, and behavior. Borderline personality disorder causes significant impairment and distress and is associated with multiple medical and psychiatric co-morbidities.

During the home visit of a client with dementia, the nurse notes that an adult daughter persistently corrects her father's misperceptions of reality, even when the father becomes upset and anxious. Which intervention should the nurse teach the caregiver? A. Anxiety-reducing measures B. Positive reinforcement C. Reality orientation techniques D. Validation techniques

Correct Answer: D. Validation techniques Validation techniques are useful measures for making emotional connections with a client who can no longer maintain reality orientation. These measures are also helpful in decreasing anxiety. The basic idea behind validation therapy is that people who are in the late stages of life may have unresolved issues that drive their behaviors and emotions. The way caregivers or family members respond to these behaviors and emotions can either make them worse or help resolve them.

A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is mostlikely to prescribe which medication for this client? A. chlorpromazine (Thorazine) B. imipramine (Tofranil) C. lithium carbonate (Lithane) D. fluphenazine decanoate (Prolixin Decanoate)

Correct Answer: D. fluphenazine decanoate (Prolixin Decanoate) Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance. Fluphenazine is a typical antipsychotic used for symptomatic management of psychosis in patients with schizophrenia. There is a long-acting fluphenazine decanoate formulation that is used primarily as maintenance therapy for chronic schizophrenia and related psychotic disorders in patients who do not tolerate oral formulations or in patients where medication compliance is of concern.

Nurse Arya assesses for evidence of positive symptoms of schizophrenia in a newly admitted client. Which of the following symptoms are considered positive evidence? Select all that apply. A. Anhedonia B. Delusions C. Flat affect D. Hallucinations E. Loose associations F. Social withdrawal

Correct Answers: B, D, E These are considered positive symptoms of schizophrenia. The typical positive symptoms of schizophrenia, such as hallucinatory experiences or fixed delusional beliefs, tend to be very upsetting and disruptive—not a positive experience at all for you or someone you care about who is experiencing them. From the outside, a person with positive symptoms might seem distracted, as if they are listening to something (psychiatrists call this "responding to internal stimuli"). The phrase "positive symptoms" refers to symptoms that are in ?excess or added to normal mental functioning.