Test 3 PSYCH Kneisl/Pearson CH 23,34,16,32,20,22,21,24,35,15,27,30

Following a natural disaster, which health care worker statement suggests the need to assess for vicarious traumatization?

"After a while, you become accustomed to hearing the same stories over and over and you develop numbness." Profound sadness, grief, and anger are normal reactions to an abnormal event. Absence of response, or lack of awareness of a response, suggests the need for further assessment.

Identical twin adolescents experience the same crisis. The older twin reports the experience as one associated with personal growth, while the younger twin never regains the precrisis level of functioning. Their mother asks the nurse, "They have had the same life experiences. How could they react so differently?" Which of the following statements by the nurse best describes resilience?

"Coping style, as well as the number and depth of supportive relationships, may explain the difference." Resilience encompasses the biological and psychological characteristics intrinsic to an individual, such as personality style and quality of interpersonal relationships, that confer protection against the development of psychopathology.

Which of the following questions would be asked as part of the cognitive assessment of a sexual history?

"How has your religion influenced your sexual values and behaviors?" The cognitive domain of the assessment focuses on thinking and thought processes. The client's thoughts on the influence of religion and sexual values are reflected in the cognitive assessment.

According to Schneidman's research, which client statement addresses the most common reason for suicide?

"I just had to succeed in school. When I failed, I could think of no other answer to my situation." The common purpose for suicide is to seek a solution to what appears to be an otherwise insoluble problem.

A nurse is designing a relapse-prevention inpatient group for clients with schizophrenia. Which statement addresses a main category of nursing activities?

"If you can increase your self-assessment skills, you'll be able to tell when you're getting more stressed."

After being discharged from the hospital less than 24 hours ago, your client with a personality disorder attempts suicide and is readmitted. You overhear a staff member saying, "Why doesn't she just kill herself and put herself out of our misery?" Which of the following is your best response?

"It is frustrating to care for people with persistent behaviors." This response demonstrates empathy for your coworker. In addition, it encourages her to continue sharing her thoughts and feelings without seeming judgmental of her. As the dialogue continues, you may be able to identify effective treatment interventions for the client. Approaching the client as a united team is most likely to ensure consistency and minimize the potential for splitting of staff.

A peer in nursing school is going through a divorce. Most of her family is overseas. When you offer assistance, she smiles and states, "I handle things myself. I always have." Then she changes the subject. Which of the following statements from your peer provides you with the greatest assurance that she has what she needs?

"My brother and I were always there for each other when we were children. I will ask him for help if I need it." This is a specific plan to call a particular individual. In addition, it is a plan that your peer has utilized in the past and that has been effective.

Your peer, who works in the emergency department, asks you to identify characteristics of the typical perpetrator of child abuse. Which of the following statements should you include in your response?

"Perpetrators often present as pleasant, concerned individuals."

A client informs the nurse, "I am thinking more about death, but I'm not going to hurt myself." Which statements by the nurse would be appropriate and therapeutic within any hospital setting? (Select all that apply.)

"Tell me more about your thoughts." Encouraging the client to elaborate gives the client an opportunity to explore and ventilate feelings, which will decrease anxiety. 4. "Sometimes clients who feel hopeless think about killing themselves. Have you had any thoughts about killing yourself?" Although the client denied he would hurt himself, consider asking about suicide directly, in case the client has framed death as nonhurtful and beneficial. 5. "You have told me that you have not had thoughts about hurting yourself. If you start having these thoughts, can you tell me or another staff member before you act on them?" This question is the basis for a

Which of the following nursing interventions is inconsistent with the ABCs of crisis counseling?

"That must bring up a lot of thoughts and fears from your past. For this session, let's focus on your childhood." Crisis intervention focuses on the here-and-now. It is potentially countertherapeutic for the nurse to delve into long-standing issues when the goal is for the client to resume optimal functioning as soon as possible.

Your client with a personality disorder informs you, "A novice like you couldn't possibly help me. What I need right now is to leave this hospital." What is your best initial response?

"What are you experiencing right now?" Encouraging the client to identify thoughts and feelings is the approach most likely to increase the client's self-awareness.

Which of the following group member statements is an example of here-and-now activation?

"You have expressed hurt when people have interrupted you, but for the past 20 minutes you have talked without allowing others to share." This statement focuses on the current behaviors, thus meeting the criteria for here-and-now activation.

At the 2-month follow-up visit at the mental health clinic, the client tells the nurse he stopped taking the clomipramine (Anafranil) 6 weeks ago because of the side effects. What symptoms should the nurse expect to observe in the client?

. Repeatedly folding pages in a magazine. Clomipramine (Anafranil), a tricyclic antidepressant, is used as an antiobsessional agent. The client's actions reflect compulsive behaviors.

The components of a sexual addiction include which of the following behaviors? (Select all that apply.

1. Preoccupation. The individual thinks about sex to the exclusion of other thoughts, resulting in a sexual high. The addiction supplants appropriate behaviors. 2. Ritualization. Ritualistic behaviors are a pattern of sexual addiction. The rituals may control the sexual addict's anxiety. Addicts are usually unable to abandon a ritual without suffering tremendous emotional consequences until they learn how to cope with their anxiety. 3. Compulsivity. The individual is unable to control sexual behavior, which has become the most important factor of their life. Other behaviors such as work, education, and hobbies are nonexistent or greatly minimized. 4. Despair. Once the sexual act has been completed, the person experiences guilt and shame for the loss of control. The feelings of guilt and pain associated with the despair creates anxiety and the need to begin the cycle all over again.

Halfway through your assessment of a suicidal client, you identify your own feelings of discomfort, anger, and apathy. When you conclude your assessment, which of the following actions should you take? (Select all that apply.)

1.Consider whether you need an opinion from another clinician. If you are concerned that your feelings were perceived by the client or otherwise interfere with the assessment, a second opinion from another nurse or clinician is a reasonable and prudent option. 2. Allow time for yourself to explore the thoughts behind your emotional response to this situation. It is essential that you inventory your response to this client so that you develop self-awareness without acting out your feelings. 3. Examine the ethical conflict of autonomy versus beneficence/nonmaleficence. The interaction may have revealed an ethical dilemma for you. 4.Consider the issues of control and responsibility in the interaction with this client. Clients who appear to reject values of health and preservation of life may elicit frustration in health care providers.

The interventions common to treatment plans for survivors include which of the following? (Select all that apply.)

1.Establish trust and rapport. This intervention provides the client with an ally. 2. Identify areas of control. This intervention empowers the client. 3. Support the client in the decisions he/she makes. This intervention empowers the client and enhances the client's current problem-solving ability.

Risk factors for intrafamily physical and sexual abuse include which of the following? (Select all that apply.)

2. Family's immigrant or refugee status. Abrupt relocation to an unfamiliar place contributes to individual and family perception of isolation, a common dynamic in families of abuse. 3. Family's primary language other than community's dominant language. Inability to communicate in the dominant language contributes to isolation, a common dynamic in families of abuse. 4. Breadwinner's active military status. If the breadwinner is absent from the household, the remaining parent has fewer resources and may experience isolation. The multiple moves that military families experience decrease social connections. Such isolation is a common dynamic in families of abuse. Support systems available to these families may offer assistance for more universally experienced stressors and may not actively seek out families at risk for abuse.

Which factors interfere with health care providers offering assistance to family survivors of suicide? (Select all that apply.)

2. The belief that health care providers should wait for family members to approach them. Survivors rarely seek assistance from mental health professionals. Therefore, health care providers should be prepared to offer assistance. 3. Fear of being blamed for the client's suicide. Family members' blame of the health care team is a common response. If this response is anticipated, offers of support to the family may be made through pastoral care or volunteer services. 4. The belief that family members will receive adequate support from their own support network. Families and friends may not receive the same degree of support as bereaved people whose loved ones died because of illness or accident. Therefore, offers of additional support (such as connection to a survivors-of-suicide support group) may be welcomed. 5. Concerns about litigation, with management directives not to interact with family members. This is a legitimate concern. If this response is anticipated, offers of support to the family may be made through nonclinical support services (pastoral care or volunteer services) or a designated administrator.

Which of the following findings supports a nursing diagnosis of Altered Family Processes?

A stable household, comprised of a married couple with two teenage children, is augmented when a family member with a chronic, debilitating illness moves into a spare room. This scenario indicates that a family member with complex needs is entering a functional household. The change may go smoothly, but it presents a potential disruption of usual roles and may represent a crisis.

The client with schizophrenia is preparing for discharge. To minimize relapse, what is the most important feature of planning the client's aftercare?

An accurate description of the medication regimen with a specific plan for obtaining refills

The husband of a client reports to the nurse that his wife "just doesn't seem to enjoy doing anything or being around anyone". The client's husband is describing a symptom often seen in clients with schizophrenia known as:

Anhedonia is the inability to experience pleasure. People with schizophrenia cannot enjoy experiences because of the physiologic reason over which they have no control.

-A strong familial tendency, particularly when a female biologic relative has the disorder -History of criminal behavior What cluster is this?

Antisocial personality disorder. Research indicates strong familial tendencies toward antisocial personality disorder. It is more common among first-degree relatives; having a female biologic relative with the disorder tends to increase the risk. History of criminal behavior. History of violence toward others is very common, including sex offenses (e.g., rape, child pornography, child molestation) and murder.

A client asks the nurse, "How can I benefit from a therapeutic group?" In terms of the Johari Window, which of the following is the nurse's best response?

As other members give you feedback about the effect you have on others, you learn to see yourself differently."

Which of the following assessment findings support a nursing diagnosis of Ineffective Family Coping?

Both parents and two of the four siblings have active chemical dependency problems. Families with chemical dependence are characteristically chaotic, enmeshed, and unpredictable.

The care plan formulated with your client includes the following goals: "Client reports fear, depression, and stranger anxiety as 'tolerable.' Client reports increased control over remembering. Client describes self as a rape 'survivor.'" For which client are these goals not appropriate?

Client in the emergency room immediately after the rape. The immediate goals for this client include "Client will make choices regarding care" and "Client will identify feelings."

An independent nursing intervention found to be effective in delaying or preventing relapse is:

Close monitoring for prodromal symptoms enables early clinical intervention, which may prevent a relapse

-More common among first-degree relatives of clients with schizophrenia -Severe cognitive impairment What cluster is this?

Cluster A personality disorders. Schizoid and schizotypal PDs are significantly more common among first-degree relatives of schizophrenic clients. Severe cognitive impairment. The major features of these disorders are pervasive distrust, social detachment, and subsequent impairment in social and occupational functioning. People with odd-eccentric personality disorders have the most cognitive impairments as well as the most peculiar behaviors and maladaptive defensive styles of people with personality disorders.

Increased levels of testosterone and estrogens and decreased levels of 5-HIAA are associated primarily with which of the following?

Cluster B personality disorders

-Correlated with family histories of mood disorders, alcoholism, and somatization disorders -Failure to develop integration of cognitive, affective, and behavioral responses What cluster is this?

Cluster B personality disorders. Cluster B illnesses are often correlated with histories of mood disorders, alcoholism, and somatization disorders among family members. Failure to develop integration of cognitive, affective, and behavioral responses. Parental deprivation; inadequate, excessive, or inconsistent discipline; and failure of the child to develop integrated cognitive, affective, and behavioral modes in early life may lead to Cluster B disorders.

Unrealistic expectations of others, with impaired decision-making and problem-solving abilities What cluster is this?

Cluster C personality disorders Unrealistic expectations of others, with impaired decision-making and problem-solving abilities. Anxious-fearful people generally experience both social and occupational impairments as a result of their restricted affect, nonassertiveness, problems expressing feelings, unrealistic expectations of others, and impaired decision making and problem solving.

Which of the following interventions are most appropriate for individuals experiencing a crisis? (Select all that apply.)

Cognitive behavioral interventions. These interventions alter the perception of the trauma and increase the client's repertoire of responses. Pharmacological interventions. Clients in crisis often benefit from medications to treat anxiety, depression, and/or sleep disturbance. Self-help support groups. These groups are more effective for clients with long-term problems characterized by exacerbations and remissions. These groups are not as beneficial for clients in crisis who require intense intervention and direct guidance.

The priority nursing intervention to prevent autoerotic asphyxia is:

Community education and awareness. Education regarding this practice is needed to alert individuals of the risk of accidental death. Parents need to be aware of physical signs of trauma to the neck, including abrasions, pressure marks, or rope burns. Once signs are seen, a discussion about the risks involved could save lives.

You volunteer in your community as a telephone crisis hotline worker. You know that during the course of a telephone session, the caller's decrease in suicidality will be most accurately evaluated by which of the following?

Decreased constriction in thought. The thought processing of suicidal clients is generally constricted; that is, people who are suicidal have great difficulty (if they can do it at all) considering alternatives to their current dilemma. The ability to envisage alternatives is a factor that could change during the course of a telephone intervention.

Your client with a personality disorder has a nursing care plan which includes the nursing diagnosis "Impaired Social Interaction." Applying the principles for caring with this client, which of the following interventions is essential to the care plan?

Demonstrate honesty and sincerity in all interactions with the client.

The most common coexisting mental health issue associated with anorexia and bulimia is:

Depression. Depression is the most common disorder associated with anorexia and bulimia. It is unclear if the eating disorder is the primary disorder resulting in depression (a secondary depression) or if depression is primary and the eating disorder is a coping method.

A nurse wants to start an outpatient support group for clients with chronic mental illness. Which of the following statements best describe the nurse's procedure? (Select all that apply.)

Determine how to identify potential members. This step is essential if the nurse is forming a group for a particular population. Often, the nurse controls for heterogeneity or homogeneity (of level of functioning, gender, or age). At the first meeting, have members identify and vote on the group rules. Many clients with chronic mental illness have had limited experience in group participation. Asking clients to identify and decide on group rules is challenging and may be perceived as threatening or overwhelming.

A client on antipsychotic medications presents with symptoms of hyperprolactinemia. What symptom should the nurse assess for?

Difficulty achieving orgasms. Hyperprolactinemia results from an increased production of the hormone prolactin, which results in difficulties with libido, arousal, excitation, orgasm, and male ejaculatory volume.

Within 3 days of beginning a new antipsychotic medication, the client reports severe muscle spasms. This adverse effect is known as

Dystonia. Dystonia is a severe muscle spasm occurring in the first days of treatment or even after a single dose of medication.

Binge-eating disorder

Eating significantly larger-than-normal amounts in a discrete time period, until uncomfortably full •Sense of lack of control •No compensatory purging

The nurse is assessing the client with schizophrenia who is taking clozapine (Clozaril). Which of the following findings should the nurse report immediately to the prescriber?

Elevated body temperature. Clozapine can cause agranulocytosis, which can result in a serious infection. An elevated body temperature may be an early indicator of an infection. The nurse should also monitor the client's white blood cell count.

Which of the following behaviors in yourself would alert you to the need to reassess your behaviors and interventions in a crisis situation? (Select all that apply.)

Expressing doubt regarding the client's capacity to function. The goal of crisis intervention is to restore the person to the pretrauma level as quickly as possible. A review of the outcome criteria for your client in crisis may reveal that the client has met the criteria and is able to resume responsibilities without further intervention. 4. Augmenting continuously the client's problem list. Crisis intervention focuses on return to function rather than addressing all identified problems. 5. Thinking about clients during leisure time. Preoccupation with clients is associated with caregiver stress and vicarious traumatization. Increased self-awareness and self-care is usually warranted.

Educational guidelines for family members of clients with eating disorders include:

Expressing love and affection both verbally and physically. Clients in treatment are learning how to feel good about themselves without the use of food. Underlying issues related to family relationships can contribute to an eating disorder. Clients need to feel accepted and loved for who they are.

Characteristics of Anorexia Nervosa

Extreme perfectionism •Fear of gaining weight •Significant weight loss •Body image disturbance •Strenuous exercising •Peculiar food handling practices

The nurse is summarizing her assessment findings with the family and tells them she perceives them to be an enmeshed family. What is the best description of enmeshment?

Family members do not have a strong sense of self. Individuals in an enmeshed family do not have a clearly differentiated sense of self. Family members are unable to define their own values and beliefs.

According to systems theory, families in which sexual abuse occurs are characterized by which of the following?

Fluid boundaries. An adult may move "down" in the structure or a child may move up in terms of roles and influence (boundaries). If the father moves downward, he assumes a childlike role and is cared for and nurtured like a child in the family. In this position, the father assumes little parental responsibility. He may then turn to the daughter as a "peer" for sexual and emotional gratification.

An important difference between a situational crisis and a maturational crisis is that the onset of the maturational crisis is:

Foreseeable.

The client reports a history of rubbing up against others to achieve sexual arousal. This behavior is known as

Frotteurism.

During an assessment in the emergency room, in the family's presence, you develop concerns about caregiver abuse. Your state requires you to report cases of suspected abuse. The family members repeat their explanation of the client's injuries. What do you say to them?

I am required by law to report suspected abuse."

Your peer informs you, "This client always disrupts our unit and leaves against medical advice. She is a typical borderline." What is your best initial response?

I wish we could identify what she needs and provide it before she acts out on the unit." This statement approaches the client as a person with unique needs and suggests an approach to positively affect her treatment.

Which client statements demonstrate acknowledgment of the effects of psychological pressures associated with schizophrenia? (select all)

I'm going to look for a job where I can use my college degree but have less day-to-day stress." "If I can't stand the side effects, how will I ask my prescriber to change my medication?" "I have designed a weekly schedule so that I can get tasks done and have planned time to relax."

An adolescent is acting out on the inpatient unit. An appropriate intervention by the staff nurse would include:

Identifying an effective way to resolve the problem. By identifying an effective way to resolve the problem, the nurse acknowledges the significance of the adolescent's behavior and assists the client in identifying a resolution to the immediate problem. This is an effective solution.

nurse is teaching a group of adolescents about the risk factors and complications of anorexia nervosa. Which of the following complications should the nurse stress as the most serious?

Increased risk of mortality. The most serious complication of anorexia nervosa is the risk of death due to the severe physiological changes and the risk of suicide.

A nurse is assessing a client to determine the effectiveness of the psychotropic medication the client has been taking. Which of the following assessment findings is reason for concern? (Select all that apply.)

Increased thirst Elevated blood pressure Increased agitation Bradycardia

A psychotic client with a family history of diabetes and hypertension is started on an antipsychotic. Which of the following symptoms should the nurse monitor the client most closely for?

Insatiable thirst. The client has a family history of diabetes. Antipsychotic medications typically cause weight gain, which increases the risk of diabetes and heart disease. Insatiable thirst may be an indicator of hyperglycemia and/or diabetes. The nurse must monitor the client's thirst level closely.

Personality disorders differ from personality traits in that personality disorders:

Interfere with role functioning. A PD is a lifelong maladaptive pattern of perceiving, thinking, and relating that impairs social or occupational functioning and can be traced back to at least adolescence or early adulthood.

e nurse observes a client admitted with anorexia nervosa doing repeated, vigorous sit-ups. The most appropriate action from the nurse is to:

Interrupt the behavior and offer to walk with the client. The nurse should interrupt behavior and offer to walk with the client. This allows the nurse to set the pace of the walk and offer the client an opportunity to discuss feelings.

Spiritual distress is an important issue for survivors of violence because survivors often report a sense of:

Isolation. Spirituality includes a sense of connectedness to others. Survivors must begin the long journey of developing trusting relationships.

After a chronically suicidal client is admitted through the emergency room, a family member informs you, "I am so tired of this. Sometimes I wish this person would succeed at suicide." What is your best response?

It is important for you to get what you need. What do you need for yourself at this time?" The family members are experiencing stress. Use active listening and remain nonjudgmental as you indicate to them that you know they are in distress.

Which family member statements demonstrate recognition of the effects of social pressures associated with schizophrenia?

It would be great if my family member could identify somebody to trust and believe when that person says, 'Your symptoms are worse. Let's go to the psychiatrist.'" "I'm going to help my family member figure out what to tell other family members, friends, and business associates about why he's been on medical leave." "I'll attend a support group, but I'm afraid my family member will not go...s/he would rather try to 'pass' as not mentally ill."

In a final exam in a comparative literature course, a student compares James Joyce to a bowl of soggy corn flakes. She grieves her low grade with the department chair, flirtatiously arguing that her professor did not appreciate her thesis. Which characteristics common to all three categories of personality disorders are evident? (Select all that apply.)

Lack of insight. In this example, the student does not demonstrate understanding of the impact of her choice of subject matter for the thesis. External response to stress. The student deals with the stress by finding fault with the professor and attempting to alter the grade through the department chair. Failure to accept consequences. The student chooses to debate the grade and attempts to manipulate the department chair rather than learn from the outcome.

The Effect of Serotonin On Eating Disorders.

Low serotonin levels - decrease satiety Increase food intake High serotonin level - Increase satiety Decrease food intake

The nurse is educating the client and family members on the symptoms associated with drug-induced parkinsonism. What safety factors should the nurse emphasize in the teaching plan?

Maintain clear walkways throughout the house. Clients with drug-induced parkinsonism experience rigidity, tremor, or rhythmic oscillations of the extremities, and a shuffling gait. They are at an increased risk for falls. Safety measures should be implemented to decrease the risk.

During a statewide environmental disaster, the most up-to-date and accurate psychoeducational resources most often include

Mass media. Public service announcements through mass media are likely to contain the most accurate information for individuals in need. It is essential for crisis workers to impart this information to victims, since victims are likely displaced and disconnected from communication networks.

A peer approaches you and shares her frustration with her older brother, who has had multiple hospitalizations with schizophrenia. "He used to show interest in me, but since his discharge 5 days ago, he just stares into space. I cannot get a reaction out of him." Which of the following statements impart accurate information? (Select all that apply.)

Maybe he's depressed about having a chronic illness." "He may have sedation or masked facial expressions from his medications." "He may be demonstrating flattening of affect and anhedonia."

The nursing diagnosis for a client with bulimia is Fluid Volume Deficit. Nursing interventions specific to the fluid volume deficit include:

Monitoring the client for at least 1 hour after meals. Clients with bulimia need to be monitored for at least 1 hour after meals to prevent purging.

Following a family meeting, a client makes the following statements. Which client statement requires the nurse's immediate intervention?

Neither my siblings nor my father can deal with the burden I present. I have no options." Recall the chapter on suicide. Clients who make serious attempts often feel as if they have no choice and see death as an escape from an unbearable situation.

There are several biopsychosocial theories associated with causation of rape and intrafamily abuse. However, the nurse knows that:

None of the contributing factors consistently results in or is predictive of rape or intrafamily abuse. Although a genetic predisposition may make certain behaviors more likely, it does not make them inevitable.

Dopamine D3 receptor gene variant What cluster is this?

OCPD. People with the dopamine D3 receptor gene variant are approximately 2.5 times more likely to be diagnosed with obsessive-compulsive personality disorder.

An example of a coercive paraphilia is:

Obscene phone calling. A coercive paraphilia occurs when the individual includes nonconsenting persons in sexual acts. The victim of an obscene phone call is a nonconsenting person and may be harmed by the caller's behaviors. 1. Fetishism. A fetish is a sexual fantasy, urge, or behavior involving an inanimate object or nonsexual part of the body to increase sexual arousal. It does not necessarily involve another person, and rarely involves coercion. 2. Cross-dressing. Cross-dressing involves dressing in the clothing of the opposite sex. It is not a paraphilia. 3. Gender dysphoria. Gender dysphoria is persistent feelings of discomfort with one's assigned sex. It is not a paraphilia.

Which of the following objective data would the nurse expect to find in the client with anorexia nervosa?

Osteoporosis. Clients with anorexia have low estrogen levels and are a high risk for developing osteopenia and osteoporosis. This is an objective finding.

Which of the following statements made by the daughter of a client with schizophrenia reflects an understanding of the genetic theory of schizophrenia?

People with schizophrenia inherit a genetic predisposition to the disease rather than the disease itself."

A client believes someone is coming into the house and stealing all the jewelry. Which type of schizophrenia is often associated with delusional thinking?

Persecutory delusions present in the client with paranoid schizophrenia

Your client has been diagnosed with a personality disorder. The care plan includes the intervention: "Encourage client to direct all requests to assigned staff." Which of the following statements provides a rationale? (Select all that apply.)

Predictability may increase the client's sense of trust and security. Consistency minimizes the opportunity for the client to split staff. Staff members are more likely to detect subtle changes in the client's behavior.

Which variables influence suicide? (Select all that apply.)

Presence of psychiatric illness. Over 90% of people who commit suicide have a psychiatric illness. 2. Receiving psychiatric-mental health care. Over 50% of people who commit suicide are under active psychiatric-mental health care. 3. History of self-injurious behavior. Of those individuals reporting self-injurious behavior, 40.3% also reported suicidal ideation. 5. Use of alcohol. Alcohol consumption is estimated to cause adolescent males to be up to 17 times more likely to attempt suicide, and females 3 times more likely. This factor may be the single greatest predictive factor for suicidal behavior.

During which point in a crisis should the nurse anticipate providing survivors with the most intense nurturing?

Recoil. Survivors become more dependent during the recoil stage, and the nurse should anticipate caring for survivors and identifying additional resources for emergency shelter, food, and clothing.

Increased suicidal behavior is associated with which of the following? (Select all that apply.)

Reduced serotonin activity in the frontal cortex. This part of the brain is thought to be associated with controlling impulsive behavior. 2. Dichotomous thinking. Suicidal individuals often believe that there is an either/or choice rather than a range of options. 3. Increased availability of serotonin. Serotonin hypofunction is associated with suicide and serious suicide attempts. Dysfunction of the hypothalamic-pituitary-adrenocorticoid axis. Some researchers report that dysfunction of the hypothalamic-pituitary-adrenocorticoid axis is associated with suicidal behavior.

Physical Manifestation of Anorexia Nervosa

Reduction in the following: - Heart rate - Blood pressure - Metabolic rate - Production of estrogen or testosterone

On your inpatient unit, a client reports increased suicidal thoughts with voices in his head screaming, "Do it! Do it! Do it!" Which action should the nurse take to provide for the client's safety?

Remain with the client.

Which of the following interventions by the nurse would not be appropriate when addressing scapegoating behaviors on a mental health unit?

Rescue the client who is being scapegoated from the group. Attempting to rescue the client being scapegoated will exacerbate the other clients' behaviors and increase their anger and frustration. This intervention would have a negative impact on the behavior.

What is the priority nursing diagnosis for the client experiencing neuroleptic malignant syndrome?

Risk for Aspiration. The client will have an altered level of consciousness, increased salivation, and difficulty swallowing. Maintaining the client's airway is the priority intervention.

An appropriate nursing intervention for a client who is verbally aggressive toward staff and other clients would include

Role-modeling socially acceptable behaviors.

Which of the following characteristics of the nurse will interfere with the therapeutic nurse client relationship?

Self awareness is a prerequisite for engaging in therapeutic interpersonal communication. With decreased self awareness the nurse will not be cognizant of his/her nonverbal communication.

A client with major depression with suicidal ideations and psychomotor retardation has been taking antidepressants for 2 weeks. What is the priority nursing assessment for this client?

Suicidality

Which of the following is needed for the psychiatric-mental health nurse generalist to work effectively with clients who are experiencing sexual problems?

The ability to explore personal values and attitudes related to sexual health. The nurse needs to be aware of personal values and attitudes related to sexual health and how this affects treatment. The nurse must be able to separate these values from those of the client.

According to behavior theory, gender dysphoria results from:

The child being rewarded for adopting behaviors of the other sex. Behaviorists believe gender dysphoria is a result of social learning. Rewarding the child for adopting behaviors of the other sex reinforces the behavior, although the child's natural responses are repressed. At some point the discomfort with the behavior that has been reinforced overwhelms the individual.

Which of the following nursing diagnoses would specifically relate to the client with delusions of grandeur?

The client with delusions of grandeur is experiencing impaired thought processes; therefore, the specific diagnosis is disturbed thought processes.

The nurse is completing a family history on a client with schizophrenia. The client has an identical twin, adopted by another family, who is "normal." This finding lends support to which of the following biopsychosocial theories of schizophrenia?

The data provided lends support to the influence of ENVIRONMENT on the incidence of schizophrenia.

A nurse wants to start an outpatient self-help support group for clients with chronic mental illness. Which of the following initial goals is most realistic?

The group will meet weekly to discuss any current concerns of interest to the group members.

The nurse is completing a family mental health assessment. Which of the following data would not be included in this assessment?

The individual food preferences of each family member. Food preferences of each family are not critical to this assessment, as people's food preferences change throughout the life cycle.

Which job would the nurse recommend to a client with paranoid schizophrenia?

The most suitable job would be working as a sorter in a packing department as repetitive skills and minimal decision making are involved.

Self-awareness is essential in caring for the survivors of rape or violence. Possible outcomes from an absence of self-awareness include which of the following? (Select all that apply.)

The perpetrator's safety may be jeopardized. The nurse may assume the perpetrator was a stranger. The nurse may "normalize" behavior the client perceives as violent. The client may feel obligated to defend the perpetrator.

According to the family systems theory, family behavior characteristics associated with anorexia include (select all that apply):

Unclear boundaries between family members. Family members' preoccupation with food and eating.

Your client is a 55-year-old white, non-Hispanic male who was just forced to retire. Within the past month, his social drinking has increased from one drink per week to one six-pack of beer per day. Ten years ago, he attempted suicide with opiates and alcohol after his wife died from cancer and the associated debt resulted in bankruptcy. He is unable to share suicidal ideation in his church community because "we worship the sanctity of life" and "the people there would not understand; they would shun me." He admits to having opiates in his possession. Based on the Lethality Assessment Scale, your client is best described as:

Very high risk of imminent suicide. The client is in a high-risk demographic group (55 years old, white, non-Hispanic widowed and male). He has a history of a suicide attempt using a mixture of alcohol and opiates, a highly lethal means. In addition, he is cut off from resources and has just experienced forced retirement, a serious loss. This client is best characterized as being at very high risk of imminent suicide.

The nurse plans to provide client education about the side effects of antipsychotic medications to a client with delusions and psychosis. When should the nurse provide the client with the educational material?

When the client is stabilized and psychotic symptoms are manageable

Which of the following client statements best reflects the client's recognition of the nature of crisis?

Within 6 weeks, for better or worse, we will be past this place."

Your peer in the emergency department expresses frustration at the incidence of domestic violence in modern society and her inability to have an impact upon it. You respond, "I act to decrease the incidence of domestic violence with activities every day." Your activities include which of the following? (Select all that apply.)

You confront sexual harassment among pre-adolescents and adolescents. You role-model self-respect in the workplace. Your community association assists new residents to develop social support networks. During your assessment, you inquire about parenting challenges and interventions.

Bulimia Nervosa

•Cyclical condition •Episodes of binge-eating and purging •Skipping meals sporadically •Strict dieting or fasting

Other Neurotransmitters Affect Eating Disorders

•Increase eating behavior: - Norepinephrine - Neuropeptide Y •Suppresses food intake: -Dopamine