Psych nursing Test 1

Which statement supports the nurse's suspicion that the client has obsessive-compulsive disorder? A. "I wash my hands every 15 minutes" B. "I have 12 puppies and love caring for them" C. "My nose has a deformity even after rhinoplasty" D. "I bite my nails and scratch myself in extreme tension"

A. "I wash my hands every 15 minutes"

Which statement made by the client indicates that his or her coping strategy in a time of grief is maladaptive? A. "I will never be able to be happy again" B. "I manage my hostile feelings by listening to music" C. "I try to find the reasons of failure whenever I experience it" D. "I do breathing exercises to rejuvenate myself after heavy work

A. "I will never be able to be happy again"

Which characteristics are associated with anxiety? Select all that apply A. A vague feeling of apprehension B. A sensation of being afraid C. A feeling that is unavoidable in life D. A reaction to internal or external stimuli E. A response to a stimulus that is clearly identifiable

A. A vague feeling of apprehension C. A feeling that is unavoidable in life D. A reaction to internal or external stimuli

Annie has a hair pulling disorder. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? Select all that apply A. Awareness training B. Competing response training C. Social support D. Hypnotherapy E. Aversive therapy

A. Awareness training B. Competing response training C. Social support

Anna, who is 72 years old, is of the age when she may have experienced many losses coming close together. What is this called? A. Bereavement overload B. Normal mourning C. Isolation D. Cultural relativity

A. Bereavement overload

Which individual characteristic has the greatest influence on one's personal health beliefs and practices? A. Culture B. Age C. Gender D. Education

A. Culture

Which symptoms are commonly observed in a client with psychosis?Select all that apply A. Delusions B. Obsessions C. Hallucinations D. Hypochondriasis E. Disorganized speech

A. Delusions C. Hallucinations E. Disorganized speech

A client's partner complains to the nurse, "My husband continues to smoke even though he knows of the dangers to his health." Which ego defense mechanism does the nurse suspect in the client? A. Denial B. Displacement C. Rationalization D. Introjection

A. Denial

Which of the following best defines "normal anxiety"? A. Dread that is appropriate to the situation in intensity and duration B. Terror triggered by the threat of known danger C. Apprehension that is ongoing and not associated with any specific stimulus D. Fright that is associated with a physical danger

A. Dread that is appropriate to the situation in intensity and duration

Which characteristic behaviors does the nurse notice in a client with panic anxiety? Select all that apply. A. Hallucinations B. Misperceptions C. Bizarre behavior D. feelings of discontent E. Heightened alertness

A. Hallucinations B. Misperceptions C. Bizarre behavior

A newly admitted client diagnosed with OCD, spends 1 hour packing and unpacking, folding and refolding personal belongings. What is the most likely reason for this behavior? A. It relieves anxiety B. It fosters organizational skills C. It delays meeting unfamiliar people in the dayroom D. It makes the client feel good

A. It relieves anxiety

What are the positive functions associated with "normal anxiety"? Select all that apply A. It triggers action to resolve an existing crisis B. It serves to motivate the individual to take action C. It is a learned response to stress D. It is usually easily managed E. It servers to bring about a solution to a problem

A. It triggers action to resolve an existing crisis B. It servers to motivate the individual to take action e. It servers to bring about a solution to a problem

Tina, who is experiencing a panic attack, has just arrived at the emergency department. Which is the priority nursing intervention for this patient? A. Stay with Tina and reassure her safety B. Administer a dose of diazepam C. Leave Tina alone in a quiet room so that she can calm down D. Encourage Tina to talk about what triggered the attack

A. Stay with Tina and reassure her safety

Which are the characteristic cognitive symptoms observed in a client with delirious mania? Select all that apply A. Stupor B. Confusion C. Disoriented D. Loquaciousness E. Disjointed thinking

A. Stupor B. Confusion C. Disorientation

What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day? A. That there is a potential for dependence and tolerance B. The importance of discontinuing Xanax immediately if addiction is suspected C. That increased caffeine consumption can enhance the effectiveness of Xanax D. That Xanax is not habit forming

A. That there is a potential for dependence and tolerance

What characteristic symptoms does a client who has social phobia exhibit? Select all that apply A. The client has a fear of using public restrooms B. The client is afraid of snakes C. The client does not cook food because of the fear of fire D. The client is afraid to present a speech in an auditorium E. The client gets embarrassed during stage performances

A. The client has a fear of using public restrooms D. The client is afraid to present a speech in an auditorium E. The client gets embarrassed during stage performances

A client with anxiety disorder is prescribed buspirone. The nurse explains to the client about safe drug administration. Which information, if not included in the medication instruction, may result in the therapy being perceived to be ineffective? A. The drug shows its action in 10 to 14 days B. The drug may cause nausea and vomiting C. The drug can be taken with milk and food D. The drug may cause orthostatic hypotension

A. The drug shows its action in 10 to 14 days

A patient with OCD spends many hour each day washing her hands. What is the most likely reason she washes her hands so much? A. To relieve her anxiety B. To reduce the probability of infection C. To gain a feeling of control over her life D. To increase her self-concept

A. To relieve her anxiety

Anna has been a widow for 20 years. Her maladaptive grief response to the loss of her dog may be attributed to which of the following? Select all that apply. A. Unresolved grief over the loss of her husband B. Loss of several relatives and friends over the last few years C. Repressed feelings of guilt over the way in which Lucky died D. Inability to prepare in advance for the loss

A. Unresolved grief over the loss of her husband B. Loss of several relatives and friends over the last few years C. Repressed feelings of guilt over the way in which Lucky died D. Inability to prepare in advance for the loss

Medications for OCD and body dysmorphic disorder

Antidepressants

Rationalization

Attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors example) John tells the rehab nurse, "I drink because it's the only way I can deal with my bad marriage and my worse job."

Jareth has a diagnosis of generalized anxiety disorder. His physician has prescribed buspirone 15mg daily. Jareth says to the nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she is feeling anxious." Which of the following would be an appropriate response by the nurse? A. "Xanax is not appropriate for general anxiety disorder." B. "Buspirone must be taken daily in order for it to be effective." C. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." D. "Your friend really should be taking the Xanax every day."

B. "Busprione must be taken daily in order for it to be effective."

Which of the following statements by Anna might suggest that she is achieving resolution of her grief over Lucky's death? A. "I never cry when I think about Lucky" B. "It's true. Lucky didn't always mind me. Sometimes he ignored my commands, but he was also a good companion" C. "I remember how it happened now. I should have held tighter to his leash! I didn't deserve to have a dog" D. "I won't ever have another dog. It's just too pain painful to lose them"

B. "It's true. Lucky didn't always mind me. Sometimes he ignored my commands, but he was also a good companion"

What is a characteristic of moderate anxiety? A. Pupils enlarge to let in more light B. Concentrating independently is difficult C. Reasoning is disrupted D. Adrenaline surge greatly increases vital signs

B. Concentrating independently is difficult

The primary health-care provider prescribes olanzapine (Zyprexa) to a client who is experiencing acute mania. Which condition in the health history of the client indicates the risk for complication? A. Goiter B. Diabetes mellitus C. Prostatic hypotrophy D. Left ventricular dysfunction

B. Diabetes mellitus

Which physiological response describes an individual preparing to defend himself or herself against a perceived stressor? A. Denial B. Fight-or-Flight C. Hypothalamus stimulation D. Panic

B. Fight-or-Flight

For the last year, a college student continually and unrealistically worries about academic performance and love life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which diagnosis? A. Agoraphobia B. Generalized anxiety disorder (GAD) C. Social phobia disorder D. Obsessive-compulsive disorder (OCD)

B. Generalized anxiety disorder (GAD) *last for at least 6 months

A widow of 23 years has not removed any of her husband's possessions, including the slippers beside their bed. Which pathological grief response is being exhibited by this client? A. Inhibited grief response B. Prolonged grief response C. Delayed grief response D. Distorted grief response

B. Prolonged grief response

Anna's daughter notices that Anna appears to be listening to another voice when just the two of them are in a room together. When questioned, Anna admits that she hears someone telling her that she was a horrible caretaker for Lucky and did not deserve to ever have a pet. Which of the following best describes what Anna is experiencing? A. Neurosis B. Psychosis C. Depression D. Bereavement

B. Psychosis

Anna, age 72, has been grieving the death of her dog, Lucky, for 3 years. She is not able to take care of her activities of daily living, and wants only to make daily visits to Lucky's grave. Her daughter has likely put off seeking help for Anna because: A. Women are less likely to seek help for emotional problems than men are B. Relatives often try to "normalize" the behavior, rather than label it mental illness C. She knows that all older people are expected to be a little depressed D. She is afraid that the neighbors "will think her mother is crazy"

B. Relatives often try to "normalize" the behavior, rather than label it mental illness

The initial care plan for a patient with OCD who washes her hands obsessively would include which of the following nursing interventions? A. Keep the patient's bathroom locked so she cannot wash her hands all the time B. Structure the patient's schedule so that she has plenty of time for washing her hands C. Place the patient in isolation until she promises to stop washing her hands so much D. Explain the patient's behavior to her because she is probably unaware that it is maladaptive

B. Structure the patient's schedule so that she has plenty of time for washing her hands

While caring for a client with anxiety, the nurse suspects that the client has ineffective impulse control. Which client behavior supports the nurse's suspicion? A. The client is afraid to venture out alone B. The client repeatedly pulls out his or her own hair C. The client is unable to meet the basic needs of life D. The client visited a plastic surgeon many times

B. The client repeatedly pulls out his or her own hair

Medications for panic and GAD

Benzodiazapiems Antidepressants Antihypertensive agents

Medications for phobic disorders

Benzodiazapiems Antidepressants Antihypertensive agents

A client hates her mother because of childhood neglect. The nurse determines which client statement represents the use of the defense mechanism of reaction formation? A. "I don't like to talk about my relationship with my mother." B. "My mother hates me." C. "I have a very wonderful mother whom I love very much." D. "My mom always loved my sister more than she loved me."

C. "I have a very wonderful mother whom I love very much."

A client with mania has shown progressive improvement with lithium therapy. After successful treatment, the client is discharged. Which suggestions would the nurse give to the client? Select all that apply A. "Avoid salt in your diet." B. "Stop taking the medication if there is an excessive weight gain." C. "Notify the primary health-care provider if pregnancy is planned or suspected." D. "Contact the primary health-care provider if you have excessive vomiting." E. "Rise slowly from a sitting or lying position."

C. "Notify the primary health-care provider if pregnancy is planned or suspected." D. "Contact the primary health-care provider if you have excessive vomiting." -Lithium may cause increased elimination of sodium from the body. Therefore, it should not be avoided in the diet of the client who is on lithium therapy. -Never stop the medication abruptly -Lithium does not cause orthostatic hypotension

Which is the normal therapeutic serum concentration in a client with acute mania receiving lithium therapy? A. 0.6 mEq/L B. 0.8 mEq/L C. 1.0 mEq/L D. 2.0 mEq/L

C. 1.0 mEq/L -The normal therapeutic serum concentration in. a client with acute mania receiving lithium therapy ranges between 1.0 and 1.5 mEq/L.

When Anna's daughter expresses concern about her mother's behavior and recommends she see a counselor, Anna declares, "I'm fine. There is nothing wrong with me!" Which of the following best describes Anna's response? A. Grief resolution B. Somatic disorder C. Anosognosia D. Intellectualization

C. Anosognosia

While communicating with a client, the nurse finds that she folds and arranges clothes five times a day. Which nursing intervention would be beneficial to the client in this situation? A. Distract the client with other activities B. Report to the primary health-care provider C. Discuss the triggers provoking this behavior D. Administer antianxiety medication to the client

C. Discuss the triggers provoking this behavior

Which of the following is the most appropriate therapy for a client with agoraphobia? A. 10mg Valium B. Group therapy with other people with agoraphobia C. Facing her fear in gradual step progression D. Hypnosis

C. Facing her fear in gradual step progression

Joselyn is a new patient at the mental health clinic. She has been diagnosed with Body Dysmorphic Disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe for Joselyn? A. Alprazolam (Xanax) B. Diazepam (Valium) C. Fluoxetine (Prozac) D. Olanzapine (Zyprexa)

C. Fluoxetine (Prozac)

Three years ago, Anna's dog Lucky, whom she had for 16 years, was run over by a car and killed. Anna's daughter reports that since that time, Anna has lost weight, rarely leaves her home, and just sits and talks about Lucky. Anna's behavior would be considered maladaptive because: A. It has been more than 3 years since Lucky died B. Her grief is too intense just over the loss of a dog C. Her grief is interfering with her functioning D. People in this culture would not comprehend such behavior

C. Her grief is interfering with her functioning

Which statement below is true only of the panic stage of anxiety? A. Redirection is needed to maintain focus B. Vital signs begin to increase C. Learning is impossible D. Restless pacing is common

C. Learning is impossible

The nurse is caring for a client who is experiencing very frequent manic episodes. Which intervention by the nurse may help the client reduce the manic episodes of bipolar disorder? A. Providing a milieu unit B. Providing a brightly lit unit C. Providing a private room in a quiet unit D. Providing a private room with embellished decor in a quiet unit

C. Providing a private room in a quiet unit

Lucky sometimes refused to obey Anna and, indeed, did not come back to her when she called to him on the day he was killed. But Anna continues to insist "he was the very best dog. He always minded me. He did everything I told him to do." Which of the following is the correct term for this defense mechanism? A. Sublimation B. Compensation C. Reaction formation D. Undoing

C. Reaction formation

Sandy, a patient with OCD says to the nurse, "I've been here four days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill-at-ease with the staff or other patients anymore." In light of this change, which nursing intervention is most appropriate? A. Give attention to the ritualistic behaviors each time they occur and point out their inappropriateness B. Ignore the ritualistic behaviors, and they will be eliminated for lack reinforcement C. Set limits on the amount of time Sandy may engage in the ritualistic behavior D. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior

C. Set limits on the amount of time Sandy may engage in the ritualistic behavior

What would be a short-term goal of the nurse caring for a client diagnosed with ineffective impulse control? A. The client will discuss his or her phobic situation with the health-care provider B. The client will decrease participation in ritualistic behavior by half within a week C. The client will verbalize adaptive ways to cope with stress other than pulling out his or her hair D. The client will understand that the perceptions of changes in the body structure are exaggerated

C. The client will verbalize adaptive ways to cope with stress other than pulling out his or her hair

What medical conditions can produce anxiety symptoms?

Cardiac Endocrine Respiratory Neurological

Body Dysmorphic Disorder

Characterized by the exaggerated belief that the body is deformed or defective in some specific way

Medications for trichotillomania (hair-pulling)

Chlorpromazine Amitriptyline Lithium carbonate Selective serotonin reuptake inhibitors and pimozide Olanzapine

Planning ineffective impulse control

Convey a nonjudgmental attitude Practice stress management techniques Offer support and encouragement

The primary health-care provider prescribes lithium carbonate therapy to a client with mania. Which instruction would the nurse provide to the client to prevent adverse effects associated with the medication? A. "Drink five cups of tea each day." B. "Drink five cups of coffee each day." C. "Drink four large glasses of cola each day." D. "Drink six to eight large glasses of water each day."

D. "Drink six to eight large glasses of water each day."

When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? A. Leave the client alone to maintain privacy B. Instruct the client regarding unit rules and regulations C. Sit with the client in the day room to provide comfort D. Communicate with simple words and brief messages

D. Communicate with simple words and brief messages

Which anxiety-related assessment tool is administered by a healthcare professional? A. Anxiety Sensitivity Index B. Beck Anxiety Inventory C. Fear Questionnaire D. Hamilton Rating Scale for Anxiety

D. Hamilton Rating Scale for Anxiety

Which behavior of a client made the nurse implement keeping juices and snacks on the unit at all times? A. Anxiety B. Insomnia C. Agitation D. Hyperactivity

D. Hyperactivity

Anna states that Lucky was her closest friend, and since his death, there is no one who could ever replace the relationship they had. According to Maslow's hierarchy of needs, which level of need is not being met? A. Physiological needs B. Self-esteem needs C. Safety and security needs D. Love and belonging needs

D. Love and belonging needs

Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? A. Ms. T experiences panic anxiety when she encounters snakes B. Ms. T refuses to fly in an airplane C. Ms. T will not eat in a public place D. Ms. T stays in her home for fear of being in a place from which she cannot escape

D. Ms. T stays in her home for fear of being in a place from which she cannot escape

With implosion therapy, a client with phobic anxiety would be: A. Taught relaxation exercises B. Subjected to graded intensities of fear C. Instructed to stop therapeutic session as soon as anxiety is experienced D. Presented with massive exposure to a variety of stimuli associated with the phobic object or situation

D. Presented with massive exposure to a variety of stimuli associated with the phobic object or situation

Anna's dog, Lucky got away from her while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember any of these circumstances of his death. This is an example of what defense mechanism? A. Rationalization B. Suppression C. Denial D. Repression

D. Repression

Which does the nurse expect in a client who shows hypomanic episodes of bipolar disorder? A. The client shows social impairment B. The client shows psychotic features C. The client shows manic symptoms that last for a week D. The client shows manic symptoms that last for at least 4 consecutive days

D. The client shows manic symptoms that last for at least 4 consecutive days.

Side effects of Antianxiety agents

Drowsiness, confusion, lethargy Tolerance, physical and psychological dependence (does not apply to buspirone) Potentiates effects of other CNS depressants (no alcohol) Orthostatic hypotension Paradoxical excitement Dry mouth, nausea and vomiting Blood dyscrasias 10- to 14-day delayed onset of action (with buspirone)

Social Anxiety Disorder

Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others

Specific Phobia

Fear of specific objects or situations that could conceivably cause harm, but the person's reaction to them is excessive, unreasonable, and inappropriate

Outcomes for phobic disorder

Functions adaptively in the presence of the phobic object or situation without experiencing panic anxiety Verbalizes a future plan of action for responding in the presence of the phobic object or situation without developing panic anxiety

Planning for disturbed body image

Help client see his or her body image is disorted Involve client in activities that reinforce positive sense of self Make referrals to support groups

Planning for fear

Include the client in making decisions Encourage the client to explore underlying feelings

Planning for ineffective coping

Initially meet the client's dependency needs Provide a structured schedule of activities

Repression

Involuntarily blocking unpleasant feelings and experiences from one's awareness example) A trauma victim is unable to remember anything about the traumatic event

Outcomes for OCD

Is able to maintain anxiety at a manageable level without resorting to the use of ritualistic behavior Demonstrates more adaptive coping strategies for dealing with anxiety than ritualistic behaviors

Planning for anxiety (panic)

Maintain calm, nonthreatening approach Keep the immediate surroundings low in stimuli Teach the client signs of escalating anxiety

reaction formation

Preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors example) Jane hates nursing. She attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career

Obsessive-Compulsive disorder (OCD)

Recurrent obsessions or compulsions that are severe enough to be time-consuming or to cause marked distress or significant impairment

Obsessions

Recurrent thoughts, impulses, or images experienced as intrusive and stressful, and unable to be expunged by logic or reasoning

Denial

Refusing to acknowledge the existence of a real situation or the feelings associated with it example) A woman drinks alcohol every day, cannot stop, and does not acknowledge that she has a problem

Compulsions

Repetitive ritualistic behavior or thoughts, the purpose of which is to prevent or reduce distress or to prevent some dreaded event or situation

Regression

Responding to stress by retreating to an earlier level of development and the comfort measures associated with that level of functioning example) When 2-year-old Jay is hospitalized for tonsillitis, he will drink only from a bottle, although his mother states he has been drinking from a cup for 6 months.

Hoarding Disorder

The persistent difficulty discarding possessions regardless of their value, and there can be a need for excessive acquiring of items

hair-pulling disorder (trichotillomania)

The recurrent pulling out of one's own hair that results in noticeable hair loss and a sense of release or gratification

Displacement

The transfer of feelings from one target to another that is considered less threatening or that is neutral example) A client is angry at his doctor and does not express it but becomes verbally abusive with the nurse

Suppression

The voluntary blocking of unpleasant feelings and experiences from one's awareness example) Scarlett says, "I don't want to think about that now. I'll think about that tomorrow."

Outcome for body dysmorphic disorder

Verbalizes a realistic perception of his or her appearance and expresses feelings that reflect a positive body image

Outcome for trichotillomania (hair-pulling disorder)

Verbalizes and demonstrates more adaptive strategies for coping with stressful situations

How do you want to treat OCD?

Want to ease into the treatment because by stopping immediately it will increase the anxiety

When is anxiety too much?

When it is out of proportion to the situation. When it interferes with social, occupational, school, or other important areas of functioning.

Anxiety

an emotional response to anticipation of danger, the source of which is largely unknown or unrecognized

Stressor

an external pressure that is brought to bear on an individual... anxiety is response of a stressor

Generalized Anxiety Disorder (GAD)

characterized by chronic, unrealistic, and excessive anxiety and worry of two or more things and need to be around for six or more months

Nursing diagnosis for body dysmorphic disorder

disturbed body image

Nursing diagnosis for phobias

fear

Agoraphobia

fear of being in places or situations from which escape might be difficult or in which help might not be available in the event of panic-like symptoms or other incapacitation symptoms

Nursing diagnoses for OCD

ineffective coping ineffective role performance

Nursing diagnosis for trichotillomania (hair-pulling disorder)

ineffective impulse control

Outcomes for panic disorder and GAD

is able to recognize signs of escalating anxiety and intervene before reaching panic level is able to maintain anxiety at manageable level and make independent decisions about life situation

Exposure to a specific phobia symptoms

panic palpitations sweating dizziness difficulty breathing

Nursing diagnoses for panic disorder and GAD

panic anxiety powerlessness

How to treat trichotillomania?

replace the behavior slowly and slowly ease into it so anxiety does not increase

Nursing diagnosis for agoraphobia

social isolation

Panic Attack Symptoms

sweating, trembling, shaking shortness of breath, chest pain, or discomfort nausea or abdominal distress dizziness, chills, or hot flashes numbness or tingling sensation derealization(feel detached from surrounding) or depersonalization(feeling detachment from one body) fear of losing control(going crazy) fear of dying

Mental Health

the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms

Information about Benzodiazopiems

they are very addicting slowly decrease dosage if become addicted Lorazepam (Ativan) main one