Psych PrepU application style questions 51Q no ans choice w/exp

A nurse is preparing to initiate a behavioral treatment program for a child with encopresis. Which of the following would the nurse most likely implement first

Bowel cleansing

A client with borderline personality disorder tells a nurse, "I'm afraid to get on a train because we'll probably get into a wreck." Which response by the nurse would be most appropriate?

"What are the chances of that actually happening?" Explanation: The nurse should challenge the client's dysfunctional thinking by encouraging the client to think about the event or situation in a different way, providing the client with a different perspective to consider. Although asking about a previous bad experience may help shed some light on the situation, the client with borderline personality disorder has dysfunctional thinking, and this needs to be addressed first. Telling the client that he or she knows it won't happen or suggesting the client travel by car does not address the client's underlying pattern of thinking.

The psychiatric mental health nurse is caring for a female client with obsessive compulsive disorder. Which action by the nurse best addresses the likely etiology of the client's disease?

Administering escitalopram as prescribed Evidence suggests a biochemical etiology for OCD. Specifically, deficient levels of serotonin have been implicated. Childhood trauma and social isolation are not significant etiologic factors. Anxiety is a symptom of the problem, not an etiologic factor.

The nurse is reviewing the medical record of a client diagnosed with depression and notes that the client has been prescribed mirtazapine. The nurse identifies this agent as which drug type?

Alpha-2 antagonist Explanation: Mirtazapine is an alpha-2 antagonist. Escitalopram, fluoxetine, and sertraline are selective serotonin reuptake inhibitors. Amitriptyline, imipramine, and amoxapine are examples of tricyclic antidepressants. Bupropion is a norepinephrine dopamine reuptake inhibitor

A nurse working with clients in recovery with antisocial personality disorder (ASPD) identifies effective teaching approaches. Which approaches support clients' health promotion? Select all that apply.

Approach the opportunity for improved health directly with brief highlights Maintain a sense of humor in interactions Engage in discussion and client understanding before offering challenging points

During the admission assessment, a client with a history of obsessive-compulsive disorder (OCD) denies performing any compulsive handwashing rituals for several months. However, the nurse observes that the client's hands appears reddened and raw. What is the nurse's best action?

Ask the client if this can be confirmed by family members Explanation: With permission, the nurse should confirm assessment findings with the client's family when necessary. Denial is not synonymous with a lack of insight. The nurse cannot deduce the severity of the client's rituals on the basis of one subjective observation. Confronting or challenging the client will harm the therapeutic relationship.

The nurse in a mental health setting plans care for a client with histrionic personality disorder. Which interventions promote optimal outcomes? Select all that apply.

Assess satisfaction with intimate relationships Support assertiveness training to promote self-worth Offer reasonable challenge to the client's negative automatic thoughts Explanation: Interventions to address the needs of a client with histrionic personality disorder include exploration of relationships that goes deeper than a superficial understanding of sexual intimacy or partnership to gather detail about the sense of belonging and any perception of loneliness or isolation. Robust interpersonal skill training and cognitive restructuring can challenge negative thinking patterns to promote self-worth and to address the common diagnosis of chronic low self-esteem.

A client who is receiving lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most appropriate?

Assist the client in minimizing exposure to stressors.

The nurse documents that the client is exhibiting negative symptoms of schizophrenia when observing the client doing what? Select all that apply.

Inability to maintain to complete a goal-directed activity Repeatedly turning down invitations to join in unit activities Pg 335-337

A client with antisocial personality disorder (ASPD) is seen in the emergency department (ED) following threats of taking an overdose. The suicidality was prompted by fraud and the client being barred from living with family. During the assessment the nursing diagnosis of dysfunctional family processes was identified. What is the outcome for this session?

Communicate to the client's family that the client is safe

A client is being discharged on lithium. The nurse encourages the client to follow which health maintenance recommendations? Select all that apply.

Drink a 2 L bottle of decaffeinated fluid daily. Do not alter dietary salt intake. See the doctor if the client gets the flu. Explanation: Clients should drink adequate water (approximately 2 L/day) and continue with the usual amount of dietary table salt. Having too much salt in the diet because of unusually salty foods or the ingestion of salt-containing antacids can reduce receptor availability for lithium and increase lithium excretion, so the lithium level will be too low. If there is too much water, lithium is diluted, and the lithium level will be too low to be therapeutic. Drinking too little water or losing fluid through excessive sweating, such as with strenuous exercise, vomiting, or diarrhea increases the lithium level, which may result in toxicity. Monitoring daily weights and the balance between intake and output and checking for dependent edema can be helpful in monitoring fluid balance. The physician should be contacted if the client has diarrhea, fever, flu, or any condition that leads to dehydration.

The nurse working in an outpatient clinic collaboratively establishes a plan for a client with schizoid personality disorder. An initial outcome is identified related to social isolation. Which activity identifies successful achievement of the outcome?

Engaged in a solitary activity such as walking

A group of nurses is reviewing information about the epidemiology of depressive disorders. The nurses demonstrate understanding of the information when they identify which factor as increasing the risk for depression? Select all that apply.

Little social support Inadequate coping skills Concomitant medical illnesses

A nurse is working in a community setting with a group of clients diagnosed with schizophrenia. Which of the following would least likely be a priority?

Managing psychosis Explanation: In the community, the priorities of care are preventing relapse, maintaining psychosocial functioning, engaging in psychoeducation, improving quality of life, and instilling hope. Managing psychosis would be a priority for a client with acute symptoms of schizophrenia requiring emergency or inpatient focused care.

A client is experiencing severe alcohol withdrawal. Which would the nurse most likely assess? Select all that apply.

Marked diaphoresis Auditory hallucinations Gross uncontrollable tremors Explanation: A person experiencing severe alcohol withdrawal would exhibit marked diaphoresis, auditory and visual hallucinations, a heart rate between 120 and 140 beats/min, gross uncontrollable tremors, and a complete inability to eat or drink.

A nurse is assessing a client with borderline personality disorder. Which response pattern would the nurse most likely assess? Select all that apply.

Mood lability Anger issues Impulsive behavior Fear of abandonment

A nurse is conducting an inservice program on personality disorders. When describing obsessive-compulsive personality disorder, which characteristics would the nurse likely include? Select all that apply

Preoccupation with control Strict attention to rules Difficulty with decision making Relationships primarily formal and polite

Which of the following are advantages of play therapy? Select all that apply.

Promotion of manual strength Teaching of rules and problem solving Mastery of control over child's environment

A psychiatric-mental health nurse is preparing an education plan about antisocial personality disorder for a class of community health nurses. Which would the nurse include as a term often used to describe the behaviors associated with this condition? Select all that apply.

Psychopath Sociopath Explanation: The terms psychopath and sociopath are often used to describe the behaviors of antisocial personality disorder. Although individuals with this disorder are self-serving, exploitive, and engage in acts that are grounds for arrest, the terms manipulator and criminality are not commonly used. Psychotic refers to behaviors in which there are disturbed thought processes.

A client has been diagnosed with posttraumatic stress disorder (PTSD) after being involved in a serious motor vehicle accident, which the client caused. Which information would the nurse most likely include when assessing the client's physical health? Select all that apply.

Quality and quantity of the client's sleep Client's pattern of alcohol consumption Client's use of over-the-counter medications Pain Heart rate and blood pressure PTSD causes varied physical effects, including sleep disruption. The nurse should assess all drug and alcohol use and determine if the client is experiencing pain. Hyperarousal often accompanies PTSD, causing tachycardia and hypertension.

The nurse seeks to establish trust while assessing the social history of a client with antisocial personality disorder (ASPD). Which findings demonstrate understanding of the client's relationship challenges? Select all that apply.

Relationships end suddenly A pattern of failed relationships Success establishing relationships

When assessing a client with delusional disorder, the nurse would most likely expect to find impairment in which of the following? Select all that apply.

Social functioning Marital functioning Chapter 23: Schizoaffective, Delusional, and Other Psychotic Disorders: Management of Thoughts and Moods - Page 395

Which are appropriate intervention for a client with schizoid personality disorder? Select all that apply.

Social skills training Recreational therapy with an individual focus A client schizoid personality disorder would likely respond to interventions aimed at improving social skills or providing individual recreation therapy. These interventions would be offered by the nurse on an individual basis by the nurse. Engaging the client in group therapy, providing training to do public speaking or to expect the client would succeed in a college environment are more likely to lead to failure and a worsening of self-esteem.

The psychiatric mental health nurse will perform the initial assessment of a client who has just been diagnosed with posttraumatic stress disorder. Which area would the nurse most likely address first?

Specific events of the trauma Explanation: Provided the client is willing, the nurse should begin the assessment by addressing the trauma. This should ideally precede other areas such as substance use, sleep, and coping.

The nurse reviews current literature about current studies of biologic theories regarding the etiology of schizophrenia. Which information would the nurse most likely find? Select all that apply.

That genetics is a major determining factor for developing schizophrenia. That persons with schizophrenia have decreased brain volume and abnormal brain function in the frontal and temporal areas. That the brain activity of persons with schizophrenia differs from people who do not have schizophrenia. That the etiology of schizophrenia may be related to overactivity of the dopamine neurotransmitter.

A client is experiencing moderate anxiety. Which manifestation would the nurse most likely observe? Select all that apply.

The client can sustain attention on a particular focus. The client verbally states, "For some reason, I am feeling anxious now."

A nurse provides care for a client recovering from orthopedic surgery. The client also has a diagnosis of antisocial personality disorder (ASPD). What factors related to the personality disorder does the nurse consider when planning care? Select all that apply

The client is likely to have a concurrent diagnose of substance abuse The client has poor impulse control that hinders compliance with a plan of care The client has personality traits that are deeply ingrained and difficult to modify The client lacks insight and commitment, making the treatment adherence a challenge

Which problems can arise during the working phase of a nurse-client relationship that serve to impair the therapeutic work? Select all that apply.

The client struggles with expressing feelings The client demonstrates dependence on the group The nurse demonstrates evidence of countertransference

A veteran has returned from a tour of duty and has been diagnosed with post-traumatic stress disorder (PTSD). The care team should consider which factor as a potential contributor to the client's diagnosis? Select all that apply.

The client's childhood experiences The severity of trauma that the client experienced Genetic factors creating a susceptibility to PTSD The client's gender Neurobiological factors Pg 485

A nurse prepares information for a family member to explain the difference between schizophrenia and schizotypal personality disorder. Which are symptoms of schizotypal personality disorder? Select all that apply.

There is more frontal lobe activity than in schizophrenia Cognitive deterioration is less progressive than in schizophrenia The reduction of grey matter loss occurs more slowly than in schizophrenia Explanation: The neurobiological differences demonstrate that clients with schizotypal personality disorder have more neural activity in their frontal lobe. The rate of cognitive decline and grey matter loss in schizophrenia is typically more aggressive than in schizotypal personality disorder. The experience of psychosis can var,y yet for those with schizotypal personality disorder it's more likely that their psychosis is transient and less persistent than with schizophrenia. Challenges establishing trust and the intersection of health determinants make treatment adherence difficult for those with schizotypal personality disorder. Although there is little evidence that they adhere worse to treatment than those with schizophrenia, there are many with schizophrenia who have established academic and social achievements and who are socially supported to follow a treatment plan.

A nurse who works in a psychiatry unit finds that young clients with schizophrenia have worse prognoses when compared with clients who are diagnosed later in life. Which reasons should lead the nurse to make this observation? Select all that apply.

They have less sense of personal identity. They are inherently more susceptible to receive a poor prognosis. They are less likely to have experiences of independent living. Explanation: Young clients with schizophrenia have a poor prognosis when compared with older clients. Possible reasons include that young clients have a less developed sense of personal identity and have not had experiences of successful independent living. Differences in treatment adherence are not related to age. Difficulty in communicating problems does not depend on the age of the client. Age at onset appears to be an important factor in how well the client fares: those who develop the illness earlier show worse outcomes than those who develop it later.

A mental health nurse is consulted by staff on a surgical unit for a client who believes their actions are being monitored by their intravenous pump. The client is assessed and determined to fit the criteria for schizotypal personality disorder. There was no evidence of major depressive disorder or significant anxiety. What is the recommendation of the nurse?

To have the surgical care team focus on surgical recovery

When giving a community lecture about posttraumatic stress disorder (PTSD) for clients and their families, a nurse would include which topics for discussion? Select all that apply.

Trying various treatment options if one does not help. Trying to identify triggers that lead to re-experiencing the trauma.

A nurse is preparing a presentation for a staff meeting about somatic symptom disorder (SSD). When describing the epidemiology associated with SSD, the nurse would identify which groups as likely to develop this condition? Select all that apply.

Women of lower socioeconomic status African American women Explanation: Epidemiological studies have reported that SSD occurs primarily in non-White, less educated women, particularly those with a lower socioeconomic status and high emotional distress. Men are less likely to be diagnosed with SSD, partly because of stereotypic male traits, such as a disinclination to admit discomfort or seek help for their symptoms.

A psychiatric-mental health nurse is interacting with a client. Which technique would demonstrate the nurse's use of therapeutic communication? Select all that apply.

restating confronting interpreting Explanation: Examples of therapeutic communication techniques are restatement, confrontation, and interpretation. Nontherapeutic techniques include agreement and challenges.

A nurse is developing an education plan for a client who is prescribed escitalopram. Which side effect would the nurse include in this plan? Select all that apply.

weight gain decreased sexual interest Dry mouth

The nurse is conducting an assessment of a client who has been diagnosed with obsessive-compulsive disorder. When assessing for common comorbidities, which question would be most appropriate to ask to gather additional information? Select all that apply.

"Would you see that you are easily influenced by other people?" "How would you describe your mood over the past several weeks?" "Have you recently had any difficulty concentrating?" Explanation: Dependent personality disorder (easily influenced) and depression (sadness and inability to concentrate) are common comorbidities of obsessive-compulsive disorder. Hallucinations and aggression do not often correlate with OCD.

The nurse is preparing a client for treatment with repetitive transcranial magnetic stimulation. When educating the client about this procedure, which would the nurse include? Select all that apply.

"You will be awake and alert during the procedure." "You can resume your normal activities right after the treatment"

When assessing a client with borderline personality disorder (BPD), which would a nurse expect to assess? Select all that apply.

Control necessary for a relationship Fear of rejection Self-injurious behavior Explanation: People with BPD have an extreme fear of abandonment as well as a history of unstable, insecure attachments. These individuals, who already are intensely emotional and have a poor sense of self, feel estranged from others and inadequate in the face of perceived social standards. Intense shame and self-hate follow. These feelings often result in self-injurious behaviors, such as wrist cutting, self-burnings, or head banging. People with BPD use elaborate strategies to structure interactions. That is, they restrict their relationships to ones in which they feel in control. They distance themselves from groups when feeling anxious (which is most of the time) and rarely use their social support system. Even if they are married or have a supportive extended family, they are reluctant to share their feelings. They do not want to burden anyone; they fear rejection and assume that people are tired of hearing them repeat the same issues.

A client on a medical unit has a comorbid diagnosis of depression and has been taking mirtazapine for several months prior to the current admission. When providing care to the client, which action would be most appropriate for the nurse to do? Select all that apply.

Ensure that the client is not cheeking or stockpiling the medication. Monitor the client's mood and affect over the course of the admission.

The nurse has been working with a client with an eating disorder for 1 week. During the morning treatment team meeting, the treatment plan is updated. Which would be appropriate interventions at this time in the nurse-client relationship? Select all that apply.

Exploring perceptions of reality Promoting a positive self-concept Working through resistance Explanation: Specific tasks of the working phase include maintaining the relationship, gathering more data, exploring perceptions of reality, developing positive coping mechanisms, promoting a positive self-concept, encouraging verbalization of feelings, facilitating behavior change, working through resistance, evaluating progress and redefining goals as appropriate, providing opportunities for the client to practice new behaviors, and promoting independence. Establishing boundaries and dealing with testing behaviors are completed in the orientation phase, which should be completed by this point.

A client with posttraumatic stress disorder (PTSD) is hospitalized on a medical unit due to unstable blood sugars. The nurse identifies a sleep pattern disturbance in the client's admission documentation. Which are consistent problems associated with a sleep pattern disturbance? Select all that apply.

Exploring the extent of nightmares Determining difficulty falling asleep Obtaining information from family members

Following a suicide attempt, a client with obsessive-compulsive disorder (OCD) is being admitted to the psychiatric unit. When planning this client's care, which action would be most appropriate? Select all that apply.

Express empathy regarding the client's need to perform compulsive rituals Integrate the client into meaningful unit activities as anxiety levels allow Chapter 26: Anxiety, Obsessive-Compulsive, Trauma, and Stressor-Related Disorders: Management of Anxiety, Panic, and Trauma-Related Stress - Page 480

A nurse is describing the various etiologies and risk factors associated with ADHD. Which of the following would the nurse include? Select all that apply

Family stress Poverty Overcrowded living conditions Genetics Marital discord

The nurse working with students in a modified school setting completes a screening with the intention to identify students at risk for antisocial personality disorder (ASPD). Which findings predict a risk of developing ASPD? Select all that apply.

Harming a sibling Pattern of impulsive behavior Treatment for attention deficit hyperactivity disorder Explanation: For a diagnosis to be made for ASPD, the individual must meet the criteria for conduct disorder prior to 15 years of age. A child or adolescent who causes harm to a sibling, maintains a pattern of behavior that is not modified or planned or who meets criteria for ADHD are at greatest risk of developing ASPD. The use of substances including tobacco and alcohol would be considered high risk if they were being abused. Substance use is not considered to be a significant risk.

A client is experiencing a panic attack while in the recreation room. Which intervention would be a priority to promote the client's safety? Select all that apply.

Remaining with the client to assess needs Turning off any televisions or radios in the immediate area Explanation: During a panic attack, the nurse's first concern is to provide a safe environment. Staying with the client to assess needs is vital. If the environment is overstimulating, the client should move to a less stimulating place. Decreasing external stimuli will help lower the client's anxiety level. An antianxiety agent may be helpful, but it is not the priority; obtaining a prescription would require that the nurse leave the client, which would be inappropriate. Trying to engage the client in recreational activities is likely to exacerbate his or her anxiety.

A psychiatric-mental health nurse is engaging in active listening with a client. Which technique would the nurse most likely use? Select all that apply.

Responding indirectly to statements Using open-ended statements Concentrating fully on what the client says Explanation: Through active listening, the nurse focuses on what the client is saying to interpret and respond objectively to the message. While listening, the nurse concentrates only on what the client is saying and on the underlying meaning. The nurse usually responds indirectly, using techniques such as open-ended statements, reflection, and questions that elicit additional responses from the client. Changing the subject is avoided. Allowing the client to talk as the client wishes reflects passive listening, which does not foster a therapeutic relationship.

A client is engaged in a nurse-client relationship that is in the orientation phase. With which activity would the client be involved?

Seeking assistance Explanation: During the orientation phase, the client seeks assistance, identifies needs, and commits to a therapeutic relationship; the client begins to test the relationship later in this phase. The client discusses underlying needs and tests new ways to solve problems in the working phase. The nurse is responsible for establishing boundaries during the orientation phase.

A nurse is assessing a client who has experienced trauma. The nurse determines that the client is experiencing physiologic hyperarousal based on which finding? Select all that apply.

Startles easily Overreacts to others Explanation: After a traumatic experience, the stress system seems to go on permanent alert, as if the danger might return at any time. In this state of physiologic hyperarousal, the traumatized person is hypervigilant for signs of danger, startles easily, reacts irritably to small annoyances, and sleeps poorly. The state of hyperarousal causes the affected individual to be irritable and overreact to others, which cause others to avoid the person. Frequent urination and vivid dreams are not associated with posttraumatic stress disorder. Avoiding places associated with the trauma is common but not associated with hyperarousal.

When a client with extremely severe obsessive-compulsive disorder (OCD) is no longer responding to intensive drug therapy or behavioral therapy, what other treatment options should the nurse prepare to educate the client/family about? Select all that apply.

Stereotactic surgical procedures Deep-brain stimulation with electrical current Explanation: Psychosurgery is sometimes used to treat extremely severe OCD that has not responded to prolonged and intensive drug treatment, behavioral therapy, or a combination of the two. Modern stereotactic surgical techniques that produce lesions of the cingulum bundle (a bundle of connective tissue) or anterior limb of the internal capsule (a region near the thalamus and part of the circuit connecting to the cortex) may bring about substantial clinical benefit in some individuals without causing significant morbidity). Other treatment options include radiotherapy and deep-brain stimulation, in which an electrical current is applied through an electrode inserted into the brain. Biofeedback is helpful when relaxation is needed. Service animals and hypnotherapy are useful treatments for patients with posttraumatic stress disorder.

A nurse suspects that a client brought to the emergency department may have used ketamine. Which assessment findings would support this suspicion? Select all that apply.

Tachycardia Memory loss Numbness Vomiting Explanation: Ketamine is associated with an increased heart rate and blood pressure, impaired motor function, memory loss, numbness, and vomiting. At high doses, delirium, depression, respiratory depression, and cardiac arrest can occur.