Unit 4 Day 1 - Mood/Affect; Coping; Sexuality
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." How should the nurse respond to this statement? "That is a good observation. Depression does mostly strike people older than 50 years." "Depression is seen in people of all ages, from childhood to old age." "Depression is most often seen among the middle adult age group." "The age of onset for most depressive episodes is given as 18 years."
"Depression is seen in people of all ages, from childhood to old age."
A 38-year-old patient is admitted with major depression. Which statement made by the patient alerts the nurse to a common accompaniment to depression? "I still pray and read my Bible every day." "My mother wants to move in with me, but I want to independent." "I still feel bad about my sister dying of cancer. I should have done more for her!" "I've heard others say that depression is a sign of weakness."
"I still feel bad about my sister dying of cancer. I should have done more for her!"
A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." What response should the nurse provide to address the client's comment? "I will be continuing to follow the care plan for the patient." "I see you are trying to control that patient's therapy as well as your own." "Your eye for perfection extends even to my nursing interventions." "That patient's care is really of no concern to you or to other clients."
"I will be continuing to follow the care plan for the patient."
A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." "I will not take any over-the-counter medication while on the fluoxetine." "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." "I will report increased thirst and urination to my provider."
"I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away."
Which statement would best show acceptance of a depressed, mute client? "I will be spending time with you each day to try to improve your mood." "I would like to sit with you for 15 minutes now and again this afternoon." "Each day we will spend time together to talk about things that are bothering you." "It is important for you to share your thoughts with someone who can help you evaluate your thinking."
"I would like to sit with you for 15 minutes now and again this afternoon."
A 24-year-old patient diagnosed with borderline personality disorder (BPD) is admitted to the inpatient psychiatric unit following a suicide attempt. Which client statements illustrate a primary coping style of persons with BPD? "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." "I will never again speak to any of my messed up family members. I know that this will help me to be more functional." "I promise I am not feeling suicidal. I won't hurt myself."
"Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here."
Which room placement would be best for a client experiencing a manic episode? A shared room with a client with dementia A single room near the unit activities area A single room near the nurses' station A shared room away from the unit entrance
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. None of the other options provide low stimulation.
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 address this cognitive distortion with which response? "Let's look at what you just said, that you can 'never do anything right.'" "Tell me what things you think you are not able to do correctly." "Is this part of the reason you think no one likes you?" "That is the most unrealistic thing I have ever heard."
"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. None of the other options examines the underlying cause of the feeling
Which statement, made by a client diagnosed with dissociative identity disorder, demonstrates effective understanding in response to the question, "What exactly are the 'alters'? your provider told you about?" illustrates that the education you provided has been effective? "So, alters are based in mysticism and religiosity, such as demons." "So, alters are separate personalities with their own characteristics that take over during stress." "So, alters are never aware of each other." "So, alters are just like me, but they have no memory of the trauma I went through."
"So, alters are separate personalities with their own characteristics that take over during stress."
When discussing the symptoms of post-traumatic stress disorder (PTSD), the nurse should make which statement? "The symptoms can occur almost immediately or can take years to manifest." "PTSD causes agitation and hypervigilance but rarely chronic depression." "When experiencing a flashback, the client generally experiences a slowing of responses." "PTSD is an emotional response that does not cause significant changes in brain chemistry."
"The symptoms can occur almost immediately or can take years to manifest."
Which statement depicts expected social development in children? "a ten year old is a boaster" "a nine year old spends a lot of time alone" "an eight year old child begins to get interested in opposite sex relationships" "a six year old plays mostly with groups of the same sex but beginning to play with the opposite sex"
"an eight year old child begins to get interested in opposite sex relationships"
What is a desired outcome for the maintenance phase of treatment for a manic client? Exhibit optimistic, energetic, playful behavior. Adhere to follow-up medical appointments. Take medication more than 50% of the time. Use alcohol to moderate occasional mood "highs."
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. None of the other options are accurate.
What info would the nurse obtain in a health history for a sexually active sixteen year old to determine clients STI risk? SATA sexual practices barrier protection use gender of sexual partners number of sexual partners use of illicit drugs before sex
All
Which points will be part of the nurse preceptor's lecture on caring for LGBTQ+ older adult population? SATA 1. this group should be forced to answer all questions 2. May have sexual organs that conflict with gender ID 3. Are at an elevated risk for disability from chronic disease and mental distress 4. older adult clients are commonly heterosexual 5. may hide gender identity or sexual orientation
2,3,5
A client diagnosed with bipolar disorder has a nursing care plan that includes several nursing diagnoses listed. Match the nursing diagnosis to the level of priority (1 to 4). 1. Self-care deficit, bathing, and hygiene 2. Knowledge, deficient 3. Nonadherence 4. Risk for injury
4, 1, 2, 3
acceptable lithium blood serum
0.6 - 1.2 (toxic affects over 1.5)
Which child is at greatest risk for developing attachment problems as a result of a neurobiological development? A 13-year-old male A 10-year-old female A 7-year-old male A 4-year-old female
A 4-year-old female
What symptom can the nurse expect a client diagnosed with depersonalization disorder to manifest? Aimless wandering with confusion and disorientation A feeling of detachment from one's body or mental processes Existence of two or more personalities that take control of behavior Worry about having a serious disease based on symptom misinterpretation
A feeling of detachment from one's body or mental processes Depersonalization is characterized by a sense of unreality or self-estrangement. None of the other options present an expected characteristic of depersonalization disorder
Which attribute is a characteristic of equitable care? SATA 1. Strives to serve the underserved 2. Does not vary in quality among groups 3. Promotes timely care delivery 4. Responsive to individual client preferences 5. Delivered in a system that allows for exemptions
1, 2, 5
Which statement is true of pharmacological therapies associated with the treatment of personality disorders? Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.
Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident.
A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact? Amitriptyline is very expensive, so the patient may have to buy fewer at a time. The goal is to see how the client responds to the first week of medication to evaluate its effectiveness. The health care provider wants to see whether any side effects occur within the first week of administration. Amitriptyline is lethal in overdose.
Amitriptyline is lethal in overdose.
Which statement about structural dissociation of the personality is true? An organic basis exists for this type of disorder. Nurses perceive clients with this disorder as easy to care for. No known link exists between this disorder and early childhood loss or trauma. This disorder results in a split in the personality causing a lack of integration.
An organic basis exists for this type of disorder.
A client arrested for an assault in which he savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of which disorder? Antisocial personality disorder Borderline personality disorder Schizotypal personality disorder Narcissistic personality disorder
Antisocial personality disorder
The nurse is performing an assessment of a female client's reproductive system. Which action is appropriate? Maintain friendly demeanor Ask about sexual practices at the beginning of assessment Ask about menstrual history at the beginning of assessment Maintain gender-specific terms when referring to sexual partner(s)
Ask about menstrual history at the beginning of assessment
What is the priority nursing intervention for a client diagnosed with borderline personality disorder? Protect other clients from manipulation. Respect the client's need for attention. Assess for suicidal and self-mutilating behaviors. Provide clear, consistent limits and boundaries.
Assess for suicidal and self-mutilating behaviors.
Dysthymia cannot be diagnosed unless it has existed for what period of time? At least 3 months At least 6 months At least 1 year At least 2 years
At least 2 years Dysthymia is a chronic condition that by definition has to have existed for longer than 2 years. None of the other options present a sufficient time period.
The client, diagnosed with which personality disorder, will most likely require admission to a psychiatric unit? Paranoid personality disorder Narcissistic personality disorder Borderline personality disorder Dependent personality disorder
Borderline personality disorder
A child who was physically and sexually abused is at great risk for demonstrating which characteristic? Depression Suicide attempts Bullying and abusing others Becoming active in a gang
Bullying and abusing others
The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that includes with characteristics? Dark colored and modest Colorful and outlandish Compulsively neat and clean Ill-fitted and ragged
Colorful and outlandish Manic clients often manage to dress and apply makeup in ways that create a colorful, even bizarre, appearance. None of the remaining options meet that criteria.
The nurse feels uncomfortable talking with a young male client about his sexual problem. Which action should the nurse take? Ask another nurse to take over the interview so you don't project your feelings onto the patient. Pause the interview and take time to gather your thoughts and do positive self-talk. Continue the interview using an appropriate professional tone and matter-of-fact approach. Ask Lance whether he would feel more comfortable speaking with a physician about his problem.
Continue the interview using an appropriate professional tone and matter-of-fact approach.
Which side effects of lithium can be expected at therapeutic levels? Fine hand tremor and polyuria Nausea and thirst Coarse hand tremor and gastrointestinal upset Ataxia and hypotension
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.
Which of the following symptoms would lead a provider to suspect that a client is experiencing PTSD? Select all that apply. Visiting the scene of the accident over and over Talking with strangers about the events of the accident Flashbacks of the accident Hypervigilance Irritability Difficulty concentrating Mania
Flashbacks of the accident Hypervigilance Irritability Mania
Which statement concerning syndromes seen in other cultures but not seen in our own, such as piblokto, Navajo frenzy witchcraft, and amok should be considered true? Dissociative disorders such as dissociative identify disorders Physical disorders, not mental disorders Culture-bound syndromes that are not dissociative disorders Myths, or rumors, because they have not been sufficiently studied to be classified as real.
Culture-bound syndromes that are not dissociative disorders
What term is used to identify the condition demonstrated by a person who has numerous hypomanic and dysthymic episodes over a two-year period? Bipolar II disorder. Bipolar I disorder. Cyclothymia. Seasonal affective disorder.
Cyclothymia. Cyclothymia refers to mood swings involving hypomania and dysthymia of 2 years duration. The mood swings are not severe enough to prompt hospitalization. None of the other options meet that criteria.R
A client hospitalized for a psychotic relapse is being discharged home to family. Which topic is important to address when teaching both the patient and the family to recognize possible signs of impending mania? Increased appetite Decreased social interaction Increased attention to bodily functions Decreased sleep
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
What statement about the comorbidity of depression is accurate? Depression most often exists in an individual as a single entity. Depression is commonly seen in individuals with medical disorders. Substance abuse and depression are seldom seen as comorbid disorders. Depression may coexist with other disorders but is rarely seen with schizophrenia.
Depression is commonly seen in individuals with medical disorders.
The preschool age client is learning sociocultural mores. Which developmental milestone would the nurse suspect? Developing a conscience Learning about gender roles Developing sense of security Learning about politices
Developing a conscience
A client has been diagnosed with gender identity disorder. The nurse can expect that the client will evidence which characteristic? Intense sexual urges focused on an object Discomfort with biological gender Self-humiliation during the sexual act Inability to maintain sexual arousal
Discomfort with biological gender
What information should the nurse give to the family of a client who has had a dissociative episode? Dissociation is a method for coping with severe stress. Dissociation suggests the possibility of early dementia. Brief periods of psychotic behavior may occur. Ways to intervene to prevent self-mutilation and suicide attempts.
Dissociation is a method for coping with severe stress.
Which of the following statements about dissociative disorders is true? Dissociative symptoms are under the person's conscious control. Dissociative symptoms are not under the person's conscious control. Dissociative symptoms are usually a cry for attention. Dissociative symptoms are always negative.
Dissociative symptoms are not under the person's conscious control.
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." What is the best initial approach to managing this behavior? Reprimand the client by stating, "What an offensive thing to suggest!" Clarifying the nurse-client relationship by stating, "I don't have sex with clients." Distracting the client by suggesting, "It's time to work on your art project." Enforcing consequences by responding, "Let's walk down to the seclusion room."
Distracting the client by suggesting, "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. This intervention is both therapeutic and less restrictive.
What is the initial task of an outpatient clinic nurse who is working with a client experiencing a sexual disorder? Establish trust with the client Assess the client's physical health Explain that the nurse is a therapeutic agent Orient the client to the clinic's programs, use as part of therapy
Establish trust with the client
Which of the following describe the symptoms of the manic phase of bipolar disorder? Select all that apply. Excessive energy Fatigue and increased sleep Low self-esteem Pressured speech Purposeless movement Racing thoughts Withdrawal from environment Distractibility
Excessive energy Pressured speech Purposeless movement Racing thoughts Distractibility
A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. The nurse should provide the client with what information regarding this practice? Agreeing that this will help the client to remember the medications. Caution the client to drink several glasses of water daily. Suggest that the client also use a sun lamp daily. Explain the high possibility of an adverse reaction.
Explain the high possibility of an adverse reaction.
Which behavior would be characteristic of a client during a manic episode? Going rapidly from one activity to another Taking frequent rest periods and naps during the day Being unwilling to leave home to see other people Watching others intently and talking little
Going rapidly from one activity to another Hyperactivity and distractibility are basic to manic episodes. None of the other options demonstrate such characteristics
What characteristic behaviors will the nurse assess in the narcissistic client? Dramatic expression of emotion, being easily led Perfectionism and preoccupation with detail Grandiose, exploitive, and rage-filled behavior Angry, highly suspicious, aloof, withdrawn behavior
Grandiose, exploitive, and rage-filled behavior
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." What term should the nurse use to identify this behavior? Flight of ideas Distractibility Limit testing Grandiosity
Grandiosity Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity. None of the other options are associated with this behavior.
A 31-year-old patient admitted with acute mania tells the staff and the other patients that he is on a secret mission for the President of the United States. He states, "I am the only one he trusts, because I am the best!" What term will the nurse use when documenting this behavior? Unpredictability Rapid cycling Grandiosity Flight of ideas
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
The symptoms of an adjustment disorder can include characteristics? Select all that apply. Guilt Social withdrawal Overachieving Anger Depression
Guilt Social withdrawal Anger Depression
Which behavior best supports the diagnosis of posttraumatic stress disorder (PTSD) in a 4-year-old child? Overeating Hypervigilance A drive to be perfect Passivity
Hypervigilance
Clients demonstrating characteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. Which nursing diagnosis best addresses this sort of interpersonal dysfunction? Spiritual distress Defensive coping Impaired social interaction Disturbed sensory perception
Impaired social interaction
A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit which behaviors? Frequent episodes of psychosis Constant involvement with the needs of significant others Inflexible and maladaptive responses to stress Abnormal ego functioning
Inflexible and maladaptive responses to stress
A client born as a male with the dx of gender dysphoria has been dressing and functioning as a woman for two years and has decided to have sex-reassignment surgery. Prioritize interventions: Accepting the client's decision to have surgery treating the client with respect Exploring ways in which the decision can be shared with significant others Encouraging client to explore her feelings Investigate one's own feelings about sexuality
Investigate one's own feelings about sexuality treating the client with respect Encouraging client to explore her feelings Accepting the client's decision to have surgery Exploring ways in which the decision can be shared with significant others
Patients diagnosed with BPD exhibit negative effect, which includes rapidly moving from one emotional extreme to another. What term is used to describe this characteristic? Lability Impulsivity Splitting Denial
Lability
A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response? Self-blame Catatonia Learned helplessness Discounting positive attributes
Learned helplessness
Empathic listening is therapeutic because it focuses on action? Enhancing self-esteem Lessening feelings of isolation Reducing anxiety Encouraging resilience
Lessening feelings of isolation
What is the first-line drug used to treat mania? Lithium carbonate Carbamazepine Lamotrigine Clonazepam
Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder. The other options are prescribed to manage other related symptoms of bipolar disorder.
SGAs that treat bipolar depression (2)
Lurasidone (latuda) and quetiapine (Seroquel)
When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with which of the client's classic characteristics? Mood shifts, impulsivity, and splitting Grief, anger, and social isolation Altered sensory perceptions and suspicion Perfectionism and preoccupation with detail
Mood shifts, impulsivity, and splitting
Beck's cognitive theory suggests that the etiology of depression is related to what factor? Sleep abnormalities Serotonin circuit dysfunction Negative processing of information S belief that one has no control over outcomes
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.
When the clinician mentions that a client has anhedonia, the nurse can expect that the client will demonstrate what behavior? Poor retention of recent events A weight loss from anorexia No pleasure from previously enjoyed activities Difficulty with tasks requiring fine motor skills
No pleasure from previously enjoyed activities
SGAs used to treat acute mania and mood stabilization (2)
Olanzapine (Zyprexa) or risperidone (Risperdal)
Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? Onset of action is from 1 to 3 weeks or longer. They tend to be more effective for men. Recent memory impairment is commonly observed. They often cause the client to have diurnal variation.
Onset of action is from 1 to 3 weeks or longer.
A 4 years old is referred to the outpatient mental health clinic after being in a severe car accident during which the child mother died. The father states that the child is withdrawn, not sleeping, having nightmares, and acts out the car accident over and over again when playing. The child states, "It's my fault because I'm bad." What trauma induced disorder does this data support? Adjustment disorder Dissociative identity disorder Posttraumatic stress disorder (PTSD) Acute stress disorder (ASD)
Posttraumatic stress disorder (PTSD)
What is the most beneficial nursing intervention directed toward minimizing the discomfort associated with conducting a sexually focused assessment? Assure the client that the responses will be kept confidential. Provide the client with a rationale for asking the questions. Begin with the most relevant, non-personal question. Project a relaxed, causal demeanor when questioning the client.
Provide the client with a rationale for asking the questions. Letting the client know why the questions are being asked increases openness and cooperation
A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with which term? Senile dementia Hypertensive crisis Psychomotor agitation Central serotonin syndrome
Psychomotor agitation
When a client experiences four or more mood episodes in a 12-month period, which term is used to describe this behavior? Dyssynchronous Incongruent Cyclothymic Rapid cycling
Rapid cycling Rapid cycling implies four or more mood episodes in a 12-month period, as well as more severe symptomatology. None of the other options are associated with this characteristic behavior
A child who is able to regain mental stability after a traumatic event is said to be demonstrating what trait? Autonomy Resilience Maturity Independence
Resilience
A newly admitted client has a diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be directed toward which classic client need? Set firm limits on behavior. Respect need for social isolation. Encourage expression of feelings. Involve in milieu and group activities.
Respect need for social isolation.
What is the priority nursing diagnosis for a hyperactive manic client during the acute phase of treatment? Risk for injury Ineffective role performance Risk for other-directed violence Impaired verbal communication
Risk for injury Risk for injury is high, related to the client's hyperactivity and poor judgment. Safety is always the priority when considering client care.
A client, prescribed which class of antidepressantive medication should be monitored for the development of premature ejaculation? Monoamine oxidase (MAO) inhibitors Tricyclic antidepressants Atypical antipsychotics selective serotonin reuptake inhibitor (SSRI) antidepressants
SSRIs
Splitting is a process in which the client demonstrates what behavior? Unconsciously represses undesirable aspects of self Places responsibility for his or her behavior outside the self Sees things as divided into "all good" or "all bad" Evidences lack of personal boundaries
Sees things as divided into "all good" or "all bad"
Assessment of the thought processes of a client diagnosed with depression is most likely to reveal what characteristic? Good memory and concentration Delusions of persecution Self-deprecatory ideation Sexual preoccupation
Self-deprecatory ideation Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world. This characteristic is not associated with any of the other options
hich statement provides accurate information regarding transvestic disorder? Most people with this disorder are homosexual. Only men are diagnosed with transvestic disorder. Sexual orientation has no bearing on transvestic disorder. Transvestic behavior develops in middle adulthood.
Sexual orientation has no bearing on transvestic disorder.
Playing one staff member against another is an example of what defense mechanism? Devaluation Splitting Impulsiveness Social ineptitude
Splitting
What is the major reason for the hospitalization of a depressed patient? Inability to go to work Suicidal ideation Loss of appetite Psychomotor agitation
Suicidal ideation
Which of the following is true of the relationship between bipolar disorder and suicide? Patients need to be monitored only in the depressed phase because this is when suicides occur. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. Patients with bipolar disorder are not considered high risk for suicide. As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.
Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. Mortality rates for bipolar disorder are severe because substantial numbers of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime. 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
A client diagnosed with post-traumatic stress disorder (PTSD) shows little symptom improvement after being prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse expects that which medication will be prescribed next? Beta blocker Barbiturate Tricyclic antidepressant (TCA) Sedative
TCA
When a client reports that lithium causes an upset stomach, the nurse should make which suggestion associated with taking the medication? With meals With an antacid 30 minutes before meals 2 hours after meals
With meals Many clients find that taking lithium with or shortly after meals minimizes gastric distress. None of the other options present accurate information.
When the nurse asks whether a client is having any thoughts of suicide, the client 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!" The nurse's response is based on what fact concerning hostility? The client is getting better and is able to be assertive. The client may be at high risk for self-harm. The client is probably experiencing transference. The client may be angry at someone else and projecting that anger to staff.
The client may be at high risk for self-harm.
Dissociative identity disorder is characterized by what event? The inability to recall important information Sudden, unexpected travel away from home and inability to remember the past The existence of two or more subpersonalities, each with its own patterns of thinking Recurring feelings of detachment from one's body or mental processes
The existence of two or more subpersonalities, each with its own patterns of thinking
Parents express concern when their 5-year-old child, who is receiving treatment for cancer, keeps referring to an imaginary friend, Candy. Which response should the nurse provide to best address the parent's concerns? Children of this age usually have imaginary friends. It is nothing to worry about unless the child starts to socially isolate. The child needs more of their one-on-one attention. The imaginary friend is a coping mechanism the child is using.
The imaginary friend is a coping mechanism the child is using.
When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on which information? No research exists to suggest genetic transmission. Much depends on the socioeconomic class of the individuals. Highly creative people tend toward development of the disorder. The rate of bipolar disorder is higher in relatives of people with bipolar disorder.
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
Which statement is descriptive of clients with a personality disorder? They are resistant to behavioral change. They have an ability to tolerate frustration and pain. They usually seek help to change maladaptive behaviors. They have little difficulty with cognitive functioning.
They are resistant to behavioral change.
A client explains that he is heterosexual but prefers to dress in feminine clothing. This characteristic behavior is suggestive of which sexual disorder? Fetishism Exhibitionism Voyeurism Transvestism
Transvestism
Anticonvulsants used to treat bipolar
Valproate (Depakote) Carbamazepine (Tegretol) Lamotrigine (Lamictal)
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 implement which intervention? Waiting quietly for the client to reply Prompting the client if the reply is slow Repeating the question if the client does not answer promptly Reviewing the client's medical record to support the client's response
Waiting quietly for the client to reply
What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? Withhold medication and notify the physician. Continue to administer medication as ordered. Advise the client to limit fluids for 12 hours. Advise the client to curtail salt intake for 24 hours.
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. None of the other options are accurate interventions.
An acute phase nursing intervention aimed at reducing hyperactivity is demonstrated by which intervention? Writing in a diary Exercising in the gym Directing unit activities Orienting a new client to the unit
Writing 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. None of the remaining options presents this opportunity to reduce physical activity
Which action of the nursing student regarding TJC recommendations for creating a safe and welcoming environment for lesbian, gay, bi, trans, and queer clients needs revision?
arranging exclusive waiting rooms for LGBTQ+ clients and their families
Which topic would the school nurse include in a sexual-education presentation for 10 year olds? SATA erections contraception menstrual cycle time for questions separate gender sessions STIs
erections contraception menstrual cycle time for questions separate gender sessions STIs
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 avocado salad plate fruit and cottage cheese plate kielbasa and sauerkraut liver and onion sandwich.
fruit and cottage cheese plate tyramine
At which stage of development would the nurse anticipate pedi clients will begin to show differences in play activities related to gender? pre-k adolescence late-school age early school age
late school age
Which guideline is useful for reducing disparity when caring for transgender clients? Learning about healthcare needs of homosexual clients always referring to transgender clients using pronouns of the sex to which they transition always referring to transgender clients using pronouns of the sex of which they were born learning about the treatment options for transgender clients and requirements of follow up care
learning about the treatment options for transgender clients and requirements of follow up care
first line mood stablilizer
lithium
first line drug for manic agitation (2)`
lithium or valproate (depakote)
When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to... question the client's motive set verbal limits. initiate physical confrontation. prepare the client for seclusion.
set verbal limits. Verbal limit setting should always precede more restrictive measures. Questioning motives does not address the safety issue that exists.
Hormone therapy for the purpose of surgical gender reassignment is initiated when the client has successfully demonstrated a genuine intent to change genders. taken on the dress and manners of the preferred gender. successfully lived the crossgender role in all aspects of life. taken all legal steps to change name and legal status.
successfully lived the crossgender role in all aspects of life.
In lithium treatment, these two levels should be checked annually
thyroid and renal
Which minor attribute affects the quality of care for the client by the nurse? SATA timely care equitable care cost effective care patient centered care sound decision making
timely, equitable, patient centered
Which strategy would the nurse adopt while performing the health assessment of an adolescent? SATA treating them as adults addressing them as mr or ms maintaining confidentiality performing exam in nonthreatening environment gathering all the history from the parent
treating them as adults maintaining confidentiality performing exam in nonthreatening environment
