Combo with "Ch 30: Family and Community Violence" and 1 other

A client diagnosed with bipolar I disorder is experiencing auditory hallucinations and flight of ideas. Which medication combination would the nurse expect to be prescribed to treat these symptoms?

(Risperdal) and (Lamictal).

A client is suspected to be experiencing a conversion disorder. Which of the following would the nurse expect to assess? Select all that apply. 1. Deep tendon reflexes intact. 2. Muscle wasting. 3. The client is unaware of the link between anxiety and physical symptoms. 4. Physical symptoms are explained by a physiological cause. 5. A lack of concern toward the alteration in function.

1 3 5

An extremely suicidal client needs to be admitted to the locked psychiatric unit. There are no beds available. Which client would the nurse anticipate that the treatment team would discharge?

A client voluntarily committed 4 days ago with delerium owing to a urinary tract infection.

After his wife's death, 84-year old is paying less attention to his hygiene, due to no wife. His wife died two months ago Lacks energy:

Arrange for appointment for suspected depression.

A client diagnosed with MDD and experiencing suicidal ideation is showing signs of anxiety. Alprazolam (Xanax) is prescribed. Which assessment should be prioritized?

Ask the client to rate his/her mood on the mood scale, and monitor for suicidal ideations.

A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following is appropriate for the nurse to include in the plan of care? (Select all that apply.) A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard client complaints E. Use a firm approach with communication

BCE

A client diagnosed with bipolar I disorder in the manic phase is yelling at another peer in the milieu. Which nursing intervention takes priority?

Calmly redirect and remove the client from the milieu.

Randall is a 36 yo male admitted to the hospital for sx's of depression and passive suicidal thoughts

Set limits on interactions with this pt and discuss his case with fellow nurses

Which nursing diagnosis supports the psychoanalytic theory of development of major depressive disorder

Social isolation r/t self directed anger

A nurse working with a client diagnosed with bipolar I disorder attempts to recognize the motivation behind the client's use of grandiosity. Which is the rationale for this nurse's action?

Understanding the reason behind a behavior would assist the nurse to accept and relate to the client, not the behavior.

Which symptom related to communication is likely to be present in a patient experiencing mania?

Verbosity

You are caring for Connor, an 8 year old boy who had been diagnosed with reactive attachment disorder. Which of the following nursing outcomes would be the most appropriate to achieve?

Writes or draws feelings in a journal

A client with borderline personality disorder is admitted to the mental health unit after lacerating her wrist. Which goal is most important after establishing a safe environment a. establishes a therapeutic relation with the client b. questions the client as to why he lacerated his wrist c. talk about his acting-out and self-destructive tendencies.

a. establishes a therapeutic relation with the client

8. Nurse is aware that which symptoms are included as a part of the borderline personality disorder? a. unstable self-image b. impulsivity d. anger control issues e. strong sense of identity c. stable send of reality

a. unstable self-image b. impulsivity d. anger control issues

A nursing instructor is presenting statistics regarding suicide. Which student statement indicates that learning has occurred?

"Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder."

A nursing instructor is teaching about the cause of mood disorders. Which statement by a nursing student best indicates an understanding of the etiology of mood disorders

"Evidence continues to support multiple causations related to an individual's susceptibility to mood symptoms.

A client on an in-patient psychiatric unit has been prescribed tranycypromine (Parnate) 30mg QD. Which client statement indicates that discharge teaching has been successful?

"I have been craving a hamburger with lettuce and onion, potato chips and milk"

A client on an in-patient psychiatric unit is prescribed lamotrigine/Lamictal 50 mg QD. After client teaching, which client statement reflects understanding of the important information related to lamotrigine/Lamictal .

"I know the importance of reporting any alteration in my medication schedule"

A client diagnosed with major depressive disorder has an outcome that states, "The client will verbalize a measure of hope about future by day 3." Which client statement indicates this outcome was successful?

"I think I am going to talk to my boss about conflicts at work."

A patient who experience a myocardial infarction was transferred from critical care to step down unit. The patient then used the call bell every 15 mins for minor requests. Staff nurses reported feeling inadequate to satisfy needs. When the nurse manager intervenes directly with the patient, which comment is most therapeutic

"I'm wondering if you are feeling anxious about illness and being left alone"

A nurse is educating a patient about the causes of depression. Which statement lets the nurse know the patient understands the neurobiological theory of depression?

"If I take these medications as prescribed, I should start to think clearly and feel energized"

A client experiencing mania states, "Everything I do is great." Using a cognitive approach, which nursing response would be most appropriate

"Is there a time in your life when things didn't go as planned?"

The nurse provides health education for an adult experiencing sleep deprivation, which instruction has the highest priority

"It is important to limit your driving time to short. Sleep deprivation increases risks for serious accidents"

Jamie, age 24, had been diagnosed with a dissociative disorder following a traumatic event. Jamie's mother asks you, "Does this mean my daughter is crazy now?" Your best response would be:

"Jamie is dealing with the anxiety associated with the trauma by separating herself from it. With treatment she can get back to her previous level of functioning."

A nursing student is studying major depressive disorder. Which student statement indicates that learning has occurred?

"Major depression is a leading cause of disability in the United States."

A female patient tells the nurse that she would like to begin taking St. John's wort for depression. What teaching should the nurse provide?

"St. John's wort has generally been shown to be effective in treating depression"

A nursing instructor is teaching about the psychosocial theory related to the development of bipolar disorder. Which student statement would indicate that learning has occurred?

"The etiology of bipolar disorder is unclear, but it is possible that biological and psy- chosocial factors are influential."

Which of the following medications may be administered before electroconvulsive therapy? Select all that apply.

(Robinul). (Pentothal). (Anectine).

A client diagnosed with major depressive disorder is newly prescribed sertraline (Zoloft). Which of the following teaching points would the nurse review with the client? Select all that apply.

-Discuss the need to take medications, even when symptoms improve. -Instruct the client about the risks of abruptly stopping the medication. -Alert the client to the risks of dry mouth, sedation, nausea, and sexual side effects. -Remind the client that the medication's full effect does not occur for 4 to 6 weeks.

Which of the following nursing evaluations for a hospitalized client diagnosed with dissociative identity disorder would lead the treatment team to consider discharge? Select all that apply. 1. The client is able to recall events associated with a traumatic or stressful situation. 2. The client is able to communicate increased levels of anxiety before dissociation occurs. 3. The client is able to demonstrate more adaptive coping strategies to avert dissociative behaviors. 4. The client is able to verbalize the existence of multiple personalities and the purposes they serve. 5. The client demonstrates continued use of alternate personalities to deal with stressful situations.

1 2 3 4

A client diagnosed with antisocial personality disorder demands, at midnight, to speak to the ethics committee about the involuntary commitment process. Which nursing statement is appropriate? 1. "I realize you're upset; however, this is not the appropriate time to explore your concerns." 2. "Let me give you a sleeping pill to help put your mind at ease." 3. "It's midnight, and you are disturbing the other clients." 4. "I will document your concerns in your chart for the morning shift to discuss with the ethics committee."

1. "I realize you're upset; however, this is not the appropriate time to explore your concerns."

A client diagnosed with antisocial personality disorder is observed smoking in a nonsmoking area. Which initial nursing intervention is appropriate? 1. Confront the client about the behavior. 2. Tell the client's primary nurse about the situation. 3. Remind all clients of the no smoking policy in the community meeting. 4. Teach alternative coping mechanisms to assist with anxiety.

1. Confront the client about the behavior.

A newly admitted client is diagnosed with dissociative identity disorder. Which nursing intervention is a priority? 1. Establish an atmosphere of safety and security. 2. Identify relationships among subpersonalities and work with each equally. 3. Teach new coping skills to replace dissociative behaviors. 4. Process events associated with the origins of the disorder.

1. Establish an atmosphere of safety and security.

A client diagnosed with bipolar affective disorder is prescribed divalproex/Depekote. Which of the following lab tests would the nurse need to monitor throughout drug therapy? Select all that apply.

1. Platelet and bleeding time. 2. AST 3. ALT 4. Valproic acid level

A client diagnosed with a conversion disorder has a nursing diagnosis of disturbed sensory perception R/T anxiety AEB paralysis. Which short-term outcome would be appropriate for this client? 1. The client will demonstrate recovery of lost function by discharge. 2. The client will use one effective coping mechanism to decrease anxiety by day 3. 3. The client will express feelings of fear about paralysis by day 1. 4. The client will acknowledge underlying anxiety by day

1. The client will demonstrate recovery of lost function by discharge.

A client diagnosed with dissociative identity disorder attributed to childhood sexual abuse has an outcome that states, "The client will verbalize causative factors for the development of multiple personalities." Which charting entry would support a successful evaluation of this outcome? 1. "Able to state the particular function of each of the different personalities." 2. "Discussed history of childhood sexual abuse." 3. "Was able to be redirected to topic at hand during group therapy." 4. "Verbalizes understanding that treatment may be lengthy."

2. "Discussed history of childhood sexual abuse."

A nurse is discharging a client diagnosed with obsessive-compulsive personality disorder. Which employment opportunity is most likely to be recommended by the treatment team? 1. Home construction. 2. Air traffic controller. 3. Night watchman at the zoo. 4. Prison warden.

2. Air traffic controller.

A client diagnosed with an antisocial personality disorder is given a nursing diagnosis of self-esteem disturbance R/T extreme poverty AEB continual boasting and grandiosity. Which nursing intervention would be appropriate? 1. Offer to remain with the client during initial interactions with others on the unit. 2. Encourage self-awareness through critical examination of feelings and behaviors. 3. Recognize when the client is "splitting" staff by playing one staff member against another. 4. Allow the client to take on responsibility for his or her own self-care practices.

2. Encourage self-awareness through critical examination of feelings and behaviors.

A client with a long history of alcohol abuse is showing signs of cognitive deficits. What drug would the nurse recognize as appropriate in assisting with this client's alcohol recovery? 1. Disulfiram (Antabuse). 2. Naltrexone (ReVia). 3. Lorazepam (Ativan). 4. Methadone (Dolophine).

2. Naltrexone (ReVia).

Which assessment data support the diagnosis of obsessive-compulsive disorder? 1. The client's thoughts, impulses, or images are excessive worries about real-life problems. 2. The client is aware at some point during the course of the disorder that the obsessions or compulsions are excessive or unreasonable or both. 3. The obsessions or compulsions experienced significantly interfere with only one area of function. 4. The client represses thoughts, impulses, or images, and substitutes other thoughts or behaviors.

2. The client is aware at some point during the course of the disorder that the obsessions or compulsions are excessive or unreasonable or both.

A client prescribed lithium 300mg bid 3 months ago is brought to the Ed with mental confusion, excessive diluted urine output, and consistent tremors. Which lithium level would the nurse expect?

2.2. When the lithium level is between 2.0-3.5 the client may show signs of excessive urine output, increased tremors, muscular irritability, psycho motor retardation and mental confusion.

A client prescribed lithium carbonate (Eskalith) is experiencing an excessive output of dilute urine, tremors, and muscular irritability. These symptoms would lead the nurse to expect that the client's lithium serum level would be which of the following?

2.6 mEq/L.

Which client is at highest risk for the diagnosis of major depressive disorders?

24 year old woman

A client fearful of an upcoming deployment to Iraq develops a paralytic conversion disorder. Which nursing diagnosis takes priority? 1. Impaired skin integrity R/T muscle wasting. 2. Body image disturbance R/T immobility. 3. Anxiety R/T fears about a combat injury. 4. Activity intolerance R/T paralysis.

3. Anxiety R/T fears about a combat injury.

A client diagnosed with antisocial personality disorder states, "My kids are so busy at home and school they don't miss me or even know I'm gone." Which nursing diagnosis applies to this client? 1. Risk for injury. 2. Risk for violence: self-directed. 3. Ineffective denial. 4. Powerlessness.

3. Ineffective denial.

A client currently hospitalized for the third alcohol detoxification in 1 year believes relapses are partially due to an inability to control cravings. Which prescribed medication would meet this client's need? 1. Buspirone (BuSpar). 2. Disulfiram (Antabuse). 3. Naltrexone (ReVia). 4. Lorazepam (Ativan).

3. Naltrexone (ReVia).

A client prescribed Lithium 300mg QAM and 600mg QHS enters the ED experiencing impaired consciousness, nystagmus, and arrhythmia. Earlier today the client had 2 seizures. Which serum lithium level would the nurse expect to assess?

3.7. Levels over 3.5 show signs of impaired consiousness, nystagmus, seizures, arrhythmias, MI,cardiovascular collapse.

Which intervention is a nurse's priority when working with a client suspected of having a conversion disorder? 1. Avoid situations in which secondary gains may occur. 2. Confront the client with the fact that anxiety is the cause of physical symptoms. 3. Teach the client alternative coping skills to use during times of stress. 4. Monitor assessments, lab reports, and vital signs to rule out organic pathology.

4. Monitor assessments, lab reports, and vital signs to rule out organic pathology.

A client diagnosed with dissociative identity disorder has been hospitalized for 7 days. The client has a nursing diagnosis of ineffective coping R/T repressed severe anxiety. Which outcome would be appropriate? 1. The client will recover deficits in memory by day 14. 2. The client will verbalize awareness of multiple personalities and the reason for their existence by day 14. 3. The client will demonstrate the ability to perceive stimuli accurately. 4. The client will demonstrate one adaptive way to deal with stressful situations by day 14.

4. The client will demonstrate one adaptive way to deal with stressful situations by day 14.

Major depressive disorder would be most difficult to detect in which of the following clients?

A 13 year old boy.

A nurse working on an acute mental health unit is caring for a client who has posttraumatic stress disorder (PTSD). Which of the following is an expected finding? (Select all that apply.) A. Hallucinations B. Obsessive need to talk about the traumatic event C. Exaggerated displays of emotion D. Recurring nightmares E. Diminished reflexes

A D

Which is the key to understanding if a child or adolescent is experiencing an underlying depressive disorder?

A change in behavior over a 2 week period

A nurse is planning to teach about appropriate coping skills. The nurse would expect which client to be at the highest level of readiness to participate in this instruction?

A client admitted 6 days ago for suicidal ideations following a depressive episode.

What statement describes a major difference between a client dignosed with major depressive disorder and a client diagnosed with dysthymic disorder

A client diagnosed with dysthymic disorder has symptoms for at least 2 years

A nurse on an in-patient psychiatric unit receives report at 1500 hours. Which client would need to be assessed first?

A client pacing the hall and experiencing irritability and flight of ideas.

Which client would the charge nurse assign to an agency nurse working on the inpatient psychiatric unit for the first time?

A client rating mood as 3/10 and attending but not participating in group therapy.

A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "Care during the continuation phase focuses on treating continued manifestations of MDD." B. "The goal of treatment during the maintenance phase is prevention of future episodes of MDD." C. "The client is at greatest risk for suicide during the first weeks of an MDD episode." D. "Medication and psychotherapy are used to prevent a relapse of MDD."

A. "Care during the continuation phase focuses on treating continued manifestations of MDD."

A nurse is caring for a client who has acute stress disorder and is experiencing severe anxiety. Which of the following statements by the nurse is appropriate? A. "Tell me about how you are feeling right now." B. "You should focus on the positive things in your life to decrease your anxiety." C. "Why do you believe you are experiencing this anxiety?" D. "Let's discuss the medications your provider is prescribing to decrease your anxiety."

A. "Tell me about how you are feeling right now."

A nurse working in an acute mental health facility is caring for a 35-year-old female client who has clinical findings of depression. The client lives at home with her husband and two young children. She currently smokes and has a history of chronic asthma. The nurse should identify which of the following as risk factors for depression for this client? (Select all that apply.) A. Age of 35 years old B. Female gender C. History of chronic asthma D. Currently smokes E. Being married

A. Age of 35 years old B. Female gender C. History of chronic asthma D. Currently smokes

A nurse observes a client who is pacing and wringing his hands. The client states, "I don't know why, but I've worried every day for over a year that my son will die a horrible death." The nurse identifies that this finding is consistent with which of the following disorders? A. Generalized anxiety disorder B. Panic disorder C. Posttraumatic stress disorder D. Acute stress disorder

A. Generalized anxiety disorder

A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following is the highest priority action by the nurse? A. Placing the client on one-to-one observation B. Assisting the client to perform ADLs C. Encouraging the client to participate in counseling D. Teaching the client about medication adverse effects

A. Placing the client on one-to-one observation

In the development of a therapeutic relationship w/ a new admission w/ the Dx of post self-inflicted GSW to the head. Which of the following is a priority for the nurse? A. assess the feelings towards this client Therapeutic relationships includes feelings only of the Pt B. assess the client's level of suicidality This is done second C. assess the client's support systems D. assess the client's plan for suicide

A. assess the feelings towards this client

Which client is most at risk for development of PTSD? A. rescued client trapped under a collapsed roof of a building > the client actually experienced near death B. client who witnessed friend die next to him after explosion C. mother of a deceased victim in the explosion D. best friend of a victim who saw the explosion on TV

A. rescued client trapped under a collapsed roof of a building

A nurse is caring for an adult client who is the victim of intimate partner abuse. The client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority? A.Advise the client about the location of women's shelters. B.Encourage the client to participate in a support group for victims of abuse. C.Implement case management to coordinate community and social services. D.Educate the client about the use of stress management techniques.

A.CORRECT: The client's safety is the highest priority. Therefore, the development of a safety plan that includes the identification of safe places to live is the priority nursing action. B.INCORRECT: It is appropriate to encourage participation in a support group. However, this does not address the greatest risk to the client and is therefore, not the priority nursing action. C.INCORRECT: It is appropriate to implement case management. However, this does not address the greatest risk to the client and is therefore, not the priority nursing action. D.INCORRECT: It is appropriate to educate the client about the use of stress management techniques. However, this does not address the greatest risk to the client and is therefore, not the priority nursing action.

A client diagnosed with bipolar affective disorder is prescribed carbamazepine/Tegretol. The client exhibits nausea, vomiting and anorexia. Which is an appropriate nursing intervention at this time?

Administer next dose with food

The provision of optimal care for patients withdrawing from substances of abuse is facilitated by the nurse's understanding that severe morbidity and mortality are often associated with withdrawal from:

Alcohol and CNS depressants

A suicidal Jewish-American client is admitted to an in-patient psychiatric unit 2 days after the death of a parent. Which intervention must the nurse include in the care of this client?

Allow the client time to mourn the loss during this time of shiva.

Which symptoms would the nurse expect to assess in a client suspected to have serotonin syndrome?

Alterations in mental status, restlessness, tachycardia, labile blood pressure, and diaphoresis.

The nurse is reviewing orders given for a patient with depression. Which order should the nurse question?

An SSRI given initially with an MAOI

A client expresses frustration and hostility toward the nursing staff regarding the lack of care his or her recently deceased parent received. Which stage of grief is this?

Anger

Which symptom is an example of an affective alteration exhibited by clients diagnosed with severe depression?

Apathy

When interviewing with a patient who is intoxicated from alcohol, it is useful to first:

Ask what drugs other than alcohol the patient has recently used

A client seen in the emergency department is experiencing irritability, pressured speech, and increased levels of anxiety. Which would be the nurse's priority intervention?

Assess vital signs, and complete physical assessment.

The nurse is planning care for a patient with depression who will be discharged to home soon. What aspect of teaching should be priority on the nurse's discharge plan of care?

Awareness of symptoms that increase depression.

A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Use caffeine in moderation to prevent relapse. B. Difficulty sleeping can indicate a relapse. C. Begin taking your medications as soon as a relapse begins. D. Participating in psychotherapy can help prevent a relapse. E. Anhedonia is a clinical manifestation of a depressive relapse.

B D E

A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following is an expected finding? (Select all that apply.) A. Bradycardia B. Fine tremors of both hands C. Hypotension D. Vomiting E. Restlessness

B, D, E

A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following is an appropriate response by the nurse? A. "Why do you think you feel the need to give money away?" B. "I am here to provide care and cannot accept this from you." C. "I can request that your case manager discuss appropriate charity options with you." D. "You should know that giving away your money is inappropriate."

B. "I am here to provide care and cannot accept this from you."

A client is diagnosed w/ Major Depression. What is the most important part of the mental status exam to assess? A. judgment B. mood > "how are you feeling?" C. insight D. behavior

B. mood > "how are you feeling?"

A nurse is preparing a community education seminar about family violence. When discussing the types of violence, the nurse should include which of the following? A.Refusing to pay bills for a dependant, even when funds are available, is neglect. B.Intentionally causing an older adult to fall is an example of physical violence. C.Striking an intimate partner is an example of sexual violence. D.Failure to provide a stimulating environment for normal development is emotional abuse.

B.CORRECT: Physical violence occurs when physical pain or harm is directed toward another individual. A.INCORRECT: Refusing to pay bills for a dependant is economic maltreatment, rather than neglect. C.INCORRECT: Striking an intimate partner or other individual is an example of physical, rather than sexual, violence. Sexual violence occurs when sexual contact takes place without consent. D.INCORRECT: Failure to provide a stimulating environment for normal development is neglect, rather than emotional abuse.

A nurse is preparing to assess an infant who has shaken baby syndrome. Which of the following is an expected finding? (Select all that apply.) A.Sunken fontanelles B.Respiratory distress C.Retinal hemorrhage D.Altered level of consciousness E.An increase in head circumference

B.CORRECT: Respiratory distress is an expected finding of shaken baby syndrome. C.CORRECT: Retinal hemorrhage is an expected finding of shaken baby syndrome. D.CORRECT: An altered level of consciousness is an expected finding of shaken baby syndrome due to intracranial trauma or hemorrhage. E.CORRECT: An increase in head circumference is an expected finding of shaken baby syndrome. A.INCORRECT: Bulging, rather than sunken, fontanelles are an expected finding of shaken baby syndrome.

A nurse working in an emergency department is assessing a child who reports abdominal pain. When conducting a head-to-toe assessment, which of the following findings should alert the nurse to possible abuse? (Select all that apply.) A.Abrasions on knees B.Round burn marks on forearms C.Mismatched clothing D.Abdominal rebound tenderness E.Areas of ecchymosis on torso

B.CORRECT: Round burn marks anywhere on the child's body can indicate cigarette burns and should alert the nurse to possible abuse. CORRECT: Areas of ecchymosis on the torso, back, or buttocks should alert the nurse to possible abuse. A.INCORRECT: Minor injuries on the arms and legs, such as abrasions, are common in this age group. C.INCORRECT: Mismatched clothing is consistent with the child's developmental age. D.INCORRECT: Abdominal rebound tenderness is a possible indication of appendicitis rather than abuse.E.

A client is exhibiting behavioral symptoms of depression. Which charting entry would appropriately document these symptoms?

Became irritable and agitated on walking.

A client has been taking Lithium for 3 months. Which assessment would make the nurse request a lithium level?

Blurred vision and vomiting

A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? A. Chlordiazepoxide (Librium) B. Bupropion (Zyban) C. Disulfiram (Antuse) D. Carbamazepine (Tegretol)

C

A nurse is planning a staff education program on substance use in older adults. Which of the following is appropriate for the nurse to include in the presentation? A. Older adults require higher doses of a substance to achieve a desired effect. B. Older adults commonly use rationalization to cope with a substance use disorder. C. Older adults are at a higher risk for substance use following retirement. D. Older adults develop substance use to mask signs of dementia.

C

A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following is the priority nursing intervention? A. Orient the client frequently to time, place, and person. B. Offer fluids and nourishing diet as tolerated. C. Implement seizure precautions. D. Encourage participation in group therapy sessions.

C

A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicates a need for further teaching? A. "We need to understand that she is not responsible for her disorder." B. "Eliminating any codependent behavior will promote her recovery." C. "She should participate in an Al-Anon group to help her recover." D. "The primary goal of her treatment is abstinence from substance use."

C

A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is the recommended initial treatment for bipolar disorder." B. "ECT is contraindicated for clients who have suicidal ideation." C. "ECT is effective for clients who are experiencing severe mania." D. "ECT is prescribed to prevent relapse of bipolar disorder."

C. "ECT is effective for clients who are experiencing severe mania."

A nurse working in an outpatient clinic is providing teaching to a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with PMDD to be worst when I'm menstruating." B. "I will use light therapy 30 min a day to prevent further recurrences of PMDD." C. "I am aware that my PMDD causes me to have rapid mood swings." D. "I should increase my caloric intake with a nutritional supplement when my PMDD is active."

C. "I am aware that my PMDD causes me to have rapid mood swings."

A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following? A. Narcissistic behavior B. Fear of rejection from staff C. Attempt to reduce anxiety D. Adverse effect of antidepressant medication

C. Attempt to reduce anxiety

A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. When assessing this client, which of the following are expected findings? (Select all that apply.) A. Demonstrates extreme anxiety when placed in a social situation B. Has difficulty making even simple decisions C. Attempts to convince other clients to give him their belongings D. Becomes agitated if his personal area is not neat and orderly E. Blames others for his past and current problems

C. Attempts to convince other clients to give him their belongings E. Blames others for his past and current problems

A nurse is interviewing a 25-year-old client who has a new diagnosis of dysthymia. Which of the following findings should the nurse expect? A. There are wide fluctuations in mood. B. The report of a minimum of five clinical findings of depression. C. The presence of manifestations for at least 2 years. D. There is an inflated sense of self-esteem.

C. The presence of manifestations for at least 2 years.

A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates a need for further teaching? A."A criminal history increases the risk for violence between strangers." B."Substance use disorder increases the risk for violence." C."Entering an intimate relationship increases the risk for violence." D."Pregnancy increases the risk for violence toward the intimate partner."

C.CORRECT: This statement requires further teaching. Victims are at the greatest risk for violence when they try to leave the relationship. A.INCORRECT: This statement does not require further teaching. A past history of violence or criminal activity is a common risk factor for violence between strangers. B.INCORRECT: This statement does not require further teaching. Substance use disorder increases the risk for violence. D.INCORRECT: This statement does not require further teaching. Pregnancy tends to increase the likelihood of violence toward the intimate partner

For assessment purposes, the nurse should identify the body system most at risk for decompensation during a severe manic episode as:

Cardiac

A client newly admitted to an in-patient psychiatric unit who is experiencing a manic episode. The client's a nursing diagnosis is imbalanced nutrition, less than body requirements. Which meal is most appropriate for this client?

Chicken fingers and French fries.

What charting entry most accurately documents a clients mood?

Client rates mood 2 out of 10

Which situation would place a client at high risk for a life threatening hypertensive crisis?

Client who is prescribed isocarboxazid (Marplan) and drinks hot chocolate.

A nursing instructor is teaching about the criteria for the diagnosis of bipolar II disorder. Which student statement indicates that learning has occurred?

Clients diagnosed with bipolar II disorder experience recurrent bouts of depression with episodic occurrences of hypomania.

Ashley is a 21 year old college student who was sexually assaulted at a party. She was seen in the local emergency department and referred for counseling after being diagnosed by the provider on call as having acute stress disorder. Which of the following treatment modalities would you expect to see used in therapy with Ashley?

Cognitive-behavioral therapy

You are caring for Mick, a 32-year old patient with chemical addiction who will soon be preparing for discharge. A principle of counseling interventions that should be observed when caring for a patient with chemical addiction is to:

Communicate that relapse are always possible.

A client denying suicidal ideations comes into the emergency department complaining about insomnia, irritability, anorexia, and depressed mood. Which intervention would the nurse implement first?

Complete a thorough physical assessment including lab tests

A nurse in an acute mental health facility is caring for a client who is experiencing a mixed episode of bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior. B. Administer prescribed medications as scheduled. C. Provide the client with step-by-step instructions during hygiene activities. D. Monitor the client for escalating behavior.

D. Monitor the client for escalating behavior.

A nurse is caring for a client who is experiencing a panic attack. Which of the following is an appropriate nursing intervention? A. Discuss new relaxation techniques. B. Show the client how to change his behavior. C. Distract the client with a television show. D. Stay with the client, and remain quiet.

D. Stay with the client, and remain quiet.

The parent of an adolescent diagnosed w/ depression asks the nurse, "Why do you want to do a family assessment? My teenager is the patient, not the rest of us." Select the nurse's best response. A. family dysfunction might have caused the mental illness B. family members provide more accurate information than the patient C. family assessment is part of the protocol for care of all patients with mental illness D. every family member's perception of events is different and helps in planning how to improve functioning of the family

D. every family member's perception of events is different and helps in planning how to improve functioning of the family

A client notifies a staff member of current suicidal ideations. Which intervention by the nurse would take priority

Determine if the client has a specific plan to commit suicide.

A client diagnosed with major depressive disorder is being considered for electroconvulsive therapy (ECT). Which client teaching should the nurse prioritize?

Discuss with the client and family expected short-term memory loss.

A client diagnosed with cyclothymia is newly admitted to an in-patient psychiatric unit. The client has a history of irritability and grandiosity and is currently sleeping 2 hours a night. Which nursing diagnoses takes priority?

Disturbed sleep patterns R / T agitation.

Which list contains medications that the nurse may see prescribed to treat clients diagnosed with bipolar affective disorder?

Divalproex sodium/Depekote. verapamil/Calan. olanzapine/Zyprexa.

A client diagnosed with bipolar I disorder experienced an acute manic episode and was admitted to the in-patient psychiatric unit. The client is now ready for discharge. Which of the following resource services should be included in discharge teaching? Select all that apply.

Financial and legal assistance Crisis hotline Individual psychotherapy Support groups Family education groups

A client diagnosed with major depressive disorder has a nursing diagnosis of low self-esteem R / T negative view of self. Which cognitive intervention by the nurse would be appropriate to deal with this client's problem?

Focus on strengths and accomplishments to minimize failures.

During an intake assessment, which client statement is evidence of the etiology of major depressive disorder from an object-loss theory perspective?

I don't know about my biological family I was in foster care as an infant

The nurse is evaluating lab results for a client prescribed lithium carbonate. The client's lithium level is 1.9. Which nursing intervention takes priority?

Immediately notify the physician, and hold the dose until instructed further.

Which statement about the development of bipolar disorder is from a biochemicl perspective?

In bipolar disorder, there may be possible alterations in normal electrolyte transfers

A client diagnosed with major depressive disorder is prescribed phenelzine (Nardil). Which teaching should the nurse prioritize?

Instruct the client and family about the many food-drug and drug-drug interactions.

A client is admitted to an inpatient pscyh unit with a dx of major depressive disorder. Which of the following would the nurse expect to assess? Select all:

Loss of interest Change in body weight Psychomotor retardation Insomnia/hypersomnia

You are caring for Susannah, a 29 year old who has been diagnosed with dissociative identity disorder. She was recently hospitalized after coming to the emergency room with deep cuts on her arms with no memory of how this occurred. The priority nursing intervention for Susannah is:

Maintain 1:1 observation

A client is prescribed Lithium. Which is the teaching priority?

Make sure your salt intake is consistent.

A client experiencing suicidal ideations with a plan to overdose on medications is admitted to an in-patient psychiatric unit. Mirtazipine (Remeron) is prescribed. Which nursing intervention takes priority?

Monitor for signs of "cheeking"

Which intervention takes priority when working with newly admitted clients experiencing suicidal ideations

Monitor the client at close, but irregular, intervals

Which client statement is evidence of the etiology of major depressive disorder from a genetic perspective?

My maternal grandmother was diagnosed with bipolar affective disorder

Nick, a construction workers, is on duty when a nearly completed wall suddenly falls, crushing a number of co-workers. Although badly shaken initially, he seemed to be coping well. About two weeks after the tragedy he begins to experience tremors, nightmares, and periods during which he feels numb or detached from his environment. He finds himself frequently thinking about the tragedy and feeling guilty that he was spared while many others died. Which statement about the situation is most accurate?

Nick has acute stress disorder and will benefit from antianxiety medication

Which medication would be classified as a tricyclic antidepressant?

Nortriptyline (Pamelor).

A 22y/o woman is seen in the outpatient mental health clinic complaining of requent nightmaires, feelings of guilt, & poor concentration. During the intake assessment, the nurse learns that the Pt was physically abused as a child. This Hx & symptoms are most related to:

PTSD

Which nursing charting entry is documentation of a behavioral symptom of mania?

Pacing halls throughout the day. Exhibits poor impulse control.

As you evaluate a patient's progress which treatment outcome would indicate a poor general prognosis for long term recovery from substance abuse?

Patient demonstrates positive expectations for ongoing drug use.

Nadia has been diagnosed with bipolar disorder. Which is an outcome for Nadia in the continuation of treatment phase of bipolar disorder?

Patient will adhere to medication regimen

A medication teaching plan for a patient receiving lithium should include:

Periodic monitoring of renal and thyroid function

You are caring for Leah a 26 y/o patient who has been abusing CNS stimulants. Which statement provides a basis for planning care for patient who abuses CNS stimulants?

Post withdrawal symptoms include fatigue and depression

A client's outcome states, "The client will make a plan to take control of one life situation by discharge." Which nursing diagnosis documents the client's problem that this outcome addresses?

Powerlessness

A provocatively dressed client diagnosed with bipolar I disorder is observed laughing loudly with peers in the milieu. Which nursing action is a priority in this situation?

Privately discuss with the client the inappropriateness of provocative dress during hospitalization.

Lithium is to mania as clozapine/Clozaril is to

Psychosis

The nurse caring for a patient who exhibits disorganized thinking and delusions. The patient repeatedly states, "I hear voices of aliens trying to contact me." The nurse should recognize this presentation as which types of major depressive disorder (major depression)?

Psychotic

A client recently prescribed venlafaxine (effexor) 37.5 mg bid complains of dry mouth, orthostatic hypotension, and blurred vision. Which nursing intervention is appropriate?

Reassure client that side effects are transient and teach ways to deal with it.

A client is discussing plans to have a serum lithium carbonate/Lithium level taken on discharge. To obtain an accurate serum level, which discharge teaching information should be included?

Remind the client to have a serum level drawn 12 hours after taking dose of lithium.

A client plans and follows thru with the wake and buriall of a child lost in an auto accident.

Restitution

Which nursing diagnosis takes priority for a client immediately after electroconvulsive therapy (ECT)?

Risk for injury r/t altered mental status

A newly admitted client has been diagnosed with major depressive disorder. Which nursing diagnosis takes priority?

Risk for self directed violence r/t depressed mood

A client diagnosed with major depressive disorder has been newly admitted to an in-patient psychiatric unit. The client has a history of two suicide attempts by hanging. Which nursing diagnosis takes priority?

Risk for suicide R / T history of attempts

A client diagnosed with bipolar I disorder and experiencing a manic episode is newly admitted to the in-patient psychiatric unit. Which nursing diagnosis is a priority at this time?

Risk for violence: other-directed R / T poor impulse control.

A newly admitted client diagnosed with major depressive disorder isolates self in room and stares out the window. Which nursing intervention would be the most appropriate to implement initially, when establishing a nurse-client relationship?

Sit with the client and offer self frequently.

A client is admitted to the hospital with suicidal ideations and is prescribed paroxetine (Paxil). The client has a nursing diagnosis of knowledge deficit R?T newly prescribed medication. Which nursing intervention addresses this problem?

Teaching the client regarding the risk for discontinuation syndrome.

A client has been taking bupropion (Wellbutrin) for more than 1 year. The client has been in a car accident with loss of consciousness and is brought to the ED. For which reason would the nurse question the continued use of this medication?

The client is at risk for seizures.

A client comes to the hospital complaining of depression with suicidal ideations. The physician prescribes citalopram (Celexa). Approximately 4 days later, the client has pressured speech and is noted wearing heavy makeup. What might be the potential reason for this behavior?

The client is in a manic episode caused by the citalopram /Celexa.

A client has a nursing diagnosis of dysfunctional grieving R / T loss of a job AEB inability to seek employment because of sad mood. Which would support a resolution of this client's problem?

The client recognizes and accepts the role he or she played in the loss of the job.

A client diagnosed with bipolar I disorder has a nursing diagnosis of disturbed thought process R / T biochemical alterations. Based on this diagnosis, which outcome would be appropriate?

The client will distinguish reality from delusions by day 6

A client diagnosed with bipolar II disorder has a nursing diagnosis of impaired social interactions R / T egocentrism. Which short-term outcome is an appropriate expectation for this client problem?

The client will have an appropriate 1:1 interaction with a peer by day 4

A client has a nursing diagnosis of risk for suicide R / T a past suicide attempt. Which outcome, based on this diagnosis, would the nurse prioritize?

The client will remain free from injury throughout hospitalization.

A client admitted with major depressive disorder has a nursing diagnosis of ineffective sleep pattern R / T aches and pains. Which is an appropriate short-term outcome for this client

The client will sleep 6 to 8 hours at night by day 5

A client diagnosed with bipolar II disorder is experiencing hypomania. The client is not hostile, but is taken talking nonstop and disrupting an educational session. The client is forcibly taken to the clients room and placed in 4-point restraints. Which principles have been violated?

The principle of 1. nonmalefence 2. least restrictive treatment. 3. beneficence 4. negligence

Which of the following are examples of anticholinergic side effects from tricyclic antidepressants? select all that apply

Urinary Hesitation. Constipation. Blurred vision.

A client newly admitted with bipolar I disorder has a nursing diagnosis of risk for injury R / T extreme hyperactivity. Which nursing intervention is appropriate?

Use PRN antipsychotic medications as ordered by the physician.

A major principle the nurse should observe when communicating with a patient experiencing elated mood is to:

Use calm, firm approach

A NURSE OBSERVES A CLIENT WITH NARCISSISTIC PERSONALITY DISORDER. Which BEHAVIOR WOULD THE NURSE RECOGNIZE AS MOST CHARACTERISTIC OF THIS DISORDER

c. belief IN ENTITLEMENT TO SPECIAL PRIVILEGE d. seductive AND MANIPULATIVE e. IMPULSIVE, ERACTIC BEHAVIOR

Which behavior by a client with antisocial personality disorder would alert the nurse to the need for teaching related to interpersonal relationship skills? a. frequently crying b. having panic attacks c. failing to follow social norms d. avoiding social activities.

c. failing to follow social norms

A male client with antisocial personality disorder is attempting to convince the nurse that he deserves special privileges and that exceptions to unit rules should be made for him. Best response that is appropriate: a. I believe we need to sit down and talk about this b. Don't you know better than to try to bend the rules c. what you are asking me to do is unacceptable d. why doesn't you bring this request to the unit community meeting

c. what you are asking me to do is unacceptable

A male client with dependent personality disorder has a goal to increase problem-solving skills. Which of the following behaviors demonstrate that the client has made progress toward this goal?

client asks questions

2. What activity is most appropriate for a bipolar clinet? a. A game of twister b. B. a football game with other clients c. Riding the stationary bike d. Coloring activity with the nurse

d. Coloring activity with the nurse

Which symptom is an example of physiological alterations exhibited by clients diag- nosed with moderate depression?

decreased libido

the mental health nurse explains to clients who are learning about cross addiction that there is a synergistic or addictive effect from using various kinds of chemicals txg.

drinking wine and taking a benzo

10. Client with dependent personality disorder states, "I will never able to take care of myself". Best response.

let's talk about what is making you feel so fearful