Psych Test #3

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? A Onset of action is from 1 to 6 weeks. B They tend to be more effective for men. C Recent memory impairment is commonly observed. D They often cause the client to have diurnal variation.

A Onset of action is from 1 to 6 weeks. People are accustomed to fast results from medication: thirty minutes for aspirin, 24 hours for antibiotics. Information is necessary to prevent discouragement and maintain compliance. REF: Page 268-269

The treatment team meets to discuss Cody's plan of care. Which of the following factors will be priorities when planning interventions? A Readiness to change and support system B Current college performance C Financial ability D Availability of immediate family to come to meetings

A Readiness to change and support system The plan will take into account acute safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and the individual's cultural needs. The other options may be factors but are not the priority factors in planning interventions for the patient as much as the patient's perceived need for change and having others who can lend support outside the hospital. Text page: 422

The nurse has developed a plan for a client with a severe sleep pattern disturbance to spend 20 minutes in the gym exercising each afternoon. Which intervention should be scheduled for upon returning to the unit? A Rest B Group therapy C A protein-based snack D Unstructured private time

A Rest A depressed client usually has little energy. After even a short exercise period, the client may feel exhausted and need rest. REF: 257-258

A client who is dependent on alcohol tells the nurse, "Alcohol is no problem for me. I can quit anytime I want to." The nurse can assess this statement as indicating A denial. B projection. C rationalization. D reaction formation.

A denial. Believing that one can control drug use, despite addiction to the substance, is based on denial (escaping unpleasant reality by ignoring its existence). REF: 423

The only class of commonly abused drugs that has a specific antidote is the A opiates. B hallucinogens. C amphetamines. D benzodiazepines.

A opiates. The effects of opiates can be negated by a narcotic antagonist such as naloxone. REF: 427

The priority nursing diagnosis for a hyperactive manic client during the acute phase is A risk for injury. B ineffective role performance. C risk for other-directed violence. D impaired verbal communication.

A risk for injury. Risk for injury is high, related to the client's hyperactivity and poor judgment. REF: Page 234-235

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by A suggesting, "Let's look at what you just said, that you can 'never do anything right.'" B querying, "Tell me what things you think you are not able to do correctly." C asking, "Is this part of the reason you think no one likes you?" D saying, "That is the most unrealistic thing I have ever heard."

A suggesting, "Let's look at what you just said, that you can 'never do anything right.'" Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate. REF: Page 262

When a client reports that lithium causes an upset stomach, the nurse suggests taking the medication: A with meals B with an antacid C 30 minutes before meals D 2 hours after meals

A with meals Many clients find that taking lithium with or shortly after meals minimizes gastric distress. REF: 240-241

An acute phase nursing intervention aimed at reducing hyperactivity is redirecting the client to A write in a diary. B exercise in the gym. C direct unit activities. D orient a new client to the unit.

A write in a diary. Manic clients often respond well to the invitation to write. They will fill reams of paper. While writing they are less physically active. REF: Page 235-236

Which statement is a fact about suicide? A More women than men commit suicide. B An intentional drug overdose is the most common method of suicide among males. Correct C Native Americans and Alaskan Natives have low suicide rates. D A client with schizophrenia is at great risk for attempting suicide.

D A client with schizophrenia is at great risk for attempting suicide. Individuals with schizophrenia are 50 times more likely to attempt suicide than is the general public. Suicide is the eleventh leading cause of death in the United States. Native Americans and Alaskan Natives have high suicide rates. More women attempt suicide, but more men are successful. REF: 481

Dysthymia cannot be diagnosed unless it has existed for A at least 3 months. B at least 6 months. C at least 1 year. D at least 2 years.

D at least 2 years. Dysthymia is a chronic condition that by definition has to have existed for longer than 2 years. REF: 251-252

Benzodiazepines are useful for treating alcohol withdrawal because they A block cortisol secretion. B increase dopamine release. C decrease serotonin availability. D exert a calming effect.

D exert a calming effect. Benzodiazepines act by binding to α-aminobutyric acid-benzodiazepine receptor sites, producing a calming effect. REF: 421

A client who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The client mentions that she will take the medication along with the St. John's wort she uses daily. The nurse should A agree that taking the drugs at the same time will help her remember them daily. B caution the client to drink several glasses of water daily. C suggest that the client also use a sun lamp daily. D explain the high possibility of an adverse reaction.

D explain the high possibility of an adverse reaction. Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants. REF: 273-274

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying A flight of ideas. B distractibility. C limit testing. D grandiosity.

D grandiosity. Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity. REF: 233-234

The nurse proposes that a suicidal client enter into a no-suicide contract. Such a contract would contain a provision that the client promises A never to attempt suicide. B to alert someone if he or she has made an attempt. C not to consider suicide for 72 hours. D not to attempt suicide in the next 24 hours.

D not to attempt suicide in the next 24 hours. A no-suicide contract is quite straightforward in seeking a client's promise not to attempt to harm oneself within a specified period. When that time expires, a new contract is negotiated. REF: 491

A client has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, nursing measures should include A induction of vomiting. B administration of ammonium chloride. C monitoring of opiate withdrawal symptoms. D observation for hyperpyrexia and seizures.

D observation for hyperpyrexia and seizures. Hyperpyrexia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose. REF: Page 414

When a client experiences four or more mood episodes in a 12-month period, the client is said to be A dyssynchronous. B incongruent. C cyclothymic. D rapid cycling.

D rapid cycling. Rapid cycling implies four or more mood episodes in a 12-month period, as well as more severe symptomatology. REF: 228

A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." The nurse should A say "I understand" and allow the client to close the door. B keep the door open, but step to the side out of the client's view. C leave the client's room and wait outside in the hall. D say "For your safety I can be no more than an arm's length away."

D say "For your safety I can be no more than an arm's length away." This level of suicide watch does not make adjustments based on client preference. The explanation quoting the protocol and the reason (your safety) is appropriate. REF: Page 493

A depressed client tells the nurse he is in the "acute phase" of his treatment for depression. The nurse recognizes that the client has been in treatment A for more than 4 months. B that is directed toward relapse prevention. C that focuses on prevention of future depression. D to reduce depressive symptoms.

D to reduce depressive symptoms. The acute phase of depression therapy (6-12 weeks) is directed toward the reduction of symptoms and restoration of psychosocial and work function and may require some hospitalization. REF: Page 261-262

An statement that would show acceptance of a depressed, mute client would be A "I will be spending time with you each day to try to improve your mood." B "I would like to sit with you for 15 minutes now and again this afternoon." C "Each day we will spend time together to talk about things that are bothering you." D "It is important for you to share your thoughts with someone who can help you evaluate your thinking."

B "I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the client without making demands is a good way to show acceptance. REF: Page 262

An assessment tool that is useful to nurses in rating suicide risk is the A AIMS scale. B Sad Persons scale. C CAGE questionnaire. D Mini-Mental Status Examination.

B Sad Persons scale. Evaluation of a suicide plan is extremely important in determining the degree of suicidal risk. The Sad Persons scale is short and easy to use. It thoroughly covers major risk factors and gives guidelines for action to meet the client's needs. REF: 486

Sasha has been having angry outbursts with staff and peers on the unit. You are talking with Sasha on her third day of admission. You ask whether she is having any thoughts of suicide. Sasha becomes angry and defensive, shouting, "I'm sick of you people! Are you ever do is ask me the same question over and over. Get out of here!" Your response is based on the knowledge that: A Sasha is getting better because she is able to be assertive. B Sasha may be at high risk for self-harm. C Sasha is probably experiencing transference. D Sasha may be angry at someone else and projecting that anger to staff.

B Sasha may be at high risk for self-harm. Overt hostility is highly correlated with suicide; therefore the patient may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them. Text page: 263-264

The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that is A dark colored and modest. B colorful and outlandish. C compulsively neat and clean. D ill-fitted and ragged.

B colorful and outlandish. Manic clients often manage to dress and apply makeup in ways that create a colorful, even bizarre, appearance. REF: 233-234

An outcome for a manic client during the acute phase that would indicate that the treatment plan was successful would be that the client A reports racing thoughts. B is free of injury. C is highly distractible. D ignores food and fluid.

B is free of injury. Risk for injury is a diagnosis of high priority for manic clients because of their hyperactivity. Lack of injury is a highly desirable outcome. REF: 234

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to A question the client's motive. B set verbal limits. C initiate physical confrontation. D prepare the client for seclusion.

B set verbal limits. Verbal limit setting should always precede more restrictive measures. REF: 233-234

The major reason for hospitalization for depressed patients is: A inability to go to work. B suicidal ideation. C loss of appetite. D psychomotor agitation.

B suicidal ideation. Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization. Text page: 255

The nursing diagnosis Imbalanced nutrition: less than body requirements has been identified for a client diagnosed with severe depression. The most reliable evaluation of outcomes will be based on the client's A energy level. B weekly weights. C observed eating patterns. D statement of appetite.

B weekly weights. The client's body weight is the most reliable and objective evaluation of success in treating this nursing diagnosis. REF: 261

Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support? A Opiates B Marijuana C Barbiturates D Hallucinogens

C Barbiturates Withdrawal from central nervous system depressants is complicated, requiring carefully titrated detoxification with a similar drug. Abrupt withdrawal can lead to death. REF: Page 416

In helping an addicted individual plan for ongoing treatment, which intervention is the first priority for a safe recovery? A Ongoing support from at least two family members must be secured. B The client needs to be employed. C The client must strive to maintain abstinence. D A regular schedule of appointments with a primary care provider must be set up.

C The client must strive to maintain abstinence. Abstinence is the safest treatment goal for all addicts. Abstinence is strongly related to good work adjustments, positive health status, comfortable interpersonal relationships, and general social stability. REF: 424

An appropriate long-term goal/outcome for a recovering substance abuser would be that the client will A discuss the addiction with significant others. B state an intention to stop using illegal substances. C abstain from the use of mood-altering substances. D substitute a less addicting drug for the present drug.

C abstain from the use of mood-altering substances. Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term. REF: Page 422

It is likely that a client diagnosed with seasonal affective disorder will begin to experience fewer symptoms in the A fall. B winter. C spring. D summer.

C spring. Seasonal affective disorder occurs during the months when sunlight diminishes. Clients may begin to feel effects in the late fall and will be affected throughout the winter. They improve during the spring and feel well during the summer. REF: 273-274

Some of the most important characteristics of staff members who work with suicidal clients are A the ability to be consistently organized. B the ability to teach problem-solving skills. C warmth and consistency when interacting. D interview and counseling skills.

C warmth and consistency when interacting. Crucial characteristics of staff members who work with suicidal clients include warmth, sensitivity, interest, and consistency. REF: 491

Tyler's nursing care plan has several nursing diagnoses listed. Match the nursing diagnosis to the level of priority (1 to 4): Knowledge, deficit Nonadherence Risk for injury Self-care deficit, bathing and hygiene

1) Risk for injury 2) Self care deficit, bathing and hygiene 3) Knowledge, deficit 4) Nonadherence

Which side effects of lithium can be expected at therapeutic levels? A Fine hand tremor and polyuria B Nausea and thirst C Coarse hand tremor and gastrointestinal upset D Ataxia and hypotension

A Fine hand tremor and polyuria The fact that fine hand tremor and polyuria are present at therapeutic levels is quite annoying to some clients. These and other side effects are factors in noncompliance. REF: Page 240 (Table 13-3)

The first-line drug used to treat mania is A lithium carbonate (Lithium). B carbamazepine (Tegretol). C lamotrigine (Lamictal). D clonazepam (Klonopin).

A lithium carbonate (Lithium). Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder. REF: 230

To plan care for a manic client the nurse must consider that lithium cannot be started until A the physical examination and laboratory tests are analyzed. B the initial doses of antipsychotic medication have brought behavior under control. C seclusion has proven ineffective as a means of controlling assaultive behavior. D electroconvulsive therapy can be scheduled to coincide with lithium administration

A the physical examination and laboratory tests are analyzed. Lithium should not be given to clients with impaired renal or thyroid function. A thorough physical examination and various laboratory tests are necessary to rule out other organic causes for the behavior and to ensure that the lithium can be excreted normally. REF: Page 240-241

A desired outcome for the maintenance phase of treatment for a manic client would be that the client will A exhibit optimistic, energetic, playful behavior. B adhere to follow-up medical appointments. C take medication more than 50% of the time. D use alcohol to moderate occasional mood "highs."

B adhere to follow-up medical appointments. The client would be living in the community during the maintenance phase. Keeping follow-up appointments is highly desirable. REF: Page 234-235

When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of A anger. B denial. C confusion. D sympathy.

B denial. Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as "I cannot understand why anyone would want to take his own life." REF: Page 486

A person who covertly supports the substance-abusing behavior of another is called a(n) A patsy. B enabler. C participant. D minimizer.

B enabler. An enabler is one who helps a substance-abusing client avoid facing the consequences of drug use. REF: 418

A suicidal individual calls a suicide hot line. This represents the level of intervention classified as A primary. B secondary. C tertiary. D quaternary.

B secondary. Secondary prevention is essentially treatment. REF: 490-491

Erik is a 26-year-old patient who abuses heroin. He states to you, "I've been using more heroin lately. I told my provider about it and she said I need more and more heroin to feel the effect I want." You know this describes: A intoxication. B tolerance. C withdrawal. D addiction.

B tolerance. Tolerance is described as needing increasing greater amounts of a substance to receive the desired result to become intoxicated or finding that using the same amount over time results in a much-diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships. Text page: 416

Which room placement would be best for a client experiencing a manic episode? A A shared room with a client with dementia B A single room near the unit activities area C A single room near the nurses' station D A shared room away from the unit entrance

C A single room near the nurses' station The room placement that provides a nonstimulating environment is best. Nearness to the nurses' station means close supervision can be provided. REF: 244-245

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? A γ-Aminobutyric acid B Dopamine C Serotonin D Acetylcholine

C Serotonin Low serotonin levels have been noted among individuals who have committed suicide. REF: 495

A person who has numerous hypomanic and dysthymic episodes can be assessed as demonstrating characteristics of A bipolar II disorder. B bipolar I disorder. C cyclothymia. D seasonal affective disorder.

C cyclothymia. Cyclothymia refers to mood swings involving hypomania and dysthymia of 2 years' duration. The mood swings are not severe enough to prompt hospitalization. REF: 228

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can identify this cognitive distortion as an example of A self-blame. B catatonia. C learned helplessness. D discounting positive attributes.

C learned helplessness. Learned helplessness results in depression when the client feels no control over the outcome of a situation. REF: Page 259-260

The nurse observes the meal tray about to serve a suicidal client. Which item should be removed from the tray? A Plastic plate B Cloth napkin C Styrofoam cup D Metal utensils

D Metal utensils In most health care agencies, suicidal clients receive plastic dinnerware on their meal trays. REF: Page 492 (Box 25-4)

Which assessment data would be most consistent with a severe opiate overdose? A Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min B Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min C Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min D Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min

A Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression. REF: Page 416

A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted? A Constant 24-hour, one-to-one observation at arm's length B One-to-one observation while client is awake C Every 15-minute observation around the clock D Seclusion with 15-minute observation

A Constant 24-hour, one-to-one observation at arm's length A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch. REF: Page 491-492

Which of the following describe the symptoms of the manic phase of bipolar disorder? (select all that apply): A Excessive energy B Fatigue and increased sleep C Low self-esteem D Pressured speech E Purposeless movement F Racing thoughts G Withdrawal from environment H Distractibility

A Excessive energy D Pressured speech E Purposeless movement F Racing thoughts H Distractibility All these options describe mania. The other options more aptly describe the opposite of what happens in mania.

Which behavior would be most characteristic of a client during a manic episode? A Going rapidly from one activity to another B Taking frequent rest periods and naps during the day C Being unwilling to leave home to see other people D Watching others intently and talking little

A Going rapidly from one activity to another Hyperactivity and distractibility are basic to manic episodes. REF: 232-233

A client was in an automobile accident and while there is the odor of alcohol on his breath, his speech is clear, and he is alert and answers questions posed to him. His blood alcohol level is determined to be 0.30 mg%. What conclusion can be drawn? A The client has a high tolerance to alcohol. B The client ate a high-fat meal before drinking. C The client has a decreased tolerance to alcohol. D The client's blood alcohol level is within legal limits.

A The client has a high tolerance to alcohol. A nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level. REF: Page 416

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? A Withhold medication and notify the physician. B Continue to administer medication as ordered. C Advise the client to limit fluids for 12 hours. D Advise the client to curtail salt intake for 24 hours.

A Withhold medication and notify the physician. The client's lithium level has exceeded desirable limits. Additional doses of the medication should be withheld and the physician notified. REF: Page 240-241

Nursing assessment of an alcohol-dependent client 6 to 12 hours after the last drink would most likely reveal the presence of A tremors. B seizures. C blackouts. D hallucinations.

A tremors. Tremors are an early sign of alcohol withdrawal. REF: Page 414

Which is the greatest protective factor against the risk of suicide? A One or more previous suicide attempts B A sense of responsibility to family, including spouse and children C Fear of dying D A cultural belief that suicide is a shameful resolution for a dilemma

B A sense of responsibility to family, including spouse and children Having family responsibilities makes a client less likely to commit suicide. Hopelessness is the greatest risk factor. REF: 483; Box 25-2

Which of the following statements is true regarding culture and protective factors against suicide? A Asian Americans have the highest rates of suicide. B Religion and the importance of family are protective factors for Hispanic Americans. C Older women have the highest risk for suicide among African Americans. D American Indians and Pacific Islanders have the lowest rates of suicide.

B Religion and the importance of family are protective factors for Hispanic Americans. Among Hispanic Americans, Roman Catholic religion (in which suicide is a sin) and the importance given to the extended family decrease the risk for suicide. The other options are all incorrect and are in fact the opposite of what is true. Text page: 484

Cocaine exerts which of the following effects on a client? A Stimulation after 15 to 20 minutes B Stimulation and anesthetic effects C Immediate imbalance of emotions D Paranoia

B Stimulation and anesthetic effects Cocaine exerts two main effects on the body, both anesthetic and stimulant. REF: Page 413-415 (Table 22-1)

A teaching need is revealed when a client taking disulfiram (Antabuse) states, A "I usually treat heartburn with antacids." B "I take ibuprofen or acetaminophen for headache." C "Most over-the-counter cough syrups are safe for me to use." D "I have had to give up using aftershave lotion."

C "Most over-the-counter cough syrups are safe for me to use." The client taking disulfiram has to avoid hidden sources of alcohol. Many cough syrups contain alcohol. REF: Page 427 (Table 22-9)

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal A good memory and concentration. B delusions of persecution. C self-deprecatory ideation. D sexual preoccupation.

C self-deprecatory ideation. Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world. REF: 255-256

You are talking with Jennifer, a patient admitted with depression. Which statement by the patient indicates the need for further assessment? A "I know a lot of people care about me and want me to get better." B "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself." C "I don't have a good support system, but I am planning on joining a recovery group." D "I think things will be better soon."

D "I think things will be better soon." This response may be a covert, or indirect, clue that the patient is thinking of suicide. The other options are all statements that, while they may be discussed further, are not clues to suicidality but rather clear communication. Text page: 485

Cody is preparing for discharge. He tells you, "Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?" Which response is appropriate teaching regarding naltrexone? A "It helps your mood so that you don't feel the need to do drugs." B "It will keep you from experiencing flashbacks." C "It is a sedative that will help you sleep at night so you are more alert and able to make good decisions." D "It helps prevent relapse by reducing drug cravings."

D "It helps prevent relapse by reducing drug cravings." Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. The other options do not accurately describe the action of naltrexone. Text page: 427 (Table 22-9)

Tyler is being discharged home to his family. Which of the following is important teaching to include for the patient and the family to recognize possible signs of impending mania? A Increased appetite B Decreased social interaction C Increased attention to bodily functions D Decreased sleep

D Decreased sleep Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania. Text page: 245

The term tolerance, as it relates to substance abuse, refers to A the use of a substance beyond acceptable societal norms. B the additive effects achieved by taking two drugs with similar actions. C the signs and symptoms that occur when an addictive substance is withheld. D the need to take larger amounts of a substance to achieve the same effects.

D the need to take larger amounts of a substance to achieve the same effects. With regard to substance abuse, tolerance is defined as the need to take higher and higher doses of a drug to achieve the desired effect. REF: 413-414

If a suicidal client is to be treated outside the hospital, which intervention would be of high priority? A Have the client identify three people to call if he is overwhelmed by hopelessness. B Make sure the client has food enough to last for 2 to 3 days. C Arrange for a police visit every 24 hours. D Provide a 1-week supply of antidepressant medication.

A Have the client identify three people to call if he is overwhelmed by hopelessness. For suicidal clients treated in the community, establishing a network of individuals to whom the client may turn if the suicidal urge becomes great is important. REF: Page 493-494

Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment? A How long the client has been suicidal B Whether the plan has specific details C Whether the method is one that causes death quickly D Whether the client has the means to implement the plan

A How long the client has been suicidal Lethality refers to how deadly a plan is. The length of time a client has been suicidal has nothing to do with the lethality of the plan. REF: 486-487

The morning after he was admitted, a suicidal client wishes to use the cordless electric razor the staff took from his suitcase the night before. The nurse should A allow him to use the razor under staff supervision. B tell him he must use a safety razor provided by the unit. C suggest that this would be a good time to grow a beard. D give him the razor and ask him to return it when he is finished.

A allow him to use the razor under staff supervision. Because the razor is cordless, independent use is relatively safe. REF: Page 492 (Box 25-4

Unit practice requires inspection of all items being brought onto the unit by visitors. This can be most effectively done by A having a staff member sit at the door and check packages as visitors enter. B having a staff member make frequent rounds during visiting hours to inspect gifts. C asking all visitors to report to the nurse's station before visiting a client. D asking clients to give staff any unsafe item that might have been left by a visitor.

A having a staff member sit at the door and check packages as visitors enter. A number of ways to inspect items are possible.Taking all potentially harmful gifts from visitors before allowing them to see clients, going through client's belongings (with client present) and removing all potentially harmful objects, ensuring that visitors do not leave potentially harmful objects in the client's room, and searching clients for harmful objects on return from pass are all effective methods to ensure a high rate of client safety. REF: Page 492 (Box 25-4)

Jermaine attempted suicide while intoxicated by using a gun, although the bullet missed when he staggered. Jermaine's method of using a gun to attempt suicide is considered: A high risk, or a hard method. B low risk, or a soft method. C not an actual suicide attempt because he was intoxicated. D a nonlethal means.

A high risk, or a hard method. Higher-risk methods, also referred to as hard methods, include using a gun, jumping from a high place, hanging, and carbon monoxide poisoning. The other responses are incorrect.

A client tells the nurse that he believes his situation is intolerable. The nurse assesses that the client is isolating socially. A nursing diagnosis that should be considered is A hopelessness. B deficient knowledge. C chronic low self-esteem. D compromised family coping.

A hopelessness. The defining characteristics are present for the nursing diagnosis of hopelessness. REF: Page 481

Symptoms that would signal opioid withdrawal include A lacrimation, rhinorrhea, dilated pupils, and muscle aches. B illusions, disorientation, tachycardia, and tremors. C fatigue, lethargy, sleepiness, and convulsions. D synesthesia, depersonalization, and hallucinations.

A lacrimation, rhinorrhea, dilated pupils, and muscle aches. Symptoms of opioid withdrawal resemble the "flu"; they include runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever. REF: 427; Table 22-9

A desirable short-term goal for the nursing diagnosis Defensive coping related to biochemical changes as evidenced by aggressive verbal and physical behaviors would be A making no attempts at self-harm within 12 hours of admission. B sleeping soundly for 12 of the next 24 hours. C willingly taking prescribed medication as offered by staff within 24 hours of admission. D demonstrating psychomotor retardation associated with sedation from prescribed medication within 6 hours of admission.

A making no attempts at self-harm within 12 hours of admission. Whenever aggressive verbal or physical behaviors are demonstrated, a desirable goal is cessation of those behaviors. Verbal and physical aggression are most apt to occur when staff are trying to structure the client's behavior for his or her own safety or the safety of others. REF: Page 234-235

An identical twin recently committed suicide. The parent tells the nurse, "Thank heavens suicide does not run in families. I won't have to worry about my other son." The nurse's response will be based on the understanding that this optimism is A not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide. B justified because twin studies suggest no genetic factor is involved in suicide. C unjustified because the parent has failed to consider the importance of the "copycat" factor. D likely evidence of her denying the possibility of a parental role in the causation of the suicide.

A not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide. Twin studies, in fact, show that a genetic component of suicide may be present. REF: Page 484

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to A wait quietly for the client to reply. B prompt the client if the reply is slow. C repeat the question if the client does not answer promptly. D review the client's medical record to support the client's response.

A wait quietly for the client to reply. Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply. REF: Page 260

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." The reply by the nurse that clarifies the prevalence of this disease is A "That is a good observation. Depression does mostly strike people older than 50 years." B "Depression is seen in people of all ages, from childhood to old age." C "Depression is most often seen among the middle adult age group." D "The age of onset for most depressive episodes is given as 18 years."

B "Depression is seen in people of all ages, from childhood to old age." Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression. REF: 251

Cody is a 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months. He is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for Cody's treatment plan while in the hospital? A Cody will return to a predrug level of functioning within 1 week. B Cody will be medically stabilized while in the hospital. C Cody will state within 3 days that he will totally abstain from drugs and alcohol. D Cody will take a leave of absence from college to alleviate stress.

B Cody will be medically stabilized while in the hospital. If the patient has been abusing substances heavily, he will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated. The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge. The first option is an unrealistic time frame. It is not likely that the patient will make a total commitment to abstinence within this time frame. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely. Text page: 422

Which nursing diagnosis would be least useful for a depressed client who shows psychomotor retardation? A Constipation B Death anxiety C Activity intolerance D Self-care deficit: bathing/hygiene

B Death anxiety A client with psychomotor retardation has vegetative signs of depression and is often constipated, too tired to engage in activities, and lacks the energy to attend to personal hygiene. Depressed clients usually do not have death anxiety. They are more likely to welcome the idea of dying. REF: Page 259-260

What statement about the comorbidity of depression is accurate? A Depression most often exists in an individual as a single entity. B Depression is commonly seen in individuals with medical disorders. C Substance abuse and depression are seldom seen as comorbid disorders. D Depression may coexist with other disorders but is rarely seen with schizophrenia.

B Depression is commonly seen in individuals with medical disorders. Depression commonly accompanies medical disorders. The other options are false statements. REF: 251-252

A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested A LAAM B GHB C ReVia D Clonidine

B GHB The drugs most frequently used to facilitate a sexual assault (rape) are flunitrazepam (Rohypnol, "roofies"), a fast-acting benzodiazepine, and gamma-hydroxybutyrate (GHB) and its congeners. These drugs are odorless, tasteless, and colorless; mix easily with drinks; and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur. REF: 414; Table 22-1

Jermaine scores a 7 on the SAD PERSONS scale. What action needs to be taken? A Closely follow up; consider hospitalization. B Hospitalize or commit. C Send home with follow-up. D Strongly consider hospitalization.

B Hospitalize or commit. A score of 7 to 10 on the SAD PERSONS scale indicates hospitalization or commitment because the person would be considered high risk for suicide. Closely follow up refers to a score of 3 to 4. Send home with follow-up refers to a score of 0 to 2. Strongly consider hospitalization refers to a score of 5 to 6. Text page: 486 (Table 25-2)

Which of the following is true of the relationship between bipolar disorder and suicide? A Patients need to be monitored only in the depressed phase because this is when suicides occur. B Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. C Patients with bipolar disorder are not considered high risk for suicide. D As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.

B Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. Mortality rates for bipolar disorder are severe because 25% to 60% of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime, and nearly 20% of all deaths among this population are from suicide. Suicides occur in both the depressed and the manic phase. Bipolar patients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only patients who stop medications commit suicide. Text page: 228

A bipolar client whose continuing phase treatment consists of lithium therapy and cognitive-behavioral therapy may become noncompliant with medication. Which factor would be of least concern to the nurse developing a psychoeducation plan to foster compliance? A The side-effects are unpleasant. B The voices tell the client to stop taking it. C The client prefers to feel "high" and energetic. D The client feels well and denies the possibility of recurrence.

B The voices tell the client to stop taking it. Manic clients may hallucinate during the delirious state but generally do not hear voices. Psychoeducation would not be going on during the time the client is delirious. REF: Page 228

A client prescribed a monamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client can safely eat A avocado salad plate. B fruit and cottage cheese plate. C kielbasa and sauerkraut. D liver and onion sandwich.

B fruit and cottage cheese plate. Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, a hypertensive crisis, and eventually a cerebrovascular accident. REF: Page 268-269

A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive, and the staff is having difficulty keeping him and themselves safe. The nursing intervention that would be most therapeutic is A taking him to the gym on the psychiatric unit. B obtaining an order for seclusion and close observation. C assigning a psychiatric technician to "talk him down." D administering naltrexone as needed per hospital protocol.

B obtaining an order for seclusion and close observation. Aggressive, violent behavior is often seen with PCP ingestion. The client will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off. Talking down is never advised because of the client's unpredictable violent potential. Naltrexone is an opiate antagonist. REF: Page 414

You are working with Ava, another student nurse on the psychiatric unit. She tells you she doesn't want to ask her patient about suicidal ideation because "It might put ideas in her head about suicide." Your best response would be: A "I'm glad you are thinking that way. She may not have thought of suicide before, and we don't want to introduce that." B "You are right; however, because of professional liability, we have to ask that question." C "Actually, it's a myth that asking about suicide puts ideas into someone's head." D "If I were you, I'd ask Dr. Carmichael to talk to the patient about that subject."

C "Actually, it's a myth that asking about suicide puts ideas into someone's head." Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients have usually been already thinking about suicide; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason we ask patients about suicidal thoughts or plan; it is for patient safety. Asking the physician to speak to the patient on that subject does not educate the student regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe. Text page: 485

Sasha is a 38-year-old patient admitted with major depression. Which of the following statements Sasha makes alerts you to a common accompaniment to depression? A "I still pray and read my Bible every day." B "My mother wants to move in with me, but I want to independent." C "I still feel bad about my sister dying of cancer. I should have done more for her!" D "I've heard others say that depression is a sign of weakness."

C "I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression. Text page: 259

Sasha is started on fluoxetine. Which statement by Sasha indicates that she understands the medication teaching you have provided? A "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." B "I will not take any over-the-counter medication while on the fluoxetine." C "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." D "I will report increased thirst and urination to my provider."

C "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine. Text page: 265

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." The best approach for the nurse to use would be A "What an offensive thing to suggest!" B "I don't have sex with clients." C "It's time to work on your art project." D "Let's walk down to the seclusion room."

C "It's time to work on your art project." Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the client. REF: Page 234-235

Which of the following is true regarding substance addiction and medical comorbidity? A Most substance abusers do not have medical comorbidities. B There has been little research done regarding substance addiction disorders and medical comorbidity. C Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. D Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier.

C Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. The more common co-occurring medical conditions are hepatitis C, diabetes, cardiovascular disease, HIV infection, and pulmonary disorders. The high comorbidity appears to be the result of shared risk factors, high symptom burden, physiological response to licit and illicit drugs, and the complications from the route of administration of substances. Most substance abusers do have medical comorbidities. There is research such as the 2001-2003 National Comorbidity Survey Replication (NCS-R) showing the correlation between medical comorbidities and psychiatric disorders. It is more likely that medical comorbidities negatively affect substance addiction in that they cause added symptoms, stress, and burden. Text page: 417

Select the nursing diagnosis least likely to be chosen after analysis of data pertinent to a client with post-partum depression. A Impaired parenting B Ineffective role performance C Health-seeking behaviors D Risk for impaired parent/infant/child attachment

C Health-seeking behaviors A client with severe depression of any etiology will not have the mental or physical energy to engage in health-seeking behaviors. Further, her negative view of self and the world would preclude such thinking. REF: Page 259-260

Tyler is a 31-year-old patient admitted with acute mania. He tells the staff and the other patients that he is on a secret mission given to him by the President of the United States to monitor citizens for terrorist activity. He states, "I am the only one he trusts, because I am the best!" For documentation purposes you know that this behavior is referred to as: A unpredictability. B rapid cycling. C grandiosity. D flight of ideas.

C grandiosity. Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although patients with mania are unpredictable, the scenario does not describe unpredictability: Rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes. Text page: 233

Beck's cognitive theory suggests that the etiology of depression is related to A sleep abnormalities. B serotonin circuit dysfunction. C negative processing of information. D a belief that one has no control over outcomes.

C negative processing of information. Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, self-deprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue. REF: 255

When the clinician mentions that a client has anhedonia, the nurse can expect that the client A has poor retention of recent events. B experienced a weight loss from anorexia. C obtains no pleasure from previously enjoyed activities. D has difficulty with tasks requiring fine motor skills.

C obtains no pleasure from previously enjoyed activities. Anhedonia is the term for the lack of ability to experience pleasure. REF: 250

The suicide intervention that has the greatest impact on a client's safety is A educating visitors about potentially dangerous gifts. B restricting the client from potentially dangerous areas of the unit. C one-on-one observation by the staff. D removal of personal items that might prove harmful.

C one-on-one observation by the staff. One-on-one observation allows for constant supervision, which minimizes the client's opportunities to cause self-harm. REF: 492; Table 25-4

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with A senile dementia. B hypertensive crisis. C psychomotor agitation. D central serotonin syndrome.

C psychomotor agitation. These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression. REF: 257-258

The most helpful message to transmit about relapse to the recovering alcoholic client is that lapses A are an indicator of treatment failure. B are caused by physiological changes. C result from lack of good situational support. D can be learning situations to prolong sobriety.

C result from lack of good situational support. Relapses can point out problems to be resolved and can result in renewed efforts for change. REF: Page 425

The nursing diagnosis Risk for self-directed violence has been added to the care plan of a suicidal client. The most appropriate short-term goal would be that while hospitalized, the client will A reclaim any prized possessions that were given away. B name three personal strengths. C seek help when feeling self-destructive. D participate in a self-help group.

C seek help when feeling self-destructive. Having the client cope with self-destructive impulses in a healthy way is the only appropriate short-term goal here. REF: Page 489

What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with the ethical obligation when the nurse observes a peer who is under the influence of alcohol? A The nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol-using nurse until a second incident takes place. B Neither should be reported until the nurse has collected factual evidence. C No report should be made until suspicions are confirmed by a second staff member. D Supervisory staff should be informed as soon as possible in both cases.

D Supervisory staff should be informed as soon as possible in both cases. If indicators of impaired practice are observed, the observations need to be reported to the nurse manager. Intervention is the responsibility of the nurse manager and other nursing administrators. However, clear documentation (specific dates, times, events, consequences) by co-workers is crucial. The nurse manager's major concerns are with job performance and client safety. Reporting an impaired colleague is not easy, even though it is our responsibility. To not "see" what is going on, nurses may deny or rationalize, thus enabling the impaired nurse to potentially endanger lives while becoming sicker and more isolated. Impairment can occur whether the nurse is under the influence of alcohol or a narcotic drug. REF: 426

Sasha's roommate Kate was admitted with major depression and suicidal ideation with a plan to overdose. Kate is preparing for discharge and asks you, "Why did Dr. Travis give me a prescription for only 7 days of amitriptyline?" Your response is based on the knowledge that: A amitriptyline (Elavil) is very expensive, so the patient may have to buy fewer at a time. B Dr. Travis is going to see how Kate responds to the first week of medication to evaluate its effectiveness. C Dr. Travis wants to see whether any minor side effects occur within the first week of administration. D amitriptyline (Elavil) is lethal in overdose.

D amitriptyline (Elavil) is lethal in overdose. Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the patient had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only one week. Side effects are always a consideration but not the most important consideration with TCAs. Text page: 266-267, Table 14-6

When working with a client who may have made a covert reference to suicide, the nurse should A be careful not to mention the idea of suicide. B listen carefully to see whether the client mentions it a second time. C ask about the possibility of suicidal thoughts in a covert way. D ask the client directly if he or she is thinking of attempting suicide.

D ask the client directly if he or she is thinking of attempting suicide. Covert references should be made overt. The nurse should directly address any suicidal hints given by the client. Self-destructive ideas are a personal decision. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living. People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis. REF: 485

When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that A no research exists to suggest genetic transmission. B much depends on the socioeconomic class of the individuals. C highly creative people tend toward development of the disorder. D the rate of bipolar disorder is higher in relatives of people with bipolar disorder.

D the rate of bipolar disorder is higher in relatives of people with bipolar disorder. This understanding will allow the nurse to directly address the question. Responses based on the other statements would be tangential or untrue. REF: Page 229-230

A syndrome that occurs after stopping the long-term use of a drug is called A amnesia. B tolerance. C enabling. D withdrawal.

D withdrawal. Withdrawal is a condition marked by physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in dosage. REF: 413-414