Psych HESI Questions

which levels of anxiety facilitate learning?

mild to moderate

What is the key differences between mild and moderate anxiety ?

moderate anxiety the patients speech becomes more rapid and perception dulls a little

Panic level anxiety

perceptions grossly distorted, unable to differentiate real from unreal unable to problem solve may have hallucinations

phenothiazines cause ________, so clients must wear protective clothing and sunglasses.

photosensitivity

kava kava

relieve anxiety elevate mood induce feelings of relaxation and contentment risk of liver failure may induce psychiatric symptoms

Common Physiologic responses to anxiety

Increased HR & BP Rapid, shallow RR Xerostomia & tight feeling in throat Tremors & muscle tension Anorexia Urinary frequency Palmar sweating

After an electroconvulsive therapy treatment, a client complains of loss of memory. What is the nurse's best response? 1 "This is temporary; your memory will return after the therapy is done." 2 "It's better if you don't remember what happened before you became ill." 3 "I'll help you try to remember things when the treatments are completed." 4 "Knowing that you're getting well is the most important thing for you right now."

1 "This is temporary; your memory will return after the therapy is done" is a true statement that addresses the client's concern regarding the temporary memory loss, although information about the therapy will not be recalled. The statement "It's better if you don't remember what happened before you became ill" denies the client's fears and feelings and may be frightening and upsetting. The statement "I'll help you try to remember things when the treatments are completed" denies the client's fears and feelings and does not address the current concern. The statement "Knowing that you're getting well is the most important thing for you right now" denies the client's fears and feelings and may not be important to the client at this time.

ccording to Erikson, what will happen to an individual who fails to master the maturational crisis of adolescence? 1 Role confusion 2 Interpersonal isolation 3 Rebellion against parental orders 4 Feelings of inferiority on comparing the self to others

1 According to Erikson, adolescents are struggling with identity versus role confusion, struggling to find out who they are. If an adolescent is unsuccessful in this regard, role confusion may result. Industry versus inferiority is the developmental struggle of the school-aged child. This reflects part of the struggle for autonomy; it does not indicate failure to achieve the developmental task of adolescence. Adolescents tend to be group oriented, not isolated; they struggle to belong, not to escape. Developing intimacy is the developmental task for the young adult.

A client is brought to the emergency department by friends because of increasingly bizarre behavior. Which signs does the nurse identify that indicate that the client was using cocaine? Select all that apply. 1 Euphoria 2 Agitation 3 Panic attacks 4 Slurred speech 5 Hypervigilance 6 Impaired judgment

1, 2, 5, 6 Cocaine is an alkaloid stimulant; euphoria or affective blunting, agitation or anger, hypervigilance, and impairment of judgment and social function are all associated with cocaine intoxication. Panic attacks are associated with hallucinogens. Slurred speech is associated with opioid

Valerian

treat insomnia s/e= uneasiness, excitability, headaches, insomnia

A client with a diagnosis of paranoid schizophrenia throws a chair across the room and starts screaming at the other clients. Several of these clients have frightened expressions, one starts to cry, and another begins to pace. A nurse removes the agitated client from the room. What should the nurse remaining in the room do next? 1 Continue the unit's activities as if nothing has happened. 2 Arrange a unit meeting to discuss what has just happened. 3 Refocus clients' negative comments to more positive topics. 4 Have a private talk with the clients who cried and started to pace.

2 Arranging a unit meeting to discuss what has just happened provides an opportunity for the other clients to voice and share feelings and to identify and separate real from imaginary fears; an open expression of feelings allows the nurse to address clients' fears and provide reassurance. Ignoring the situation denies reality and may precipitate or reinforce feelings of vulnerability and fear in the other clients. Refocusing clients' negative comments to more positive topics denies clients' concerns and could increase their anxiety and fear. Having a private talk with the clients who cried or started to pace may meet the needs of these two clients but ignores the needs of the other clients.

A nurse is interviewing a client newly admitted to an outpatient program after withdrawal from alcohol. What behavior best indicates that the client has accepted that drinking is a problem? 1 Participates in scheduled counseling sessions 2 Attends Alcoholics Anonymous meetings daily 3 Volunteers to be a sponsor for another alcoholic 4 Apologizes to family members for causing distress

2 Daily attendance at AA meetings usually indicates an acceptance of the problem and a desire for help. Attendance at counseling sessions is helpful but is not specific to the problem of alcoholism. Clients with alcohol problems should not sponsor other clients until sobriety has been maintained for a long period. Clients with alcohol problems may say that they are sorry many times but still not take responsibility for their drinking problem.

A client is found to have a conversion disorder. What is the typical reaction by the client to the physical symptom? 1 Anger 2 Apathy 3 Anxiety 4 Agitation

2 Development of the symptom is an unconscious method of reducing anxiety. Because the symptom is meeting this need, it does not create anxiety itself but is passively accepted (la belle indifférence). There is no anger or agitation; symptoms are passively accepted. There is no anxiety; the conflict is resolved by the physical symptom.

A client is admitted to a long-term care facility and placed in a semiprivate room. After the second night on the unit, the client's roommate reports that the client is masturbating at night and demands another room. What is the most appropriate intervention by the nurse? 1 Moving the roommate who made the report to another room 2 Providing the client who was masturbating with periods of private time 3 Telling the roommate that this is acceptable behavior and that the client has the right to engage in it 4 Informing the client who is masturbating that this behavior is inappropriate and should not continue

2 Masturbating is a healthy human sexual behavior. The client should be provided with private time. Moving the roommate to another room could be ineffective because this may happen with the client's future roommate. Telling the roommate that this is acceptable behavior and that the client has the right to engage in it does not address either client's needs. The client has the right to meet physical needs but should not impose the behavior on others.

An executive assistant experiences an overwhelming impulse to count and arrange the rubber bands and paper clips in his desk. The client feels that something dreadful will occur if the ritual is not carried out. Considering the client's symptoms, what does the nurse conclude about the rituals? 1 They are useful in our society as long as they can be controlled 2 They serve to control anxiety resulting from unconscious impulses 3 They are a displacement of general anxiety onto an unrelated specific fear 4 They serve to consciously limit the associated anxiety that otherwise is overwhelming

2 Serving to control anxiety resulting from unconscious impulses is the psychoanalytical explanation for the development of obsessive-compulsive symptomatology. Compulsive rituals commonly result in interference with activities of daily living, and the individual becomes dysfunctional; the need to perform rituals cannot be controlled. A displacement of general anxiety onto an unrelated specific fear is the general description of phobias. The client is unable to consciously stop the behavior because anxiety will become overwhelming if the ritualistic defense is not used. The behavior is not overwhelming because it limits anxiety.

A client is admitted to an alcohol rehabilitation center. On the fourth day after admission, the nurse detects a strong odor of alcohol on the client's breath. What is the nurse's first action? 1 Asking where the client got the alcohol 2 Locating and removing the alcoholic substance 3 Conveying the staff's disappointment in this behavior 4 Documenting and notifying the practitioner of the client's drinking

2 The nurse should remove the substance before the client or other clients have an opportunity to consume more alcohol. The primary concern is not where the alcohol was obtained but instead protecting the client from consuming more. Making the client feel guilty could increase the desire for more alcohol. The client may drink the remaining alcohol while the nurse documents the information and notifies the practitioner.

A hospitalized client with an obsessive-compulsive disorder tells the nurse that coworkers and roommates get upset because the client spends at least 30 minutes in the bathroom six times a day. The client says, "It keeps me from getting nervous." What is the most appropriate response by the nurse? 1 "That's not a problem now, because you have your own bathroom here." 2 "Tell me how spending time in the bathroom helps you avoid becoming nervous." 3 "Tell me more about what you do in the bathroom during those 30-minute periods." 4 "Let's start by cutting down the time you spend in the bathroom to 20 minutes three times a day."

2 The response "Tell me how spending time in the bathroom helps you avoid becoming nervous" encourages the client to explore the defenses employed to cope with anxiety. The response "That's not a problem now, because you have your own bathroom here" is a nontherapeutic response that denies the importance of a problematic area of behavior. The response "Tell me more about what you do in the bathroom during those 30-minute periods" focuses on tasks rather than feelings; also, it may be perceived as threatening or judgmental. The response "Let's start by cutting down the time you spend in the bathroom to 20 minutes three times a day" is a nontherapeutic response because it will increase the client's anxiety. It is too early to start changing the behavior.

What nursing intervention should the nurse provide to an individual in the intimacy versus isolation stage? 1 Choosing creative ways to promote social participation 2 Providing information to a client about his or her treatment plan 3 Involving a client's partners or family members in the caring process 4 Encouraging the client to participate actively in the treatment procedure

3 If a client in the intimacy versus isolation stage is admitted to the hospital, the nurse should try involving the client's partners or family members in the caring process because young adults benefit from the support of their partners or significant others. During the generativity versus self-absorption and stagnation stage, the nurse should help the client socialize to help him or her find a sense of fulfillment. During the identity versus role confusion or puberty stage, the nurse should help a client deal with his or her illness by providing enough information to allow him or her to make decisions about his or her treatment plan. During the industry versus inferiority stage, the nurse should encourage the client to actively participate in his or her treatment.

A client with the diagnosis of bipolar disorder, depressive episode, has been hospitalized on a psychiatric unit for 1 week. What is the most appropriate activity for this client? 1 Completing a jigsaw puzzle alone 2 Playing cards with several other clients 3 Talking with the nurse several times during the day

3 Involving the client in a one-on-one conversation provides individualized, low-anxiety-producing attention and gives the message that the client is important, which supports self-esteem. Completing a jigsaw puzzle alone may require too much concentration for a depressed client. Playing a game of cards with several other clients may require too much concentration for a depressed client; also, it involves competition, which is not therapeutic at this time. A depressed client does not have the energy to engage in a game of table tennis; also, this is a competitive game, which is not therapeutic at this time.

What is the most important nursing intervention for minority adolescents? 1 Identifying individuals at risk for substance abuse 2 Providing counseling to adolescents during rehabilitation 3 Helping ensure improved access to appropriate healthcare 4 Guiding minority adolescents to prevent injuries and accidental deaths

3 Minority adolescents experience a greater likelihood of health problems and barriers to healthcare. Hence, helping improve access to appropriate healthcare is the most important intervention for the nurse working with minority adolescents. Identifying individuals who are at risk for substance abuse, providing counseling to adolescents during rehabilitation, and guiding adolescents to help prevent injuries and accidental deaths are applicable to all adolescents.

A nurse is volunteering on the community crisis hotline. What is the final objective of the counseling process? 1) Reducing anxiety 2) Exploring feelings 3) Developing constructive coping skills 4) Accomplishing the debriefing process

3 Past coping behaviors have been inadequate in resolving the current crisis; new coping skills are needed to manage anxiety-producing conflicts. Reduction of anxiety is an early objective. Exploration of feelings is an immediate objective. Accomplishment of the debriefing process is an early objective.

A nurse is assessing a client with the diagnosis of schizophrenia, undifferentiated type. What defense mechanisms should the nurse anticipate that this client might use? 1 Projection 2 Repression 3 Regression 4 Conversion

3 Regression is an unconscious defense mechanism that reduces anxiety by returning to behavior that was successful in earlier years. Regression commonly is used by clients with undifferentiated schizophrenia to reduce anxiety. Projection is the attributing of unacceptable feelings or thoughts to others. It is an organized defense used by clients with paranoid, not undifferentiated, schizophrenia. Clients with undifferentiated schizophrenia have psychotic manifestations that are extreme and do not have thought processes effective enough to use projection. Repression is unintentionally putting disturbing thoughts, feelings, or desires out of the conscious mind. Clients with schizophrenia are not able to do this and therefore have a need to escape from reality. Conversion is an unconscious defense mechanism in which a person develops physical symptoms that have no organic cause. Conversion serves the purpose of reducing anxiety. Conversion is not used by clients with undifferentiated schizophrenia.

A client becomes hostile when learning that amputation of a gangrenous toe is being considered. After the client's outburst, what is the best indication that the nurse-client interaction has been therapeutic? 1 Increased physical activity 2 Absence of further outbursts 3 Relaxation of tensed muscles 4 Denial of the need for further discussion

3 Relaxation of muscles and facial expression are examples of nonverbal behavior; nonverbal behavior is an excellent index of feelings because it is less likely to be consciously controlled. Increased activity may be an expression of anger or hostility. Clients may suppress verbal outbursts despite feelings and become withdrawn. Refusing to talk may be a sign that the client is just not ready to discuss feelings.

A client with bipolar I disorder, manic episode, is admitted to the mental health unit of a community hospital. When developing an initial plan of care for this client, what should the nurse plan to do? 1 Increase the client's gym time. 2 Isolate the client from peers. 3 Encourage increased nutritional intake. 4 Reinforce participation in unit programs.

3 The client in a manic episode of the illness often neglects basic needs; these needs are a priority to ensure adequate nutrition, fluid, and rest. The hyperactivity of mania creates an increased need for calories. Although the client needs to expend excess energy, physical exhaustion and dehydration are real possibilities during the manic episode of the illness. Isolating the client from peers is counterproductive and punitive. The client is unable to actively participate in group activities at this time.

After a week on the mental health unit, a client with the diagnosis of paranoid schizophrenia continues to say, "They're trying to kill me. They all are." What is the best response by the nurse? 1 "We're here to protect you." 2 "No one wants to hurt anyone." 3 "You're having very frightening thoughts." 4 "Tell me more about their wanting to kill you."

3 The observation that the client is experiencing frightening thoughts is a reflection of the client's feelings; it leaves the line of communication open. Telling the client that the staff is there to protect the client does not provide security, because the client may believe that the nurse is one of the people plotting. Telling the client that no one wants to hurt anyone discounts the client's thoughts and may increase the agitation. Asking the client to detail the plot supports the client's delusion.

A hospice nurse is caring for a dying client and his wife. What factor will be a major determinant in the mourning outcome for the wife? 1) Duration of the relationship shared by the couple 2) Age of the wife at the time of the husband's death 3) Health of the surviving spouse at the time of the death 4) Importance of the deceased person as a source of support

4 The more dependent the client was on the deceased for support, the more difficult the grieving process will be. Emotional and financial considerations are major factors. The duration of the couple's relationship and the age of the wife at the time of the man's death are not major influences on the mourning outcome. The health of the surviving spouse at the time of the death may or may not be a major factor in the mourning outcome; the spouse may be healthy and still be dependent on the partner.

When taking a health history from a client who has a moderate level of cognitive impairment as a result of dementia, what does the nurse expect to find? 1 Hypervigilance 2 Increased inhibition 3 Enhanced intelligence 4 Accentuated premorbid traits

4 A moderate level of cognitive impairment because of dementia is characterized by increasing dependence on environmental and social structure and by increasing psychological rigidity with accentuated previous traits and behaviors. Although paranoid attitudes, which are associated with hypervigilance, may be exhibited, the disorientation, loss of memory, and decrease in cognition usually do not lead to hypervigilance. With the decrease in impulse control that is associated with dementia, decreased, not increased, inhibition occurs. Enhancement of intelligence does not occur with dementia, but initially intellectual deterioration is subtle.

It is most helpful to the nurse who is attempting to apply the principles of mental health to consider what? 1 Emotionally ill people will initially reject psychological support. 2 People with emotional illnesses can empathize easily with others. 3 Mental illness is characterized by signs and symptoms of socially inappropriate behavior. 4 Emotional health is promoted when there is a sense of mastery of self and the environment.

4 An individual must feel a sense of control over self and the environment to feel secure, reduce anxiety, and function at an optimum level. Most emotionally ill people are too introspective to empathize with others. Although some emotionally ill people will reject help, many are in pain and recognize that they need psychological support. Some clients actively seek out care on the basis of positive past experiences and the secondary gain of getting attention. Many individuals with mental illness do not demonstrate observable signs of socially inappropriate behavior.

A hospitalized client with borderline personality disorder consistently breaks the unit's rules. How will confronting the client about this behavior help the client? 1 By controlling anger 2 By reducing anxiety 3 By setting realistic outcomes 4 By fostering self-awareness

4 Clients must become aware of their behavior before they can change it. Confrontation may increase anxiety, anger, and agitation. Setting of realistic outcomes occurs after the client is aware of the behavior and has a desire to change it.

What should the nurse monitor for especially after ECT treatment?

Aspiration because they give things like atropine to dry out secretions

MAOI hypertensive crisis when mixed with?

SSRI's tyramine psudophedrine meds (cold/ flu)

Which type of anxiety stimulates the full on fight/fight response and causes sensory stimuli and perceptions to be distorted?

Severe Anxiety

conversion reactions

The individual develops some physical dysfunctions which is not organic in nature. Examples are paralysis, deafness, and loss of sensations, each of which is brought on by severe anxiety rather than a physical causes.

La belle indifference is a term used to describe the lack of concern over physical illness; seen in _______ reactions

conversion reactions

kava ________ of levodopa in patients with parkinsons

decreases the effects

St Johns wort may induce _______ in bipolar clients and enhance _________. It may also _______ the plasma concentrations of other meds such as oral contraceptives, statins, and warfarin.

induce mania enhance photosensitivity reduce plasma concentrations of oral contraceptives, statins, and warfarin

Antidepressent drug side effects

anticholinergic postural hypotension